edus2

Trouble with Olimex RFID cards and readers

2017-11-16T00:00:00+00:00

There have been some reports of trouble with certain cards not being read by the Olimex reader. Cam got in touch with DigiKey after he had to return a set of cards and they did some digging, it seems the problem is the chip inside the RFID card not matching what the reader supports.

From the Olimex MOD-RFID125 reader user manual: - Supports Manchester-encoded 64-bit EM4102 RFID tags with 64 periods of carrier frequency per data bit; - Base RFID frequency 125kHz;

However, the Parallax cards we had been using apparently have support for multiple encoding methods, and which one is used in the card is often not in the supplier data.

If you choose to use an Olimex reader in your design please contact your supplier and ensure the cards you purchase will meet the requirements. It may be that they can’t guarantee this. Cam had previously purchased more than he needed and returned the unusable cards, less than ideal but it got the job done.

In the meantime, there are some alternative readers available that might fit the bill but they have not been tested by us and there form factor might be less than ideal. One option I came across at SparkFun was the SparkFun RFID Starter Kit. It would be worth while to check suppliers like DigiKey, or to try contacting Olimex and asking if they can ensure the cards you purchase will work with the reader, though Cam has had some trouble with there customer service in the past.

Please let us know about your experience with this issue in the comments below, or check the relevant wiki page.

edus2 lives!

2016-12-12T00:00:00+00:00

Bump!

There has been a flurry of edus2 questions lately. One was “Is this project still available, there has been no update since 2013…” Unfortunately, I (Paul K) have not been doing much development lately, however we added a new developer Cam Auser to the team. He has done some good work, and, being much more open minded than me, he even put together a windows version. Paul O has been busy promoting the edus2 all over the world and many new systems have been springing up.

There have been some issues with Mplayer and Ubuntu which are easily solved but the documentation has not yet been updated to reflect all that needs doing. There will be some cleaning of the website and links to the windows version in the next few weeks.

edus2 workout

2013-11-13T00:00:00+00:00

Paul Olszynski strikes again! This time with his edus2 workout shirt… a mash up between his Halloween costume and the edus2.

edussimulation.wordpress.com

2013-04-05T00:00:00+00:00

Paul Olszynski has taken the plunge and started his very own blog. He’s not only been enjoying the English weather but also doing some serious thinking about EM and edus education. A few posts were put up here but he has started thinking about some issues not entirely dealing with our simulator.

Without further ado, please check out edussimulation.wordpress.com.

Drawing Generalizations from High Fidelity Simulation Research

2013-03-29T00:00:00+00:00

Generally, I don’t generalize. That being said…

I’ve just returned from a productive meeting at the Whipps Cross University Hospital Simulation Suite (aka the MET suite). We are preparing for a study that is intended to assess the value of simulation in the development of critical care ultrasound skills.

We tested out ‘little Ben’ (London’s first edus2 system), went over our study design, looked at props needed, and discussed roles for stooges (the local term for confederates that I am already quite fond of). To top it all off, we engaged in the usual sim centre chit-chat that those who regularly sim are accustomed to: recent projects, gag reel, local goings on. In fact, I’d say it was a very productive meeting.

This is welcome news. As a guy who managed to convince himself that flying overseas to conduct medical education research was the only logical next step (after conceiving a study design too cumbersome to pull off in his own backyard), meeting great folk at the MET suite helps this study get off to a good start.

In this short time, it has struck me that there exists a tremendous degree of similarity amongst the sim suite back home (University of Saskatchewan) and the one here at Whipps Cross University Hospital. This has me wondering, and hopeful, about our potential to generalize our upcoming research findings.

The Value of Conducting Research Outside One’s Own Home Turf

The posters have been made and sent out, the faculty slowly enrolling, and the next step is trainee recruitment. Here we will hopefully recruit more participants than what would be possible at the U of S, here there will be less bias as most people in London have never heard my big mouth flap about ultrasound (except those fine physicians at last week’s course), here they have not used an edus2.

