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Platt A, Allan J, Leader C, Prescott-Clements L, McMeekin P. Preparing for practice, the effects of repeated immersive simulation on the knowledge and self-efficacy of undergraduate nursing students: A mixed methods study. Nurse Educ Pract 2024; 74:103866. [PMID: 38104396 DOI: 10.1016/j.nepr.2023.103866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
AIM The aim of this study was to compare the effects of two immersive simulation-based education instructional designs, immersive simulation with team deliberate practice and immersive repeated standard simulation, when delivered over the same time on the knowledge and self-efficacy of nursing students. BACKGROUND Implementing immersive simulation-based education is not without its resource challenges, making it prohibitive for simulation educators to include it in their curricula. Subsequently, there is a need to identify instructional designs that meet these challenges. DESIGN A two-stage mixed methods approach was used to compare the two instructional designs. METHODS In stage one, data were collected using questionnaires and differences estimated using analysis of covariance. In stage two, data were collected from two focus groups and analysed using a qualitative content analysis approach. Data were collected as part of a doctoral study completed in 2019 and was analysed for this study between 2022 and 2023. The justification for this study was that the identification of effective designs for immersive simulation remains a key research priority following the increase in allowable simulation hours by the Nursing and Midwifery Council. RESULTS In stage one, there was no statistical significance in the participant's knowledge or self-efficacy between the models. In stage two, four themes were identified: vulnerability, development of knowledge, development of self-efficacy and preparation for placement. In contrast to stage one, participants reported that the repeated nature of both designs reinforced their knowledge base increased their self-efficacy, reduced their anxiety levels, and helped them to prepare for placement. CONCLUSION The results inferred that both designs had a positive impact on the participants. Overall, participants reported that it helped them prepare for placements. Based on the findings, wherever possible, repeated immersive simulation-based education designs should be used and not a standalone immersive simulation-based education scenarios. If resources allow, this could be either a repeated scenario, or if there are resource constraints to use, over the same time, immersive simulation with team deliberate practice, or a similar model. Thus, giving a potential return on investment, one that supports simulation educators making those sensitive decisions regarding the inclusion of immersive simulation with team deliberate practice in their curriculum. Further research is needed into this area to ascertain the design features that maximise this impact and support a move away from standalone scenarios to an approach that uses repetitive immersive simulation.
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Mausz J, Jackson NA, Lapalme C, Piquette D, Wakely D, Cheskes S. Protected 911: Development, Implementation, and Evaluation of a Prehospital COVID-19 High-Risk Response Team. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053004. [PMID: 35270696 PMCID: PMC8910754 DOI: 10.3390/ijerph19053004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023]
Abstract
Patients with COVID-19 who require aerosol-generating medical procedures (such as endotracheal intubation) are challenging for paramedic services. Although potentially lifesaving for patients, aerosolizing procedures carry an increased risk of infection for paramedics, owing to the resource limitations and complexities of the pre-hospital setting. In this paper, we describe the development, implementation, and evaluation of a novel pre-hospital COVID-19 High-Risk Response Team (HRRT) in Peel Region in Ontario, Canada. The mandate of the HRRT was to attend calls for patients likely to require aerosolizing procedures, with the twofold goal of mitigating against COVID-19 infections in the service while continuing to provide skilled resuscitative care to patients. Modelled after in-hospital 'protected code blue' teams, operationalizing the HRRT required several significant changes to standard paramedic practice, including the use of a three-person crew configuration, dedicated safety officer, call-response checklists, multiple redundant safety procedures, and enhanced personal protective equipment. Less than three weeks after the mandate was given, the HRRT was operational for a 12-week period during the first wave of COVID-19 in Ontario. HRRT members attended ~70% of calls requiring high risk procedures and were associated with improved quality of care indicators. No paramedics in the service contracted COVID-19 during the program.
