title: Diagnostic instrumentation aboard ISS: just-in-time training for non-physician crewmembers.
abstract: BACKGROUND
  The performance of complex tasks on the International Space Station (ISS) requires significant preflight crew training commitments and frequent skill and knowledge refreshment. This report documents a recently developed "just-in-time" training methodology, which integrates preflight hardware familiarization and procedure training with an on-orbit CD-ROM-based skill enhancement. This "just-in-time" concept was used to support real-time remote expert guidance to complete ultrasound examinations using the ISS Human Research Facility (HRF).
  
  
  METHODS
  An American and Russian ISS crewmember received 2 h of "hands on" ultrasound training 8 mo prior to the on-orbit ultrasound exam. A CD-ROM-based Onboard Proficiency Enhancement (OPE) interactive multimedia program consisting of memory enhancing tutorials, and skill testing exercises, was completed by the crewmember 6 d prior to the on-orbit ultrasound exam. The crewmember was then remotely guided through a thoracic, vascular, and echocardiographic examination by ultrasound imaging experts.
  
  
  RESULTS
  Results of the CD-ROM-based OPE session were used to modify the instructions during a complete 35-min real-time thoracic, cardiac, and carotid/jugular ultrasound study. Following commands from the ground-based expert, the crewmember acquired all target views and images without difficulty. The anatomical content and fidelity of ultrasound video were adequate for clinical decision making.
  
  
  CONCLUSIONS
  Complex ultrasound experiments with expert guidance were performed with high accuracy following limited preflight training and multimedia based in-flight review, despite a 2-s communication latency. In-flight application of multimedia proficiency enhancement software, coupled with real-time remote expert guidance, facilitates the successful performance of ultrasound examinations on orbit and may have additional terrestrial and space applications.
authors.affiliation: National Aeronautics and Space Administration, Lyndon B. Johnson Space Center, Houston, TX, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Foale
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Kaleri
authors.forename: Ashot E
authors.initials: AE
authors.lastname: Sargsyan
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Hamilton
authors.forename: Shannon
authors.initials: S
authors.lastname: Melton
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.forename: Scott A
authors.initials: SA
authors.lastname: Dulchavsky
mesh_terms: D000337:Aerospace Medicine / Q000193:education*; D016251:CD-ROM; D003162:Competency-Based Education; D003194:Computer-Assisted Instruction / Q000379:methods*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D017145:Models, Educational; D015397:Program Evaluation; D012426:Russia; D013026:Space Flight; D018531:Spacecraft; D013995:Time; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods; D014481:United States; D018557:United States National Aeronautics and Space Administration; D014584:User-Computer Interface; D000078329:Workforce