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Purpose: Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system. Methods: Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes. Results: A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively. Conclusion: If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies. [ABSTRACT FROM AUTHOR]

Introduction: Studies of learning conversations in medical education suggest these interactions can be supervisor driven, monologic and may involve poor recall of events. Educators often use camouflaged comments to avoid upsetting learners, which can interfere with meaning making. Using video of clinical practice within learning conversations could address some of these potential limitations. Despite educators using video of clinical practice in learning conversations for decades, we could find no synthesis of empirical studies to provide insight into the influence of video in learning conversations. Therefore, we conducted a scoping review to answer the question "How does video of clinical practice influence learning conversations in post-graduate medical education?" Methods: We employed a scoping review methodology. MEDLINE, Embase, PsycINFO and ERIC databases were searched for articles from 1 January 2010 to 1 January 2022. Major inclusion criteria were postgraduate medical learners and video of clinical practice that was used in a learning conversation. The qualitative data relating to video's influence on learning conversations were synthesised and thematically analysed. Results: Five articles were included in the synthesis. We generated four themes from the qualitative data about the influence of video on the learning conversation. Video: (1) captures performance data that can be co-analysed, (2) enables the learning conversation to take place in a different environment, (3) changes the teaching approaches of educators and (4) may promote learner agency and voice. Conclusion: Video may influence learning conversations, and video's influence is likely entangled with the educational design associated with its use. No study directly addressed the phenomenon of how video influences learning conversations, and further study is required in this area. [ABSTRACT FROM AUTHOR]

Objective: To investigate residents' experiences recording and receiving feedback on a challenging video of a patient encounter. Methods: We used a qualitative design with first year residents who took part in a mandatory communication skills course in which all participants were asked to bring a challenging video of a patient encounter. The methods consisted of brief reflection texts and focus groups related to their perspectives on the use of challenging videos. Results: 106 residents wrote brief reflection texts, and 13 residents participated in four focus groups. Residents mainly expressed positive experiences with the challenging video exercise. Residents reported that the pressure to perform was felt to be less than on previous teaching sessions because the focus was on choosing an encounter which was less than perfect. They also reported that they appreciated the opportunity to see that other doctors were not performing optimally. Conclusion: The use of challenging videos as a teaching method for communication skills was experienced as encouraging by residents and facilitated enhanced learning. Innovation: We recommend adding more focus on challenging situations in video review. This could support learning by providing what our participants found to be a less daunting learning environment.

Abstract Background and importance Use of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement. Objective There is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context. Design, setting and participants Studies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion. Outcome measures and analysis Reliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred. Main results There are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified – 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context. Conclusion T-NOTECHS is the tool of choice for assessing ED teams in this context.

Background and importance: Use of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement. Objective: There is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context. Design, setting and participants: Studies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion. Outcome measures and analysis: Reliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred. Main results: There are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified – 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context. Conclusion: T-NOTECHS is the tool of choice for assessing ED teams in this context. [ABSTRACT FROM AUTHOR]

Video Review (VR) is a well established educational tool for developing the practice of patient-centered care in family medicine residents. There are a number of behaviorally-based checklists that can be use in both live observation as well as VR of clinical encounters to identify and promote behaviors associated with patient-centered care, most of which also overlap with behaviors associated with Emotional Intelligence (EI). We propose a VR that is structured less on a seek-and-find of clinician behaviors and more as a self-reflective exercise of how the clinician presents in the room alongside how they were feeling during that encounter. We believe that this exercise promotes the first two skills of EI (self-awareness and self-management) and then provides a foundation on which to build the second pair of skills (social awareness and relationship management). This perspective paper offers guidance, including stepwise instruction, on how to facilitate such a VR curriculum. [ABSTRACT FROM AUTHOR]

Video Review (VR) is a well established educational tool for developing the practice of patient-centered care in family medicine residents. There are a number of behaviorally-based checklists that can be use in both live observation as well as VR of clinical encounters to identify and promote behaviors associated with patient-centered care, most of which also overlap with behaviors associated with Emotional Intelligence (EI). We propose a VR that is structured less on a seek-and-find of clinician behaviors and more as a self-reflective exercise of how the clinician presents in the room alongside how they were feeling during that encounter. We believe that this exercise promotes the first two skills of EI (self-awareness and self-management) and then provides a foundation on which to build the second pair of skills (social awareness and relationship management). This perspective paper offers guidance, including stepwise instruction, on how to facilitate such a VR curriculum.