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Affiliation(s)
- Justin Mausz
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
- Correspondence:
| | - Nicholas A. Jackson
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West Room HSC-2C1, Hamilton, ON L8S 4K1, Canada
| | - Corey Lapalme
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Dan Piquette
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Dave Wakely
- Peel Regional Paramedic Services, 1600 Bovaird Drive East, Brampton, ON L6V 4R5, Canada; (N.A.J.); (C.L.); (D.P.); (D.W.)
| | - Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine, 77 Brown’s Line, Suite 100, Toronto, ON M8W 3S2, Canada;
- Division of Emergency Medicine, University of Toronto, 6 Queen’s Park Cres. W., Toronto, ON M5S 3H2, Canada
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Gjeraa K, Dieckmann P, Jensen K, Møller LB, Petersen RH, Østergaard D, Ersbøll AK, Konge L. Effects of shared mental models in teams performing video-assisted thoracoscopic surgery lobectomy. Surg Endosc 2022; 36:6007-6015. [PMID: 35075526 DOI: 10.1007/s00464-021-08972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Important non-technical skills enable operating teams to establish shared mental models (SMMs). The importance of SMMs in regards to surgical performance and peri-operative outcomes remains to be investigated. The aim of this study was to explore whether shared mental models (SMMs) of team resources and the current situation, respectively, were predictive of technical skills, duration of surgery, and amount of intra-operative bleeding in video-assisted thoracoscopic surgery (VATS). METHODS A prospective multi-center observational study was conducted at four tertiary academic hospitals during VATS lobectomy procedures. Data included pre-operative and post-operative questionnaires answered by each of the six team members to measure the SMMs; thoracoscopic video recordings assessed using the previously validated VATS lobectomy Assessment Tool (VATSAT); surgery-related time stamps; and amount (volume) of intra-operative bleeding. Linear regression analyses were conducted to adjust for confounders. RESULTS Fifty-eight lobectomy procedures were included. Median (interquartile range) VATSAT score was 33.3 (scale 8-40) duration of surgery 101 min (88-123), and amount of intra-operative bleeding 100 ml (20-150). The mean (± SD) of teams' SMMs of the current situation was 20 (± 5). They were not predictive of the surgeons' technical skills, but every one point increase in SMM score significantly predicted a 1 min 52 s decrease in duration of surgery and an 11% decrease in amount of bleeding. The SMMs of team resources were not predictive of any outcomes. CONCLUSION VATS teams' superior SMMs of the current situation related to significantly shorter duration of surgery and decreased intra-operative bleeding, indicating an effect on team performance and patient care. TRIAL REGISTRATION NCT02999113 at http://www.clinicaltrials.gov .
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Affiliation(s)
- Kirsten Gjeraa
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev, Denmark
| | - Katrine Jensen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lars B Møller
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Copenhagen, Denmark
| | - René H Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev, Denmark.
| | - Annette K Ersbøll
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev, Denmark
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Koo A, Almeida BA, Kerluku J, Yang B, Fufa D. Teaching in Orthopaedic Surgery: Effective Strategies for Educating the Modern Learner in a Modern Surgical Practice. JB JS Open Access 2022; 7:JBJSOA-D-22-00005. [PMID: 35999853 PMCID: PMC9387961 DOI: 10.2106/jbjs.oa.22.00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Prioritizing the education of orthopaedic surgery residents and fellows is essential for the future of the field. This review highlights strategies that educators may find useful in improving their teaching skills for the modern orthopaedic surgery learner. Educators may benefit from focusing on active, effortful, and repetitive engagement in lecture; setting clear expectations to help track progress in clinic; and breaking skills into smaller steps in context of a framework when teaching procedural skills. Providing objective assessment and growth-oriented feedback helps establish a close rapport between educator and trainee while encouraging personal development. Through a remediation process that examines deficiency in core areas and equitability of the learning environment, the trainee and the educator may engage in a fair discussion that prevents trainees from falling behind. Finally, in the era of COVID-19, e-learning and virtual simulations have become increasingly used as effective modalities for teaching clinical knowledge and procedures to trainees. The medical education landscape has been changing at a rapid pace, and by evaluating and adapting to the novel educational models of today, the modern orthopaedic surgeon ensures a learning environment that is equitable, effective, and inspiring for the orthopaedic surgeon of tomorrow.
