INACSL Standards of Best Practice: Simulation sm : Operations

Simulators and Simulations for Extracorporeal Membrane Oxygenation: An ECMO Scoping Review

High-volume extracorporeal membrane oxygenation (ECMO) centers generally have better outcomes than (new) low-volume ECMO centers, most likely achieved by a suitable exposure to ECMO cases. To achieve a higher level of training, simulation-based training (SBT) offers an additional option for education and extended clinical skills. SBT could also help to improve the interdisciplinary team interactions. However, the level of ECMO simulators and/or simulations (ECMO sims) techniques may vary in purpose. We present a structured and objective classification of ECMO sims based on the broad experience of users and the developer for the available ECMO sims as low-, mid-, or high-fidelity. This classification is based on overall ECMO sim fidelity, established by taking the median of the definition-based fidelity, component fidelity, and customization fidelity as determined by expert opinion. According to this new classification, only low- and mid-fidelity ECMO sims are currently available. This comparison method may be used in the future for the description of new developments in ECMO sims, making it possible for ECMO sim designers, users, and researchers to compare accordingly, and ultimately improve ECMO patient outcomes.

Simulation-Based Education in Physical Therapist Education: A Survey of Current Practice

OBJECTIVES

The purposes of this study were to describe the current use of (1) simulation in student physical therapist professional education programs and (2) standards of best practice (SOBP) for simulation-based education (SBE) in physical therapist education.

METHODS

Two surveys were created about current use of SBE in student physical therapist professional education programs in the United States. The first survey contained questions about the program, including the best contact person regarding simulation. The second survey investigated simulation use within the context of SOBP. Survey data were analyzed using descriptive statistics.

RESULTS

Survey 1 was sent to the program director at all fully accredited physical therapist programs (N = 236), and 143 responses were returned (61% response rate). Survey 2 was sent to the 136 individuals identified in Survey 1, and we received 81 completed surveys (60%). Over 90% of programs reported including SBE in their curricula, with 86% providing 3 or more experiences. A median of 1 core faculty at each program reported training in SBE, but 23% reported no training. A lack of training in specific elements of the SOBP for SBE was reported by 40% to 50% of faculty. Limited use of SOBP was reported, and use of outcome measures without validation was common.

CONCLUSION

Although SBE is commonly used in physical therapist education, many faculties (1) do not have training in SBE, (2) do not consistently follow the SOBP, and (3) utilize unvalidated outcome measures. Limited faculty training in SBE and inconsistent inclusion of the SOBP suggest student learning in simulation is not optimized.

IMPACT

These results show that, despite increased use of simulation in physical therapist education programs, there is a dearth of faculty trained in SBE and inconsistent use of SOBP. Addressing these deficiencies could help to optimize the benefits of SBE in physical therapist education.

Simulation-Based Education in Physical Therapist Professional Education: A Scoping Review

OBJECTIVES

The purposes of this study were to (1) describe and summarize the use of simulation-based education (SBE) with student physical therapists in the international literature and (2) describe the application and integration of standards of best practice (SOBP) for SBE reported in published physical therapy education research.

METHODS

Ovid MEDLINE, CINAHL, Web of Science, and ERIC databases were searched. The search included any published study that involved the use of SBE with student physical therapists. Because this was a scoping review, only descriptive statistics were compiled; no methodological quality assessment was performed.

RESULTS

This scoping review revealed a significant increase in literature describing SBE with student physical therapists in the past 10 years. Simulation was used to address learning objectives across a variety of content areas and clinical settings. Communication skills were the most common objectives for simulation. Limited use of SOBP, published in 2016, was reported, and use of author-generated outcome measures without validation was common.

CONCLUSIONS

Although there has been an increase in literature reporting the use of SBE with student physical therapists across many practice areas and settings, many articles reported limited use and integration of published SOBP and frequently utilized outcome measures that had not been validated.

IMPACT

The findings show that limited use of validated outcome measures and SOBP constrain the capacity for reproducing studies, comparing findings among studies, and completing systematic reviews that could inform and optimize best practices for the use of SBE in physical therapist professional education. Further research on SBE in physical therapy would benefit from investigations that integrated and reported the use of SOBP for standardized patients, simulation design, and delivery and assessment of learning outcomes over time at multiple Kirkpatrick learning levels.

Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review

Introduction

High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS.