Background Significant effort has gone into the identification and quantification of the underlying mechanisms of primary ACL injury. Secondary ACL injury is observed in approximately 1/4 to 1/3 of athletes who return to sport following ACL reconstruction. However, little has been done to evaluate the mechanisms and playing circumstances surrounding these repeat injuries. Hypothesis/Purpose The purpose of this study was to characterize the mechanisms of non-contact secondary ACL injuries using video analysis. It was hypothesized that in video recordings of secondary ACL injury, athletes would exhibit greater frontal plane hip and knee angles, but not greater hip and knee flexion, at 66 ms following initial contact (IC) as compared to at IC and 33ms following IC. Study Design Cross-Sectional Study Methods Twenty-six video recordings of competitive athletes experiencing secondary ACL ruptures via noncontact mechanisms were analyzed for lower extremity joint kinematics, playing situation, and player attention. Kinematics were assessed at IC as well as 33 ms (1 broadcast frame) and 66 ms (2 broadcast frames) following IC. Results Knee flexion and knee frontal plane angles were greater at 66 ms than IC (p ≤ 0.03). Hip, trunk, and ankle frontal plane angles were not greater at 66 ms than IC (p ≥ 0.22). Injuries were distributed between attacking play (n=14) and defending (n=8). Player attention was most commonly focused on the ball (n=12) or an opponent (n=7). A single-leg landing accounted for just over half of the injuries (54%), while a cutting motion accounted for the remainder of the injuries (46%). Conclusion Secondary ACL injury was most likely to occur during landing or a sidestep cut with player attention external to their own body. Knee valgus collapse combined with limited hip motion was identified in the majority of secondary injuries. Level of Evidence Level IIIb [ABSTRACT FROM AUTHOR]

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Introduction: A trauma resuscitation is dynamic and complex process in which failures could lead to serious adverse events. In several trauma centers, evaluation of trauma resuscitation is part of a hospital's quality assessment program. While video analysis is commonly used, some hospitals use live observations, mainly due to ethical and medicolegal concerns. The aim of this study was to compare the validity and reliability of video analysis and live observations to evaluate trauma resuscitations. Methods: In this prospective observational study, validity was assessed by comparing the observed adherence to 28 advanced trauma life support (ATLS) guideline related tasks by video analysis to life observations. Interobserver reliability was assessed by calculating the intra class coefficient of observed ATLS related tasks by live observations and video analysis. Results: Eleven simulated and thirteen real-life resuscitations were assessed. Overall, the percentage of observed ATLS related tasks performed during simulated resuscitations was 10.4% (P < 0.001) higher when the same resuscitations were analysed using video compared to live observations. During real-life resuscitations, 8.7% (p < 0.001) more ATLS related tasks were observed using video review compared to live observations. In absolute terms, a mean of 2.9 (during simulated resuscitations) respectively 2.5 (during actual resuscitations) ATLS-related tasks per resuscitation were not identified using live observers, that were observed through video analysis. The interobserver variability for observed ATLS related tasks was significantly higher using video analysis compared to live observations for both simulated (video analysis: ICC 0.97; 95% CI 0.97–0.98 vs. live observation: ICC 0.69; 95% CI 0.57–0.78) and real-life witnessed resuscitations (video analyse 0.99; 95% CI 0.99–1.00 vs live observers 0.86; 95% CI 0.83–0.89). Conclusion: Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These outcomes may guide the debate to justify video review instead of live observations. [ABSTRACT FROM AUTHOR]

Background: Umbilical two-port laparoscopic percutaneous extraperitoneal processus vaginalis closure (UTLPEPVC) has been performed for children recent years. In addition to the basic concept of preperitoneal closure of the proecessus vaginalis at the level of internal ring, more conceptual and skillful cognitions deserve to be further probed for a smoother and swifter performance. Methods: From June 2021 to September 2021, 27 patients of 5 girls and 22 boys with a total of 45 patent processus vaginalis closure were consecutively performed UTLPEPVC by a laparoscopic novice and an experienced surgeon in our department. The video clips of all the procedures were recorded in a SanDisk. The needle piercing site, piercing route, piercing time, dissecting time and peritoneal puncture were defined, measured and evaluated between the novice and the expert. P ​ ​0.05). There were no postoperative complications or open conversions for all the patients. The piercing time and the dissecting time of the novice were significantly longer than that of the expert (P ​= ​0.0000, 0.0000). Dissecting puncture occurred more frequently than that of the expert (P ​= ​0.0036). Due to unawareness of pneumoperitoneum-induced anatomic changes of the inguinal canal, the piercing site of the novice was higher than that of the expert. The piercing route of the novice did not directly operate from the external inguinal fossa compared to that of the expert. Furthermore, the novice's spatial orientation was not adequately developed with more peritoneum punctures and the inflexible clamping and lifting of the peritoneum during the dissecting process. Conclusion: In UTLPEPVC for children, pneumoperitoneum-induced anatomic changes of the inguinal canal and peritoneal flexibility utilization deserve to be cognized.