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Affiliation(s)
- Alexander Koo
- Weill Cornell Medicine, New York, New York
- E-mail address for A. Koo:
| | | | - Jona Kerluku
- Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Brian Yang
- Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Duretti Fufa
- Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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van Tetering AAC, Fransen AF, van der Hout-van der Jagt MB, Oei SG. The use of a stronger instructional design by implementing repetitive practice in simulation-based obstetric team training: trainees' satisfaction. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:284-288. [PMID: 35517385 PMCID: PMC8936909 DOI: 10.1136/bmjstel-2019-000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/03/2022]
Abstract
Objective This study compares satisfaction levels from multiprofessional obstetric care teams about simulation-based obstetric team training courses with and without the instructional design feature repetitive practice. Methods The present study is part of a multicentre cluster-randomised controlled trial (TOSTI trial) that investigated the effectiveness of a 1 day, multiprofessional, simulation-based obstetric team training. The initial training group received a training which was designed based on best practice. After 1 year, the control group received a training course in which the instructional design was changed by providing repetitive practice. All participants were asked to fill in a 29-item evaluation form with seven questions about baseline characteristics and 22 questions about training features. The questions about training features could be rated on a scale of 1 to 5. Finally, all participants were asked to rate the total training day on a scale of 1-10. Results The best practice group consisted of 471 trainees and the repetitive practice group of 549, including gynaecologists, residents, midwives and nurses. The best practice group rated the total training day significantly higher than the repetitive practice group (mean 8.8, SD 0.6 and mean 8.7, SD 0.6; p<0.003, Cohen's d=0.19). Several training features were also scored higher in the best practice group. Conclusion This study showed that obstetric healthcare professionals rated a simulation-based obstetric team training course, with and without repetition of scenarios, both high. The training without the repetitive elements gained higher scores for the total training dayand several, and several training features were scored higher. The difference between the mean scores and the effect sizes for the training features were small. This implies that repetitive practice can be integrated in simulation-based team training to optimise learning effects, with small effects on trainees satisfaction.
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Affiliation(s)
- Anne A C van Tetering
- Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands
| | - Annemarie F Fransen
- Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Guid Oei
- Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Karageorge N, Muckler VC, Toper M, Hueckel R. Using Simulation With Deliberate Practice to Improve Pediatric ICU Nurses' Knowledge, Clinical Teamwork, and Confidence. J Pediatr Nurs 2020; 54:58-62. [PMID: 32544800 DOI: 10.1016/j.pedn.2020.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this quality improvement project was to implement an educational intervention involving High-Fidelity Simulation (HFS) with deliberate practice for low-frequency, high-impact events in a Pediatric Intensive Care Unit (PICU), with the goal of improving nurses' crisis management skills. DESIGN AND METHODS Four interprofessional simulation education sessions with scenarios were created for this project. A list of knowledge and skills points was used to guide debriefings. All scenarios were based on low-frequency, high-impact events that required the use of Pediatric Advanced Life Support algorithms. Participants included 24 PICU nurses with less than two years of nursing experience. Knowledge and confidence were measured at three timepoints: pre-simulation, one-week post-simulation, and one-month post-simulation series. Clinical teamwork performance was measured twice, during the first and second scenario of each simulation session. RESULTS Scores for knowledge, confidence, and clinical teamwork performance improved from pre- to post-simulation, with confidence scores showing the largest increase. CONCLUSIONS Regular simulation training with deliberate practice can improve PICU nurses' knowledge, clinical teamwork skills, and confidence when managing low-frequency, high-impact events. PRACTICE IMPLICATIONS Regular in-situ simulation training with deliberate practice can improve nursing comfort with managing high-impact, low-frequency events in the PICU. This could lead to improved management of actual events, especially for novice nurses with less than one year of PICU experience.
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Affiliation(s)
| | | | | | - Rémi Hueckel
- Duke University School of Nursing, Durham, NC, USA.
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Platt A, McMeekin P, Prescott-Clements L. Effects of the Simulation Using Team Deliberate Practice (Sim-TDP) model on
the performance of undergraduate nursing students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:66-74. [DOI: 10.1136/bmjstel-2019-000520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Abstract
Background
The use of simulation has grown in prominence, but variation in the
quality of provision has been reported, leading to calls for further research
into the most effective instructional designs. Simulation Using Team Deliberate
Practice (Sim-TDP) was developed in response. It combines the principles of
simulation with deliberate practice, therefore, providing participants with
opportunities to work towards well-defined goals, rehearse skills and reflect
on performance whilst receiving expert feedback. This study aimed to compare
the effects of Sim-TDP, versus the use of traditional simulation, on the
performance of second year adult nursing students.
