RESUMEN La investigación propone un laboratorio virtual y las tareas docentes que relaciona la biomecánica con la actividad física y deportiva en la Universidad de Cienfuegos. El “Proyecto Hypathia” se propone transformar los procesos sustantivos de la Universidad de Cienfuegos en los campos en los que se integran las Ciencias-Tecnología-Ingeniería-Matemáticas, pero sesgados por una participación escasa, asistemática de las relaciones interdisciplinarias que abarcan las nuevas tecnologías e incursionan en los simuladores, la robótica manifestaciones del arte que se suman como propuesta creativa en los procesos de investigación, formación de profesionales y de extensión universitaria. Se propone un laboratorio virtual y las tareas docentes que relaciona la biomecánica con la actividad física y deportiva en la Universidad de Cienfuegos. Los resultados logrados en la investigación en gran medida fueron posibles por la implementación de diversos métodos y técnicas de investigación los cuales posibilitaron la fundamentación del tema y la valoración del diseño empleado. La implementación de tareas docentes con enfoque STEAM permitió evaluar el proceso y sus resultados desde la práctica educativa en los estudiantes de segundo año de la facultad de Ciencias de la Cultura Física y el deporte de Cienfuegos.

ABSTRACT The research proposes a virtual laboratory and teaching tasks that relate biomechanics with physical and sports activity at the University of Cienfuegos. The “Hypathia Project” aims to transform the substantive processes of the University of Cienfuegos in the fields in which Sciences-Technology-Engineering-Mathematics are integrated, but biased by a scarce, unsystematic participation in the interdisciplinary relationships that encompass new technologies. and they venture into simulators, robotics, art manifestations that add as a creative proposal to the research processes, training of professionals and university extension. A virtual laboratory and teaching tasks that relate biomechanics with physical and sports activity at the University of Cienfuegos are proposed. The results achieved in the research were largely possible due to the implementation of various research methods and techniques which made it possible to substantiate the topic and evaluate the design used. The implementation of teaching tasks with a STEAM approach allowed the evaluation of the process and its results from educational practice in the second-year students of the Faculty of Physical Culture and Sports Sciences of Cienfuegos.

Abstract Objective To evaluate surgeons’ performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. Methods An arthroscopic simulator was created using low-cost materials with the help of a GTMax Core A1 3D printer and the programs Invesalius and Meshmixer 2017, which were used to develop femoral head parts in ABS material, with the presence of a CAM-type deformity, to mimic a femoroacetabular impact situation. After the operations were performed by 16 surgeons, the femurs were compared to a previous model with deformity and another without, using Cloudcompare, and parameters such as the volumetric difference between the operated femurs, with and without deformity, the minimum and maximum distance between them, the percentage of the deformity resected, the estimated time for total resection of the deformity, as well as a qualitative analysis based on the images and graphs provided by the program representing the areas of the parts resected, were evaluated at the end. Results The average resection speed was 34.66 mm3/min (SD = 46 mm3/min, max = 147.33; min = −2.66). The average resection rate was 26.2% (SD = 34.7%, max = 111; min = −2). Qualitative analysis showed hyporesection of deformities and sometimes hyperresection of nondeformed areas. The simulator was highly rated by the surgeons, with a tactile sensation very similar to real surgery, according to them. Conclusion Arthroscopic simulators have proved very useful in training less experienced surgeons. surgeons CAMtype CAM type lowcost low cost A D 2017 material situation 1 Cloudcompare them resected end 3466 34 66 34.6 mm3min mmmin mm3 mm SD 4 147.33 14733 147 33 −2.66. 266 −2.66 . 2 −2.66) 262 26 26.2 347 7 34.7% 111 −2. −2 −2) 201 346 3 6 34. 147.3 1473 14 −2.6 26. 34.7 11 − 20 147.