Review of video recorded sessions is a powerful teaching tool in medical education, helping students appreciate both spoken and unspoken communications not fully appreciated in the moment. For many years, the American Balint Society has used video review in its Leadership Training Intensive courses, however technical challenges around setting up and operating the equipment have led some faculty to question whether the benefits are worth the effort and anxiety. We describe here an approach to video review in Intensives with a focus on the case presentation. Close attention to the case presentation can uncover important clues about a presenter's feelings and conflicts in a case, clues that may easily be missed on first pass. The Balint group leader listens for clues and cues to the patient's state of mind, and how the clinician is being distracted or deflected from their authentic role. Focusing the video review at an Intensive on the case presentation highlights for novice leaders the importance of maintaining keen focus on this initial section of the Balint group process for information on "what this case is about." Finally, we predict that Balint group leaders who emerge from an Intensive with this new appreciation for close listening to the presentation will not only be more effective Balint group leaders but will also be in a better position to serve as clinical role models, teaching by example to their Balint group members the importance of attending closely to the patient's communications in the patient – clinician encounter. [ABSTRACT FROM AUTHOR]

Understanding characteristics of head acceleration events (HAEs) in youth football is vital in developing strategies to improve athlete safety. This study aimed to characterize HAEs in youth football using an instrumented mouthpiece. Youth football athletes (ages 11–13) participating on two teams were enrolled in this study for one season. Each athlete was instrumented with a mouthpiece-based sensor throughout the season. HAEs were verified on film to ensure that mouthpiece-based sensors triggered during contact. The number of HAEs, peak resultant linear and rotational accelerations, and peak resultant rotational velocity were quantified. Mixed effects models were used to evaluate differences in mean kinematic metrics among all HAEs for session type, athlete position, and contact surface. A total of 5,292 HAEs were collected and evaluated from 30 athletes. The median (95th percentile) peak resultant linear acceleration, rotational acceleration, and rotational velocity was 9.5 g (27.0 g), 666.4 rad s−2 (1863.3 rad s−2), and 8.5 rad s−1 (17.4 rad s−1), respectively. Athletes experienced six (22) HAEs per athlete per session (i.e., practice, game). Competition had a significantly higher mean number of HAEs per athlete per session and mean peak rotational acceleration. Peak resultant rotational kinematics varied significantly among athlete positions. Direct head impacts had higher mean kinematics compared to indirect HAEs, from body collisions. The results of this study demonstrate that session type, athlete position, and contact surface (i.e., direct, indirect) may influence HAE exposure in youth football. [ABSTRACT FROM AUTHOR]

This empirical study examines the effects of user generated vlogs (UGV) versus brand generated ads (BGA) on consumer decisions on YouTube. UGV refers to any type of review video content about brands or products, created and published by users on YouTube. BGA refers to brand generated advertisements on YouTube. Guided by the elaboration likelihood model of persuasion, this online experimental research involved a 2 (source: UGV versus BGA) X 2 (involvement: high versus low) X 2 (gender: male versus female) between-subjects research design. Results showed that UGV elicited significantly greater effects on consumer brand attitudes and purchase intentions than BGA, when involvement was high. No significant gender differences were observed. In a constantly growing YouTube influencer economy, this study offers important theoretical and managerial implications.

Background: Since the transition of surgical robot systems into the medical field, physicians have had to develop new dexterity skills. The ideal learning environment for robotic surgery has yet to be discovered. Virtual reality (VR) simulation is a possible safe and economic method. In VR simulator training human feedback is hardly used, and an alternative may be found in video revision. The purpose of this study is to investigate whether adding video review to VR simulation-based training in novice physicians improves their ability to complete a complex robot task. In addition, the secondary goal is to investigate whether the skills learned on the robotic simulator can be transferred to a real robotic system. Materials and Methods: Forty participants, medical students and, medical-PhD candidates, from one university hospital were included. Baseline dexterity skills were measured through completion of a vesicourethral anastomosis on a VR robot simulator and the da Vinci robot. Participants were randomized into a video and control group. The video group practiced skills on the robot simulator with intermediate video revision, whereas the control group had intermediate pause instead. Postintervention dexterity skills were measured using the same exercises as the baseline tests. Results: No significant differences were found in baseline performance. Postintervention results on the VR simulator show that the video group commits significantly fewer injuries to the urethra and sutures at a greater optimal depth. The control group was significantly faster, had less camera travel, and had their instruments less out of view. On the da Vinci robot, participants in both groups performed significantly faster and had better global evaluative assessment of robotic skill score after the training sessions on the VR simulator. Conclusions: Video revision significantly improves the quality of robotic skills in novice surgeons on the VR simulator, although at the expense of time. Furthermore, both groups demonstrated enhanced skills on the da Vinci robot after training sessions, which advocates transferability of skill. [ABSTRACT FROM AUTHOR]

We introduce an active learning framework for content-based image retrieval for video surveillance that can be trained ad-hoc for a single camera in a matter of minutes. This technique allows searching for both, known and unknown objects, given a region of interest. The process does not require prior labelled data and treats image retrieval as a binary classification task, in which frames can be similar or different from a query image. The technique is compatible with any pre-trained deep feature extractor. In addition, we propose a novel label propagation algorithm that benefits from (1) visual similarity of image pairs and (2) the semantic representation of the feature vectors from a pre-trained deep feature extractor. This approach allows to reduce the amount of labels needed, while avoiding the propagation of errors. Our experiments with three use-cases from a nuclear facility show the validity of the proposed method, which achieves high precision and recall while requiring minimal amounts of labelled data. [Display omitted] • Present a relevant video frame retrieval pipeline that can be trained interactively. • Propose an active learning algorithm that leverages visual and semantic similarity. • Visual similarity makes label propagation less prone to introducing errors. [ABSTRACT FROM AUTHOR]

As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams’ management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.