That said, there are some challenges. Putting aside the bureaucratic demands of ethics approval for a study from abroad, there are major implications in terms of the significance of the research findings. Coming to the UK means an increased challenge in terms of the generalization of findings (not to be confused with Generalizability Theory which is a statistical construct with respect to test reliability and validity).

What I mean here by ‘generalization’ is the extent to which the findings in one study can be applied, or generalized, to other groups or environments. It is an area of controversy in education research circles, and rightfully so. The arguments for either side can be made on both pragmatic and theoretical terms.

“Well that’s nice that they got those results, but that would never work in my class!” This is a common refrain heard amongst educators when discussing the merits of a given learning program or initiative (especially one being imposed on them by higher-ups). And they’ve got a point. Intuitively, the complex and dynamic nature of a classroom does limit the degree to which we can generalize the impact of even the most promising of learning initiatives.

In most educational settings the variables, and confounders, seem almost limitless: the size and condition of the school/classroom, the neighborhood, local socioeconomic determinants, funding, special needs, cultural context, individual learner needs, and the list goes on… enough to make anyone a skeptic about generalizations in education research in general! And yet it is done, often through advanced statistical analysis of quantitative data.

Thankfully, it might just be that simulation based medical education (SBME), and specifically High Fidelity Simulation, is as close to the perfect education research lab as one could ask for.

It is uncanny just how similar the sim suite at Whipps Cross University Hospital is to the sim suite I am used to at the University of Saskatchewan. The layout of the rooms, the mannequins, the one-way mirrors, control rooms, all make for a very familiar feel. I’ll take it a step further and say that even the staff members seem almost kindred. Enough so that within a very short time we have already begun working as a team. I’ve been to other sim suites as well (albeit for much briefer experiences) and would suggest this seems fairly consistent (I welcome any other thoughts on this experience). What does this mean for research? It means fewer variables, fewer confounders, and more potential to generalize!

We are also no longer talking about a very heterogenous group; we are talking about medical graduates who are, in most instances, driven & dedicated learners. Don’t get me wrong, I fully acknowledge there are cultural and gender issues that affect even this small subset of learners, but these are far fewer than those facing a sixth grade teacher in downtown London or Saskatoon.

During my proposal defense, I suggested to my committee that even with a small study size (20-30 participants compared to larger education studies with hundreds of participants), the results of this study may still help inform EM programs elsewhere of the value of ultrasound simulation during High Fidelity Simulation. The look of surprise on their faces made it clear I was wading into uncharted waters. How could a relatively small study offer much by way of generalization?

The Case for the Generalization of Findings in High Fidelity Simulation Research (as a subset of simulation based medical education research)

In the high fidelity simulation (HFS) setting, we can and do control the environment: the mannequins, background, monitors, and treatments are all standardized through clear written instructions and preparation. Did I mention they use the exact same Laerdal equipment here as we do at the U of S?

The learners represent a somewhat homogenous group. Of course the extent of this depends on the intended study population/audience but as mentioned above, you’re already further ahead because they are all medical graduates (and in our case training in EM). That said, before jumping into a new initiative that looks great, to look at the study population carefully to assess for similarity with your own institution.

High Fidelity Simulation within SBME is largely a western medicine phenomenon. It has a particular focus on acute and critical care, crisis resource management and safety. As such, many of the concepts are already consistently taught (the ABCs, BLS, ACLS, ATLS, and so on). This means sim faculty are already well versed in a similar language (to lesser and greater extents of course).

That last piece of the puzzle is the most challenging: meaningful research outcomes that are worth generalizing! Its great that we have a good setting for research, but that in no way guarantees worthwhile research is being conducted.

Firstly, the nature of the data plays a big role in the generalization of findings. Whereas quantitative data lends itself reasonably well as it reduces data to numbers and mathematical relationships, qualitative data is much more challenging (if not impossible) to use for generalization (More on this soon as this study employs both methods but I am told does not fall into mix-methods methodology?!)

Whatever the case, whenever possible we should be looking for outcomes at the upper ends of Kirkpatrick’s Framework: transfer to practice, improved patient outcomes, and improved health of the community. Studies assessing ACLS adherence and outcomes, decreased procedural complication rates, and faster times to diagnosis using specific devices, these represent the best that SBME research has to offer. Here comes in an additional challenge to generalization: if we are looking at patient outcomes, patients now represent an added variable to the equation.