Resumo Objetivo Avaliar o desempenho de cirurgiões na ressecção de deformidades tipo CAME fazendo uso de um simulador realista de cirurgia artroscópica. Métodos Um simulador artroscópico foi criado a partir de materiais de baixo custo com auxílio de uma impressora 3D GTMax Core A1 e dos programas Invesalius e Meshmixer 2017, que foram utilizados para criar peças de cabeça de fêmur em material ABS, com a presença de uma deformidade tipo CAME, a fim de mimetizar uma situação de impacto femoroacetabular. Após as operações serem realizadas por 16 cirurgiões, os fêmures foram comparados a um modelo prévio com e outro sem deformidade pelo programa Cloudcompare, sendo avaliados ao final parâmetros como diferença volumétrica entre os fêmures operados, com e sem deformidade, distância mínima e máxima entre eles, porcentagem da deformidade ressecada, tempo estimado para ressecção total da deformidade, além de uma análise qualitativa feita com base nas imagens e gráficos fornecidos pelo programa representando as áreas das peças efetivamente ressecadas. Resultados A velocidade média de resseção foi de 34,66mm3/minuto (DP = 46 mm3/min, max = 147,33 mm3/min; min = −2,66 mm3/min). A média de ressecção obtida foi de 26,2% (DP = 34,7%, max = 111%; min = −2%). A análise qualitativa demonstrou uma hiporresecção das deformidades e, por vezes, hiperresecção de áreas não deformadas. O simulador foi muito bem avaliado pelos cirurgiões, tendo uma sensação tátil bem semelhante à cirurgia real segundo os mesmos. Conclusão Simuladores artroscópicos se mostraram muito úteis no treinamento de cirurgiões menos experientes. artroscópica D 2017 ABS femoroacetabular 1 Cloudcompare operados eles ressecada ressecadas 3466mm3minuto mmminuto 34 66mm3 minuto mm DP 4 mm3min mmmin mm3 mm3/min 14733 147 33 147,3 266 2 66 −2,6 mm3/min. . mm3/min) 262 26 26,2 347 7 34,7% 111% 111 −2%. −2% −2%) vezes deformadas mesmos experientes 201 3 66mm 1473 14 147, 6 −2, 26, 34,7 11 −2 20 34, −

Introdução: O ensino em cirurgia deve acompanhar a evolução das técnicas, procedimentos e tecnologia. Desde a década de 90 a videocirurgia vem se desenvolvendo e hoje é a primeira escolha para muitos procedimentos em cirugia geral. Com características diferentes da cirurgia convencional, os residentes treinaram em simuladores para adaptação. A literatura médica mundial já apresenta programas consagrados para treinamento entre eles os Fundamentos da Cirurgia Laparoscópica (FLS). A avaliação das habilidades técnicas cirúrgicas é uma ferramenta importante em programas de residência médica. Objetivo: Avaliar o impacto do treinamento através de aquisição de habilidades dos médicos residentes em cirurgia geral antes e após treinamento teórico-prático em videocirurgia utilizando um simulador de baixa fidelidade baseado em exercícios do FLS. Método: Estudar de modo prospectivo a aquisição de habilidades de médicos residentes em cirurgia geral de primeiro e segundo ano (R1 e R2), antes e após realização de treinamento teórico-prático pré-definido. Conclusão: Houve melhora significativa com o treinamento atingindo níveis de conhecimento e aprimoramento semelhantes aos trabalhos da literatura mundial. A melhoria no desempenho dos residentes foi evidente em ambos os grupos da amostra. Aqueles do primeiro ano atingiram a concentração de conhecimento após o treinamento semelhante ao desempenho dos residentes de segundo ano na avaliação inicial, destacando que o treinamento sequenciado realizado equivale a um ano de prática no programa de residência geral de cirurgia

Introduction: Teaching in surgery must follow the evolution of medical techniques, procedures and technology. Since the 90s videosurgery has been developing and nowadays is the gold standard for many procedures in general surgery. As there are different characteristics from conventional surgery, residents need to practice in order to adapt to simulators. The world medical literature has established many training programs among them the Fundaments of laparoscopic Surgery (FLS). Evaluation of surgical technical abilities is a major tool for the residency programs. Objectives: To assess the effect of training acquiring skills of residents at first and second postgraduated level year (PGY1 and PGY2) before and after practice using low fidelity simulator based on tasks from FLS. Methods: A prospective study was conducted to determinate skills acquisition of residents at first and second postgraduated level year l (PGY1 and PGY2) before and after standardized practice using low fidelity simulator. Conclusions: There was a significant improve of the technical abilities reaching levels of improvement. Resident’s performance was evident in the sample groups. First year residents (PGY1) achieved knowledge retention after training similar to the performance of second in the initial assessment, suggesting that the sequenced training carried out is equivalent to one year of practice in the general surgery residency program

Introduction: Surgical procedures were systematized and scientifically based at the end of the 19th century by William Stewart Halsted. Through scientific studies, anatomical principles, knowledge of physiology and pathology, strict aseptic techniques, gentle tissue manipulation, among others, were systematized. This lasted for centuries. But the modern technological era invented videosurgery and complicated the previously used teaching method. Objective: Review previously published teaching methods using simulators. Method: This is a narrative review carried out in the PubMed and Scielo databases. The search used the following keywords: videosurgery, teaching, simulators, training. The inclusion criteria comprised review articles and experimental studies, written in Portuguese and English and available in full text. The selected articles were analyzed based on the technologies covered, future perspectives and challenges mentioned. Result: 28 articles were included. Conclusion: As the results of this review on simulators show, once trained residents begin learning videolaparoscopic operations much more easily and safely.

