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Hamza A, Warczok C, Meyberg-Solomayer G, Takacs Z, Juhasz-Boess I, Solomayer EF, Radosa MP, Radosa CG, Stotz L, Findeklee S, Radosa JC. Teaching undergraduate students gynecological and obstetrical examination skills: the patient's opinion. Arch Gynecol Obstet 2020; 302:431-438. [PMID: 32488397 PMCID: PMC8595149 DOI: 10.1007/s00404-020-05615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/20/2020] [Indexed: 12/02/2022]
Abstract
Introduction Our study assesses the patients’ opinion about gynecological examination performed by undergraduate students (UgSts). This assessment will be used in improving our undergraduate training program. A positive opinion would mean a lower chance of a patient refusing to be examined by a tutor or student, taking into account vaginal examination (VE). Materials and methods We performed a prospective cross-sectional survey on 1194 patients, consisting of outpatient and inpatient at the departments of obstetrics and gynecology from November 2015 to May 2016. The questionnaire consisted of 46 questions. Besides demographic data, we assessed the mindset of patients regarding the involvement of undergraduate student (UgSt) in gynecological and obstetrical examinations. We used SPSS version 23 for the statistical analysis. For reporting the data, we followed the STROBE statement of reporting observational studies. Results The median age was 38 years having a median of one child. 34% presented due to obstetrical problems, 38% due to gynecological complaints, and 19% due to known gynecological malignancies. Generally, we retrieved a positive opinion of patients towards the involvement of students in gynecological and obstetrical examination under supervision in 2/3 of the cases. Conclusions There is no reason to exclude medical UgSts from gynecological and obstetrical examinations after obtaining a written or oral consent.
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Affiliation(s)
- Amr Hamza
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany.
| | - C Warczok
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - G Meyberg-Solomayer
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - Z Takacs
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - I Juhasz-Boess
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - E-F Solomayer
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - M P Radosa
- Department of Radiology, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - C G Radosa
- Department for Gynecology, Diaconia Clinic Kassel, Kassel, Hessen, Germany
| | - L Stotz
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - S Findeklee
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
| | - J C Radosa
- Department of Obstetrics and Gynecology, Homburg University Medical Centre, 66421, Homburg, Germany
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Varpio L, Bader KS, Meyer HS, Durning SJ, Artino AR, Hamwey MK. Interprofessional Healthcare Teams in the Military: A Scoping Literature Review. Mil Med 2018; 183:e448-e454. [DOI: 10.1093/milmed/usy087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/10/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Karlen S Bader
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Holly S Meyer
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Anthony R Artino
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Meghan K Hamwey
- Department of Medicine, The Henry M Jackson Foundation for the Advancement of Military Medicine and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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Simulation as Part of Discharge Teaching for Parents of Infants in the Neonatal Intensive Care Unit. MCN Am J Matern Child Nurs 2017; 42:95-100. [PMID: 28234646 DOI: 10.1097/nmc.0000000000000312] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simulation has become accepted as a method to increase confidence among healthcare professionals. We felt simulation might have similar benefits for parents of babies about to be discharged from the neonatal intensive care unit. PURPOSE We developed the Neonatal Home Environment Learning Program to promote parental confidence in anticipation of their infant's discharge from the neonatal intensive care unit. METHODS This evaluation study was conducted with 15 mother/father dyads. Each participant recorded a self-perceived confidence score before and after the simulation experience. Participants also completed a program evaluation and participated in a debriefing session. Confidence scores (pre- and postsimulation) and evaluation scores were analyzed with descriptive statistics. Responses from the debriefing sessions were analyzed using descriptive phenomenology. RESULTS Parents rated the simulation experience highly. During debriefings, parents shared that the simulation made them feel more prepared. Two themes emerged from the debriefing data: doing it alone was different than I expected and feeling more confident. CLINICAL IMPLICATIONS A simulation experience for parents helps to ensure a positive transition to home and safe, effective care after discharge of the infant.
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Woda A, Hansen J, Paquette M, Topp R. The impact of simulation sequencing on perceived clinical decision making. Nurse Educ Pract 2017; 26:33-38. [PMID: 28666183 DOI: 10.1016/j.nepr.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 04/24/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
Abstract
An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students' perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources.
