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Blanié A, Amorim MA, Benhamou D. Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students. BMC MEDICAL EDUCATION 2020; 20:53. [PMID: 32075641 PMCID: PMC7031947 DOI: 10.1186/s12909-020-1939-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/16/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Early detection and response to patient deterioration influence patient prognosis. Nursing education is therefore essential. The objective of this randomized controlled trial was to compare the respective educational value of simulation by gaming (SG) and a traditional teaching (TT) method to improve clinical reasoning (CR) skills necessary to detect patient deterioration. METHODS In a prospective multicenter study, and after consent, 2nd year nursing students were randomized into two groups: Simulation by gaming "SG": the student played individually with a serious game consisting of 2 cases followed by a common debriefing with an instructor;Traditional Teaching "TT": the student worked on the same cases in text paper format followed by a traditional teaching course with a PowerPoint presentation by an instructor. CR skill was measured by script concordance tests (80 SCTs, score 0-100) immediately after the session (primary outcome) and on month later. Other outcomes included students' satisfaction, motivation and professional impact. RESULTS One hundred forty-six students were randomized. Immediately after training, the SCTs scores were 59 ± 9 in SG group (n = 73) and 58 ± 8 in TT group (n = 73) (p = 0.43). One month later, the SCTs scores were 59 ± 10 in SG group (n = 65) and 58 ± 8 in TT group (n = 54) (p = 0.77). Global satisfaction and motivation were highly valued in both groups although significantly greater in the SG group (p < 0.05). The students declared that the training course would have a positive professional impact, with no difference between groups. CONCLUSIONS In this study assessing nursing student CR to detect patient deterioration, no significant educational difference (SCT), neither immediate nor 1 month later, was observed between training by SG and the TT course. However, satisfaction and motivation were found to be greater with the use of SG. TRIAL REGISTRATION ClinicalTrials.gov; NCT03428269. Registered 30 january 2018.
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Affiliation(s)
- Antonia Blanié
- Centre de simulation LabForSIMS, Faculté de médecine Paris Saclay, 94275, Le Kremlin Bicêtre, France.
- Département d'Anesthésie-Réanimation, CHU Bicêtre, 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, Cedex, France.
- CIAMS, Université d'Orléans, 45067, Orléans, France.
| | - Michel-Ange Amorim
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, Cedex, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
| | - Dan Benhamou
- Centre de simulation LabForSIMS, Faculté de médecine Paris Saclay, 94275, Le Kremlin Bicêtre, France
- Département d'Anesthésie-Réanimation, CHU Bicêtre, 78, rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
- CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, Cedex, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
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A Call to Action: The Future of Simulation-based Research in Emergency Medicine in Canada. CAN J EMERG MED 2020; 22:8-10. [PMID: 31965962 DOI: 10.1017/cem.2019.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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153
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Abstract
INTRODUCTION Experiential learning through active participation is thought to be a key benefit of simulation-based education. Recent research has challenged this assumption, suggesting that active participants learn just as well as observers. Studies report that active participants experience stress and anxiety during simulation, which may hamper learning by active participants. We undertook the current study to examine whether active participation results in different emotional arousal than observing during simulation. We hypothesized that participants in active roles experience higher levels of negative emotions than those observing and looked for evidence that this may impact learning. METHODS Pediatric residents participate in simulations, rotating through active and observer roles, as part of their standard curriculum. We assessed both positive and negative emotional arousal with the Positive and Negative Affect Scale immediately after each simulation and assessed learning through multiple-choice questions. We used repeated measures analysis of variance to examine potential interactions between Positive and Negative Affect Scale scores and role in simulation. To explore differences in learning, we examined whether knowledge retention differed between the groups. RESULTS Residents had higher levels of both positive and negative emotional arousal in active roles compared with observing roles. We could not detect a difference in learning between the roles. CONCLUSIONS The increase in both positive and negative emotions among active participants compared with observers may have important implications for simulation design and participant learning. Future studies should be powered to detect differences in learning and examine the impact of contributing factors such as learner level and context.
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154
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Ontrup G, Vogel M, Wolf OT, Zahn PK, Kluge A, Hagemann V. Does simulation-based training in medical education need additional stressors? An experimental study. ERGONOMICS 2020; 63:80-90. [PMID: 31587619 DOI: 10.1080/00140139.2019.1677948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
The increased curricular integration of simulation-based training (SBT) in medical education is accompanied by researchers' calls to examine the effectiveness of SBT. We address conflicting results regarding effects of an added stressor on learning outcomes. In an experimental setting, one group of medical students (N = 20) performed cardiopulmonary resuscitation on a patient simulator. For a second group (N = 21) the scenario differed in that they encountered a defect defibrillator. We found participants of both groups to show increased biological stress-levels, independent of group allocation. Paradoxically, participants who encountered the equipment failure subjectively reported less stress. We discuss the implications of the comparable high stress levels in both groups with regards to future studies. We further discuss the result regarding subjective stress levels within the framework of attribution theory. Practitioner summary: The results of our experimental study underline the need for evidence-based choices of additional stressors for the design of simulation scenarios. We describe the choice of stimuli and setting in detail to maximise practical value for the construction of simulation-based medical trainings.
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Affiliation(s)
- Greta Ontrup
- Department of Work Organizational and Business Psychology, Ruhr University Bochum, Bochum, Germany
| | - Miriam Vogel
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Management, Klinikum Kassel, Kassel, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Ruhr University Bochum, Bochum, Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, University Hospital Bergmannsheil, Bochum, Germany
| | - Annette Kluge
- Department of Work Organizational and Business Psychology, Ruhr University Bochum, Bochum, Germany
| | - Vera Hagemann
- Human Resources, Department of Business Studies and Economics, University of Bremen, Bremen, Germany
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156
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Gefen N, Rigbi A, Archambault PS, Weiss PL. Comparing children's driving abilities in physical and virtual environments. Disabil Rehabil Assist Technol 2019; 16:653-660. [PMID: 31805790 DOI: 10.1080/17483107.2019.1693644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare children's driving abilities in a physical and virtual environment and to validate the McGill Immersive Wheelchair Simulator (MiWe-C) for the use of children with disabilities. MATERIALS AND METHODS Participants included 30 children (17 males, 13 females; mean age 14 y 1 mo, [SD 3 y 6 mo]; range: 5-18 y) with cerebral palsy, neuromuscular disease and spinal cord injury. All children were proficient drivers with more than 3 months' experience, who had their own powered wheelchairs. Participants drove a 15-minute physical route and high-fidelity simulation of that route in a counterbalanced order. Performance of the two routes was compared using the 32 item Powered Mobility Programme (PMP). Differences between the driving modes were analyzed with the non-parametric Wilcoxon signed-rank test. Significance was set at α = 0.05. RESULTS The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M = 4.90, SD = 0.20; M = 4.96, SD = 0.12, respectively) with no significant difference between them (z= -1.69, p = .09). Five out of the 32 PMP tasks showed significant differences between driving modes (narrow corridors, crowded corridors, doorway, sidewalks), with higher scores for the physical driving mode. CONCLUSIONS Having a validated powered mobility simulator for children provides a viable option for an additional practice mode. The MiWe-C simulator is affordable and a user-friendly simulator that can be used anywhere including at home and in school. Children can be independent when practicing even if they are not yet proficient drivers since continual adult assistance is not needed.Implications for rehabilitationHaving a validated powered mobility simulator for children provides a viable option for an additional practice mode.The MiWe-C is now validated to be used with children 5-18 years with physical disabilities.The MiWe-C is one of the few options for children to practice outside of a research environment.
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Affiliation(s)
- Naomi Gefen
- Department of Occupational Therapy, ALYN Hospital, Jerusalem, Israel.,Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | | | - Phillipe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Jewish Rehabilitation Hospital, Laval, Canada
| | - Patrice L Weiss
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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de la Fuente R, Fuentes R, Munoz-Gama J, Riquelme A, Altermatt FR, Pedemonte J, Corvetto M, Sepúlveda M. Control-flow analysis of procedural skills competencies in medical training through process mining. Postgrad Med J 2019; 96:250-256. [PMID: 31776174 DOI: 10.1136/postgradmedj-2019-136802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Procedural skills are key to good clinical results, and training in them involves a significant amount of resources. Control-flow analysis (ie, the order in which a process is performed) can provide new information for those who train and plan procedural training. This study outlines the steps required for control-flow analysis using process mining techniques in training in an ultrasound-guided internal jugular central venous catheter placement using a simulation. METHODS A reference process model was defined through a Delphi study, and execution data (event logs) were collected from video recordings from pretraining (PRE), post-training (POST) and expert (EXP) procedure executions. The analysis was performed to outline differences between the model and executions. We analysed rework (activity repetition), alignment-based fitness (conformance with the ideal model) and trace alignment analysis (visual ordering pattern similarities). RESULTS Expert executions do not present repetition of activities (rework). The POST rework is lower than the PRE, concentrated in the steps of the venous puncture and guidewire placement. The adjustment to the ideal model measure as alignment-based fitness, expressed as a median (25th-75th percentile) of PRE 0.74 (0.68-0.78) is less than POST 0.82 (0.76-0.86) and EXP 0.87 (0.82-0.87). There are no significant differences between POST and EXP. The graphic analysis of alignment and executions shows a progressive increase in order from PRE to EXP executions. CONCLUSION Process mining analysis is able to pinpoint more difficult steps, assess the concordance between reference mode and executions, and identify control-flow patterns in procedural training courses.