Introdução: Os procedimentos cirúrgicos foram sistematizados e embasados cientificamente no final do século XIX por William Stewart Halsted. Por meio de estudos científicos, princípios anatômicos, conhecimento de fisiologia e patologia que permitiram sistematizar técnica asséptica estrita, manipulação tecidual gentil, dentro de outros. Isto perdurou por séculos. Mas a moderna era tecnológica inventou a videocirurgia e complicou o método de ensino anteriormente usado. Objetivo: Revisar os métodos de ensino feito por simuladores já publicados. Método: Trata-se de revisão narrativa realizada nas bases de dados PubMed e Scielo. A busca utilizou as seguintes palavras-chave: videocirurgia, ensino, simuladores, treinamento. Os critérios de inclusão compreenderam artigos de revisão e estudos experimentais, escritos em português e inglês e disponíveis em texto completo. Os trabalhos selecionados foram analisados com base nas tecnologias abordadas, perspectivas futuras e desafios mencionados. Resultado: Foram incluídos 28 artigos. Conclusão: Conforme mostram os resultados desta revisão sobre simuladores, os residentes depois de treinados, iniciariam o aprendizado de operações videolaparoscópicas com muito mais facilidade e segurança.

Resumen Introducción: Las fracturas de tibia por estrés son un cuadro muy frecuente en el personal militar recién incorporado. Nuestro objetivo fue demostrar que existe una asociación entre fracturas por estrés y otros hallazgos patológicos. Materiales y Métodos: Se evaluaron retrospectivamente 42 fracturas por estrés en 34 pacientes, entre noviembre de 2012 y septiembre de 2014. Todos se habían incorporado recientemente al Ejército Argentino y consultaron por cuadros dolorosos en la tibia. Se realizó el diagnóstico clínico y centellográfico de fractura por estrés. Se documentaron datos filiatorios, hallazgos patológicos asociados y factores de riesgo. Los criterios de inclusión fueron: reciente incorporación, mismo entrenamiento, edad 16-23 años. Se excluyó a pacientes con traumatismos, enfermedad tumoral o centellograma negativo, y a los simuladores. Resultados: Se evaluaron 42 fracturas por estrés en 34 pacientes (14 hombres y 20 mujeres). La edad promedio era de 20 años. No hubo diferencias significativas en el número de lesiones respecto al miembro afectado. El 64,7% tenía hallazgos patológicos asociados (mujeres 73%, hombres 27%). El 80% de las mujeres y el 43% de los hombres tenían un hallazgo patológico asociado. Se detectaron diversos hallazgos patológicos asociados con desejes de miembros inferiores en varo y en valgo, los primeros fueron los que más se asociaron con fracturas. Conclusiones: La tasa de asociación con hallazgos patológicos en los miembros inferiores fue alta, con predominio de los desejes en varo. Las mujeres con fracturas por estrés tenían más hallazgos patológicos asociados que los hombres.

Abstract Introduction: Tibial stress fractures are a very common condition in military recruits. Our objective is to demonstrate that stress fractures are associated with other pathologies. Materials and Methods: 42 stress fractures in 34 patients were retrospectively evaluated. Every patient had recently joined the Argentine Army and consulted for painful symptoms in the tibia. A clinical and scintigraphic diagnosis of stress fracture was made. Patient data, associated pathologies, and risk factors were documented. Inclusion criteria: recent incorporation, same training, age between 16 and 23 years. Trauma, simulators, tumoral pathology, and cases with negative scintigraphy were excluded. Results: We studied 42 stress fractures in 34 patients, 14 were men and 20 were women. The average age was 20 years. There were no significant differences in the number of injuries regarding the affected limb. 64.7% had associated pathologies, 73% in women and 27 % in men. Among the women with stress fractures, 80% had associated pathologies, compared to 43% for men. Different pathologies were found with lower limb varus and valgus imbalances. Varus was the most associated with fractures. Conclusions: A high rate of associated pathologies was found in patients with tibial stress fractures with a predominance of lower limb varus imbalances. Associated pathologies were more likely to be found in women with stress fractures than in men.