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Affiliation(s)
- Aimee Woda
- Marquette University College of Nursing, P.O. Box 1881, Milwaukee, WI 53201-1881, USA.
| | - Jamie Hansen
- Carroll University, College of Nursing, 100 N. East Avenue, Waukesha, WI 53186, USA.
| | - Mary Paquette
- Marquette University College of Nursing, P.O. Box 1881, Milwaukee, WI 53201-1881, USA.
| | - Robert Topp
- University of San Diego Hahn School of Nursing and Health Science, 5998 Alcala Park, San Diego, CA 92110, USA.
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Boutonnet M, Pasquier P, Raynaud L, Vitiello L, Bancarel J, Coste S, de Saint Maurice GP, Ausset S. Ten Years of En Route Critical Care Training. Air Med J 2017; 36:62-66. [PMID: 28336015 DOI: 10.1016/j.amj.2016.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/10/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The French Military Health Service (FMHS) has developed a training program for medical evacuation (MEDEVAC) of critical care patients on fixed wing aircraft. METHODS We conducted a 10-year retrospective analysis (2006-2015) of the data from the FMHS Academy. The number of trainees was listed according to the different courses and medical specialties. The number of MEDEVACs recorded during the period was described. RESULTS Since 2006, the FMHS has developed training courses designed for MEDEVAC of critical care patients. Forty-five collective strategic MEDEVAC courses were delivered to 91 intensivists, 130 anesthetic nurses, 79 flight surgeons, 55 flight nurses, and 89 nurses. Five sessions of tactical MEDEVAC courses were performed for 14 flight surgeons, 6 flight nurses, and 17 other nurses. Ten sessions of individual strategic MEDEVAC courses were delivered to 17 intensivists, 10 flight surgeons, 21 flight nurses, and 7 other nurses. Between 2006 and 2015, 818 (± 68) individual strategic MEDEVACs were performed per year. Thirty-three (± 19) concerned critical care patients. Five missions of collective strategic MEDEVAC were performed for 56 patients. CONCLUSION The FMHS has developed specific courses for the MEDEVAC of critical care patients, allowing the training of numerous MEDEVAC teams.
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Affiliation(s)
- Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France.
| | - Pierre Pasquier
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France; 14th Airborne Forward Surgical Team, Percy Military Teaching Hospital, Clamart, France
| | - Laurent Raynaud
- Department of Anesthesiology and Intensive Care, Bégin Military Teaching Hospital, Saint-Mandé, France
| | | | - Jérôme Bancarel
- Operational Headquarters of the French Military Health Service, Paris, France
| | | | | | - Sylvain Ausset
- Department of Anesthesiology and Intensive Care, Percy Military Teaching Hospital, Clamart, France
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Abstract
The safe transport of infants in critical condition requires highly reliable inter-professional transport teams that are equipped with the expertise to provide neonatal care in unfamiliar and resource-limited environments. Increasingly, transport teams are comprised of health professionals from various disciplines. Providing didactic and experiential learning alone is insufficient to fully prepare teams that have limited exposure to rare events. Simulation-based training supplements and reinforces knowledge, skills, and the experiences of team members. This article presents the current use of simulation in the training of neonatal transport teams and critically reviews how simulation methodologies may be further incorporated into curricula and quality improvement to achieve high-reliability teams.
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Affiliation(s)
- Douglas M Campbell
- Department of Pediatrics, University of Toronto, Toronto, Ontario; Allan Waters Family Simulation Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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Grisham LM, Vickers V, Biffar DE, Prescher H, Battaglia NJ, Jarred JE, Reid SAH, Hamilton AJ. Feasibility of Air Transport Simulation Training: A Case Series. Air Med J 2016; 35:308-313. [PMID: 27637443 DOI: 10.1016/j.amj.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/07/2016] [Accepted: 02/22/2016] [Indexed: 06/06/2023]
Abstract
Limited clinical site availability and an increased need for clinical training experiences often make it difficult for prehospital health care providers to complete new and annual training requirements. Medical simulation provides an alternative learning environment that provides trainees the opportunity to acquire and perfect new clinical skills without compromising patient care. The following is a detailed description of an air medical transport simulation of a neonate with hypoxic ischemic encephalopathy requiring transport to a higher level of care. Patient parameters were altered during flight to simulate potential complications unique to air medical transport. Use of this training strategy is particularly beneficial for low-volume, high-risk patients, and these lessons can be applied across all age patient groups, making the experience broadly applicable.
