Amitai Ziv

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (111)229.22 Total impact

  • No preview · Article · Feb 2016
  • Imri Amiel · Daniel Simon · Ofer Merin · Amitai Ziv
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    ABSTRACT: Background: Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully. Methods: The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention. Results: The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005). Conclusion: The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment.
    No preview · Article · Oct 2015 · Journal of Surgical Education
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    ABSTRACT: We previously developed a prototype computer-based simulation to teach residents how to integrate better EMR use in the patient-physician interaction. To evaluate the prototype, we conducted usability tests with three non-clinician students, followed by a pilot study with 16 family medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and the acceptability of the simulation, as well as 'think aloud' observations. After using the simulation prototypes, the mean scores for competencies and attitudes improved from 14.88/20 to 15.63/20 and from 22.25/30 to 23.13/30, respectively; however, only the difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10 on a 5-point scale, respectively). Issues identified in usability testing include confusing interaction with some features, preferences for a more interactive representation of the EMR, and more options for shared decision making. In conclusion, computer-based simulation may be an effective and acceptable tool for teaching residents how to better use EMRs in clinical encounters.
    Full-text · Article · Aug 2015 · Studies in health technology and informatics
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    ABSTRACT: hPurpose/Objective: As electronic medical records (EMRs) become ubiquitous, concerns have been raised about their impact on patient-clinician communication. Communication has been associated with patient satisfaction, conflict resolution, adherence to treatment, and a myriad of health outcomes. Research has shown that the use of EMRs affects patient consultation various ways. On the positive side, the use of EMR improves the exchange of medical information between physicians and patients. However, it often interferes with maintaining eye contact, establishing rapport, and psychological and emotional communication. In previous research, we identified strategies and best practices employed by physicians to minimize the negative impacts and maximize the benefits of using the EMR in the clinical encounter. We built on these findings to develop a series of educational interventions. In this presentation we will describe the development of one of these interventions, a computer-based simulation, and results from a pilot study of its impact on Family Medicine residents’ skills and attitudes. Methodology/Approach: We employed the following process to develop 3 prototype computer-based simulation modules: 1. Defining the learning objectives and drafting a case synopsis (a brief narrative of the case); 2. Mapping the story by creating a flow chart of the case events with a detailed description of the actors’ actions, conversations, decisions that would be made by trainees, results of these decisions and visual elements; 3. Designing the storyboard by creating sketches of the simulation slides based on the story maps. Additionally, the storyboards include the feedback provided to the trainees based on their decisions and technical infrastructure details of developing the simulation in an authoring tool (Adobe Captivate), such as variables, standard actions, conditional actions and navigation objects; and 4. Developing the prototype in the authoring tool. We conducted a usability test of the simulation prototype with 3 Master of Information students, followed by a pilot study with 16 Family Medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and acceptability of the simulation (based on the Technology Acceptance Model), as well as free text comments and ‘think aloud’ observation of 6 residents. Findings/Results: After using the simulation prototypes, the mean scores for both self-reported competencies and attitudes improved from 14.88±2.63 to 15.63±2.80 (M±SD; out of maximum 20 points possible) and from 22.25±2.44 to 23.13±2.16 (M±SD; out of maximum 30 points possible), respectively. The difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10, respectively, on a 5-point scale) and intention to use the simulation and overall assessment of the session were average (3.50 and 3.16, respectively). Issues identified in usability testing include confusing interaction with some of the software features, and preferences for more interactive representation of the EMR and shared decision making opportunities. Conclusions/Implications/Recommendations: Computer-based simulation may be an effective and acceptable tool for teaching Family Medicine residents how to better use the EMR in the consultation. This potential should be further explored in future research.
    Full-text · Conference Paper · Jun 2015
  • Imri Amiel · Jakob Arad · Mordechai Gutman · Amitai Ziv
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    ABSTRACT: BACKGROUND: In recent years the city of Eilat has come under threat of rocket attacks. This emphasized the need for an upgrade of the city's medical center capabilities in trauma care. Medical simulation has been used for many years in training and for the improvement of trauma care both at the field Level and in hospitals. Although there was significant improvement in the technological aspects of simulations, the use of simulators was restricted mainly to simulation centers and its effectiveness in training and assessment of trauma teams in situ in emergency departments was still not examined.
    No preview · Article · May 2015 · Harefuah
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    ABSTRACT: It is widely believed that electronic health records (EHR) improve medical decision-making by enabling medical staff to access medical information stored in the system. It remains unclear, however, whether EHR indeed fulfills this claim under the severe time constraints of Emergency Departments (EDs). We assessed whether accessing EHR in an ED actually improves decision-making by clinicians. A simulated ED environment was created at the Israel Center for Medical Simulation (MSR). Four different actors were trained to simulate four specific complaints and behavior and 'consulted' 26 volunteer ED physicians. Each physician treated half of the cases (randomly) with access to EHR, and their medical decisions were compared to those where the physicians had no access to EHR. Comparison of diagnostic accuracy with and without access showed that accessing the EHR led to an increase in the quality of the clinical decisions. Physicians accessing EHR were more highly informed and thus made more accurate decisions. The percentage of correct diagnoses was higher and these physicians were more confident in their diagnoses and made their decisions faster. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Mar 2015 · Journal of Biomedical Informatics
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    Full-text · Dataset · Jan 2015
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    Full-text · Dataset · Jan 2015
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    ABSTRACT: Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current find-ings to support simulation in the next developmental stages.
    Full-text · Article · Nov 2014
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    ABSTRACT: Clinicians in Neonatal Intensive Care Units are required to perform assessments under extreme pressure to determine the illness severity of neonates. Currently there is no reference that indicates the clinical condition of a neonate according to its vital signs. Agreement between clinicians’ assessments can provide initial indication for the clinicians’ ability to systematically perform assessments. Agreement was tested between 16 clinicians who viewed 31 recorded cases and scored the illness severity of a neonate mannequin in each case. The agreement level was fair (0.28), but high correlation between the assessments (0.8<r<0.94) suggests that the clinicians were able to systematically score the cases, and they had similar interpretation about the relative illness severity between cases. Future studies are required to determine the sources for the relative low agreement level and to identify means for improvement. Establishment of a valid reference early warning score is essential to guide the assessment.
    Preview · Article · Oct 2014
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    ABSTRACT: Study objective The objective of this study was to evaluate and compare the impact of three-dimensional (3D) imaging system on the performance of basic laparoscopic tasks in a test model by novice and experienced surgeons. Design Three tasks were performed in a test model by 30 surgeons, 15 experienced surgeons, and 15 with minimal laparoscopic experience. The tasks were performed using 2D and 3D vision systems. Design classification Canadian Task Force II-1. Subjects Fifteen experienced laparoscopic surgeons and fifteen novices with minimal laparoscopic experience. Measurements Performance times were recorded using both two-dimensional and 3D imaging system for each task. Main results Performance time for all skills was significantly (P < 0.02) shorter when using 3D imaging system. Performance times were reduced by 18–31 % using 3D imaging for all participants. Experienced surgeons performed the tasks faster and showed similar improvement while using 3D imaging system. Conclusion 3D vision systems allow for significant improvement in performance times of basic laparoscopic tasks in a test model for both inexperienced and advanced laparoscopic surgeons. Experienced surgeons benefit as much as novices from 3D imaging system. This benefit should be weighed against the disadvantages of the 3D vision systems, mainly cost, decreased light, eye strain, headaches, and shorter focal lengths.
    No preview · Article · Jun 2014 · Journal of Minimally Invasive Gynecology