ABSTRACT Purpose: To assess the effect of the Coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator’s cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic. Purpose 201 COVID19 COVID 19 (COVID-19 Methods retrospective study (201 prepandemic 202 (202 COVID-1 compared evaluated Results 127 256 respectively 502 50 2 50.2 4.2% 42 4 (4.2 49 9 4.9 p=0.314. p0314 p p=0.314 . 0 314 p=0.314) simulators s p<0.696. p0696 p<0.696 696 (p<0.696) Conclusion increase 20 COVID1 1 (COVID-1 (20 COVID- 12 25 5 50. 4.2 (4. 4. p031 p=0.31 31 p069 p<0.69 69 (p<0.696 (COVID- (2 (4 p03 p=0.3 3 p06 p<0.6 6 (p<0.69 (COVID ( p0 p=0. p<0. (p<0.6 p=0 p<0 (p<0. p= p< (p<0 (p< (p

ABSTRACT Introduction: medical training should provide the future professional, in addition to theoretical knowledge, general and specific skills. In urology, urogenital training simulators have been presented as an ally in improving the degree of confidence and development of competencies for undergraduate medical students. Methods: exploratory descriptive research with a quantitative approach, of an experimental nature, of the randomized controlled type with cross-sectional cut. Conducted with the students of the 4th year of medicine of a Higher Education Institution in the West of Paraná. Results: 91 students attended a theoretical class with a complete explanation of the activities to be performed and answered the initial questionnaire about the degree of confidence to perform tasks in three stations with male urogenital training simulators (prostatic touch, bladder catheterization and scrotal evaluation). Of these, 45 received guidance and training with the simulators prior to the stations, while 46 should demonstrate skills directly in the three stations, mimicking patient care, only with information from the theoretical classes. The students who received previous guidance with the simulators had their scores in the development of competence higher. And, when they repeated the questionnaire about the degree of confidence to demonstrate skills with the mannequins, there was a higher degree of confidence in performing the tasks, except for the execution of a task considered more difficult. Conclusion: there was an improvement in the degree of confidence and in the development of competencies of undergraduate medical students with the orientations in the male urogenital training simulators. Introduction professional knowledge urology Methods approach nature crosssectional cross sectional cut th Paraná Results 9 prostatic touch evaluation. evaluation . evaluation) these 4 care classes And mannequins difficult Conclusion

RESUMO Introdução: a formação médica deve fornecer ao futuro profissional, além de conhecimentos teóricos, habilidades gerais e específicas. Na urologia, os simuladores de treinamento urogenital, têm se apresentado como aliado na melhora do grau de confiança e desenvolvimento de competências para estudantes de graduação em medicina. Métodos: pesquisa exploratória descritiva, com abordagem quantitativa, de natureza experimental, do tipo randomizado controlado com recorte transversal. Realizada com os estudantes do 4º ano de medicina de uma Instituição de Ensino Superior no Oeste do Paraná. Resultados: 91 estudantes assistiram a uma aula teórica com explanação completa das atividades a serem realizadas, e responderam ao questionário inicial sobre o grau de confiança para executar tarefas em três estações com simuladores de treinamento urogenital masculino (toque prostático, cateterismo vesical e avaliação escrotal). Destes, 45 receberam orientações e treinamento junto aos simuladores previamente as estações, enquanto 46 deveriam demonstrar habilidades diretamente nas três estações, mimetizando o atendimento ao paciente, apenas com informações das aulas teóricas. Os estudantes que receberam orientação prévia junto aos simuladores, tiveram seus escores no desenvolvimento de competência mais elevados. E, ao repetirem o questionário sobre o grau de confiança para demonstrar habilidades junto aos manequins, houve maior grau de confiança em executar as tarefas, com exceção da execução de uma tarefa considerada mais difícil. Conclusão: houve melhora no grau de confiança e no desenvolvimento de competências dos estudantes de graduação em medicina com as orientações nos simuladores de treinamento urogenital masculino. Introdução profissional teóricos específicas urologia Métodos descritiva quantitativa experimental transversal º Paraná Resultados 9 realizadas toque prostático escrotal. escrotal . escrotal) Destes 4 paciente teóricas elevados E manequins difícil Conclusão