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Affiliation(s)
- Lisa M Grisham
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA.
| | - Valerie Vickers
- Arizona LifeLine, a Med-Trans Corporation, Lewisville, TX, USA
| | - David E Biffar
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA
| | - Hannes Prescher
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA
| | | | - John E Jarred
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA
| | - Sirandon A H Reid
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA
| | - Allan J Hamilton
- Arizona Simulation Technology & Education Center, University of Arizona, Tucson, AZ, USA
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Powell DK, Jamison DK, Silberzweig JE. An endovascular simulation exercise among radiology residents: comparison of simulation performance with and without practice. Clin Imaging 2015; 39:1080-5. [PMID: 26385172 DOI: 10.1016/j.clinimag.2015.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/26/2015] [Accepted: 08/24/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose was to compare resident endovascular simulator performance with and without prior simulation. METHODS Radiology residents were guided through a practice simulation and lectured on endovascular therapy, then randomized to simulate femoral arterial intervention with or without prior iliac simulation. Simulator measurements, performance grading and resident surveys were recorded. RESULTS Prior simulation of iliac intervention significantly improved resident performance. In particular, it resulted in less catheter placement without a wire (P=.01), shorter time to proper catheter positioning (P=.045) and use of oblique digital subtraction angiography (P=.035). Survey respondents valued the experience. CONCLUSION Endovascular simulator training improves simulation skills. Improvement of real-world performance and generalizability remain to be shown.
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Affiliation(s)
- Daniel K Powell
- New York Presbyterian, Columbia Campus, Department of Radiology, 622 West 168th Street, PB1-301, New York, NY, 10032.
| | - D Kenneth Jamison
- Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY, 10029
| | - James E Silberzweig
- Mount Sinai Beth Israel, Department of Radiology, 10 Nathan D. Perlman Pl., 2 Karpas, New York, NY, 10003
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Robertson J, Bandali K. Bridging the gap: enhancing interprofessional education using simulation. J Interprof Care 2015; 22:499-508. [PMID: 24567962 DOI: 10.1080/13561820802303656] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Simulated learning and interprofessional education (IPE) are increasingly becoming more prevalent in health care curriculum. As the focus shifts to patient-centred care, health professionals will need to learn with, from and about one another in real-life settings in order to facilitate teamwork and collaboration. The provision of simulated learning in an interprofessional environment helps replicate these settings thereby providing the traditional medical education model with opportunities for growth and innovation. Learning in context is an essential psychological and cognitive aspect of education.This paper offers a conceptual analysis of the salient issues related to IPE and medical simulation. In addition, the paper argues for the integration of simulation into IPE in order to develop innovative approaches for the delivery of education and improved clinical practice that may benefit students and all members of the health care team.
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Netzer I, Weiss A, Hoppenstein D. Naval casualty management training using human patient simulators. DISASTER AND MILITARY MEDICINE 2015; 1:9. [PMID: 28265424 PMCID: PMC5330130 DOI: 10.1186/2054-314x-1-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extended-evacuation or austere environments (e.g. naval, immature or depleted combat zones) are characterized by the lack of resources to facilitate medical evacuation in the "Golden Hour" from moment of injury. This may require the primary caregiver, often a relatively inexperienced general physician or EMT, to administer extended medical care in the field. We describe the Shipboard and Underwater Casualty Care and Sedation Simulation (SUCCeSS) program in the Israeli Navy, intended to train caregivers for extended prehospital intensive casualty care using high fidelity life-size simulation mannequins set up onboard corvettes or submarines during maneuvers, in maximally realistic conditions. Twenty two general physicians and EMTs in 12 teams were enrolled in the program in the years 2011-2013. Two to three hour long training sessions were headed by senior surgeons and anesthesiologists using flexible scripts enabling the mannequin operators to react to caregivers' actions and their consequences. Trainee evaluation was performed by the preceptors using semi-structured forms taking into account both critical treatment decisions and observation on the effects of actions taken. Trainees also completed self-report CRM (Crisis Resource Management) questionnaires before and after the sessions. RESULTS Success of the trainees correlated with an evaluation score above 72%. The mean overall CRM score for team leaders post exercise was 74.64%, an improvement of 10% over pre-exercise scores (p < 0.0001). CONCLUSION Caregiver self-perceived competence and self-sufficiency in treating casualties at sea was improved via high fidelity simulation in theatre using realistic naval casualty care situations. We discuss the relative strengths and weaknesses of our training program for the teaching of "NCM", or Naval Casualty Management, as well as the emergent concepts of the military extended evacuation environment.
