title: Telesimulation: an innovative and effective tool for teaching novel intraosseous insertion techniques in developing countries.
abstract: OBJECTIVE
  Telesimulation is a novel concept coupling the principles of simulation with remote Internet access to teach procedural skills. This study's objective was to determine if telesimulation could be used by pediatricians in Toronto, Ontario, Canada, to teach a relatively new intraosseous (IO) insertion technique to physicians in Africa.
  
  
  METHODS
  One simulator was located in Toronto and the other in Gaborone, Botswana. Instructors and trainees could see one another, see inside each other's simulators, and communicate in real time. Learner's opinions and skills were evaluated. Before and after the curriculum, physicians completed a self-assessment questionnaire, a multiple-choice test, and during session 3, a demonstration of competence using an IO infusion system was timed and scored locally and via the Internet.
  
  
  RESULTS
  Twenty-two physicians participated. The scores on the pretest ranged from 1 to 12 out of 15. The range of scores on the posttest was 10 to 15 out of 15. The mean (±SD) score on pre- and post-multiple choice testing increased by +5 (±2.75; 95% confidence interval [CI] for mean difference = 3.92 to 6.35). Based on McNemar's chi-square test, physicians reported a significant improvement in their comfort and knowledge inserting IO needles (p < 0.01), familiarity with the EZ-IO infusion system (p < 0.01), and knowledge handling the IO equipment (p < 0.01). Postintervention, all physicians reported that telesimulation teaching was a worthwhile experience, and 95% felt more prepared to manage pediatric resuscitation. There was no evidence of a difference in scoring or timing of IO insertion tasks whether measured locally or remotely (mean ± SD score difference = -0.11 ± 1.22 [95% CI = -0.66 to 0.43]; mean ± sd time difference = 0.01 ± 0.15 seconds [95% CI = -0.06 to 0.08 seconds]).
  
  
  CONCLUSIONS
  Telesimulation is a novel method for teaching procedural skills. The session improved physicians' knowledge, self-reported confidence, and comfort level in inserting the IO needle. Accurate scoring is possible via the Internet. This modality offers potential for teaching other procedural skills over distances.
authors.affiliation: Division of Pediatric Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada. angelo.mikrogianakis@albertahealthservices.ca
authors.forename: Angelo
authors.initials: A
authors.lastname: Mikrogianakis
authors.forename: April
authors.initials: A
authors.lastname: Kam
authors.forename: Shawna
authors.initials: S
authors.lastname: Silver
authors.forename: Balisi
authors.initials: B
authors.lastname: Bakanisi
authors.forename: Oscar
authors.initials: O
authors.lastname: Henao
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Georges
authors.initials: G
authors.lastname: Azzie
mesh_terms: D001902:Botswana; D002170:Canada; D003198:Computer Simulation; D003906:Developing Countries; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement / Q000706:statistics & numerical data; D006801:Humans; D017148:Infusions, Intraosseous / Q000379:methods*; D007391:International Cooperation; D020407:Internet; D013685:Telecommunications; D017216:Telemedicine / Q000379:methods*; D057211:Webcasts as Topic