Arguments against the generalization of findings are certainly worth consideration. Institutions that have well imbedded simulation programs (as a continuous part of the curriculum) are more likely to have more robust outcomes. This is partly because, when it comes to SBME, major gains are made with repeated exposure (including, but not exclusive to, deliberate practice). Other drawbacks include differences in terminology (stooges vs confederates) and levels of resources.

For a great overview of SBME, check out this Medical Journal of Australia article

When I read SBME research (specfically the High Fidelity Simulation kind), I often find myself thinking that the methods and findings seem consistent with practices at my own institution. Certainly this was the case with the Girzadas et al. (2009) Hybrid Simulation study. And so yes, I do find myself generalizing study implications to my trainees. Ultimately, this is the whole point, right? As education researchers, we can only hope that our research designs will serve to inform others of best practices, worthwhile initiatives, and potential pitfalls.

And while it is often criticized as excessively resource intensive, it just may be that the HFS environment does hold promise as being the near-ideal education research lab.

Cheers from London,

Paul Olszynski

Peer review by Brent Thoma @boringem

License and FAQ

2013-03-28T00:00:00+00:00

I’ve been reformatting the website and this seemed like something that was better served as a blog entry with a link to it. Paul Olszynski made this a couple years back when we first got started, it explains some of our thoughts behind the design.

We’ve been getting a few questions, particularly about licensing and patents… the project is licensed under the Creative Common’s Attribution Non-commercial Share-Alike license. This and few other questions we’ve been receiving are addressed in the video below.”

edus2
by: pao292

about edus2 and the creative commons license

It's not about what comes next, it's about what comes first...

2013-03-24T00:00:00+00:00

It’s not about what comes next, it’s about what comes first!

A week into my 4 month stay in London I am given the opportunity to assist with one of London’s Thoracic U/S courses. The venue is impressive: large sky-lit rooms, plenty of room for the audience and scanning stations, multiple flat screens displaying real time scans performed by the speakers.

The audience, a little different than I’m used to, is made up of all varieties of physicians: internists, respirologists, GPs, surgeons, & emergency physicians. The course speakers come from a range of specialities as well: here we have radiologists, respirologists, & surgeons.

Late into the course, a speaker initiates a case-based review of some of the material just covered. Case 2: a young male with history of fall from scaffold. He puts up a CXR showing a substantial hemopneumothorax. The speaker goes on to ask the audience about the next best test. It’s clear that he’s looking to make a point: despite everything he had just taught, the next best test would not be ultrasound, it would be CT.

He was right, the next best test would have been CT. And yet, in my mind, as I sat there doing my best to not blurt out my frustration, all I could think was that he had asked the wrong question.

It’s not about what comes next, it’s about what comes first!

Now, I know very well I do not own this idea. The “Ultrasound First” movement has been gaining ground for some time (www.ultrasoundfirst.org). Top that with this year being “the Year of Ultrasound” and you’d think maybe I should calm down. After all, we’ll get there eventually, right?

Well, I’m not so sure. First of all, I wasn’t in some backroom rounds, I was at a dedicated point-of-care thoracic ultrasound course. Of all the places, the role of POCUS should be clearest here. And yet it’s not. Part of the message is coming through, but there’s a lot being lost. Time to turn up the gain.

Sure, POCUS has a tremendous role to play in the outpatient setting. The British Thoracic Society now strongly recommends (if not mandates) that whenever applicable thoracic procedures should be done under u/s guidance. Great, I get that. But what concerns me is that we are failing to illustrate to our colleagues the broader utility that can be found in this remarkable technology.