Methods
Using a longitudinal quasi-experimental design, the effects of the two
approaches were compared over a 1-year period. Sixteen groups, each containing
an average of six participants, were randomised into an intervention arm (n=8)
or comparison arm (n=8). Data collection took place at 3 monthly intervals, at
which point the performance and time to complete the scenario objectives/tasks,
as a team, were recorded and analysed using a validated performance
tool.
Results
The independent t-tests, comparing the performance of the groups, did not
demonstrate any notable differences during the three phases. However, in phase
1, the independent t-tests suggested an improvement in the Sim-TDP
participants’ time spent on task
(t(14) = 5.12, p<0.001),
with a mean difference of 7.22 min. The mixed analysis of covariance inferred
that the use of the Sim-TDP led to an improvement, over time, in the
participants’ performance (F(1, 5) = 12.91, p=0.016), and
thus, an association between Sim-TDP and the enhanced performance of
participants.
Conclusion
The results suggest that Sim-TDP, potentially, optimised participant
performance, while maximising the use of Simulation-based education (SBE)
resources, such as simulation facilities and equipment. The model could be of
practical benefit to nurse educators wishing to integrate SBE into their
programmes.
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Miranda A, Kelly A, Williams V, Kelly M. Designing authentic simulations in ROSE and EBUS for undergraduate laboratory
medicine students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:97-101. [DOI: 10.1136/bmjstel-2020-000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/03/2022]
Abstract
Introduction
Simulation-based education (SBE) has successfully been implemented in
several healthcare professions, more so in the fields of medicine and nursing.
Laboratory medicine courses prepare medical scientists for employment in
pathology laboratories typically via a staged training regime. Laboratory
techniques related to the diagnostic disciplines are introduced to students in
a graduated fashion over time for the development of professional skills and
technical competencies. For students specialising in diagnostic cytology, there
are continual changes to the scope of practice of scientists in industry that
require advanced training at undergraduate level to meet expectations of
contemporary laboratory testing.
Methods
The National Health Education and Training in Simulation (NHET-Sim)
framework was applied to create and deliver bespoke simulations for laboratory
medicine students. This paper outlines the steps taken, including working with
actors and industry partners, to create simulations which contextualise the
pressures and team interactions during diagnostic procedures.
Findings
Supported by a range of expertise and personnel, five laboratory medicine
simulations were developed and delivered to final year students. Details of the
steps taken and range of scenarios are included for sharing and
discussion.
Discussion
SBE can contribute positively to student confidence in communication at
interdisciplinary and interprofessional levels in ways that can be essential to
successful patient management. Understanding that cytology has now evolved to
become part of a multidisciplinary approach to patient-centred care will
improve the overall patient outcome and experience to personalised
medicine.
Conclusion
This paper demonstrates how a high-fidelity SBE scenario can test
students’ decision-making around technical, clinical and diagnostic
competencies in a complex investigation that they would likely experience in
industry.
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Exploring the Role and Application of the Deliberate Practice Concept in Radiation Therapy. J Med Imaging Radiat Sci 2018; 49:237-242. [PMID: 32074048 DOI: 10.1016/j.jmir.2018.04.024] [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: 03/02/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
The concept of deliberate practice (DP) has been extensively applied to the development of skill and expert performance in many domains of professional practice. Although it has been widely reviewed in other health professions, there is a lack of evidence on its application in radiation therapy practice. This article aims to explore the concept of DP and how it can be applied to radiation therapy practice. The authors define DP, why it is essential, and how it can be implemented in radiation therapy. Evidence from the DP literature in the health professions was used to clarify the guiding principles for successful DP implementation within both the clinical and educational contexts. While the authors encourage radiation therapy practitioners to engage in DP approaches, every profession utilizing DP will develop strategies unique to the individual discipline. Hence, rather than imitating other professions, it is essential that radiation therapists engage evidence-based approaches that will generate empirical evidence to model radiation therapy-specific DP approaches.
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