Effectiveness of Debriefing Methods for Virtual Simulation: A Systematic Review

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

Engagement in Distance Healthcare Simulation Debriefing: A Concept Development and Framework

SUMMARY STATEMENT

Understanding distance health care simulation debriefing is crucial in light of the increased use of and emerging technology in remote education for reasons of accessibility, global collaboration, and continuous professional development. This article is a confluence of a number of previously published studies designed to serve as a foundation to develop the concept of "engagement in health care distance simulation debriefing" using the Schwartz-Barcott & Kim hybrid mixed methods model. The model uses 3 phases: theoretical (a realist systematic review of the literature), fieldwork (3 exploratory studies and 2 pilot experimental studies), and analytical (analysis of the theoretical and fieldwork findings through expert discussion). This study defines the concept of "engagement in health care simulation distance debriefing" through exploration of its uses and analysis in literature, interviews, and expert review. The hybrid approach to the analysis provided rigor to generate a new, reflective conceptual model. This conceptual model defines the complexity in engagement during distance debriefing and helps shape the development of simulationists and debriefers, leading to more effective distance simulations and debriefings.

A Staged Defragmented Simultaneous Debriefing Model As Integrated Micro-debriefing Components Inside Online Simulation for Competencies Formation

Background Currently, there are no separate debriefing models for online simulation training, and existing models simply imitate the traditional models used in on-site simulation training (the physical presence of individuals, such as students or trainees, in a simulation center). This involves hands-on, in-person training within a simulated environment to enhance practical skills and knowledge in a controlled setting. This scenario does not fully meet the requirements and capabilities of distance learning. Objective To develop a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation to support the development of clinical decision-making and competencies formation within medical education and offer recommendations to support the use of this debriefing model as a teaching strategy. Methods This descriptive study was conducted from August 2020 to September 2023. To build a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation for competencies formation the traditional debriefing model's components for on-site simulation training, simulation type, and structure, modern concepts of e-learning, and classification of the seriousness of medication errors were used. The main focus of this study was on providing a detailed account of the debriefing components for online simulation training, features, and implementation of this new teaching model. A total of 38 participants, healthcare professionals, were recruited for this study. The participants were randomly assigned to two groups: one experiencing the staged defragmented debriefing model (n = 20) and the other control group, which received traditional debriefing following simulation training (n = 18). Results The results allowed us to successfully develop a staged defragmented debriefing model inside the simulation that integrates micro-debriefing components located at different points of the simulation scenarios. This teaching approach was successfully implemented in online clinical case scenarios in the "ClinCaseQuest" Simulation Training Platform for continuous medical education. Additionally, an internal validation experiment comparing the effectiveness of the staged defragmented debriefing model with the traditional debriefing method demonstrated superior learning outcomes and participant satisfaction in the staged debriefing group. Conclusions The staged defragmented debriefing model, when integrated into online simulations, represents a promising strategy for advancing clinical decision-making skills and competencies formation in medical education. Implementation of this debriefing model as a teaching strategy holds promise for enhancing learning outcomes in medical education settings. Further research, validation, and implementation are recommended to maximize the model's potential impact on medical education and training.

Use of Virtual Reality Simulations to Embody a Patient: Exploring the Impact on Nursing Students' Confidence, Feelings, and Perceptions

BACKGROUND

Using immersive virtual reality (VR), students are able to physically and emotionally embody patients while interacting in simulated environments with family and health care providers.

PURPOSE

This pilot study explored how embodying patients with Alzheimer disease and terminal cancer at end of life using highly immersive VR impacted nursing students' confidence, feelings, and perceptions.

METHODS

A quasi-experimental design was used with a convenience sample of bachelor of science in nursing students who completed pre/posttest scaled and open-ended questions.

RESULTS

Participants (N = 32) reported significant confidence increases; feelings about dying and hospice were also significantly changed. The majority described how the simulations would impact their future nursing care.

CONCLUSION

Using VR, students experienced disease, dying, and health care from the patient's perspective reporting differences in confidence, feelings, and perceptions. Immersive VR simulations warrant further study and have the potential to transform nursing education and impact health care.

Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study

Background

Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries.

Objective

To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units.

Methods

This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups.

Results

The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions.

Conclusion

Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

Health Care and Social Work Students' Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study

BACKGROUND

Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students' experiences with such a learning activity.

OBJECTIVE

The aim of this study was to explore occupational therapy, social education, nursing, and social work students' experiences with virtual reality simulation as a learning activity in an interdisciplinary subject.

METHODS

The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke.