Methods

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence.

Conclusion

Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.

Effectiveness of multiple scenario simulations of acute and critical care for undergraduate nursing students: A quasi-experimental design

BACKGROUND

Acute care and critical care are among the most challenging tasks in nursing, which requires information, knowledge, and skills across multiple areas. Scenario simulations can teach nursing students how to respond to these challenges in a safe environment, which can also reduce the stress of acute and critical care prior to exposure to a clinical setting. However, few studies have examined whether scenario simulations of acute and critical care can improve the abilities of nursing students.

OBJECTIVES

To examine the effects of acute and critical care scenario simulations for nursing students.

DESIGN

A quasi-experimental design.

SETTING

A department of nursing at a university.

PARTICIPANTS

A total of 88 senior nursing students enrolled in a course in acute and critical care nursing volunteered to participate.

METHODS

The experience provided by scenario simulations was guided by the best practice standards of the International Nursing Association for Clinical Simulation and Learning, which recommends outcome measures include a change in knowledge, skills, and attitudes. Students completed three self-assessment instruments before and after completion of the course: simulation learning effectiveness, self-reflection and insight, and satisfaction with the simulation format. Comparisons of pre-test and post-test scores on the self-assessment instruments evaluated the effects of the simulation learning.

RESULTS

Post-test scores for subscale of self-regulation for simulation learning effectiveness and insight were significantly higher compared with pre-test scores (t = -2.85, p < 0.01 and t = -5.23, p < 0.001, respectively). There was also a significant increase for learning satisfaction in post-test, compared with pre-test (t = -3.70, p < 0.001).

CONCLUSION

The use of scenario simulations for teaching acute and critical care nursing improved self-regulation, insight and learning satisfaction for undergraduate nursing students.

Electronic Workflow for High-Fidelity Clinical Simulation in Nursing

Recognizing the importance of following the International Nursing Association for Clinical Simulation and Learning Standards: Healthcare Simulation Standards of Best Practice to ensure a successful simulation-based experience, this study aimed to update an electronic workflow created to guide teachers in the development and conduct of a clinical simulation for undergraduate nursing students, according to the latest evidence published in the International Nursing Association for Clinical Simulation and Learning Standards; implement it for online access; and describe the results of its usability criteria evaluation. It is a technological production and study of quantitative nature, descriptive and exploratory. The workflow was reconfigured according to the Contextualized Instructional Design model. The usability criteria analysis occurred through the application of a questionnaire to 23 undergraduate nursing courses professors. It was possible to identify that the technology reached high levels of global classification among faculty, being classified as "excellent" (M [SD], 81.9 [14.9]) by the final score. In view of the results obtained, it is concluded that the Electronic Workflow for High-Fidelity Clinical Simulation in Nursing can serve as a reference to promote the best simulation-based learning for professional training in nursing.

Development of a simulation placement in a pre-registration nursing programme

BACKGROUND

A 4-week simulation placement for first-year student nurses using an innovative blended approach was developed and delivered in one university. This was the first tariff-funded simulation placement in the UK for student nurses.

AIMS

To describe how this flexible simulation placement was developed, operated and adapted due to COVID-19 while exploring the student nurses' experiences and preparedness for practice.

METHODS

An anonymous online survey was undertaken and a placement evaluation was completed and compared with traditional clinical placement evaluations by previous students at the same point in their studies.

RESULTS

Students were as satisfied with the simulation placement as students who had attended real practice placements: 92% of students were satisfied with their simulated placement experience and 92% felt prepared for practice.

CONCLUSION

This simulated placement has been an acceptable replacement for traditional practice placements, particularly during the COVID-19 pandemic.

Healthcare Simulation: A Key to the Future of Medical Education - A Review

Aim

Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education.

Purpose

To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides.

Conclusion

Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.

Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care

PURPOSE

New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model.

DESIGN AND METHODS

Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey.

RESULTS

Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL.

PRACTICE IMPLICATIONS

This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children. Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.

Management in clinical simulation: a proposal for best practices and process optimization

OBJECTIVES

to develop a best practices document with facilitating components and processes for simulation management.

METHODS

the methodological research was conducted between April and October 2017, using four approaches: observational research, conducted in an international simulation institution; Definition of theoretical framework, from the International Nursing Association for Clinical Simulation and Learning; integrative literature review, in international databases; and comparative analysis. It used Bardin's analysis for the categorization of the information.