ABSTRACT Purpose: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator’s cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic. Purpose 201 COVID19 COVID 19 (COVID-19 Methods retrospective study (201 prepandemic 202 (202 COVID-1 compared evaluated Results 127 256 respectively 502 50 2 50.2 4.2% 42 4 (4.2 49 9 4.9 p=0.314. p0314 p p=0.314 . 0 314 p=0.314) simulators s p<0.696. p0696 p<0.696 696 (p<0.696) Conclusion increase 20 COVID1 1 (COVID-1 (20 COVID- 12 25 5 50. 4.2 (4. 4. p031 p=0.31 31 p069 p<0.69 69 (p<0.696 (COVID- (2 (4 p03 p=0.3 3 p06 p<0.6 6 (p<0.69 (COVID ( p0 p=0. p<0. (p<0.6 p=0 p<0 (p<0. p= p< (p<0 (p< (p

ABSTRACT The research relevance is predefined by the air travel number growth. Accordingly, the relevance of this issue is increasing, especially concerning air travel safety. Also, due to the increasing demand for international flights, it becomes essential to harmonize the standards and methodology of training aviation personnel. The research aims to consider the parameters of flight safety and the impact of the unification of training programs for aviation personnel. The conclusion that unification can significantly affect safety was made with the help of scientific and special methods, including analysis, synthesis, concretization, and generalization. An analysis of existing unification methods was conducted. The multi-crew pilot training program proved to be one of the most advanced compared to standard flight crew training programs. The method was determined to be a specialized training program tailored to the needs of the aviation industry and focused on training pilots for multi-crew and jet operations. The program is more challenging, intensive and dynamic, and includes a significant amount of simulator training. Traditional flight training programs, such as Private Pilot Licenses (PPL), Commercial Pilot Licenses (CPL), instrument qualification, and multi-engine rating, have a broader scope and provide pilots with more career opportunities. Simulator training has been identified as a critical component of many flight training programs and plays a vital role in flight safety. The study may be of interest to a range of readers concerned with the issue of standardizing aviation training and improving safety in aviation, including researchers, faculty, and students of higher education institutions in the aviation field. growth Accordingly Also flights personnel synthesis concretization generalization conducted multicrew multi operations challenging dynamic PPL, PPL , (PPL) CPL, CPL (CPL) qualification multiengine engine rating opportunities researchers faculty field (PPL (CPL

RESUMO Introdução: A cricotireotomia é um procedimento que pode salvar vidas em caso de insuficiência respiratória aguda de emergência. A cricotireotomia deve ser treinada durante a graduação médica, e simuladores de baixo custo podem oferecer uma solução satisfatória em termos econômicos e práticos. Objetivo: Este estudo teve como objetivos construir e determinar as validades de face, conteúdo e construção de um simulador caseiro de cricotireotomia de baixo custo desenvolvido pelos autores. Método: Quarenta e sete estudantes e nove cirurgiões realizaram três cricotireotomias simuladas sucessivas e responderam a um questionário de validade de face e de conteúdo. A validade de construto foi testada comparando tempos procedurais e um escore de desempenho global intragrupos e intergrupos. Resultado: A maioria dos itens do questionário de validade face e de conteúdo foram avaliados de forma positiva, sem diferença entre os grupos. Assim, estudantes e cirurgiões concordaram que o simulador se assemelha a uma superfície anterior do pescoço humano, é fácil e seguro de usar, permite a realização de etapas críticas da cricotireotomia e apresenta potencial viabilidade de ensino. O tempo de procedimento diminuiu entre a primeira e a terceira tentativa entre os estudantes (diminuição média do tempo = 61,85 s; IC 95% - 41,86 - 81,85; p < 0,001), e foi encontrada diferença significativa entre os tempos de atuação dos cirurgiões e dos estudantes (diferença média = 101,36 segundos [IC 95% = 69,08 - 133,64] p < 0,001), sugerindo validade de construto. Os escores de desempenho dos alunos melhoraram entre a primeira e a segunda tentativa (diferença média = 2,25 pontos; IC 95% = 1,31 - 3,20; p < 0,001). Conclusão: O simulador de cricotireotomia inorgânico, de fabricação caseira e de baixo custo possui validade de face, conteúdo e construção aceitáveis para ser usado como ferramenta de treinamento para estudantes de graduação em Medicina. Introdução emergência médica práticos Objetivo autores Método intergrupos Resultado positiva grupos Assim humano usar ensino diminuição 6185 61 85 61,8 s 95 4186 41 86 41,8 81,85 8185 81 0,001, 0001 0,001 , 0 001 0,001) 10136 101 36 101,3 6908 69 08 69,0 133,64 13364 133 64 225 2 25 2,2 pontos 131 1 31 1,3 3,20 320 3 20 0,001. . Conclusão inorgânico Medicina 618 6 8 61, 9 418 4 41, 81,8 818 000 0,00 00 1013 10 101, 690 69, 133,6 1336 13 22 2, 1, 3,2 32 81, 0,0 133, 3, 0,