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Affiliation(s)
- Rene de la Fuente
- Anaesthesiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Fuentes
- Anaesthesiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Munoz-Gama
- Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Gastroenterology, Centre for Medical Education and Health Sciences. Department of Health Sciences. Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando R Altermatt
- Anaesthesiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pedemonte
- Anaesthesiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Corvetto
- Anaesthesiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
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158
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Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V. Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis. BMJ Open 2019; 9:e028800. [PMID: 31740464 PMCID: PMC6886915 DOI: 10.1136/bmjopen-2018-028800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents. DESIGN This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search. ELIGIBILITY CRITERIA Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis. RESULTS In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence. CONCLUSION CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning. PROSPERO REGISTRATION NUMBER CRD42017067054.
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Affiliation(s)
| | | | - Mark E Engel
- Medicine, Unversity of Cape Town, Cape Town, South Africa
| | - Mary Shelton
- Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Vanessa Burch
- Medicine, Unversity of Cape Town, Cape Town, South Africa
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159
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Tavares W. Roads less traveled: understanding the "why" in simulation as an integrated continuing professional development activity. Adv Simul (Lond) 2019; 4:24. [PMID: 31741749 PMCID: PMC6849187 DOI: 10.1186/s41077-019-0111-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background The simulation community has experienced significant advances, strengthening the case for the use of simulation in medical education toward improving patient outcomes. However, an underlying assumption particularly regarding utilization of simulation by those who are in practice, is that simulation will be selected as a continuing professional development (CPD) strategy. Exploring reasons for choices of educational formats, particularly regarding simulation, is poorly integrated into CPD research. Discussion Despite significant advances the scientific simulation community has been slow to produce evidence regarding why practitioners may be reserved in engaging in simulation or not. Using examples from related education contexts the author attempts to bridge simulation science, CPD and less commonly used theoretical frameworks to address this issue. The author argues that theoretical perspectives that recognize the use of simulation for CPD as a socio-personal process and/or a personal or group issue (e.g., theories of intelligence, self-determination theory, theory of planned behavior, social identity theory) and that are conceptually distinct from educational mechanisms/ provision are necessary to advance simulation use in CPD contexts. Conclusion Given the close relationship practicing clinicians have to patient outcomes a new imperative may be to focus on the theoretical and practical links informing simulation use for CPD at the level of the individual and individual-among-professional groups. The simulation community may therefore need to engage in research that attempts to further uncover and address underlying issues of “why” clinicians integrate simulation as CPD activities or not.
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Affiliation(s)
- Walter Tavares
- 1The Wilson Centre, University Health Network, 200 Elizabeth St. 1Es-565, Toronto, Ontario M5G 2C4 Canada.,2Post MD Education, Faculty of Medicine, Univeristy of Toronto, Toronto, Ontario Canada.,The Regional Municipality of York, Community and Health Services, Newmarket, Ontario Canada
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160
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Shailaja S, Hilda SS, Pinto PA, D'Cunha RJ, Mahmood LS, Hegde RB. Evaluation of resident satisfaction and change in knowledge following use of high-fidelity simulation teaching for anaesthesia residents. Indian J Anaesth 2019; 63:908-914. [PMID: 31772399 PMCID: PMC6868659 DOI: 10.4103/ija.ija_133_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/26/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators. Methods: Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario. Results: 95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant (P = 0.007). Conclusion: The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.
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Affiliation(s)
- S Shailaja
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
| | - S S Hilda
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
| | - Prajna A Pinto
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
| | - Rithesh J D'Cunha
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
| | - Lulu S Mahmood
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
| | - Radhesh B Hegde
- Department of Anaesthesia, Father Muller Medical College, Mangalore, Karnataka, India
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161
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Kesrouani A, Nemr E, Nasr M, Naccache N, AbouJaoude S. Integrating obstetrical simulation into the medical curriculum: one more gap in women's health for low-income countries. Health Care Women Int 2019; 40:1012-1015. [PMID: 31560275 DOI: 10.1080/07399332.2019.1652302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Low-income countries do not have well-established simulation centers; introduction of simulation-based learning in obstetrics faces many cost-associated difficulties. Simulation-based learning yield many benefits that are reported in many studies such as improved maternal and neonatal outcomes, social stature of medical teachers, and better management of difficult situations. Though low-income countries do not have established surgical simulations, centralization, and cooperation amongst the educational institutions and local and regional hospitals for maintenance of medical educational practices and financial supplementation through both established and newly created entities will provide the potential for improved patient outcomes and maintenance of quality of education, that is, comparable to the medical education found in higher income countries.
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Affiliation(s)
- A Kesrouani
- Medical Education Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon.,Obstetrics & Gynecology Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon
| | - E Nemr
- Medical Education Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon
| | - M Nasr
- Medical Education Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon
| | - N Naccache
- Medical Education Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon
| | - S AbouJaoude
- Medical Education Department, Faculty of Medicine, St Joseph University , Beirut , Lebanon
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162
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Ming JL, Huang HM, Hung SP, Chang CI, Hsu YS, Tzeng YM, Huang HY, Hsu TF. Using Simulation Training to Promote Nurses' Effective Handling of Workplace Violence: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193648. [PMID: 31569382 PMCID: PMC6801794 DOI: 10.3390/ijerph16193648] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/03/2023]
Abstract
Background: Workplace violence in the health care sector has become a growing global problem. Research has shown that although caregivers comprise a high-risk group exposed to workplace violence, most of them lacked the skills and countermeasures against workplace violence. Therefore, through a quasi-experimental design, this study aimed to investigate the effectiveness of situational simulation training on the nursing staffs’ concept and self-confidence in coping with workplace violence. Methods: Workplace violence simulation trainings were applied based on the systematic literature review and the conclusions from focus group interviews with nursing staff. Data were obtained from structured questionnaires including: (1) baseline characteristics; (2) perception of aggression scale (POAS); and (3) confidence in coping with patient aggression. Results: The results revealed that training course intervention significantly improved the nursing staffs’ self-perception and confidence against workplace violence (p < 0.001). Conclusions: The “simulation education on workplace violence training” as the intervention significantly improved the workplace violence perception and confidence among nursing staffs in coping with aggression events.
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Affiliation(s)
- Jin-Lain Ming
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Hui-Mei Huang
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Shiao-Pei Hung
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Ching-I Chang
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Yueh-Shuang Hsu
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Yuann-Meei Tzeng
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Hsin-Yi Huang
- Department of Biostatistics Task Force, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
| | - Teh-Fu Hsu
- Emergency Department, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan.
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163
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Improved Team Performance During Pediatric Resuscitations After Rapid Cycle Deliberate Practice Compared With Traditional Debriefing: A Pilot Study. Pediatr Emerg Care 2019; 35:480-486. [PMID: 27741071 DOI: 10.1097/pec.0000000000000940] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods. OBJECTIVE The aim of the study was to compare traditional and RCDP SBME. METHODS Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected. RESULTS Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, -11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue. CONCLUSIONS This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.
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164
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Drummond D. Apprentissage par simulation en pédiatrie : l’exemple de l’arrêt cardiorespiratoire de l’enfant. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La simulation en santé s’est diffusée très rapidement en pédiatrie à partir des années 2000 aux États-Unis et au Canada, puis à partir des années 2010 en France. L’arrêt cardiorespiratoire (ACR) de l’enfant représente le meilleur exemple des bénéfices qui peuvent être apportés par la simulation. La simulation peut reproduire à l’infini cette situation exceptionnelle, offre un apprentissage sans risque pour le patient ni pour l’apprenant, permet de travailler ses aspects cognitifs, techniques et humains. La simulation est effectivement associée à un gain en connaissance et en compétence chez les apprenants et participe à l’amélioration du pronostic des patients. Afin de maximiser l’efficacité pédagogique de l’enseignement de la prise en charge de l’ACR de l’enfant, les responsables pédagogiques devraient sans cesse évaluer leurs programmes, privilégier des curriculums qui associent la simulation avec d’autres modalités d’apprentissage et avoir pour objectif une pédagogie de la maîtrise. Les mannequins haute fidélité, s’ils sont appréciés par les apprenants, restent pédagogiquement équivalents aux mannequins basse fidélité pour l’apprentissage de la prise en charge de l’ACR de l’enfant.