RESULTS

creation of a document with good practices in simulation regarding management and practice in simulation and management of resources and data, highlighting the use of technology and the training of professionals as the most important allies for overcoming the main limitations found.

FINAL CONSIDERATIONS

the product of this study is a compilation of strategies for simulation management as a tool to enhance the application of the method with greater effectiveness.

Comparing traditional, immersive simulation with Rapid Cycle Deliberate Practice in postgraduate year 2 anesthesiology residents

Background

Rapid Cycle Deliberate Practice (RCDP) is an increasingly popular simulation technique that allows learners to achieve mastery of skills through repetition, feedback, and increasing difficulty. This manuscript describes the implementation and assessment of RCDP in an anesthesia residency curriculum.

Methods

Researchers describe the comparison of RCDP with traditional instructional methods for anesthesiology residents' application of Emergency Cardiovascular Care (ECC) and communication principles in a simulated environment. Residents (n = 21) were randomly assigned to either Traditional or RCDP education groups, with each resident attending 2 days of bootcamp. On their first day, the Traditional group received a lecture, then participated in a group, immersive simulation with reflective debriefing. The RCDP group received education through an RCDP simulation session. On their second bootcamp day, all participants individually engaged in an immersive simulation, then completed the “Satisfaction and Self-Confidence in Learning” survey. Application of ECC and communication principles during the simulation was scored by a blinded reviewer through video review. Participants ended the bootcamp by ranking the experiences they found most valuable.

Results

No significant differences were found in the different group members’ individual performances during the immersive simulation, nor in the experiences they deemed most valuable. However, the Traditional education group reported higher levels of satisfaction and self-confidence in learning in 5 areas (p = 0.004–0.04).

Conclusions

Regardless of RCDP or Traditional education grouping, anesthesia residents demonstrated no difference in ECC skill level or perceived value of interventions. However, members of the Traditional education group reported higher levels of satisfaction and self-confidence in numerous areas. Additional RCDP opportunities in the anesthesia residency program should be considered prior to excluding it as an educational method in our program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-021-00174-0.

Evaluation of Simulation Outcomes

Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.

Use of simulation for global health pre-departure training

BACKGROUND

Opportunities for students to participate in global health mission trips have expanded. However, lack of pre-departure training is often reported and has been associated with negative outcomes for participants. Simulation is an effective method for providing customized situational learning.

OBJECTIVE

To evaluate the effectiveness of a Pre-Departure Training program incorporating simulation for advanced practice registered nursing (APRN) students prior to a global health mission trip.

DESIGN

This program employed a pre-posttest design with surveys administered at baseline, after a computer-based learning module, and after a simulation-based learning experience.

SETTING

A university in the Southeastern United States.

PARTICIPANTS

Twenty-two APRN students in their first clinical rotation of the program.

METHODS

APRN students with interest in global health missions partake in a pre-departure training program. Pre-departure training includes a computer-based learning module followed by an outdoor simulation replicating a low-income setting. Pre-posttest surveys assessed students' perceptions of confidence, skill, knowledge and comfort regarding global health. A skills checklist was used to evaluate student clinical patient presentation during the simulation.

RESULTS

Students' preparedness scores increased after the computer-based learning and significantly increased after the simulation. In the simulation, 42% of students successfully completed their patient presentation during their first attempt while 58% required remediation.

CONCLUSION

After the pre-departure program, students felt more confident in their global health knowledge, and felt significantly more prepared to provide health care in a low-income country. Schools of nursing offering global health mission trips or study abroad programs should consider implementing pre-departure programs using simulation as a teaching method.

Professional Development for Simulation Education

Professional development in simulation methodologies is essential for implementation of quality, consistent, simulation-based experiences. Evidence demonstrates that participation in comprehensive training positively impacts learner outcomes. There are many benefits to professional development, however, challenges exist requiring thoughtful planning, administrative buy-in, and fiscal support. While there are no established guidelines, the literature provides an ongoing consensus related to overall concepts and strategies for training in simulation. We describe a continuum of growth for simulationists, ranging from novice/advanced beginner, competent/proficient, to expert. As a novice, one must conduct a self-assessment of current strengths and create a development plan to advance simulation skills and knowledge. A simulationist should use evidenced-base guidelines, mentorship, and feedback to inform simulation practices. They should be knowledgeable of the standards of best practice, modalities, simulation design, learning theories, and professional integrity. Simulationists must seek ongoing advancement through certification, scholarship, and lifelong learning. This chapter describes the continuum of education and methodologies for the development of simulationists.