Paraconduit hiatal hernia (PCHH) is a known complication of esophagectomy with significant morbidity. PCHH may be more common with the transition to a minimally invasive approach and improved survival. We studied the PCHH occurrence following minimally invasive esophagectomy to determine the incidence, treatment, and associated risk factors. We retrospectively reviewed records of patients who underwent esophagectomy at an academic tertiary care center between 2013-2020. We divided the cohort into those who did and did not develop PCHH, identifying differences in demographics, perioperative characteristics and outcomes. We present video of our laparoscopic repair with mesh. Of 49 patients who underwent esophagectomy, seven (14%) developed PCHH at a median of 186 d (60-350 d) postoperatively. They were younger (57 versus 64 y, P < 0.01), and in cases of resection for cancer, more likely to develop tumor recurrence (71% versus 23%, P = 0.02). There was a significant difference in 2-y cancer free survival of patients with a PCHH (PCHH 19% versus no hernia 73%, P < 0.01), but no significant difference in 5-y overall survival (PCHH 36% versus no hernia 68%, P = 0.18). Five of seven PCHH were symptomatic and addressed surgically. Four PCHH repairs recurred at a median of 409 d. PCHH is associated with younger age and tumor recurrence, but not mortality. Safe repair of PCHH can be performed laparoscopically with or without mesh. Further studies, including systematic video review, are needed to address modifiable risk factors and identify optimal techniques for durable repair of post-esophagectomy PCHH. [ABSTRACT FROM AUTHOR]

Abstract Background Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear. Methods Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored. Results The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p

Objective: To investigate residents' experiences recording and receiving feedback on a challenging video of a patient encounter. Methods: We used a qualitative design with first year residents who took part in a mandatory communication skills course in which all participants were asked to bring a challenging video of a patient encounter. The methods consisted of brief reflection texts and focus groups related to their perspectives on the use of challenging videos. Results: 106 residents wrote brief reflection texts, and 13 residents participated in four focus groups. Residents mainly expressed positive experiences with the challenging video exercise. Residents reported that the pressure to perform was felt to be less than on previous teaching sessions because the focus was on choosing an encounter which was less than perfect. They also reported that they appreciated the opportunity to see that other doctors were not performing optimally. Conclusion: The use of challenging videos as a teaching method for communication skills was experienced as encouraging by residents and facilitated enhanced learning., Innovation: We recommend adding more focus on challenging situations in video review. This could support learning by providing what our participants found to be a less daunting learning environment., Competing Interests: None., (© 2024 The Authors. Published by Elsevier B.V.)

Introduction: Tools for improving operative performance for surgical trainees are increasingly desirable, particularly in the context of EWTD and 'run-through' training programmes. In addition, positive direct trainer feedback to trainees can improve skill acquisition and motivation, whilst negative feedback may have the opposite effect.1 We aimed to examine the impact of targeted trainer feedback based on video analysis on trainee confidence and objective operative performance in laparoscopic cholecystectomy.Methods: Selected procedures designated as training cases were recorded. These were assessed by the trainers using the Independence-Scaled Procedural Assessment Score for laparoscopic cholecystectomy. Targeted feedback based on video review of selected procedures was then delivered by the trainers to the trainees. Trainees completed a self-reported questionnaire based on their response to this feedback. Subsequent to the feedback intervention, further training procedures were recorded and assessed.Results: A total of 6 trainees and 4 trainers participated in the study. For the pre-intervention assessment 15 cases were recorded, with a further 13 for the post-intervention assessment (total n = 28). The overall scores for the procedures performed post video feedback were improved, with a trend towards statistical significance (p = 0.08). However, there was a statistically significant improvement in the scores for performance of the triangle of Calot dissection after the feedback intervention (p = 0.009). The response rate to the questionnaire was 100%, with all trainees agreeing that they felt more confident and competent after the feedback intervention.Conclusion: Targeted feedback to trainees based on post-procedure video review improves trainee confidence and may also improve performance. ACGME Core Competencies; Patient Care and Procedural Skills; Practice Based Learning and Improvement. [ABSTRACT FROM AUTHOR]