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Rivière E, Jaffrelot M, Jouquan J, Chiniara G. Debriefing for the Transfer of Learning: The Importance of Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:796-803. [PMID: 30681450 DOI: 10.1097/acm.0000000000002612] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The advent of simulation-based education has caused a renewed interest in feedback and debriefing. However, little attention has been given to the issue of transfer of learning from the simulation environment to real-life and novel situations. In this article, the authors discuss the importance of context in learning, based on the frameworks of analogical transfer and situated cognition, and the limitations that context imposes on transfer. They suggest debriefing strategies to improve transfer of learning: positioning the lived situation within its family of situations and implementing the metacognitive strategies of contextualizing, decontextualizing, and recontextualizing. In contextualization, the learners' actions, cognitive processes, and frames of reference are discussed within the context of the lived experience, and their mental representation of the situation and context is explored. In decontextualization, the underlying abstract principles are extracted without reference to the situation, and in recontextualization, those principles are adapted and applied to new situations and to the real-life counterpart. This requires that the surface and deep features that characterize the lived situation be previously compared and contrasted with those of the same situation with hypothetical scenarios ("what if"), of new situations within the same family of situations, of the prototype situation, and of real-life situations. These strategies are integrated into a cyclical contextualization, decontextualization, and recontextualization model to enhance debriefing.
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Affiliation(s)
- Etienne Rivière
- E. Rivière is internal medicine specialist, University Hospital Center of Bordeaux, and director, Hospital and University SimBA-S Simulation Center of Bordeaux, Bordeaux, France. M. Jaffrelot is simulation program director, Collège des Hautes Etudes en Médecine, Brest, France, and adjunct professor, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec City, Québec, Canada. J. Jouquan is internal medicine specialist and professor, Université de Bretagne occidentale, Brest, France, and editor-in-chief, Pédagogie Médicale. G. Chiniara is professor and chair, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec City, Québec, Canada, and teaching leadership chair in health sciences simulation, Université Laval and Université Côte d'Azur
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166
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Comparing the Learning Effectiveness of Healthcare Simulation in the Observer Versus Active Role: Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 14:318-332. [DOI: 10.1097/sih.0000000000000377] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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167
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de Melo BCP, Van der Vleuten CPM, Muijtjens AMM, Rodrigues Falbo A, Katz L, Van Merriënboer JJG. Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study. J Matern Fetal Neonatal Med 2019; 34:245-252. [PMID: 31023119 DOI: 10.1080/14767058.2019.1606195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: To compare postpartum hemorrhage (PPH) patient outcomes before and after an in situ instructional design based PPH simulation attended by obstetrics and gynecology (OBGYN) residents.Methods: This uncontrolled before-and-after study was conducted in Recife, Brazil including all 1388 women delivering from June to August 2012 and all 1357 delivering from June to August 2013. The 36 OBGYN residents were divided into13 teams of two or three participants and were trained through ID based PPH simulation training with the following eight steps: (1) prior knowledge activation, (2) video demonstration, (3) dual-coding PPH protocol discussion-an image association during the training, (4) training scenario # 1, (5) debriefing, (6) training scenario # 2 with immediate feedback, (7) training scenario # 3, and (8) debriefing with self-assessment. The training scenarios had an increasing level of complexity. The main goal of the training was the adequate management of PPH and situational awareness improvement-the ability to anticipate, recognize, and intercept unfolding error chains. The primary patient outcomes rates used for the before and after comparison were therapeutic uterotonics use within 24 h of birth and blood transfusion. Secondary outcomes were therapeutic oxytocin mean dosage IU within 24 h of birth, postpartum Hb < 6 g/dL, among others. Chi-square test was used for categorical variables comparison and independent t-test for continuous variables.Results: PPH rates were 100 (7.2% of 2012 deliveries) and 80 cases (5.9% of 2013 deliveries), respectively. Comparison of primary post- and pre-simulation outcomes revealed no significant differences. However, in the comparison for therapeutic oxytocin mean dosage IU within 24 h of birth, there was an increase found after the simulation (15.98 ± 7.4 versus 25.1 ± 12.3; p < .001). For all other outcome measures, there were no statistical differences.Conclusions: In situ ID based PPH simulation leads to an increase in the mean dosage of oxytocin after training, in selected cases. This may indicate better situational awareness when managing women with PPH.
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Affiliation(s)
- Brena Carvalho Pinto de Melo
- Centro de Atenção, à Mulher, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.,Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.,Medical Course, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil
| | - Cees P M Van der Vleuten
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arno M M Muijtjens
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Ana Rodrigues Falbo
- Medical Course, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil.,Faculty Development Coordination, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil.,Programa de Pós-Graduação, Recife, Brazil
| | - Leila Katz
- Centro de Atenção, à Mulher, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.,Programa de Pós-Graduação, Recife, Brazil
| | - Jeroen J G Van Merriënboer
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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168
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Tremblay ML, Leppink J, Leclerc G, Rethans JJ, Dolmans DHJM. Simulation-based education for novices: complex learning tasks promote reflective practice. MEDICAL EDUCATION 2019; 53:380-389. [PMID: 30443970 DOI: 10.1111/medu.13748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/31/2018] [Accepted: 09/07/2018] [Indexed: 05/08/2023]
Abstract
CONTEXT Simulated clinical immersion (SCI), in which clinical situations are simulated in a realistic environment, safely and gradually exposes novices to complex problems. Given their limited experience, undergraduate students can potentially be quite overwhelmed by SCI learning tasks, which may result in misleading learning outcomes. Although task complexity should be adapted to the learner's level of expertise, many factors, both intrinsic and extraneous to the learning task, can influence perceived task complexity and its impact on cognitive processes. OBJECTIVES The purpose of this mixed-methods study was to understand the effects of task complexity on undergraduate pharmacy students' cognitive load, task performance and perception of learning in SCI. METHODS A total of 167 second-year pharmacy students were randomly assigned to undertake one simple and one complex learning task in SCI consecutively. Participants' cognitive load was measured after each task and debriefing. Task performance and time on task were also assessed. As part of a sequential explanatory design, semi-structured interviews were conducted with students showing maximal variations in intrinsic cognitive load to elucidate their perceptions of learning when dealing with complexity. RESULTS Although the complex task generated significantly higher cognitive load and time on task than the simple task, performance was high for both tasks. Qualitative results revealed that a lack of clinical experience, an unfamiliar resource in the environment and the constraints inherent to SCI, such as time limitations, hindered the clinical reasoning process and led to poorer self-evaluation of performance. Simple tasks helped students gain more self-confidence, whereas complex tasks further encouraged reflective practice during debriefings. CONCLUSIONS Although complex tasks in SCI were more cognitively demanding and took longer to execute, students indicated that they learned more from them than they did from simple tasks. Complex tasks constitute an additional challenge in terms of clinical reasoning and thus provide a more valuable learning experience from the student's perspective.