  • No preview · Article · Jun 2014 · European Journal of Anaesthesiology
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    ABSTRACT: Background: Prescription errors are common in hospitalized patients and result in significant morbidity, mortality and costs. Electronic prescriptions with computerized physician order entry systems (CPOE) and integrated computerized decision support systems (CDSS providing online alerts) reduce prescription errors by approximately 50%. However, the introduction of CDSS is often met by opposition due to the flood of alerts, and most prescribers eventually ignore even crucial alerts ("alert fatigue"). Objectives: To describe the implementation and customization of a commercial CDSS (SafeRx) for electronic prescribing in Internal Medicine departments at a tertiary care center, with the purpose of improving comprehensibility and substantially reducing the number of alerts to minimize alert fatigue. Methods: A multidisciplinary expert committee was authorized by the hospital administration to customize the CDSS according to the needs of six internal medicine departments at Sheba Medical Center. We assessed volume of prescriptions and alert types during the period February-August 2012 using the statistical functions provided by the CDSS. Results: A mean of 339 +/- 13 patients per month per department received 11.2 +/- 0.5 prescriptions per patient, 30.1% of which triggered one or more CDSS alerts, most commonly drug-drug interactions (43.2%) and dosing alerts (38.3%). The review committee silenced or modified 3981 alerts, enhancing comprehensibility, and providing dosing instructions adjusted to the patient's renal function and recommendations for follow-up. Conclusions: The large volume of drug prescriptions in internal medicine departments is associated with a significant rate of potential prescription errors. To ensure its effectiveness and minimize alert fatigue, continuous customization of the CDSS to the specific needs of particular departments is required.
    Full-text · Article · May 2014 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: Physicians are often insufficiently trained in bedside teaching and mentoring skills. To develop, implement and assess a simulation-based training program designed to improve clinical teaching among physicians. We developed a one-day tutor training program based on six simulated scenarios with video-based debriefing. The program's efficacy was assessed using questionnaires completed by the participating physicians and their students. Main outcome measures were self-perceived teaching skills at baseline, after participation in the program, and following completion of the tutor role. Secondary outcome measures were the students' perceptions regarding their tutor skills. Thirty-two physicians (mean age 35.5 years, 56% females) participated in the program. Self-assessment questionnaires indicated statistically significant improvement following the program in 13 of 20 measures of teaching skills. Additional improvement was observed upon completion of the tutor role, leading to significant improvement in 19 of the .20 measures. Questionnaires completed by their students indicated higher scores in all parameters as compared to a matched control group of tutors who did not participate in the program, though not statistically significant. Most participants stated that the program enhanced their teaching skills (88%), they implement program-acquired skills when teaching students (79%), and they would recommend it to their peers (100%). Satisfaction was similar among participants with and without previous teaching experience. A novel one-day simulation-based tutor training program was developed and implemented with encouraging results regarding its potential to improve clinical teaching and mentoring skills.
    No preview · Article · Mar 2014 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: Patient education is a critical factor in the treatment of chronic disease because it reduces gaps in health care and disease management. We implemented different methods of physician training for patient education of asthma and compared the effects on patients' health. Four interventions were administered to groups of primary care physicians in one health care maintenance organization. All physicians received a list of their patients who were classified with uncontrolled asthma. Additional educational methods were implemented as follows: no additional intervention (group 1); lectures on patient education (group 2); standardized patient-based simulation training (group 3); and lectures and standardized patient-based simulations (group 4). We compared among the intervention groups and to a control group changes in rates of patients with uncontrolled asthma at 1 and 2 years after the intervention. During 1 year of follow-up, rates of uncontrolled asthma decreased from 7.2% to 6.2% (by 15%), from 7.5% to 6.5% (by 13%), from 6.4% to 5.1% (by 19%), and from 6.3% to 4.6% (by 27%) in intervention groups 1 to 4, respectively (P < 0.01). Rates decreased by approximately 7% more in all intervention groups at 2 years of follow-up. No decrease in rates was observed in the control group. An intervention for primary care physicians on educating patients with asthma to manage their disease resulted in improved patient health. The most effective intervention was the combination of lectures and standardized patient-based simulation.
    No preview · Article · Feb 2014 · Simulation in healthcare: journal of the Society for Simulation in Healthcare