Simulation-Based Operations

Simulation pedagogy and the operations of simulation-based experiences have become an integral part of healthcare education. Academic and healthcare institutions constructed simulation centers or dedicated simulation spaces to provide simulation-based experiences for multiple health professions. Architectural designs resemble acute care settings that have the flexibility to change or include virtual reality and enhanced technology. Professional organizations have standards of best practice, credentialing requirements, and accreditation standards that support the need for high-quality, high-fidelity simulation experiences. Within healthcare education, simulation operation has become a specialty in itself that requires knowledge and experience of healthcare, education, and simulation pedagogy (INACSL Standards Committee, 2017). Simulation center administration needs an understanding of personnel management, including standardized patients (SPs), staff, faculty, and learners, as well as knowledge of budgeting, revenue streams, and technology. Personnel with unique skills and knowledge in engineering, healthcare, or information technology are required to support the simulation activities. Resources that manage inventory, supplies, equipment assets, and audiovisual requirements will increase efficiency and enhance fiscal responsibility. Technology assets such as high-fidelity human patient simulators can be used to enhance high-quality simulation, while audiovisual and data capturing software can be used for assessment, evaluation, and quality improvement. Simulation operations provides the infrastructure that supports the daily activities of simulation-based education.

Simulation in Undergraduate Education

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

A qualitative study of perioperative nursing students' experiences of interprofessional simulation-based learning

AIM

To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes.

BACKGROUND

Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required.

DESIGN

The study's qualitative and explorative design is reported in accordance with the COREQ guideline.

METHOD

Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding.

RESULTS

Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice.

CONCLUSION

Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice.

RELEVANCE TO CLINICAL PRACTICE

The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.

Manifesto for healthcare simulation practice

A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to advocate collaboratively and to lead ethically.

Operationalizing a simulation program: Practical information for leadership

Failure to ensure organizational readiness for curricular integration of simulation can result in a costly and ineffective simulation program. Organizational leaders who are aware of the principles of changemaker leadership and specific operational considerations are best positioned to ensure a quality simulation program. To assist these leaders, this article provides practical information derived from dissection of the Standard of Best Practice: Simulation^SM : Operations, including topics of strategic planning, financial resources, expert personnel, resource management systems, policies and procedures, and systems integration. Additionally, an introduction to a foundational tool to spearhead change is offered, and characteristics of the changemaker leader needed to develop and sustain an effective and efficient simulation program are highlighted. Understanding the criteria necessary for effective simulation operations and early recognition of the conditions and variables that can influence organizational culture is of utmost importance to ensure programmatic success.

Using simulation-based learning to provide interprofessional education in diabetes to nutrition and dietetics and exercise physiology students through telehealth

BACKGROUND

Current workforce demands require new graduates to competently work within health care teams and often in remote settings. To better prepare students for this work, universities have spent much time developing interprofessional education (IPE) activities. The body of literature supporting IPE of allied health students is growing. Simulation-based learning with simulated patients is one platform through which IPE can be implemented in a dedicated, supported environment and potentially at scale. This study describes an interprofessional simulation-based learning experience with nutrition and dietetics and exercise physiology students. The common practice area of interacting with patients who have type 2 diabetes was targeted, and the simulation was delivered in partnership with simulated patients via a telehealth platform to allow interprofessional teams to work collaboratively in remote locations.

METHODS

Ten nutrition and dietetics and 13 exercise physiology students participated in a simulation module in which students observed and collaborated in the development and delivery of an interprofessional treatment plan for patients with diabetes. Learning outcomes were measured according to the first two levels of Kirkpatrick's (1994) model for training evaluation (i.e. reaction and learning), as well as the perceived impact on behaviour.

RESULTS

The students' confidence in communication, assessment, management and ability to work with another health professional significantly increased (p < 0.05) post-activity. Students perceived that the simulation-based learning would have a positive impact on their clinical skills and ability to work with other health professionals. Students reported that the most effective aspects of the simulation module were learning from and about each other, the opportunity for experiential learning and the supportive learning environment. However, the telehealth platform audio clarity and delay had negative impact on the learning experiences for students.