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Affiliation(s)
| | - Jimmie Leppink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Gilles Leclerc
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Jan-Joost Rethans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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169
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Bearman M, Greenhill J, Nestel D. The power of simulation: a large-scale narrative analysis of learners' experiences. MEDICAL EDUCATION 2019; 53:369-379. [PMID: 30334299 PMCID: PMC6518920 DOI: 10.1111/medu.13747] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/23/2018] [Accepted: 09/07/2018] [Indexed: 05/28/2023]
Abstract
CONTEXT Simulation-based education (SBE) includes a broad spectrum of simulation activities, which are individually well researched. An extensive literature reports on SBE methods, topics and modalities, but there are limited studies investigating how simulation as a holistic phenomenon promotes learning. This study seeks to identify the ways in which health professionals narrate powerful SBE experiences and through this to understand in what ways SBE may influence learning. METHODS Three hundred and twenty-seven narratives about powerful learning through SBE were gathered from participants' online reflections from a national faculty development programme in SBE. Narrative and thematic analyses were conducted on included texts, using 'transformative learning theory' as a sensitising notion. RESULTS Narratives were categorised into the following categories: progress (267/327 = 81%); transformation (25/327 = 8%); practice (27/328 = 8%); and humiliation (8/327 = 2%). Recurrent features across narrative categories were as follows: early experiences in training; dramatic scenarios; developing appreciation of SBE; highly emotional experiences; things that 'went wrong'; and ongoing reflection. Themes regarding mechanisms that supported learning were as follows: verisimilitude; feedback, debriefing and facilitation; observation of self and others; repetition of activities; and role-playing the patient. CONCLUSIONS The results generally support the notion that SBE is experienced as a holistic phenomenon, rather than separate modalities. The narrative categories, recurrent features and learning themes tended to work across all simulation modalities, with the exception of 'being in the patient's shoes' being supported by role-play in particular. Although powerful experiences were not necessarily transformative ones, they often occurred at formative stages of training. There was a strong sense that things going wrong in simulation scenarios (and the associated emotions and reflection) were a key part of learning. This underlines SBE's potential role in helping learners see fallibility as part of professional practice.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital LearningDeakin UniversityGeelongVictoriaAustralia
| | - Jennene Greenhill
- Rural Clinical SchoolFlinders UniversityRenmarkSouth AustraliaAustralia
| | - Debra Nestel
- Monash Institute for Health and Clinical EducationMonash UniversityClaytonVictoriaAustralia
- Department of Surgery (Austin)University of MelbourneHeidelbergVictoriaAustralia
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170
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Khan R, Scaffidi MA, Grover SC, Gimpaya N, Walsh CM. Simulation in endoscopy: Practical educational strategies to improve learning. World J Gastrointest Endosc 2019; 11:209-218. [PMID: 30918586 PMCID: PMC6425285 DOI: 10.4253/wjge.v11.i3.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
In gastrointestinal endoscopy, simulation-based training can help endoscopists acquire new skills and accelerate the learning curve. Simulation creates an ideal environment for trainees, where they can practice specific skills, perform cases at their own pace, and make mistakes with no risk to patients. Educators also benefit from the use of simulators, as they can structure training according to learner needs and focus solely on the trainee. Not all simulation-based training, however, is effective. To maximize benefits from this instructional modality, educators must be conscious of learners' needs, the potential benefits of training, and associated costs. Simulation should be integrated into training in a manner that is grounded in educational theory and empirical data. In this review, we focus on four best practices in simulation-based education: deliberate practice with mastery learning, feedback and debriefing, contextual learning, and innovative educational strategies. For each topic, we provide definitions, supporting evidence, and practical tips for implementation.
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Affiliation(s)
- Rishad Khan
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London ON N6A 5C1, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
- Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston ON K7L 3N6, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto ON M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto ON M5G 1X8, Canada
- The Wilson Centre, Faculty of Medicine, University of Toronto, Toronto ON M5G 2C4, Canada
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171
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Sheehan FH, McConnaughey S, Freeman R, Zierler RE. Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics. Mil Med 2019; 184:386-391. [PMID: 30901403 PMCID: PMC6433213 DOI: 10.1093/milmed/usy388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. METHODS Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from measurements of blood flow velocity, parameter settings, and diagnosis. The validity of the vascular simulator was assessed from the accuracy with which experts can measure peak systolic blood flow velocity (PSV). RESULTS In the TTE simulator, the skill metric enabled immediate feedback, formative assessment of curriculum efficacy, and comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback, and experts' measurements of PSV deviated from actual PSV in the model by <10%. CONCLUSIONS Skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Current applications are provision of feedback to learners to enable training without direct faculty oversight and formative assessment of curricula. Simulator-based metrics could also be applied for summative assessment.
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Affiliation(s)
- Florence H Sheehan
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - Shannon McConnaughey
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - Rosario Freeman
- Department of Medicine, Division of Cardiology, University of Washington, Campus Box 356422, Seattle, WA
| | - R Eugene Zierler
- Department of Surgery, Division of Vascular Surgery, University of Washington, Campus Box 356410, Seattle, WA
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Nassif J, Sleiman AK, Nassar AH, Naamani S, Sharara-Chami R. Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:194-200. [PMID: 29019167 DOI: 10.1007/s13187-017-1287-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N = 82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p = 0.889). Hybrid simulation improved lesion identification grades (p < 0.001) without increasing false positives. Hybrid simulation relieved the fear of missing a lesion on CBE (p = 0.043) and increased satisfaction with the teaching method among students (p = 0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.
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Affiliation(s)
- Joseph Nassif
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul-Karim Sleiman
- Simulation Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Duke Eye Center, Duke University, Durham, NC, USA
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sima Naamani
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Rana Sharara-Chami
- Duke Eye Center, Duke University, Durham, NC, USA.
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
- American University of Beirut, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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173
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Jeffers JM, Poling S. The development and implementation of a 12-month simulation-based learning curriculum for pediatric emergency medicine fellows utilizing debriefing with good judgment and rapid cycle deliberate practice. BMC MEDICAL EDUCATION 2019; 19:22. [PMID: 30646903 PMCID: PMC6334393 DOI: 10.1186/s12909-018-1417-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There are currently training gaps, primarily procedural and teamwork skills, for pediatric emergency medicine (PEM) fellows. Simulation-based learning (SBL) has been suggested as an educational modality to help fill those gaps. However, there is little evidence suggesting how to do so. The objective of this project is to develop and implement an SBL curriculum for PEM fellows with established curriculum development processes and instructional design strategies to improve PEM fellowship training. METHODS We developed a 12-month longitudinal SBL curriculum focused on needs assessment, instructional strategies, and evaluation. The curriculum development process led us to combine the instructional strategies of debriefing with good judgment, rapid cycle deliberate practice, and task-training to improve core PEM skills such as procedural competence, crisis resource management, and managing complex medical and traumatic emergencies. Using multiple approaches, we measured outcomes related to learners (attendance, performance, critical procedure opportunities), instructor performance, and program structure. RESULTS Eight/Eight (100%) PEM fellows participated in this curriculum from July 2015 to June 2017 with an overall attendance rate of 68%. Learners self-reported high satisfaction (4.4/5, SD = 0.5) and perceived educational value (4.9/5, SD = 0.38) with the curriculum and overall program structure. Learners had numerous opportunities to practice critical procedures such as airway management (20 opportunities), defibrillator use (ten opportunities), and others (ten opportunities). Learner Debriefing Assessment for Simulation in Healthcare (short version) scores had mean scores greater than 5.8/7 (SD = 0.89) across all six elements. CONCLUSIONS This longitudinal SBL curriculum combining debriefing with good judgment and rapid cycle deliberate practice can be a feasible method of reducing current training gaps (specifically with critical procedure opportunities) in PEM fellowship training. More work is needed to quantify the training gap reduction and to refine the curriculum.
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Affiliation(s)
- Justin M. Jeffers
- Department of Pediatrics, Bloomberg Children’s Center, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Suite G-1509, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Shannon Poling
- Johns Hopkins Medical Simulation Center, Johns Hopkins University, 600 North Wolfe Street, Blalock 701, Office 702A, Baltimore, MD 21287 USA
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Andersen SAW, Mikkelsen PT, Sørensen MS. Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance. Laryngoscope 2019; 129:2170-2177. [DOI: 10.1002/lary.27798] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology—Head & Neck Surgery Rigshospitalet
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES)Centre for HR, the Capital Region of Denmark Copenhagen
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175
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Mileder LP, Gressl J, Urlesberger B, Raith W. Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention. Front Pediatr 2019; 7:132. [PMID: 31024872 PMCID: PMC6467958 DOI: 10.3389/fped.2019.00132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Resuscitation of neonates after birth in the out-of-hospital setting is challenging. Thus, we aimed to assess paramedics' newborn life support knowledge and skills before and after targeted simulation-based training. Methods: Voluntary paramedics were recruited from a single Red Cross division. During a 1-day simulation-based educational intervention, essential aspects of neonatal resuscitation were taught and practiced. Before and after simulation-based training, we assessed (1) knowledge of current European Resuscitation Council (ERC) guidelines using a 20-item-questionnaire and (2) the quality of simulated bag-valve-mask ventilation by measuring face mask leakage, using a respiratory function monitor (Standardized Measurement of Airway Resuscitation Training [SMART], GM Instruments Ltd., United Kingdom). Results: Forty-one paramedics participated in the initial survey and 12 took part in the simulation-based educational intervention. There was a significant increase in the number of correctly answered questions: median 62.1% (IQR 37.5-77.4%) vs. 91.7% (IQR 83.3-100%; p = 0.001). A total of 1,332 inflations were analyzed. The incidence of substantial mask leakage >75% decreased significantly after training (15.8 vs. 6.1%; p < 0.001), while median mask leakage was similar (17.0% [IQR 0.0-55.0%] vs. 18.0% [IQR 6.0-34.0%]; p = 0.414). Conclusions: Among paramedics, theoretical knowledge of current ERC guidelines was moderate in this study. Participation in a targeted simulation-based educational intervention was associated with a significant increase in theoretical knowledge. The initially high incidence of substantial mask leakage >75% was decreased after simulation-based training using respiratory function monitoring.
