Pamela Andreatta

Uniformed Services University of the Health Sciences | USUHS · Department of Surgery

Introduction Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discover...

Introduction In deployed contexts, military medical care is provided through the coordinated efforts of multiple interdisciplinary teams that work across and between a continuum of widely distributed role theaters. The forms these teams take, and functional demands, vary by roles of care, location, and mission requirements. Understanding the requir...

Introduction: As combat-related trauma decreases, there remains an increasing need to maintain the ability to care for trauma victims from other casualty events around the world (e.g., terrorism, natural disasters, and infrastructure failures). During these events, military surgeons often work closely with their civilian counterparts, often in aus...

Objectives: 1) Evaluate the value and strength of a competency framework for identifying and measuring performance requirements for expeditionary surgeons; 2) Verify psychometric integrity of assessment instrumentation for measuring domain knowledge and skills; 3) Identify gaps in knowledge and skills capabilities using assessment strategies; 4) E...

Importance Sustainment of comprehensive procedural skills in trauma surgery is a particular problem for surgeons in rural, global, and combat settings. Trauma care often requires open surgical procedures for low-frequency/high-risk injuries at a time when open surgical experience is declining in general and trauma surgery training. Objective To de...

Surgery is an exceptionally complex domain where multi-dimensional expertise is developed over an extended period of time, and mastery is maintained only through ongoing engagement in surgical contexts. Expert surgeons integrate perceptual information through both conscious and subconscious awareness, and respond to the environment by leveraging th...

There are two forms of disciplined inquiry that examine impacts of training or educational interventions on performance outcomes: Research and Evaluation. Although similar in many practical respects, the purposes of each are quite different. The criteria for designing and implementing controls when examining study outcomes are distinct and much mor...

Comprehensive acquisition and mastery of psychomotor skills for surgical procedures must eventually be facilitated in the context of applied surgery. Although simulation-supported instruction provides a benign environment for acquiring basic abilities such as suturing and knot tying, the application of those abilities within procedural contexts req...

Simulation centers of all sizes must provide professional resources to support and deliver high-quality, sustainable education that meets the needs of affiliated stakeholders. This chapter will outline the diverse staffing roles and associated breadth of expertise that is required to provide administrative, technical, educational, and managerial se...

Background: Laparoscopic camera navigation is vital to laparoscopic surgery, yet often falls to the most junior member of the surgical team who has limited laparoscopic operating experience. Previously published reports on simulation models fail to address qualitative scoring of movement, method of communication and correct physician location with...

This chapter describes how healthcare simulation professional societies and organizations have contributed to the development of simulation education and clinical practice over the last 20 years. It explores the various ways in which healthcare simulation is embraced by professional associations. First, it considers how discipline-specific organiza...

This article describes a framework that has been developed to monetize the real value of simulation-based training in health care. A significant consideration has been given to the incorporation of the intangible and qualitative benefits, not only the tangible and quantitative benefits of simulation-based training in health care. The framework buil...

Objectives: We evaluated the retention of pediatric and neonatal intubation performance abilities of clinicians trained on a simulated or live tissue model at 3 intervals after initial training to assess competency degradation related to either training modality or retention interval. Methods: We implemented a quasi-experimental design with purp...

“… they’re just learning to play the game” - metaphors in healthcare simulation education Debra Nestel, Pamela Andreatta, Margaret Bearman, Cathy Smith Metaphors form part of everyday life and help us to make sense of the worlds we inhabit, explain what we do and what we experience. In this session, we will explore ways in which metaphors – textu...

Mobile health technology, specifically Short Message Service (SMS), provides a low-cost medium to transmit data in real time. SMS has been used for data collection by highly literate and educated health care workers in low-resource countries; however, no previous studies have evaluated implementation of an SMS intervention by low-literacy providers...

Military and civilian first responders must be able to recognize and effectively manage mass disaster casualties. Clinical management of injuries resulting from nerve agents provides different challenges for first responders than those of conventional weapons. We evaluated the impact of a mixed-methods training program on competency acquisition in...