CONCLUSION

The overall positive results demonstrate the potential of simulation-based learning activities for preparing allied health students for working in interprofessional teams. Although remote access was possible, the telehealth platform was identified as a limiting factor to this simulation-based learning experience. However, videoconferencing technology has advanced considerably since this study. Hence, there is an opportunity to employ more reliable technology for future simulations.

The physical demands and risks of working in healthcare simulation center

BACKGROUND

The purpose of this study was to describe the physical demands and risks associated with working in a simulation center.

METHODS

The 26-item online survey included questions about the physical nature of a simulationist's role and about what engineering and administrative controls they most commonly used. The sample consisted of 119 simulation operators and educators recruited from simulation interest groups based in the United States.

RESULTS

Fifty-five percent of participants reported that their job description did not match their work, and 59% of participants believed that they experienced a musculoskeletal disorder resulting from their work in a simulation center.

CONCLUSION

This study highlights the need to address workplace safety in simulation centers. Future research is needed to inform best practices for safe handling policies and procedures in simulation programs.

Bug Busters: Who you gonna call? Professional development for healthcare simulation technology specialists

SimGHOSTS introduced Bug Busters to train healthcare simulation technology specialists (HSTSs) as a way to showcase experienced HSTSs’ approaches to technology troubleshooting. This competition functions as a collaborative exchange of technology and operational solutions. It has been stated that Bug Busters is an equivalent to SimWars but for technology specialists. The competition starts with groups of individuals that function in the role of HSTSs. They are given a set of tasks that need to be completed within 10 min prior to a pending simulation scenario. The simulation room is designed with planned technical glitches, equipment that is defective, or inappropriate setup. There are multiple rounds of competition at a group level. In the final round, individual HSTSs from the advancing group complete challenges to win the competition. The number of correct tasks completed is used as the primary score determinant with time being the tie breaker. During each round, a set of distractors is introduced for a time bonus, asking technical or simulation-based questions that might be encountered in daily work. The competition demonstrates the need for HSTSs and provides an innovative way to acknowledge the complexity of their work and assess their skills. To ensure that the field of simulation continues to expand, training opportunities must be provided for all those involved in simulation. Bug Busters is one way to train and encourage “out of the box” thinking for HSTSs.

Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis

OBJECTIVE

The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes.

DESIGN

A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

DATA SOURCES

PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references.

STUDY SELECTION

To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis.

REVIEW METHOD

Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria.

SYNTHESIS METHOD

For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI.

RESULTS

Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected.

CONCLUSIONS

Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.

Bridging medical simulation with computer science and engineering: A growing field of study

BACKGROUND

Medical simulation has become an essential educational tool in the curricula of healthcare professionals. A literature review revealed a knowledge gap in healthcare simulation education with respect to the technological expertise required to operate highly sophisticated simulation equipment. With this motivation, a case study was designed to determine if implementing on-site technological expertise allows for the facile navigation of high fidelity manikins. Next, a research study was conducted to evaluate engineering students understanding of simulation, and their interest to attend a program in medical simulation.

OBJECTIVES

To determine if on-site technological expertise lifts barriers associated with manikin use and to assess levels of understanding and interest among engineering students following exposure to the technology used in healthcare simulation.

DESIGN

A prospective, descriptive study with pre-post surveys.

SETTINGS

The Nursing Skills and Simulation Center at a New England University campus.

PARTICIPANTS

Engineering students attending 6 different engineering programs (Computer Science, Computer Engineering, Mechanical Engineering, Biomedical Engineering, Electrical Engineering and Technology Management) and having different educational levels (undergraduate and graduate).

METHODS

Two assessments were applied to engineering students attending a class on technology used in healthcare simulation. A pre-test measured the understanding and interest of students in the engineering/computer science courses before attending a simulation class. A post-test assessment measured their improvement in understanding and interest to learn more about simulation technologies.

RESULTS

Statistical analysis and comparisons of pre-and post-test assessments show a 23% gain in understanding of this field following exposure to the healthcare simulation class. Furthermore, post test results show greater than 67% of those surveyed have an interest in attending a program in healthcare simulation.

CONCLUSIONS

The results indicate the collaboration of nursing and engineering has lifted known barriers to simulation education, and reveal engineering students have an interest in the field of medical simulation.