Background: Rugby league is a high-intensity collision sport that carries a risk of concussion. Youth athletes are considered to be more vulnerable and take longer to recover from concussion than adult athletes. Purpose: To review head impact events in elite-level junior representative rugby league and to verify and describe characteristics of X-patchTM-recorded impacts via video analysis. Study Design: Observational case series. Methods: The X-patchTM was used on twenty-one adolescent players (thirteen forwards and eight backs) during a 2017 junior representative rugby league competition. Game-day footage, recorded by a trained videographer from a single camera, was synchronised with X-patchTM-recorded timestamped events. Impacts were double verified by video review. Impact rates, playing characteristics, and gameplay situations were described. Results: The X-patchTM-recorded 624 impacts ≥ 20g between game start and finish, of which 564 (90.4%) were verified on video. Upon video review, 413 (73.2%) of all verified impacts ≥ 20g where determined to be direct head impacts. Direct head impacts ≥ 20g occurred at a rate of 5.2 impacts per game hour; 7.6 for forwards and 3.0 for backs (range = 0–18.2). A defender's arm directly impacting the head of the ball carrier was the most common event, accounting for 21.3% (n = 120) of all impacts, and 46.7% of all "hit-up" impacts. There were no medically diagnosed concussions during the competition. Conclusion: The majority (90.4%) of head impacts ≥ 20g recorded by the X-patchTM sensor were verified by video. Double verification of direct head impacts in addition to cross-verification of sensor-recorded impacts using a secondary source such as synchronised video review can be used to ensure accuracy and validation of data. [ABSTRACT FROM AUTHOR]

Abstract Background Rugby league is a full-contact collision sport with an inherent risk of concussion. Wearable instrumented technology was used to observe and characterize the level of exposure to head impacts during game play. Purpose To verify the impacts recorded by the x-patch™ with video analysis. Study design Observational case series. Methods The x-patch™ was used on eight men’s semi-professional rugby league players during the 2016 Newcastle Rugby League competition (five forwards and three backs). Game day footage was recorded by a trained videographer using a single camera located at the highest midfield location to verify the impact recorded by the x-patch™. Videographic and accelerometer data were time synchronized. Results The x-patch™ sensors recorded a total of 779 impacts ≥ 20 g during the games, of which 732 (94.0%) were verified on video. In addition, 817 impacts were identified on video that did not record an impact on the sensors. The number of video-verified impacts ≥ 20 g, per playing hour, was 7.8 for forwards and 4.8 for backs (range = 3.9–19.0). Impacts resulting in a diagnosed concussion had much greater peak linear acceleration (M = 76.1 g, SD = 17.0) than impacts that did not result in a concussion (M = 34.2g, SD = 18.0; Cohen’s d = 2.4). Conclusions The vast majority (94%) of impacts ≥ 20 g captured by the x-patch™ sensor were video verified in semi-professional rugby league games. The use of a secondary source of information to verify impact events recorded by wearable sensors is beneficial in clarifying game events and exposure levels.

The goal of this in-the-wild study was to understand how different patient, provider, and environment contexts affected the use of a tablet-based checklist in a dynamic medical setting. Fifteen team leaders used the digital checklist in 187 actual trauma resuscitations. The measures of checklist interactions included the number of unchecked items and the number of notes written on the checklist. Of the 10 contexts we studied, team leaders' arrival after the patient and patients with penetrating injuries were both associated with more unchecked items. We also found that the care of patients with external injuries contributed to more notes written on the checklist. Finally, our results showed that more experienced leaders took significantly more notes overall and more numerical notes than less experienced leaders. We conclude by discussing design implications and steps that can be achieved with context-aware computing towards adaptive checklists that meet the needs of dynamic use contexts. [ABSTRACT FROM AUTHOR]

Background: Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation., Hypothesis: In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation., Results: There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days])., Conclusion: In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions., Competing Interests: The following authors declared potential conflicts of interest: M.J.C. has received royalties or licenses from Arthrex, Stryker, and Smith & Nephew, consulting fees from Donjoy, and patents from Tenova Tenodesis Screw. M.M.H. has received consulting fees from the National Football League (NFL) and is a full-time employee of IQVIA. N.W. has received consulting fees from the NFL and is a full-time employee of the Green Bay Packers. E.M.S. has received consulting fees from the NFL and is a full-time employee of Biocore. C.M.O. has received consulting fees from the NFL and is a full-time employee of Biocore. R.B.A. has received royalties or licenses from Stryker and Artelon, and consulting fees from Stryker, Envois, Arthrex, Artelon, OsteoRemedies, and Nuvasive.

Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries. Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League's (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters. Study design: Cohort study Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41–.60), moderate (.61–.80), or substantial (.81–1.00). Significance was set at p <.05. Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from.52 to.68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from.56 to.86. Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40–100 g, 3.3–7.0 m/s and 35–118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts. [ABSTRACT FROM AUTHOR]

Background: Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear.Methods: Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored.Results: The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period (p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period (p = 0.006).Conclusions: Fully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia. [ABSTRACT FROM AUTHOR]

Objective: To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters. Background: Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries. Description: The NFL first began a program using spotters in 2011, and the ATC Spotter Program has undergone systematic enhancements each year. This article describes the evolution of the ATC Spotter Program, the requirements and training of its participants, and the program data available to date. Directions for future improvement and research are addressed. Clinical Advantages: The use of ATC spotters stationed in the broadcast booth has enhanced the real-time detection of concussed players in the NFL. [ABSTRACT FROM AUTHOR]