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Affiliation(s)
- Lukas P Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jennifer Gressl
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Suseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study. Indian J Crit Care Med 2019; 23:509-512. [PMID: 31911741 PMCID: PMC6900883 DOI: 10.5005/jp-journals-10071-23284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Our current medical curriculum devotes a large percentage of time to knowledge acquisition by means of didactic lectures. Psychomotor skill acquisition takes a back seat. Certain lifesaving skills like basic life support skill training have not even made an appearance in the current curriculum. Equal time distribution to cognitive and psychomotor skills should be allotted for MBBS trainees, which is a very practical subject. Simulation can prove to be a valuable tool in imparting skill training. The present study aims to evaluate the efficacy of different teaching modalities in imparting lifesaving skills among first-year MBBS students. Materials and methods This cross-sectional study was conducted among 33 first-year students who consented to participate. Approval was obtained from the institutional ethics committee. The students were divided into three groups, each undergoing either didactic lecture or animation-based videos or simulation studies. Pretest, posttest, and skills tests were administered to them. One-way analysis of variance (ANOVA) and paired t test were the statistical tests employed using SPSS version 21. Results The pretest and posttest scores were comparable in the three groups while the improvement in the posttest scores in all the three groups was significant. The skills test was significantly better in the group undergoing simulation training compared to the other groups. Conclusion Didactic, animation, and simulation are all good methods in imparting cognitive knowledge, but simulation is the method of choice in imparting psychomotor skills. Clinical significance An overhauling of the medical curriculum to include more skills training to the budding doctors using simulation-based techniques is recommended. How to cite this article Suseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study. IJCCM 2019;23(11): 509–512.
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Affiliation(s)
- Appu Suseel
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Pallavi Panchu
- Department of Physiology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Salish Varghese
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Tijo George
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Lijo Joy
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
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Multimodal Interaction of Contextual and Non-Contextual Sound and Haptics in Virtual Simulations. INFORMATICS-BASEL 2018. [DOI: 10.3390/informatics5040043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Touch plays a fundamental role in our daily interactions, allowing us to interact with and perceive objects and their spatial properties. Despite its importance in the real-world, touch is often ignored in virtual environments. However, accurately simulating the sense of touch is difficult, requiring the use of high-fidelity haptic devices that are cost-prohibitive. Lower fidelity consumer-level haptic devices are becoming more widespread, yet are generally limited in perceived fidelity and the range of motion (degrees of freedom) required to realistically simulate many tasks. Studies into sound and vision suggest that the presence or absence of sound can influence task performance. Here, we explore whether the presence or absence of contextually relevant sound cues influences the performance of a simple haptic drilling task. Although the results of this study do not show any statistically significant difference in task performance with general (task-irrelevant) sound, we discuss how this is a necessary step in understanding the role of sound on haptic perception.
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178
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Xu J, Campisi P, Forte V, Carrillo B, Vescan A, Brydges R. Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial. J Otolaryngol Head Neck Surg 2018; 47:70. [PMID: 30458877 PMCID: PMC6247612 DOI: 10.1186/s40463-018-0317-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Portable educational technologies, like simulators, afford students the opportunity to learn independently. A key question in education, is how to pair self-regulated learning (SRL) with direct instruction. A cloud-based portable otoscopy simulator was employed to compare two curricula involving SRL. Pre-clerkship medical students used a prototype smartphone application, a 3D ear attachment and an otoscope to complete either otoscopy curriculum. Methods Pre-clerkship medical students were recruited and randomized to two curriculum designs. The “Discovery then Instruction” group received the simulator one week before a traditional lecture, while the “Instruction then Discovery” group received it after the lecture. To assess participants’ ability to identify otoscopic pathology, we used a 100-item test at baseline, post-intervention and 2-week retention time points. Secondary outcomes included self-reported comfort, time spent using the device, and a survey on learning preferences. Results Thirty-four students completed the study. Analysis of knowledge acquisition and retention showed improvement in scores of both groups and no significant effects of group (F1,31 = 0.53, p = 0.47). An analysis of participants’ self-reported comfort showed a significant group x test interaction (F1,36 = 4.61, p = 0.04), where only the discovery then instruction group’s comfort improved significantly. Overall device usage was low, as the discovery then instruction group spent 21.47 ± 26.28 min, while the instruction then discovery group spent 13.84 ± 18.71 min. The discovery first group’s time spent with the simulator correlated moderately with their post-test score (r = 0.42, p = 0.07). After the intervention, most participants in both groups (63–68%) stated that they would prefer the instruction then discovery sequence. Conclusions Both curricular sequences led to improved knowledge scores with no statistically significant knowledge differences. When given minimal guidance, students engaged in discovery learning minimally. There is value in SRL in simulation education, and we plan to further improve our curricular design by considering learner behaviours identified in this study.
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Affiliation(s)
- Josie Xu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street 3S-438, Toronto, M5G 2C4, Canada.
| | - Paolo Campisi
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street 3S-438, Toronto, M5G 2C4, Canada
| | - Vito Forte
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street 3S-438, Toronto, M5G 2C4, Canada
| | | | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth Street 3S-438, Toronto, M5G 2C4, Canada
| | - Ryan Brydges
- The Wilson Centre, University Health Network & University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Allan Water Family Simulation Centre, St. Michael's Hospital, Toronto, Canada
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Cognitive load theory as a framework for simulation-based, ultrasound-guided internal jugular catheterization training: Once is not enough. CAN J EMERG MED 2018; 21:141-148. [PMID: 30404670 DOI: 10.1017/cem.2018.456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The main objective of this study was to use the principles of cognitive load theory to design a curriculum that incorporates a progressive part practice approach to teaching ultrasound-guided (USG) internal jugular catheterization (IJC) to novices. A secondary objective was to compare the technical proficiency of residents trained using this curriculum with the technical proficiency of residents trained with the current local standard of a single simulation session. METHODS The experimental group included 16 residents who attended three 2-hour sessions of progressive part practice in a simulation lab. The control group included 46 residents who attended the current local standard of a single 2-hour simulation session just prior to their intensive care unit rotation. Technical proficiency was assessed using hand motion analysis and time to procedure completion. RESULTS After three sessions, median scores for right hand motion (RHM) (34.5; [27.0-49.0]), left hand motion (LHM) (35.5; [20.0-45.0]), and total time (TT) (117.0 s; [82.7-140.0]) in the experimental group were significantly better than the control group (p<0.001). Results for eight experimental group residents who were assessed for retention at a later date revealed median scores for RHM (45.0; [32.0-58.0]), LHM (33.5; [20.0-63.0]), and TT (150.0 s; [103.0-399.6]), which were significantly better than those of the control group (p=0.01, p<0.01, and p=0.02, respectively). CONCLUSION These results support multiple sessions of progressive part practice in a simulation lab as an effective competency-based approach to teaching USG IJC in preparation for the clinical setting.
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Cold KM, Konge L, Clementsen PF, Nayahangan LJ. Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion. Respiration 2018; 97:160-167. [PMID: 30391958 DOI: 10.1159/000493431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. OBJECTIVES The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. METHODS Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. RESULTS Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being "too busy." CONCLUSION Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.
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Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark, .,University of Copenhagen, Copenhagen, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
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Abstract
With the ongoing changes in graduate medical education, emphasis has been placed on simulation models to increase clinical exposure and optimize learning. In specific, high-fidelity simulation presents as a potential option for procedural-skill development in interventional radiology. With improved haptic, visual, and tactile dynamics, high-fidelity endovascular simulators have gained increasing support from trainees and certified interventionalists alike. The 2 most common high-fidelity endovascular simulators utilized today are the Procedicus VIST and ANGIO Mentor, which contain notable differences in technical features, case availability, and cost. From the perspective of a trainee, high-fidelity simulation allows for the ability to perform a greater volume of cases. Additionally, without the risk of potential harm to the patient, trainees can focus on repetition and improved performance in a stress-free environment. When errors are made, high-fidelity simulator metrics will generate instantaneous feedback and error notification, erasing ambiguity and thus facilitating learning. Furthermore, in an environment devoid of time and cost stressors, the supervising physician is afforded the opportunity to properly mentor and instruct the trainee throughout the case. For the experienced interventionalists, high-fidelity simulation allows for a decreased learning curve for new procedures or techniques, as well as the opportunity for procedure rehearsal for unusual or high-risk cases. Despite the limitations created by cost, high-fidelity endovascular simulation should continue to be increasingly utilized in the development of the interventional radiology curriculum.
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Affiliation(s)
- Ayush Amin
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
| | - Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Thomas Sullivan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
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Buijs-Spanjers KR, Hegge HH, Jansen CJ, Hoogendoorn E, de Rooij SE. A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial. JMIR Serious Games 2018; 6:e17. [PMID: 30368436 PMCID: PMC6229519 DOI: 10.2196/games.9886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient’s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students’ skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture.