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Affiliation(s)
- Itamar Netzer
- Medical Department, Haifa Naval Base, Israeli Navy, IDF Medical Corp, Heyl Hayam Square, Haifa, Israel
| | | | - David Hoppenstein
- Department of Anesthesia, Critical Care and Pain Management, Meir Medical Center, Kfar Sava, Israel
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11
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Time matters--realism in resuscitation training. Resuscitation 2014; 85:1093-8. [PMID: 24842847 DOI: 10.1016/j.resuscitation.2014.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/29/2014] [Accepted: 05/10/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting. METHODS This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120s) or shortened CPR cycles (30-45s instead of 120s) in the scenarios. Adherence to time was measured using the European Resuscitation Council's Cardiac Arrest Simulation Test (CASTest) in retention tests conducted one and 12 weeks after the course. RESULTS The real-time group adhered significantly better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (p<0.001.) CONCLUSION This study indicates that time is an important part of fidelity. Variables critical for performance, like adherence to time in resuscitation, should therefore be kept realistic during training to optimise outcome.
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Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J 2014; 43:962-9. [PMID: 23611153 DOI: 10.1111/imj.12172] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.
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Affiliation(s)
- R P Chalwin
- Intensive Care Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
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13
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‘eSimulation’ Part 2: Evaluation of an interactive multimedia mental health education program for generalist nurses. Collegian 2014; 21:3-9. [DOI: 10.1016/j.colegn.2012.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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O'Connell KM, De Jong MJ, Dufour KM, Millwater TL, Dukes SF, Winik CL. An Integrated Review of Simulation Use in Aeromedical Evacuation Training. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2013.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Breckwoldt J, Gruber H, Wittmann A. Simulation Learning. INTERNATIONAL HANDBOOK OF RESEARCH IN PROFESSIONAL AND PRACTICE-BASED LEARNING 2014. [DOI: 10.1007/978-94-017-8902-8_25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bluestone J, Johnson P, Fullerton J, Carr C, Alderman J, BonTempo J. Effective in-service training design and delivery: evidence from an integrative literature review. HUMAN RESOURCES FOR HEALTH 2013; 11:51. [PMID: 24083659 PMCID: PMC3850724 DOI: 10.1186/1478-4491-11-51] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 05/02/2013] [Indexed: 05/04/2023]
Abstract
BACKGROUND In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE. METHODS A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education. RESULTS The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Very limited quality data are available from low- to middle-income countries. CONCLUSIONS Educational techniques are critical to learning outcomes. Targeted, repetitive interventions can result in better learning outcomes. Setting should be selected to support relevant and realistic practice and increase efficiency. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. CPE can lead to improved learning outcomes if effective techniques are used. Limited data indicate that there may also be an effect on improving clinical practice behaviours. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries.
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Affiliation(s)
- Julia Bluestone
- Jhpiego Corporation, 1615 Thames Street, Baltimore, MD 21231, USA
| | - Peter Johnson
- Jhpiego Corporation, 1615 Thames Street, Baltimore, MD 21231, USA
| | | | - Catherine Carr
- Jhpiego Corporation, 1615 Thames Street, Baltimore, MD 21231, USA
| | | | - James BonTempo
- Jhpiego Corporation, 1615 Thames Street, Baltimore, MD 21231, USA
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Patterson MD, Geis GL. On the Move: Simulation to Improve and Assure Transport Team Performance. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Swickard S, Manacci CF. Synthetic natural environments: an exemplar of advanced simulation. Air Med J 2012; 31:181-184. [PMID: 22748415 DOI: 10.1016/j.amj.2011.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/15/2011] [Accepted: 12/02/2011] [Indexed: 06/01/2023]
Affiliation(s)
- Scott Swickard
- Cleveland Clinic Critical Care Transport, Cleveland, OH, USA
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Maneval R, Fowler KA, Kays JA, Boyd TM, Shuey J, Harne-Britner S, Mastrine C. The Effect of High-Fidelity Patient Simulation on the Critical Thinking and Clinical Decision-Making Skills of New Graduate Nurses. J Contin Educ Nurs 2012; 43:125-34. [DOI: 10.3928/00220124-20111101-02] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 09/12/2011] [Indexed: 11/20/2022]
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Acquisition and maintenance of competencies through simulation for neonatal nurse practitioners: beyond the basics. Adv Neonatal Care 2011; 11:321-7. [PMID: 22123401 DOI: 10.1097/anc.0b013e31822a34a0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Turmoil in the economy, looming health care reform, and the convergence of a shortage of nursing professionals accompanied by the demand for improving patient safety and decreasing medical errors with limited resources has created an environment likened to the perfect storm. As nurses make up the single largest component of the health care system, it is imperative that nurses achieve and maintain the highest level of competency. The Institute of Medicine's report on the future of nursing identified simulation as a key technological component in facilitating nurses in acquiring and maintaining competencies. This article will review the evidence supporting simulation, define the core elements of health care simulation, describe the bodies that regulate advanced practice nursing, identify the principle areas in which neonatal nurse practitioners (NNPs) must maintain proficiency and expertise, and illustrate how simulation is utilized in acquisition, maintenance and competency evaluation for NNPs in 1 of the largest NICUs in the country.