There is limited guidance on how to longitudinally administer simulation materials or to incorporate video recordings into assessment portfolios of simulated surgical skills. We launched a longitudinal weekly simulation curriculum for PGY1-PGY3 surgical residents based on the ACS/APDS Curriculum. Residents underwent monthly objective structured assessment of technical skills (OSATS) while wearing head-mounted cameras. Videos of OSATS performance accrued into individual online video portfolios. Residents were surveyed about their attitudes toward video recording. Twenty-seven general surgical residents participated, completing 161 OSATS encompassing 11 distinct skills and generating 258 videos of simulated skills performance. The overall survey response rate was 88%. Residents viewed the curriculum favorably overall, and 36.4% of residents accessed their videos. Of those who did not watch their videos, 78.6% cited not having enough time, whereas 28.6% did not think the videos would be useful. Over 95% of surveyed residents expressed interest in having a video library of attending-performed procedures, 59.1% were interested in having their own operations recorded, and 45.5% were interested in video-based coaching. Residents viewed longitudinal administration of the ACS/APDS Curriculum positively. Although video recording in simulation is feasible, resident interest may be higher for intraoperative recordings than for simulated skills. [ABSTRACT FROM AUTHOR]

Introduction: Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1) direct observation of an encounter followed by verbal feedback (direct feedback) and 2) subsequent review of the videotaped encounter by both student and supervisor (video-based feedback). The aim of the study was to evaluate whether content and process of feedback differed between both formats. Methods: In 2013, all second- and third-year medical students and clinical supervisors involved in formative sessions were asked to take part in the study. A sample of audiotaped feedback sessions involving supervisors who gave feedback in both formats were analyzed (content and process of the feedback) using a 21-item feedback scale. Results: Forty-eight audiotaped feedback sessions involving 12 supervisors were analyzed (2 direct and 2 video-based sessions per supervisor). When adjusted for the length of feedback, there were significant differences in terms of content and process between both formats; the number of communication skills and clinical reasoning items addressed were higher in the video-based format (11.29 vs. 7.71, p=0.002 and 3.71 vs. 2.04, p=0.010, respectively). Supervisors engaged students more actively during the video-based sessions than during direct feedback sessions (self-assessment: 4.00 vs. 3.17, p=0.007; active problem-solving: 3.92 vs. 3.42, p=0.009). Students made similar observations and tended to consider that the video feedback was more useful for improving some clinical skills. Conclusion: Video-based feedback facilitates discussion of clinical reasoning, communication, and professionalism issues while at the same time actively engaging students. Different time and conceptual frameworks may explain observed differences. The choice of feedback format should depend on the educational goal.

Background: Surgical video review has been shown to improve technical skill in novice surgeons; however, to date, there are no studies examining the use of video review by experts. This study sought to understand the process expert robotic surgeons use when they review their surgical videos., Methods: In this qualitative pilot study, eight expert robotic colorectal surgeons individually participated in semi-structured interviews and video elicitation sessions. Grounded theory was used to develop a process model on how expert surgeons review their robotic videos., Results: The participants identified four categories of video review: critical incidents, unique cases, new techniques/procedures, and routine cases. They ask themselves questions with the primary goal of improving surgical technical skills. Surgeons compare their performance to benchmark videos and share videos for teaching and collaboration., Conclusions: Expert robotic surgeons use video review for self-reflection and self-assessment. They recognize that improving surgical skills requires a growth mindset. These findings may contribute to the surgical education of novices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: A randomized controlled double‐blind sham surgery trial was conducted to determine the effectiveness of implantation of human embryonic dopamine neurons into the putamen of patients with advanced Parkinson's disease (PD). The present analyses determined whether patients viewing a video of them performing motor activities off medications at baseline would affect self‐ratings 12 months later on the Global Rating Scale (GRS). Objectives: To examine changes in GRS scores pre‐ and post‐video review for the total sample; to examine differences in scores between actual implant and sham groups, as well as perceived groups pre‐ and post‐video review; to examine differences among four subgroups of patients based on actual and perceived treatment (i.e., actual implant/perceived implant). Methods: Forty participants were recruited and randomly assigned to receive either neural implantation or sham surgery. The primary outcome variable was a one‐item GRS ranging from −3 (much worse since surgery) to +3 (much improved since surgery). At 12 months (before the blind was lifted) patients rated themselves on the GRS before and after viewing the baseline video. Results: Total sample GRS scores improved after the video (P = .001). There were no differences between the actual implant and sham groups before or after the video, but there were differences between perceived groups at both times (P < .001). Among subgroups, improvement after the video was found only in the group receiving the implant but who thought sham (P = .011). Conclusions: When self‐ratings are an outcome variable, review of baseline videos is recommended before making comparative ratings. [ABSTRACT FROM AUTHOR]