ABSTRACT Introduction: Cricothyrotomy is a procedure that may save lives in emergency acute respiratory failure. Cricothyrotomy must be trained during undergraduate medical education, and low-cost simulators may offer a satisfying solution in economical and practical terms. Objective: The aims of this study were to build and assess the face, content, and construct validity of a low-cost, homemade cricothyrotomy simulator developed by the authors. Methods: Forty-seven students and nine surgeons performed three successive simulated cricothyrotomies and answered a face and content validity questionnaire. The construct validity was tested by comparing procedural duration and a global performance score intra- and between groups. Results: Most face and content validity questionnaire items were highly and positively rated, with no difference between the groups. Accordingly, students and surgeons agreed that the simulator resembles a human neck anterior surface, is easy and safe to use, allows the performance of critical steps of the cricothyrotomy, and exhibits potential teaching feasibility. Procedural duration decreased between the first and third attempts among students (mean time decrease = 61.85 s; 95% CI - 41.86 - 81.85; p < 0.001), and a significant difference was found between surgeons’ and students’ performance duration (mean difference = 101.36 seconds [95% CI = 69.08 - 133.64] p < 0.001), suggesting construct validity. The students’ performance scores improved between the first and second attempts (mean difference = 2.25 points; CI 95% = 1.31 - 3.20; p < 0.001). Conclusions: The non-organic, homemade, low-cost cricothyrotomy simulator has acceptable face, content, and construct validity and is suitable for use as a training tool by undergraduate medical students. Introduction failure education lowcost low cost terms Objective lowcost, cost, authors Methods Fortyseven Forty seven intra groups Results rated Accordingly surface feasibility mean 6185 61 85 61.8 s 95 4186 41 86 41.8 81.85 8185 81 0.001, 0001 0.001 , 0 001 0.001) 10136 101 36 101.3 [95 6908 69 08 69.0 133.64 13364 133 64 225 2 25 2.2 points 131 1 31 1.3 3.20 320 3 20 0.001. . Conclusions nonorganic, nonorganic non organic, organic non-organic 618 6 8 61. 9 418 4 41. 81.8 818 000 0.00 00 1013 10 101. [9 690 69. 133.6 1336 13 22 2. 1. 3.2 32 81. 0.0 [ 133. 3. 0.

ABSTRACT: Surgical simulation laboratories make it possible to perfect skills and reduce learning gaps in the teaching of surgical sciences because it is possible to reduce training time and improve quality, without stress for professionals and with greater safety for patients. The use of simulators allows minimizing the ethical conflict between patient safety and teaching, achieving greater efficiency in the teaching-learning process, by reducing costs for supplies and patient complications. It is the author's purpose to communicate about the importance of surgical simulation laboratories in medical teaching and to motivate the Universities of Medical Sciences in Cuba so that, through development projects, they can obtain useful alternatives with these learning strategies before the economic effects caused by the blockade.

RESUMEN: Los laboratorios de simulación quirúrgica permiten perfeccionar las habilidades y disminuir las brechas de aprendizaje en la enseñanza de las ciencias quirúrgicas porque se logra disminuir el tiempo de formación y mejorar la calidad, sin estrés en los profesionales y con mayor seguridad para los pacientes. El uso de los simuladores permite minimizar el conflicto ético entre la seguridad del paciente y la enseñanza, lograr mayor eficiencia en el proceso de enseñanza aprendizaje, al disminuir los costos por concepto de insumos y complicaciones de los pacientes. Es propósito del autor comunicar sobre la importancia de los laboratorios de simulación quirúrgica en la docencia médica y motivar a las Universidades de Ciencias Médicas en Cuba para que, a través de proyectos de desarrollo, puedan obtener con estas estrategias de aprendizaje, alternativas útiles, ante las afectaciones económicas que provoca el bloqueo.