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Affiliation(s)
- Kiki R Buijs-Spanjers
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harianne Hm Hegge
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Carolien J Jansen
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Sophia E de Rooij
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Haukedal TA, Reierson IÅ, Hedeman H, Bjørk IT. The Impact of a New Pedagogical Intervention on Nursing Students' Knowledge Acquisition in Simulation-Based Learning: A Quasi-Experimental Study. Nurs Res Pract 2018; 2018:7437386. [PMID: 30363931 PMCID: PMC6188728 DOI: 10.1155/2018/7437386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/09/2018] [Accepted: 08/16/2018] [Indexed: 12/24/2022] Open
Abstract
Simulation-based learning is an effective technique for teaching nursing students' skills and knowledge related to patient deterioration. This study examined students' acquisition of theoretical knowledge about symptoms, pathophysiology, and nursing actions after implementing an educational intervention during simulation-based learning. A quasi-experimental study compared theoretical knowledge among two groups of students before and after implementation of the intervention. The intervention introduced the following new components to the existing technique: a knowledge test prior to the simulation, video-recording of the performance, and introduction of a structured observation form used by students and facilitator during observation and debriefing. The intervention group had significantly higher scores on a knowledge test conducted after the simulations in comparison to the scores in the control group. In both groups scores were highest on knowledge of symptoms and lowest on knowledge of pathophysiology; the intervention group had significantly higher scores than the control group on both topics. Students' theoretical knowledge of patient deterioration may be enhanced by improving the students' prerequisites for learning and by strengthening debriefing after simulation.
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Affiliation(s)
- Thor Arne Haukedal
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Post Box 235, 3603 Kongsberg, Norway
| | - Inger Åse Reierson
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Post Box 235, 3603 Kongsberg, Norway
| | - Hanne Hedeman
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Post Box 235, 3603 Kongsberg, Norway
| | - Ida Torunn Bjørk
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Post Box 235, 3603 Kongsberg, Norway
- Department of Nursing Science, University of Oslo, Post Box 1130, Blindern, 0318 Oslo, Norway
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184
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Rourke L, Leong J, Chatterly P. Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example. TEACHING AND LEARNING IN MEDICINE 2018; 30:386-394. [PMID: 29452002 DOI: 10.1080/10401334.2018.1428611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: An evidence-informed era of medical education encourages the generation and use of comparative-effectiveness reviews, yet the reviews often conclude, curiously, that all instructional approaches are equally effective. Approach: We used a conditions-based learning theory to structure a review of the comparative-effectiveness literature on electrocardiogram instruction. We searched MEDLINE, EMBASE (Ovid), ERIC (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO) from inception to June 2016. We selected prospective studies that examined the effect of instructional interventions on participants' knowledge and skill with electrocardiogram interpretation. Two reviewers extracted information on the quality of the studies, the effect of instruction on the acquisition of knowledge and skill, and instructional quality. Instructional quality is an index of the extent to which instruction incorporates 4 practices of Gagne's conditions-based learning theory: presenting information, eliciting performance, providing feedback, and assessing learning. Findings: Twenty-five studies (3,286 participants) evaluating 47 instructional interventions were synthesized. The methodological quality of most studies was moderate. Instructional quality varied: All interventions presented information and assessed learning, but fewer than half elicited performances or provided feedback. Instructional interventions that incorporated all 4 components improved trainees' abilities considerably more than those that incorporated 3 or fewer; respectively, standardized mean difference (SMD) = 2.80, 95% confidence interval (CI) [2.05, 3.55], versus SMD = 1.44, 95% CI [1.18, 1.69]. Studies that compared "innovative" to "traditional" types of instruction did not yield a significant pooled effect: SMD = 0.18, 95% CI [-0.09, 0.45]. Insights: The use of a conditions-based learning theory to organize the comparative-effectiveness literature reveals differences in the instructional impact of different instructional approaches. It overturns the unlikely, but common, conclusion that all approaches are equally effective.
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Affiliation(s)
- Liam Rourke
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Jessica Leong
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
| | - Patricia Chatterly
- a Department of Medicine , University of Alberta , Edmonton Alberta , Canada
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Mariani B, Fey MK, Gloe D. The Simulation Research Rubric: A Pilot Study Evaluating Published Simulation Studies. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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186
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Marei HF, Donkers J, Van Merrienboer JJG. The effectiveness of integration of virtual patients in a collaborative learning activity. MEDICAL TEACHER 2018; 40:S96-S103. [PMID: 29730966 DOI: 10.1080/0142159x.2018.1465534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Virtual patients (VPs) have been recently integrated within different learning activities. AIM To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students' knowledge acquisition, retention and transfer. METHODS For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment. RESULTS For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group. CONCLUSION On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students' knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students' interaction.
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Affiliation(s)
- Hesham F Marei
- a Department of Biomedical Dental Sciences, College of Dentistry , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia
| | - Jeroen Donkers
- b Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Jeroen J G Van Merrienboer
- b Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
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Yovanoff MA, Chen HE, Pepley DF, Mirkin KA, Han DC, Moore JZ, Miller SR. Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training. JOURNAL OF SURGICAL EDUCATION 2018; 75:1410-1421. [PMID: 29574019 PMCID: PMC6139271 DOI: 10.1016/j.jsurg.2018.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system. DESIGN Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period. Self-efficacy surveys were distributed before and following training. Training consisted of a pretest, 22 practice IJ CVC needle insertion attempts, 2 full-line practice attempts, and a posttest. Participants provided self-ratings of performance for each needle insertion and were presented with feedback from either an upper level resident (manikin) or a personalized learning system (DHRT). SETTING A study was conducted from July 2016 to February 2017 through a surgical skills training program at Hershey Medical Center in Hershey, Pennsylvania. PARTICIPANTS Twenty-six first-year surgical residents were recruited for the study. Individuals were informed that IJ CVC training procedures would be consistent regardless of participation in the study and that participation was optional. All recruited residents opted to participate in the study. RESULTS Residents in both groups significantly improved their self-efficacy scores from pretest to posttest (p < 0.01). Residents in the manikin group consistently provided higher self-ratings of performance (p < 0.001). Residents in the DHRT group recorded more feedback on errors (228 instances) than the manikin group (144 instances). Self-ratings of performance on the DHRT system were able to significantly predict the objective score of the DHRT system (R2 = 0.223, p < 0.001). CONCLUSION Simulation training with the DHRT system and the personalized learning feedback can improve resident self-efficacy with IJ CVC procedures and provide sufficient feedback to allow residents to accurately assess their own performance.
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Affiliation(s)
- Mary A Yovanoff
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania
| | - Hong-En Chen
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania
| | - David F Pepley
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Katelin A Mirkin
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - David C Han
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jason Z Moore
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Scarlett R Miller
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania; School of Engineering Design, Technology, and Professional Programs, Penn State, University Park, Pennsylvania.
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Thomsen ASS, la Cour M, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L, Nayahangan LJ. Consensus on procedures to include in a simulation-based curriculum in ophthalmology: a national Delphi study. Acta Ophthalmol 2018; 96:519-527. [PMID: 29575657 DOI: 10.1111/aos.13700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The number of available simulation-based models for technical skills training in ophthalmology is rapidly increasing, and development of training programmes around these procedures should follow a structured approach. The aim of this study was to identify all technical procedures that should be integrated in a simulation-based curriculum in ophthalmology. METHODS Key opinion leaders involved in the education of ophthalmologists in Denmark including heads of departments, heads of clinical education, professors and board members of the society were invited to participate in a three-round Delphi process. Round 1 aimed at identifying technical procedures that physicians should be able to perform competently when completing specialty training; round 2 involved characterization of each procedure including frequency, number of operators, risk and/or discomfort for patients associated with an inexperienced physician, and feasibility of simulation-based training; round 3 included a priority ranking of procedures. RESULTS The response rate for each round was 71%, 64% and 64%, respectively. Sixty-five procedures were reduced to 25 prioritized procedures during the three rounds. Two-thirds of the procedures that were identified and highly prioritized were therapeutic procedures such as intravitreal injection therapy, yttrium-aluminium-garnet laser iridotomy/capsulotomy, minor ocular surface procedures and retinal argon laser therapy. The diagnostic procedures that were prioritized were ocular ultrasound, superficial keratectomy and optical coherence tomography (OCT). CONCLUSION The Delphi process identified and prioritized 25 procedures that should be practised in a simulation-based environment to achieve competency before working with patients. The list may be used to guide the development of future training programmes for ophthalmologists.