RESULTS

The analysis revealed 3 overall themes for students' experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students' experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students' learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity.

CONCLUSIONS

Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services.

Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings

BACKGROUND

Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings.

METHODS

In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection.

RESULTS

The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes.

CONCLUSION

When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.

Developing simulation games to advance public health nursing competence in baccalaureate education

We describe the development of an innovative baccalaureate nursing education strategy for public health nursing. Virtual simulation pedagogy is known to be effective for acute care nursing practice while less known for public health nursing. Three Canadian nursing schools, the Canadian Association of Schools of Nursing (CASN), and the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) partnered to develop three public health nursing virtual simulation games. Learners work through unfolding population health scenarios, simulating public health nursing practice focused on entry level public health nursing competencies. Each game fosters clinical reasoning and collaborative, community decision-making to respond to population health issues during community assessment, evidence-informed health promotion planning, and evaluation processes. A companion guide was developed to support best practices in implementing virtual simulation and promote optimum student learning using the public health nursing games.

The synchronous group virtual simulation experience: Associate degree nursing students' perceptions

The use of virtual simulations exponentially increased as nursing schools experienced an urgent need to integrate online educational technologies during the COVID-19 pandemic. This qualitative descriptive study was conducted to explore associate degree nursing students' perceptions about the comprehensive Synchronous Group Virtual Simulation educational strategy. This strategy was developed based on the National League for Nursing Jeffries Simulation Theory (JST) and the Healthcare Simulation Standards of Best Practice^TM, including structured synchronous prebriefing and debriefing stages. Content analysis revealed 12 recurrent themes, from which 10 positive themes strongly correlated with concepts of the JST. Our findings support the effectiveness of a high-quality synchronous virtual simulation-guided by an empirically supported simulation theoretical framework and evidence-based simulation best practice standards-can be realistic, experiential, interactive, collaborative, learner-centered, and promote simulation participant outcomes.

The effect of asynchronous group discussions on nurse practitioner student debriefing experience in virtual simulation

ABSTRACT

Debriefing facilitates student learning of critical concepts and faculty evaluation of simulation learning outcomes. However, effective practices in debriefing after virtual simulation, including the impact of software-generated performance feedback and asynchronous group debriefing, are not well understood. Student perceptions of two different methods of postsimulation debriefing were explored by comparing software-generated performance feedback only versus software-generated feedback combined with an asynchronous, faculty-facilitated, online discussion based on the 3D Model of Debriefing. The Debriefing Experience Scale was used to evaluate self-reported debriefing experiences in 68 advanced practice nursing students before and after implementation of an online discussion-board debriefing strategy. Students reported an improved debriefing experience when simulation software-generated feedback was combined with asynchronous online discussion compared with automated software-generated feedback alone. Implications for faculty are discussed including lessons learned to support online, asynchronous debriefing experiences, and how to engage students in meaningful discussions that triangulate feedback from the simulation software, peers, and their instructor.

Effect of a virtual simulated participant experience on antibiotic stewardship knowledge among pre-licensure baccalaureate nursing students: A pilot study

BACKGROUND

Antibiotic resistant infections are a growing global public health threat poised to render antibiotics ineffective in treating even the most common infectious diseases. It is essential that future nurses have the knowledge and skills to keep patients safe from antibiotic harm in all health care settings, however, studies indicate that there is limited education provided in nursing schools regarding antibiotic use, antibiotic resistance, and antibiotic stewardship nursing practices.

OBJECTIVE

Evaluate the effect of a virtual, scenario-based simulation experience using simulated participants on pre-licensure baccalaureate nursing students' antibiotic, antibiotic resistance, and antibiotic stewardship nursing practice knowledge.

METHODS

A quasi-experiential repeated measure pre-posttest design was used with a convenience sample of 165 pre-licensure baccalaureate nursing students enrolled in a health promotion course at a private university in the northeast region of the United States. The NLN Jeffries Simulation Theory guided the virtual simulation experience and used simulated participants methodology.

RESULTS

All students participated in the simulation experience. Statistically significant increases were noted (p < 0.005) in antibiotic, antibiotic use, and antibiotic resistance knowledge between the pre and post surveys. The most significant changes were in knowledge of antibiotic stewardship nursing practices.

CONCLUSION

Integration of virtual, scenario-based simulations provided students an active learning opportunity to practice antibiotic stewardship assessment and practice skills through real life-like situational experiences with simulated participants, resulting in improved antibiotic, antibiotic resistance, and antibiotic stewardship knowledge.