ABSTRACT Purpose: To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). Methods: The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants’ individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). Results: At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. Conclusions: Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS. Purpose . (RIRS) Methods Pará threedimensional dimensional technology course S0, S0 S , (S0) sessions S1, S1 (S1 S3. S3 S3) way stepbystep step checklist participants assessment pre (pre posttraining, posttraining post post-training) simulation SSSCL. (SSSCL) Results standard 005 0 05 0.05 feedback 96 96% Conclusions (RIRS (S0 (S post-training (SSSCL 00 0.0 9 0.

BACKGROUND: The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. AIM: This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. SETTING: The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. METHODS: Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. RESULTS: Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. CONCLUSION: The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. CONTRIBUTION: Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.

Objetivo: comprobar la tasa de evaluación correcta mediante la comparación visual directa de las medidas de dilatación cervical en modelos de cuello uterino de consistencia dura. Método: estudio aleatorizado abierto con 63 estudiantes de obstetricia a los que se les asignó usar o no la comparación visual directa con una guía de dilatación. Los estudiantes estimaron de forma ciega la dilatación cervical en simuladores con diferentes dilataciones. El resultado primario fue la tasa de evaluación correcta. Resultados: los estudiantes realizaron 441 pruebas. Se observó una mayor tasa de evaluación correcta en el grupo experimental que en el grupo control (47,3% versus 27,2%; p < 0,001; Odds Ratio = 2,41; intervalo de confianza del 95% = 1,62-3, 58). Conclusión: la comparación visual directa aumentó la precisión de la evaluación de la dilatación cervical en modelos de simulación de cuello, lo que podría ser beneficioso en el entrenamiento de laboratorio. Registro Brasileño de Ensayos Clínicos n.º U1111-1210-2389. Objetivo dura Método 6 dilataciones Resultados 44 pruebas 47,3% 473 47 3 (47,3 27,2% 272 27 2 0,001 0001 0 001 2,41 241 41 95 1,623, 1623 1,62 3, 1 62 1,62-3 58. 58 . 58) Conclusión laboratorio nº n º U111112102389. U111112102389 U U1111 1210 2389. 2389 U1111-1210-2389 4 47,3 (47, 27,2 0,00 000 00 2,4 24 9 623 1,623 162 1,6 1,62- 5 U11111210238 U111 121 238 U1111-1210-238 47, (47 27, 0,0 2, 16 1, U1111121023 U11 12 23 U1111-1210-23 (4 0, U111112102 U1 U1111-1210-2 ( U11111210 U1111-1210- U1111121 U1111-1210 U111112 U1111-121 U11111 U1111-12 U1111-1 U1111-

Objective: to verify the correct assessment rate when using direct visual comparison in the cervical dilation measures in hard-consistency cervix simulation models. Method: an open-label and randomized study conducted with 63 Obstetrics students that were designated either to use direct visual comparison in a dilation guide or not. The students estimated cervical dilation blindly in simulators with different dilations. The primary outcome was the correct assessment rate. Results: the students performed 141 tests. A higher correct assessment rate was found in the Experimental Group than in the Control Group (47.3% versus 27.2%; p<0.001; Odds Ratio = 2.41; 95% Confidence Interval = 1.62-3.58). Conclusion: the direct visual comparison increased precision of the cervical dilation assessment in cervix simulation models, with the possibility of being beneficial in laboratory training. Brazilian Registry of Clinical Trials No. U1111-1210-2389. Objective hardconsistency hard consistency models Method openlabel open label 6 not dilations Results 14 tests 47.3% 473 47 3 (47.3 27.2% 272 27 2 p<0.001 p0001 p 0 001 2.41 241 41 95 1.623.58. 162358 1.62 3.58 . 1 62 58 1.62-3.58) Conclusion training No U111112102389. U111112102389 U U1111 1210 2389. 2389 U1111-1210-2389 47.3 4 (47. 27.2 p<0.00 p000 00 2.4 24 9 623 1.623.58 16235 162 1.6 358 3.5 5 1.62-3.58 U11111210238 U111 121 238 U1111-1210-238 47. (47 27. p<0.0 p00 2. 1.623.5 1623 16 1. 35 3. 1.62-3.5 U1111121023 U11 12 23 U1111-1210-23 (4 p<0. p0 1.623. 1.62-3. U111112102 U1 U1111-1210-2 ( p<0 1.623 1.62-3 U11111210 U1111-1210- p< 1.62- U1111121 U1111-1210 U111112 U1111-121 U11111 U1111-12 U1111-1 U1111-