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Affiliation(s)
- Ann Sofia Skou Thomsen
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
| | - Morten la Cour
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
| | - Charlotte Paltved
- MidtSim - Centre for Human Resources; Central Region of Denmark and Aarhus University; Aarhus Denmark
| | | | - Bjørn Ulrik Nielsen
- Sim-C - Simulation Centre of Odense; Odense University Hospital; Odense Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
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Tremblay ML. Simulation-based Crisis Resource Management in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6531. [PMID: 30181673 PMCID: PMC6116865 DOI: 10.5688/ajpe6531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/27/2017] [Indexed: 06/08/2023]
Abstract
Objective. To describe strategies for implementation of simulation-based crisis resource management (CRM) in pharmacy education and present students' appreciation of an interdisciplinary CRM training at a university in Canada. Methods. In fall 2016, third-year undergraduate pharmacy students at Laval University and pharmacy technician students from Fierbourg school participated in a CRM activity and completed a five-item survey to assess the quality of the CRM activity they had just experienced. Paired t-tests were computed to detect differences of appreciation between pharmacy technician students and pharmacy students. Results. Students rated each item as very good or excellent varying from 81% to 97%. The only difference found between the two types of students was on their overall appreciation of the experience. Pharmacy technician students rated their experience as very good while pharmacy students rated it as excellent. Conclusion. CRM training can easily be adapted to the context of pharmacy education because its key concepts of team management, resource allocation, awareness of environment and dynamic decision-making directly apply to pharmacy practice. Based on the results of this study, students greatly value their CRM training experience. Future research is needed to measure the transfer into practice of CRM principles.
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Lemay DJ, Morin MM, Bazelais P, Doleck T. Modeling Students' Perceptions of Simulation-Based Learning Using the Technology Acceptance Model. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2018.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dieckmann P, Birkvad Rasmussen M, Issenberg SB, Søreide E, Østergaard D, Ringsted C. Long-term experiences of being a simulation-educator: A multinational interview study. MEDICAL TEACHER 2018; 40:713-720. [PMID: 29793384 DOI: 10.1080/0142159x.2018.1471204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The long-term reactions, experiences and reflections of simulation educators have not been explored. In a semistructured, exploratory interview study, the experiences of simulation educators in either Advanced Life Support (ALS) or Crisis Resource Management (CRM) courses in Denmark, Norway and the USA were analyzed. Three overarching themes were identified: (1) general reflections on simulation-based teaching, (2) transfer of knowledge and skills from the simulation setting to clinical settings and (3) more overarching transformations in simulation educators, simulation participants, and the healthcare system. Where ALS was deemed as high on the efficiency dimension of learning, CRM courses were described as high on the innovation dimension. General reflections, transfer and transformations described were related to differences in course principles. The results are relevant for career planning, faculty development and understanding simulation as social practice.
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Affiliation(s)
- P Dieckmann
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - M Birkvad Rasmussen
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
| | - S B Issenberg
- c University of Miami Gordon Center for Simulation and Innovation in Medical Education , Miami , USA
| | - E Søreide
- d Stavanger University Hospital, Critical Care and Anesthesiology Research Group , Stavanger , Norway
- e Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - D Østergaard
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - C Ringsted
- f Center for Health Science Education , University of Aarhus , Aarhus , Denmark
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Bjerrum F, Thomsen ASS, Nayahangan LJ, Konge L. Surgical simulation: Current practices and future perspectives for technical skills training. MEDICAL TEACHER 2018; 40:668-675. [PMID: 29911477 DOI: 10.1080/0142159x.2018.1472754] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Simulation-based training (SBT) has become a standard component of modern surgical education, yet successful implementation of evidence-based training programs remains challenging. In this narrative review, we use Kern's framework for curriculum development to describe where we are now and what lies ahead for SBT within surgery with a focus on technical skills in operative procedures. Despite principles for optimal SBT (proficiency-based, distributed, and deliberate practice) having been identified, massed training with fixed time intervals or a fixed number of repetitions is still being extensively used, and simulators are generally underutilized. SBT should be part of surgical training curricula, including theoretical, technical, and non-technical skills, and be based on relevant needs assessments. Furthermore, training should follow evidence-based theoretical principles for optimal training, and the effect of training needs to be evaluated using relevant outcomes. There is a larger, still unrealized potential of surgical SBT, which may be realized in the near future as simulator technologies evolve, more evidence-based training programs are implemented, and cost-effectiveness and impact on patient safety is clearly demonstrated.
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Affiliation(s)
- Flemming Bjerrum
- a Department of Surgery , Herlev Gentofte Hospital , Herlev , Denmark
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Ann Sofia Skou Thomsen
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- c Department of Ophthalmology , Rigshospitalet-Glostrup , Copenhagen , Denmark
| | - Leizl Joy Nayahangan
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- d Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
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Nayahangan LJ, Stefanidis D, Kern DE, Konge L. How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified Delphi method and a needs assessment formula. MEDICAL TEACHER 2018; 40:676-683. [PMID: 29938547 DOI: 10.1080/0142159x.2018.1472756] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Simulation-based training (SBT) is a revolutionary addition to the education of residents in different specialties. However, the selection of training programs is often reliant on commercially available equipment or on experiential notions, local interests or coincidence. The first step to developing training programs should be problem identification and general needs assessment to ensure that these are aligned with current trainee needs. We describe a stepwise approach to performing a needs assessment following the Delphi process and using a needs assessment formula (NAF) to prioritize technical procedures for simulation training. This technique relies on a panel of experts to gather information and achieve a convergence of opinion. We used three rounds of survey iterations. Round 1: A brainstorming phase to gather all procedures that a newly qualified resident should be able to perform. Round 2: Rating and preliminary prioritization with a NAF including frequency of the procedure, number of doctors, impact, and feasibility. Round 3: Elimination and final prioritization of procedures. The needs assessment identifies and prioritizes procedures for simulation training. It can guide medical educators in the planning of SBT programs to address current trainee needs with the aim of improving the education and training of future doctors.
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Affiliation(s)
- Leizl Joy Nayahangan
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
| | | | - David E Kern
- c School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Lars Konge
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
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195
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Andersen SAW, Konge L, Sørensen MS. The effect of distributed virtual reality simulation training on cognitive load during subsequent dissection training. MEDICAL TEACHER 2018; 40:684-689. [PMID: 29730952 DOI: 10.1080/0142159x.2018.1465182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Complex tasks such as surgical procedures can induce excessive cognitive load (CL), which can have a negative effect on learning, especially for novices. AIM To investigate if repeated and distributed virtual reality (VR) simulation practice induces a lower CL and higher performance in subsequent cadaveric dissection training. METHODS In a prospective, controlled cohort study, 37 residents in otorhinolaryngology received VR simulation training either as additional distributed practice prior to course participation (intervention) (9 participants) or as standard practice during the course (control) (28 participants). Cognitive load was estimated as the relative change in secondary-task reaction time during VR simulation and cadaveric procedures. RESULTS Structured distributed VR simulation practice resulted in lower mean reaction times (32% vs. 47% for the intervention and control group, respectively, p < 0.01) as well as a superior final-product performance during subsequent cadaveric dissection training. CONCLUSIONS Repeated and distributed VR simulation causes a lower CL to be induced when the learning situation is increased in complexity. A suggested mechanism is the formation of mental schemas and reduction of the intrinsic CL. This has potential implications for surgical skills training and suggests that structured, distributed training be systematically implemented in surgical training curricula.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- a Department of Otorhinolaryngology-Head and Neck Surgery , Rigshospitalet , Copenhagen , Denmark
- b Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR , Copenhagen , Denmark
| | - Mads Sølvsten Sørensen
- a Department of Otorhinolaryngology-Head and Neck Surgery , Rigshospitalet , Copenhagen , Denmark
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196
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Cheng A, Calhoun A, Topps D, Adler MD, Ellaway R. Using the METRICS model for defining routes to scholarship in healthcare simulation. MEDICAL TEACHER 2018; 40:652-660. [PMID: 29720011 DOI: 10.1080/0142159x.2018.1465184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In this paper, we explored the utility and value of the METRICS model for modeling scholarship in healthcare simulation by: (1) describing the distribution of articles in four healthcare simulation journals across the seven areas of METRICS scholarship; and (2) appraising patterns of scholarship expressed in three programs of simulation scholarship and reflecting on how these patterns potentially influence the pursuit of future scholarly activities. METHODS Two raters reviewed abstracts of papers published between January 2015 and August 2017 in four healthcare simulation journals and coded them using METRICS. Descriptive statistics were calculated for scholarship type and distribution across journals. Twenty-eight articles from three scholars were reviewed, with patterns of scholarship within articles mapped to METRICS. Descriptive synthesis was constructed through discussion between two reviewers. RESULTS A total of 432 articles from four journals were reviewed. The three most commonly published areas of scholarship were: 32.2% (139/432) evaluation, 18.8% (81/432) innovation, and 15.3% (66/432) conceptual. The METRICS model was able to represent different kinds of scholarship expressed in all of the papers reviewed and across programs of research. Reflecting on patterns of scholarship within their scholarly programs was helpful for research in planning future directions. CONCLUSIONS The METRICS model for scholarship can describe a wide range of patterns of simulation scholarship within individual articles, programs of research, or across journals.