Introduction: Emergency department thoracotomy (EDT) must be rapid and well-executed. Currently there are no defined benchmarks for EDT procedural milestones. We hypothesized that trauma video review (TVR) can be used to define the 'normative EDT' and generate procedural benchmarks. As a secondary aim, we hypothesized that data collected by TVR would have less missingness and bias than data collected by review of the Electronic Medical Record (EMR).Methods: We used continuously recording video to review all EDTs performed at our centre during the study period. Using skin incision as start time, we defined four procedural milestones for EDT: 1. Decompression of the right chest (tube thoracostomy, finger thoracostomy, or clamshell thoracotomy with transverse sternotomy performed in conjunction with left anterolateral thoracotomy) 2. Retractor deployment 3. Pericardiotomy 4. Aortic Cross-clamp. EDTs with any milestone time ≥ 75th percentile of time or during which a milestone was omitted were identified as outliers. We compared rates of missingness in data collected by TVR and EMR using McNemar's test.Results: 44 EDTs were included from the study period. Patients had a median age of 30 [IQR 25-44] and were predominantly African-American (95%) males (93%) with penetrating trauma (95%). From skin incision, median times in minutes to milestones were as follows: right chest decompression: 2.11 [IQR 0.68-2.83], retractor deployment 1.35 [IQR 0.96-1.85], pericardiotomy 2.35 [IQR 1.85-3.75], aortic cross-clamp 3.71 [IQR 2.83-5.77]. In total, 28/44 (64%) of EDTs were either high outliers for one or more benchmarks or had milestones that were omitted. For all milestones, rates of missingness for TVR data were lower than EMR data (p < 0.001).Conclusions: Video review can be used to define normative times for the procedural milestones of EDT. Steps exceeding the 75th percentile of time were common, with over half of EDTs having at least one milestone as an outlier. Data quality is higher using TVR compared to EMR collection. Future work should seek to determine if minimizing procedural technical outliers improves patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose was to determine if a standardized video review program for residents improves operative performance.Methods: Participation was offered to surgical residents rotating on a minimally invasive service. Residents were randomized to either the video review group or no video review group. Every participant in the video review group underwent video reviews with an attending surgeon for 30 min once weekly during their 1-month rotation. A blinded surgeon evaluated performance in the operating room using validated assessment tools. The amount of time the resident spent as primary surgeon was recorded. One-way analysis of variance was used to compare the video and no video review groups. Differences were considered statistically significant for p values < 0.05.Results: Sixteen residents were randomized to the video review group (n = 8) or the no video review group (n = 8). Residents in the video review cohort significantly improved in creating a working space (p = 0.04), hernia sac reduction (p = 0.01), mesh placement (p = 0.01), knowledge of the procedure (p = 0.01), and overall competence (p = 0.02). Residents in the no video review group did not significantly improve in five of seven categories. The video review group significantly increased the time spent as primary surgeon (p = 0.02).Conclusion: Video review with a coach proved to be beneficial for residents when learning laparoscopic inguinal hernia repairs. We conclude that systematic video review is a good supplemental tool in resident surgical training. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This exploratory study evaluated student perceptions of their ability to self‐ and peer assess (i) interpersonal communication skills and (ii) clinical procedures (a head and neck examination) during standardised patient (SP) interactions recorded by Google Glass compared to a static camera. Methods: Students compared the Google Glass and static camera recordings using an instrument consisting of 20 Likert‐type items and four open‐ and closed‐text items. The Likert‐type items asked students to rate how effectively they could assess specific aspects of interpersonal communication and a head and neck examination in these two different types of recordings. The interpersonal communication items included verbal, paraverbal and non‐verbal subscales. The open‐ and closed‐text items asked students to report on more globally the differences between the two types of recordings. Descriptive and inferential statistical analyses were conducted for all survey items. An inductive thematic analysis was conducted to determine qualitative emergent themes from the open‐text questions. Results: Students found the Glass videos more effective for assessing verbal (t22 = 2.091, P = 0.048) and paraverbal communication skills (t22 = 3.304, P = 0.003), whilst they reported that the static camera video was more effective for assessing non‐verbal communication skills (t22 = −2.132, P = 0.044). Four principle themes emerged from the students' open‐text responses comparing Glass to static camera recordings for self‐ and peer assessment: (1) first‐person perspective, (2) assessment of non‐verbal communication, (3) audiovisual experience and (4) student operation of Glass. Discussion and conclusion: Our findings suggest that students perceive that Google Glass is a valuable tool for facilitating self‐ and peer assessment of SP examinations because of students’ perceived ability to emphasise and illustrate communicative and clinical activities from a first‐person perspective. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the duration and frequency of communication between EMS (Emergency Medical Services) and ED (Emergency Department) staff during handoff and the subsequent time to critical cardiac care (rhythm determination, defibrillation) using CA (cardiac arrest) video review. A single-center retrospective study of video-recorded adult CAs between August 2020 and December 2022 was performed. Two investigators assessed the communication of 17 data points, time intervals, EMS initiation of handoff, and type of EMS agency. Median times from initiation of handoff to first ED rhythm determination and defibrillation were compared between the groups above versus below the median number of data points communicated. Overall, 95 handoffs were reviewed. The handoff was initiated in a median of 2 seconds (interquartile range (IQR) 0–10) after arrival. EMS initiated handoff in 65 (69.2%) patients. The median number of data points communicated was 9 and median duration was 66 seconds (IQR 50–100). Age, location of arrest, estimated down time, and medications administered were communicated > 80% of the time, initial rhythm 79%, and bystander cardiopulmonary resuscitation and witnessed arrest < 50%. The median times from initiation of handoff to first ED rhythm determination and defibrillation were 188 (IQR 106–256) and 392 (IQR 247–725) seconds, though not statistically different between handoffs with <9 vs. ≥9 data points communicated (p > 0.40). There is no standardization for handoff reports from EMS to ED staff for CA patients. Using video review, we demonstrated the variable communication during handoff. Improvements to this process could reduce the time to critical cardiac care interventions. [ABSTRACT FROM AUTHOR]