Objetivo: verificar a taxa de avaliação correta com o uso da comparação visual direta nas medidas de dilatação cervical em modelos de simulação de colo com consistência dura. Método: estudo randomizado aberto com 63 estudantes de obstetrícia que foram designados para usar comparação visual direta em um guia de dilatação ou não. Os estudantes estimaram cegamente a dilatação cervical em simuladores com diferentes dilatações. O desfecho primário foi a taxa de avaliação correta. Resultados: os estudantes realizaram 441 testes. Foi encontrada maior taxa de avaliação correta no grupo experimental do que no grupo controle (47,3% versus 27,2%; p <0,001; Odds Ratio = 2,41; intervalo de confiança de 95% = 1,62-3,58). Conclusão: a comparação visual direta aumentou a precisão da avaliação da dilatação cervical em modelos de simulação de colo, podendo ser benéfica no treinamento em laboratório. Registro Brasileiro de Ensaios Clínicos nº U1111-1210-2389. Objetivo dura Método 6 não dilatações Resultados 44 testes 47,3% 473 47 3 (47,3 27,2% 272 27 2 <0,001 0001 0 001 2,41 241 41 95 1,623,58. 162358 1,62 3,58 . 1 62 58 1,62-3,58) Conclusão laboratório U111112102389. U111112102389 U U1111 1210 2389. 2389 U1111-1210-2389 4 47,3 (47, 27,2 <0,00 000 00 2,4 24 9 623 1,623,58 16235 162 1,6 358 3,5 5 1,62-3,58 U11111210238 U111 121 238 U1111-1210-238 47, (47 27, <0,0 2, 1,623,5 1623 16 1, 35 3, 1,62-3,5 U1111121023 U11 12 23 U1111-1210-23 (4 <0, 1,623, 1,62-3, U111112102 U1 U1111-1210-2 ( <0 1,623 1,62-3 U11111210 U1111-1210- < 1,62- U1111121 U1111-1210 U111112 U1111-121 U11111 U1111-12 U1111-1 U1111-

Resumen En los últimos veinte años se ha generado una tendencia hacia la digitalización de productos y procesos, por lo que el nuevo concepto de salud 4.0 promueve el uso de simuladores y gemelos digitales para la formación del personal sanitario, así como para la planificación personalizada de tratamientos de rehabilitación de pacientes. Este artículo presenta una herramienta virtual de capacitación para el personal de salud, que se basa en el prototipo de un gemelo digital de un exoesqueleto para la rehabilitación del miembro superior. El dispositivo fue diseñado en Solidworks® y posteriormente se obtuvo su modelo equivalente en el software Matlab/Simulink®. Mediante este último se evalúa la funcionalidad del dispositivo a través de la implementación de diferentes rutinas terapéuticas, que ayudan al fisioterapeuta a planificar y evaluar el rendimiento del tratamiento de cada paciente. En este caso, la evaluación de los movimientos del miembro superior se genera a través de movimientos independientes y combinados de las articulaciones del hombro, codo y muñeca; como resultados se obtienen gráficos de los movimientos, una representación virtual del gemelo digital y los valores de los pares en cada articulación. Finalmente, se obtiene una herramienta digital que permite configurar el prototipo de gemelo digital a condiciones similares a las del exoesqueleto real para tareas de automatización y supervisión.

Abstract In the last twenty years, a trend towards the digitization of products and processes has been generated, so the new concept of health 4.0 promotes the use of simulators and digital twins for the training of health personnel, as well as for the personalized planning of patients rehabilitation treatments. This paper presents a virtual training tool for health personnel, which is based on the prototype of a digital twin of an exoskeleton for upper limb rehabilitation. The device was designed in Solidworks® and later its equivalent model was obtained in Matlab/Simulink® software. Through the latter, the functionality of the device is evaluated through the implementation of different therapeutic routines, which help the physiotherapist to plan and evaluate the performance of each patient’s treatment. In this case, the evaluation of the movements of the upper limb are generated through independent and combined movements of the shoulder, elbow and wrist joints and, as a result, graphs of the movements are obtained, as well as a virtual representation of the digital twin and the values of the torques in each joint. Finally, a digital tool that allows the digital twin prototype to be configured to conditions similar to those of the real exoskeleton for automation and supervision tasks is obtained.