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Affiliation(s)
- Adam Cheng
- a KidSIM Simulation Program, Department of Pediatrics , Alberta Children's Hospital, University of Calgary , Calgary , Canada
| | - Aaron Calhoun
- b Department of Pediatrics , University of Louisville , Louisville , KY , USA
| | - David Topps
- c Department of Family Medicine and Office of Health and Medical Education Scholarship (OHMES) , University of Calgary , Calgary , Canada
| | - Mark D Adler
- d Department of Pediatrics and Medical Education , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Rachel Ellaway
- e Department of Community Health Sciences and Office of Health and Medical Education Scholarship (OHMES) , University of Calgary , Calgary , Canada
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Grant VJ, Robinson T, Catena H, Eppich W, Cheng A. Difficult debriefing situations: A toolbox for simulation educators. MEDICAL TEACHER 2018; 40:703-712. [PMID: 29792100 DOI: 10.1080/0142159x.2018.1468558] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Simulation-based education (SBE) has emerged as an essential modality for health professions education. One of the central tenants of effective SBE is reflective practice, typically guided by a facilitated debriefing. The debriefing conversation has the possibility of becoming a difficult conversation based on learner and situation-related factors. Difficult debriefing situations may threaten the learning environment, thus requiring an appreciation and understanding of the various ways that learners may react adversely to simulation and debriefing. AIM This article provides a review of the various phenotypes of difficult debriefing situations and a toolbox of proactive and reactive strategies to help guide the simulation educator to manage these situations, with the ultimate goal of achieving learning objectives.
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Affiliation(s)
- V J Grant
- a Department of Pediatrics and Emergency Medicine, Cumming School of Medicine , University of Calgary , Calgary , Canada
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - T Robinson
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - H Catena
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
| | - W Eppich
- c Departments of Pediatrics and Medical Education , Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - A Cheng
- a Department of Pediatrics and Emergency Medicine, Cumming School of Medicine , University of Calgary , Calgary , Canada
- b KidSIM Simulation Program , Alberta Children's Hospital , Calgary , Canada
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Alhazmi MS, Butler CW, Junghans BM. Does the virtual refractor patient-simulator improve student competency when refracting in the consulting room? Clin Exp Optom 2018; 101:771-777. [PMID: 29895093 DOI: 10.1111/cxo.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The use of patient simulators in ophthalmic education appears limited. This study examines the effects of the addition of the 'Virtual Refractor' patient simulator learning activity into a short unit preparing students to determine the power of the spectacle lenses required by patients in a clinic. METHODS Twenty-four year one optometry students were randomly assigned to either the simulator-intervention group (n = 12) or the non-intervention group. All students attended tutorials on refraction and the use of a refractor-head. Simulator-intervention students additionally attended a tutorial on the Virtual Refractor. All answered a questionnaire concerning time spent studying, perceived knowledge and confidence. Twenty-four short-sighted patients were recruited. Two refractions per student were timed and the accuracy compared with that of an experienced optometrist. RESULTS Ten students from each group completed the study. Students who used the simulator were significantly (p < 0.05) more accurate at a clinical level (within 0.22 ± 0.22 DS, 95 per cent CI 0.12-0.32) than those who did not (within 0.60 ± 0.67 DS, 95 per cent CI 0.29-0.92) and 13 per cent quicker (4.7 minutes, p < 0.05). Students who used the simulator felt more knowledgeable (p < 0.05) and confident (p < 0.05), but had spent more time reading about refraction and practised on the Virtual Refractor at home for 5.7 ± 1.3 hours. CONCLUSION The Virtual Refractor has many features of high-fidelity medical simulation known to lead to effective learning and it also offers flexible independent learning without a concomitant increase in the student time-burden. The improved accuracy and speed on first patient encounters found in this study validates the use of this patient simulator as a useful bridge for students early in training to successfully transfer theoretical knowledge prior to entering the consulting room. The translational benefits resulting from compulsory learning activities on a patient simulator can lead to reduced demands on infrastructure and clinical supervision.
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Affiliation(s)
- Mohammed S Alhazmi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Optometry, King Saud University, Riyadh, Saudi Arabia
| | - Craig W Butler
- Brien Holden Vision Institute Foundation, Sydney, New South Wales, Australia
| | - Barbara M Junghans
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Rooney MK, Zhu F, Gillespie EF, Gunther JR, McKillip RP, Lineberry M, Tekian A, Golden DW. Simulation as More Than a Treatment-Planning Tool: A Systematic Review of the Literature on Radiation Oncology Simulation-Based Medical Education. Int J Radiat Oncol Biol Phys 2018; 102:257-283. [PMID: 30191859 DOI: 10.1016/j.ijrobp.2018.05.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/17/2018] [Accepted: 05/20/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Simulation-based medical education (SBME) is gaining prominence as a tool to meet Accreditation Council for Graduate Medical Education-mandated competency-based assessment educational goals. SBME is used in radiation oncology, although the type and extent are not clear. This study reports a systematic literature review designed to clarify the type and extent of radiation oncology SBME. METHODS AND MATERIALS The systematic review focused on radiation oncology SBME literature. The methods followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were identified according to the PICOS (population, intervention, comparison, outcome, and setting) framework. The population included undergraduate, graduate, and continuing medical education learners. Studies were limited to English-language studies published on or after January 1, 1990, in peer-reviewed journals. PubMed, MedEdPORTAL, and in-press articles were searched. The PubMed search was conducted using predefined search terms. References and similar articles were examined. Medical Subject Headings terms in selected articles were reviewed to ensure relevant terms were included. RESULTS Fifty-four SBME publications met the inclusion criteria. Only 9 of 54 studies (17%) self-identified as SBME. SBME types included screen-based simulators (56%), simulated environments (13%), virtual reality and haptic systems (13%), simulated patients (11%), part-task trainers (6%), and computer-based systems with mannequins (2%). A variety of radiation oncology skill sets were addressed, including contouring (54%), treatment planning (20%), clinical decision making (17%), anatomy and/or radiology (13%), radiation biology and/or physics (13%), communication skills and/or patient education (13%), brachytherapy (13%), and immobilization (11%). A target learning population was defined in 47 studies, including residents (53%), attending physicians (36%), medical students (21%), medical physicists (11%), radiation therapists (9%), nurses (6%), administrative staff (4%), and dosimetrists (4%). Learner feedback was reported in 32 studies. CONCLUSIONS Overall, this systematic literature review provides context and guidance for future radiation oncology SBME development. Appropriately framing SBME reports in the radiation oncology literature will facilitate development, implementation, and evaluation of SBME interventions. SBME resources should be centralized to facilitate dissemination and share resources.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Fan Zhu
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jillian R Gunther
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Ryan P McKillip
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Matthew Lineberry
- Zamierowski Institute for Experiential Learning, University of Kansas, Kansas City, Kansas
| | - Ara Tekian
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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Evaluation of virtual patient cases for teaching diagnostic and management skills in internal medicine: a mixed methods study. BMC Res Notes 2018; 11:357. [PMID: 29871699 PMCID: PMC5989465 DOI: 10.1186/s13104-018-3463-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022] Open
Abstract
Objective The virtual patient (VP) is a computer program that simulates real-life clinical scenarios and allows learners to make diagnostic and therapeutic decisions in a safe environment. Although many VP cases are available, few focus on junior trainees as their target audience. In addition, there is wide variability in trainees’ clinical rotation experiences, based on local practice and referral patterns, duty hour restrictions, and competing educational requirements. In order to standardize clinical exposure and improve trainees’ knowledge and perceived preparedness to manage core internal medicine cases, we developed a pool of VP cases to simulate common internal medicine presentations. We used quantitative and qualitative analyses to evaluate the effectiveness of one of our VP cases among medical trainees at University of Toronto. We also evaluated the role of VP cases in integrated teaching of non-medical expert competencies. Results Despite modest effects on knowledge acquisition, a majority of participants enjoyed using VP cases as a resource to help them prepare for and reinforce clinical experiences. Cognitive interactivity and repetitive practice were particularly appreciated by study participants. Trainees perceived VP cases as a useful resource as their learning can be customized to their actions within the case, resulting in unique learning trajectories. Electronic supplementary material The online version of this article (10.1186/s13104-018-3463-x) contains supplementary material, which is available to authorized users.
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