  • No preview · Article · Dec 2013 · Obstetric Anesthesia Digest
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    ABSTRACT: Patient-clinician communication has been associated with patient satisfaction, compliance/ adherence and better health outcomes. Although electronic medical records (EMRs) have many benefits, one concern that remains is their impact on communication and especially on psychological and emotional exchange, establishing rapport and maintaining eye contact with the patient. In this project, we are developing a set of computer game-like simulations for enhancing family medicine residents' competence in computerized settings, based on previous research findings and modeled after a simulation-based intervention that we previously developed and tested. First, we selected an authoring tool (Adobe Captivate 7) suitable for the project. Next, we defined the design process of building computer-based simulations to include four iterative phases that we employed in developing 3 prototype scenarios. We will illustrate this process and discuss our future plans for usability evaluation and pilot testing of the simulation.
    Full-text · Conference Paper · Nov 2013
  • Danielle Nelson · Amitai Ziv · Karim S Bandali
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    ABSTRACT: The recent technological advance of digital high resolution imaging has allowed the field of pathology and medical laboratory science to undergo a dramatic transformation with the incorporation of virtual microscopy as a simulation-based educational and diagnostic tool. This transformation has correlated with an overall increase in the use of simulation in medicine in an effort to address dwindling clinical resource availability and patient safety issues currently facing the modern healthcare system. Virtual microscopy represents one such simulation-based technology that has the potential to enhance student learning and readiness to practice while revolutionising the ability to clinically diagnose pathology collaboratively across the world. While understanding that a substantial amount of literature already exists on virtual microscopy, much more research is still required to elucidate the full capabilities of this technology. This review explores the use of virtual microscopy in medical education and disease diagnosis with a unique focus on key requirements needed to take this technology to the next level in its use in medical education and clinical practice.
    No preview · Article · Oct 2013 · Postgraduate medical journal
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    ABSTRACT: Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.
    No preview · Article · Sep 2013 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.
    Full-text · Article · Aug 2013 · Patient Education and Counseling

Publication Stats

2k Citations
229.22 Total Impact Points


  • 2005-2015
    • Tel Aviv University
      • • Department of Family Medicine
      • • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2003-2015
    • Sheba Medical Center
      • Department of Pathology
      Gan, Tel Aviv, Israel
    • University of Chicago
      Chicago, Illinois, United States
  • 2010
    • Imperial College London
      • Division of Surgery
      Londinium, England, United Kingdom
  • 2006
    • Ben-Gurion University of the Negev
      Be'er Sheva`, Southern District, Israel
  • 2000
    • University of Pennsylvania
      Filadelfia, Pennsylvania, United States
  • 1998
    • William Penn University
      Filadelfia, Pennsylvania, United States