That brings me to the second point: in medicine we are used to thinking about what comes next, and not so much about what should have come first. In a sound world, that young fall victim would have had his hemopneumothorax identified within minutes of presentation to the ED (if not prehospital even as some may have it). Had he been unstable, that chest would have been decompressed right then and there with chest drain in place soon after. No CXR for diagnosis needed, the significant pathology would have been suspected through a combination of history & physical exam and then solidified by POCUS performed by the attending care team. All within minutes, all at the bedside. For the stable fall patient, the same approach would have exposed somewhat occult pathology to the benefit of the entire care team and most importantly the patient who would now be identified as having (not suspected of having) a large hemopneumothorax.

But for us to get there, we actually have to go back. We have to hit ‘rewind’ in our clinical skill-set back to the point of the bedside examination. There we have to insert our newly acquired bedside ultrasound assessments. It is there that we have to teach ourselves to think “Ultrasound First.”

As physicians, we are going to have to spend some serious time unlearning our first steps. Let’s be clear and honest about this: It is very difficult to unlearn anything!

And so maybe that is why the process has been slow going. Perhaps we need to be more explicit about the fact that we’re not just talking about adding the next test. What we’re talking about now is the first, and in some cases most important, test of all.

Cheers from London,

Paul Olszynski

Goliath carves out an edus2 probe

2013-02-28T00:00:00+00:00

I’ve been a member of the local hackerspace Saskatoon TechWorks for a while, finally I started making use of the tools they have. Here is a video of an edus2 probe being carved out of a piece of maple. Hoping to add the electronics and polish it up this weekend.

edus2 CNC Router from Paul Kulyk on Vimeo.

More features, save settings

2013-02-07T00:00:00+00:00

Now that the quick add feature is set up to greatly simplify the process of adding videos in groups is set up we decided to make things even easier. Once your card/video pairings have been setup for any given simulation you can now save that settings file for easy access later.

Why do I want this feature? Well the slickest thing about it is that there is no longer any need for physical card switching or scanning between runs in the sim lab. Once the videos are set up all that needs to be done is a couple of clicks to load the previous simulation for reuse and the students can scan away.

Follow the instructions on the January 30, 2013 post to upgrade and test these new features.

Here is short video overview of the new features.

edus2 Save and Load Settings Tutorial

New Feature! Quick add!

2013-01-31T00:00:00+00:00

In addition to the bugs pointed out yesterday, there was a request to have a quick-add feature so cards could be put in the list fast. I rigged this up today and put it through some testing. It seems to work well and offers some advantages.

The SimGod now just has to set up a directory with all the files they want for a particular simulation. They can then delete the existing list and use the quick add feature to add everything in the directory. It takes only a few seconds to change simulations this way and gets rid of fighting to peel back mannequin skin every time. Details on its usage are here.

Please give it a shot and let me know how you use it.

It is in the master branch on github. Follow the instructions from my last post to update your software.

Here’s a video overview, if you go to the vimeo site the quality is much better.

edus2 quick scan feature from Paul Kulyk on Vimeo.

Once some others verify it is working I am going to bump the version number.

If you are using this, saving tonnes of money by not buying the expensive commercial simulator, and want to donate to my huge college debt to show your appreciation I’m sure something can be arranged!

Please comment on any issues you encounter or post below to let me know if you are using it/like the changes.

Development Reopens

2013-01-30T00:00:00+00:00

I received some excellent feedback on the edus2 system regarding usability of the interface and system as a whole. Glenn Verheul was having issues with the volume of scans he was using. Scrollbars were added to the settings menu so the list isn’t limited by the size of your screen anymore. This was a bug I hadn’t picked up simply because we didn’t use as many scans.

Glenn mentioned some trouble deleting scans. Has anyone else run into this? Please email or comment.

To try the new changes for yourself try the following steps.

Copy your working edus2 directory into a back up just in case something goes wrong, this way your scan list won’t be affected. Change the ~/src/edus2 part to whatever directory you have your system in.
```
 cp -a ~/src/edus2 ~/src/edus2-backup
```
Update to the latest version from github
```
 cd ~/src/edus2
 git pull
```
Run it and check that your settings menu is now scrollable, if you have any problems email/comment and remember that you can run the simulator out of the backup directory you made.

SAEM 2012 Video Overview

2012-05-22T00:00:00+00:00

Here is a brief overview of the edus2 system in action and how it is going to be used for some further medical education research.

edus2 - The Emergency Department Ultrasound Simulator from Academic Emergency Medicine on Vimeo.