Background Abnormal involuntary postures are characteristic of dystonia, but the specific postures observed clinically have not previously been categorized or enumerated. The objective of this study was to determine whether there is a set of specific postures that are common between different children with dystonia. Methods Videotapes were examined from all children who were seen in a pediatric movement disorders clinic over a 4-year period and had a diagnosis of nonpsychogenic dystonia. In total, 179 children were included in the video review. Results Visually similar postures were identified in 152 different children. Seven different common postures were identified. All 152 children exhibited at least 1 of these postures, and most had more than 1. Conclusions Involuntary postures in childhood dystonia exhibit unexpected similarities despite a wide range of underlying etiology, severity, and developmental experience. This is consistent with the hypothesis that childhood dystonia is a symptom that reflects a shared pathway of expression for multiple anatomic and functional abnormalities. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effectiveness of using a video recording and replaying system in robotic surgical training. Summary Background Data: Robotic surgical videos are reviewed to accelerate the acquisition of robotic surgical skills. However, few professional recording and replaying systems have been used during robotic surgical training. The effectiveness of these professional video systems should be investigated and validated. Methods: A randomized study was conducted to analyze the performance of 60 participants, who were unfamiliar with surgical robotics, in a robotic simulator. Participants were enrolled in 2 groups to perform 2 exercises on a Mimic dV-Trainer. One group was trained with the new protocol based on a recording and replaying system (controller of events on simulator and robot) and the other group was trained with the conventional method. The overall scores were automatically evaluated by the simulator. The number of additional requests for reviewing the videos or watching the trainer's demonstration and the learning curves based on the overall scores were compared between the 2 groups. Results: The group trained with controller of events on simulator and robot presented a significantly improved learning curve in both exercises (P < 0.001) with more additional requests (P < 0.001) in comparison with the group trained with the conventional method. Conclusions: In robotic skills training, the use of a recording and replay system is beneficial and more efficient than the conventional training method. [ABSTRACT FROM AUTHOR]

Background: Simulation-based medical education (SBME) provides key medical training for providers to safely and ethically practice high-risk events. Augmented reality (AR)-enhanced simulation projects digital images of realistic examination findings into a participant's field of view, which allows nuanced physical examination findings such as respiratory distress and skin perfusion to be prominently displayed. It is unknown how AR compares to traditional mannequin (TM)-based simulation with regard to influencing participant attention and behavior., Objective: The purpose of this study is to use video-based focused ethnography-a problem-focused, context-specific descriptive form of research whereby the research group collectively analyzes and interprets a subject of interest-to compare and categorize provider attention and behavior during TM and AR and provide suggestions for educators looking to delineate these 2 modalities., Methods: Twenty recorded interprofessional simulations (10 TM, 10 AR) featuring a decompensating child were evaluated through video-based focused ethnography. A generative question was posed: "How do the attention and behavior of participants vary based on the simulation modality?" Iterative data collection, analysis, and pattern explanation were performed by a review team spanning critical care, simulation, and qualitative expertise., Results: The attention and behavior of providers during TM and AR simulation clustered into three core themes: (1) focus and attention, (2) suspension of disbelief, and (3) communication. Participants focused on the mannequin during AR, especially when presented with changing physical examination findings, whereas in TM, participants focused disproportionately on the cardiorespiratory monitor. When participants could not trust what they were seeing or feeling in either modality, the illusion of realism was lost. In AR, this manifested as being unable to physically touch a digital mannequin, and in TM, participants were often unsure if they could trust their physical examination findings. Finally, communication differed, with calmer and clearer communication during TM, while AR communication was more chaotic., Conclusions: The primary differences clustered around focus and attention, suspension of disbelief, and communication. Our findings provide an alternative methodology to categorize simulation, shifting focus from simulation modality and fidelity to participant behavior and experience. This alternative categorization suggests that TM simulation may be superior for practical skill acquisition and the introduction of communication strategies for novice learners. Meanwhile, AR simulation offers the opportunity for advanced training in clinical assessment. Further, AR could be a more appropriate platform for assessing communication and leadership by more experienced clinicians due to the generated environment being more representative of decompensation events. Further research will explore the attention and behavior of providers in virtual reality-based simulations and real-life resuscitations. Ultimately, these profiles will inform the development of an evidence-based guide for educators looking to optimize simulation-based medical education by pairing learning objectives with the ideal simulation modality., (©Daniel Loeb, Jamie Shoemaker, Allison Parsons, Daniel Schumacher, Matthew Zackoff. Originally published in JMIR Medical Education (https://mededu.jmir.org), 30.06.2023.)