The purpose of this article was to establish psychometric validity evidence for competency assessment instruments and to evaluate the impact of 2 forms of training on the abilities of clinicians to perform neonatal intubation. To inform the development of assessment instruments, we conducted comprehensive task analyses including each performance do...

Intubating adult patients presents numerous challenges for clinicians. Procedural complexities associated with performing pediatric and neonatal intubation, along with a lower frequency of a need for intubating pediatric and neonatal patients, further amplifies the difficulties associated with acquiring and maintaining relevant clinical skills. Cli...

Introduction: Laparoscopic tissue handling is quite difficult to measure using virtual-reality laparoscopic simulators and box-trainer exercises, and therefore, completion time is the predominant performance measure for simulation-based laparoscopic training exercises. The purpose of this study was to evaluate the construct validity of a training...

Low-cost, high-fidelity models for training in advanced laparoscopic surgery techniques are not currently available. The objective of this study was to evaluate a model and assessment protocol for developing associated fine, precise laparoscopic dissection skills with accompanying surgical decision making. Novice to expert laparoscopists (n = 41) w...

With a large number of births occurring outside the formal health system, it is difficult to determine the number of pregnant women in rural regions of Liberia. The exponential growth of mobile phone use in developing countries provides a potential avenue for data collection on maternal and child health in such rural, remote regions. A pre-, post-,...

Simulation is an important methodology in bridging the gap between theory and practice in medical education. Simulation-based education (SBE) provides a structured, learner-centred environment in which novice, intermediate, and advanced practitioners can learn or practise skills without causing harm to patients. A range of systematic reviews indica...

The use of simulation in healthcare education has increased exponentially in the past decade. As a result, more and more professional organizations are developing or implementing processes focused on defining and implementing best practices in simulation-based education. Such processes are quite resource intensive, and it is unclear at this time wh...

Purpose Evaluate feasibility and impact of on-unit simulation-based nurse first-responder team training in a large tertiary care hospital. Method Prospective study of nurses’ performance, before and after interactive review of protocols and hospital-based resources, and demonstration of performance on unit-appropriate simulated patients. We evaluat...

This paper addresses some of the challenges met when developing widely distributed, broad spectrum, simulation-based education (SBE) for health professionals, such as resource duplication, inconsistent facilities utilization, discipline-specific silos, and the intersection of academic institutions and health services sectors. We examine three prima...

Purpose of review: Interdisciplinary team factors are significant contributors to clinical performance and associated patient outcomes. Quality of care and patient safety initiatives identify human factors associated with team performance as a prime improvement area for clinical patient care. Recent findings: The majority of references to interd...

Bimanual uterine compression may provide a reasonable treatment option for controlling or arresting postpartum hemorrhage in areas where access to care and advanced medical interventions are limited. Preliminary evidence suggests that correctly performed bimanual uterine compression is unsustainable for more than a few minutes, despite empirical ev...

To report findings on knowledge and skill acquisition following a 3-day training session in the use of short message service (SMS) texting with non- and low-literacy traditional midwives. A pre- and post-test study design was used to assess knowledge and skill acquisition with 99 traditional midwives on the use of SMS texting for real-time, remote...

Residency programs seek to match the best candidates with their positions. To avoid ethical conflicts in this process, the National Residency Matching Program (NRMP or Match) has rules regarding appropriate conduct, including guidelines on contact between candidates and programs. Our study examined communication between obstetrics and gynecology (O...

A taxonomy was developed a) to describe surgical procedures with sufficient detail to review differences among surgeons, b) to examine the relationship between individual technique and outcomes, c) to enable surgeons to standardize technique around best practices and d) to identify clinical-evidence-based key points of teaching and assessment for s...

Validity refers to an evidence-based claim about the trustworthiness of decisions made from context-specific performance data. Validity requirements for competency-based assessments in obstetrics and gynecology have not been defined in the literature. We explain why validity is intrinsic to any discussion about competency assessment and provide a m...

To evaluate the use of cell phones by professional and traditional birth attendants in rural Africa for reporting postpartum hemorrhage (PPH) data. Ten birth attendants from the remote Sene District of Ghana participated in the study. Subjects were trained to send Short Message Service text messages from cell phones using a simple numeric protocol...