Paul Kulyk, BSc BEng
Paul Olszynski, MD CCFP EM

SAEM and edus2

2012-05-16T00:00:00+00:00

SAEM, this is our edus2… edus2, please behave.

With this year’s emphasis on simulation and ultrasound in EM, our little emergency department ultrasound simulator (edus2) found that the SAEM Conference made for very good company.

For us, the Pauls, highlights included the inaugural Sono Games as well as the return of Sim Wars. The enthusiasm shown by both faculty and residents was inspiring while the cases intriguing.

Seeing our American counterparts pull off sim roles worthy of Oscar nomination and elsewhere deliver top game show quality entertainment reminded us of our own experiences here at home. We have a great team here at the U of S, capable of achieving the same level of expertise and engagement that we saw this past week in Chicago.

We come home with several ideas thanks to the impressive work of so many at this year’s conference. Props to Matt and Mike and The Ultrasound Podcast, Paul O is hooked.

Of course, we are also optimistic that some of the attending faculty will now pursue development of their own edus2 machines. We look forward to hearing from them as they proceed.

Cheers, The Pauls

Check us out at SAEM in Chicago on May 12, 2012

2012-05-10T00:00:00+00:00

Dr. Olszynski and I are taking edus2 to Chicago for SAEM. We are presenting as part of the IEME Spotlight Session on Ultrasound this Saturday (May 12) between 12:00 and 13:00 in the Erie Room. The schedule and blurb on us is here under the IEME Spotlight section.

We will be bringing an edus2 machine with us to demonstrate in addition to presenting our research and design process.

Development help needed

2012-05-04T00:00:00+00:00

Do you have any skills in Python, Ubuntu packaging, or CAD?

There are several issues that need addressing. (Matt this means you).

Alternatively, if you would like to support the project and get a FREE PROBE! A one time donation of a rapid-prototyping machine would be welcome.

Brisbane machine

2012-04-28T00:00:00+00:00

Here’s an image of the machine Luke Wainwright put together.

Looks excellent. Waiting to hear about what was used for the probe, this will be outlined on the hardware wiki page.

edus2 down under

2012-04-27T00:00:00+00:00

We received news today that another system is near completion. This one is Brisbane, Australia. Cheers to Luke Wainwright and team.

It is great to hear about edus2 making it’s way around the world. Please let us know if you are building your own system and keep us posted on what it is looking like.

We have added another pin to the map.

View edus2 in a larger map

edus2 systems built across the country

2012-04-22T00:00:00+00:00

Several medical schools and organizations have now expressed interest in the edus2 system. Jel Coward and Rebecca Lindley in BC were the first to put anything together. Sev Perelman and Finch Taylor have put a system together in Toronto. Many other institutions have begun purchasing parts or have expressed interest in integrating this system into their own simulation centers.

View edus2 in a larger map

If you have started building one let us know and we can update the map.

User submitted probe design.

2012-04-21T00:00:00+00:00

One of our early adopters, Jel Coward, hacked up a pneumostat collection chamber to use as a case for the probe. Full details of the problems encountered here

Affordable and looks probish, only problem is that the RFID reader antenna needs to be aligned flat with the card to get any distance out of the read.

A couple of options come to mind:

Cut off the heat shrink and reposition the antenna manually
Cut off the top and fix it flat to container

Thanks to Jel for submitting his idea, will update the blog with further developments.

edus2, Calgary EM Education Symposium Presentation

2012-04-11T00:00:00+00:00

Here is the Prezi on our project as delivered at the Calgary EM Research Symposium April 11, 2012.

It might not be that useful without me jabbering in the background… but here it is.

</embed>

edus2 on Prezi

edus2 website comes together

2011-12-24T00:00:00+00:00

The main design and basic details for the website are nearing completion. The website is host to the basic project details and from here interested parties should be able to find links to our videos, which are all hosted on Vimeo. A wiki with more in-depth information on all aspects of the project that is user editable. Contact information for myself and Dr. Olszynski.