The objective of this study was to evaluate the impact of an interdisciplinary team-training program in obstetric emergencies on identifying unsupportive institutional policies and systems-based practices. We implemented a qualitative study design with a purposive sample of interdisciplinary physicians, nurses, and ancillary allied health professio...

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Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia. Despite an UN Millennium Development Goal to reduce maternal mortality rates, no significant effect has resulted to date, in large part because women in these areas give birth in rural communities with poor access to definitive care. Traditional birth attenda...

To evaluate the viability and effectiveness of a simulation-based pediatric mock code program on patient outcomes, as well as residents' confidence in performing resuscitations. A resident's leadership ability is integral to accurate and efficient clinical response in the successful management of cardiopulmonary arrest (CPA). Direct experience is a...

Effective interdisciplinary health care teamwork improves clinical and financial outcomes, and training and assessment of team competencies are central to establishing high-functioning health care teams. The roles that team members assume in the provision of patient care are important contributors to effective health care team performance; however,...

Many trauma related surgical procedures cannot ethically be practiced by medical students or inexperienced doctors. Therefore, medical simulators that provide high anatomical and procedural fidelity are used. One of the most important things to monitor during such a procedure is the vital signs of the patient. One procedure for which this is import...

The use of simulation-based methods for clinical and team training provides an opportunity for health care professionals to develop and maintain the skills required to effectively manage patient care. This is especially true for those rare events when emergency interventions require urgent, accurate, and cohesive team functioning. We present a fram...

The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the tria...

Trauma is the leading cause of death in persons younger than 44 years old in America; half of the deaths occur within the first hour following the incident. The likelihood of survival for such critical trauma patients is significantly increased if an Emergency Department Thoracotomy (EDT) is performed. EDT entails the surgeon performing large and r...

This study aimed to quantify learner reactions manifesting from a realistic contextual stressor while training with a laparoscopic simulator, and to identify learner-derived stress-modifying behaviors. Stress factors are known to affect cognitive and psychomotor performance. Simulation-based medical training typically occurs in environments that ar...

Skilled placement of peripherally inserted central catheters (PICC) has a profound impact on patient well-being and costs of care. The use of ultrasound-guided methods and prescribed training for cannulation skills are evidence-based practice recommendations. The purpose of this study was to compare two methods of PICC instruction on the acquisitio...

This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress. Fourteen surgery interns were randomized into 2 groups. The intervention group received task-specific proficiency criteria to guide practice. The control group did not. After training, parti...

The term 'validity' is used pervasively in medical education, especially as it relates to curriculum, assessment, measurement and instrumentation. Exactly what is meant by the term 'validity' in the medical education literature is not always clearly defined. This study attempts to clarify, conceptualise and classify how validity fits within the con...

There is growing appreciation of the value of early preparation of future medical educators. Staff development programmes, conferences and workshops pertaining to the training of educators may be crucial to the pursuit of a school's larger educational mission to educate students, doctors and scholars and to provide comprehensive knowledge, research...

The goal of this study was to determine if clinical simulation improved resident confidence in performing critical care skills, neonatal resuscitation, and colonoscopy. Residents participated in clinical simulations utilizing high-fidelity medical simulators in a realistic environment. We compared resident responses on pre- and post-experience surv...

Many surgical training programs are introducing virtual-reality laparoscopic simulators into their curriculum. If a surgical simulator will be used to determine when a trainee has reached an "expert" level of performance, its evaluation metrics must accurately reflect varying levels of skill. The ability of a metric to differentiate novice from exp...

To determine if prior training on the LapMentor laparoscopic simulator leads to improved performance of basic laparoscopic skills in the animate operating room environment. Numerous influences have led to the development of computer-aided laparoscopic simulators: a need for greater efficiency in training, the unique and complex nature of laparoscop...

Computer-aided simulators may increase the safety and efficiency of training in laparoscopic surgery. Before implementation of the Immersion LapSim (Gaithersburg, MD) simulator in our training curriculum, we wished to determine its construct validity (ie, whether the simulator could differentiate laparoscopic novices from trainees with greater expe...