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Effectiveness of a simulation-based educational program in a pediatric cardiac intensive care unit. J Pediatr Nurs 2011; 26:287-94. [PMID: 21726778 DOI: 10.1016/j.pedn.2010.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 05/28/2010] [Accepted: 05/31/2010] [Indexed: 11/20/2022]
Abstract
Optimal staff performance of resuscitation skills is best achieved through regular effective training. However, providing this teaching in a busy high-acuity pediatric cardiac intensive care unit (ICU) had become a challenge due to time and logistical constraints. A program to effectively and efficiently teach ICU nurses the skills necessary in patient resuscitation was developed using simulation training to better meet staff learning needs. Training via simulation provides an ideal learning environment with hands-on experience with the roles required in patient resuscitation. A simulation training program incorporating simulation training was developed for ICU nursing staff. All staff nurses in the ICU were required to attend over a year's time. The program involved mock resuscitation scenarios in which participants performed various resuscitation roles, followed by video review and group debriefing. All participants completed a survey prior to and immediately following participation in the training and again at 1 year. Data collected included self-report of knowledge, skill, and comfort related to patient resuscitation. Data revealed statistically significant improvement in scores pre and post training and at 1 year for self-reported knowledge, skills, and comfort related to resuscitation. Nursing staff reported that simulation training in resuscitation skills was helpful and positively impacted their knowledge, comfort, and skills. Feedback from nursing staff continues to be very positive, and performance of actual resuscitations on the unit has improved anecdotally.
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22
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Riley W, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. Didactic and Simulation Nontechnical Skills Team Training to Improve Perinatal Patient Outcomes in a Community Hospital. Jt Comm J Qual Patient Saf 2011; 37:357-64. [DOI: 10.1016/s1553-7250(11)37046-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Abstract
Successful transition of the neonate from the intrauterine environment to the extrauterine world is a complex and unique process. The assessments and interventions of the nurse during these precious moments following birth have a dramatic impact on the well-being of the neonate. This article reports on the development and implementation of a nursing situation simulation focused on educating nurses for this role. Simulation has been shown to increase confidence and competence of nurses. Use of simulation allows nurses to gain experience without placing the patient at risk.
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24
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Smith FC, Donaldson J, Pirie L. Pre-registration adult nurses’ knowledge of safe transfusion practice: Results of a 12month follow-up study. Nurse Educ Pract 2010; 10:101-7. [DOI: 10.1016/j.nepr.2009.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/24/2009] [Accepted: 04/18/2009] [Indexed: 10/20/2022]
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25
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Cross B, Wilson D. High-Fidelity Simulation for Transport Team Training and Competency Evaluation. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.nainr.2009.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Wagner D, Bear M, Sander J. Turning simulation into reality: increasing student competence and confidence. J Nurs Educ 2009; 48:465-7. [PMID: 19681537 DOI: 10.3928/01484834-20090518-07] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 08/04/2008] [Indexed: 11/20/2022]
Abstract
Clinical experiences are an essential part of nursing education as students learn technical skills, build on critical thinking skills, and hone skills in patient teaching. To build competence and confidence in each of these skill areas, an innovative clinical experience for senior students enrolled in women's health nursing was developed to provide nursing care and independent discharge teaching for postpartum mothers. Faculty facilitated this clinical experience by designing a simulation laboratory for students to practice their maternal self-care teaching and infant care skills prior to beginning their clinical rotation. In the hospital, students spent a day independently prioritizing new mothers' need for education and teaching new mothers to care for themselves and their newborns. Students reported confidence in teaching maternal self-care and newborn care, and satisfaction with this unique clinical experience. This approach may assist students in transferring skills learned in simulation laboratories to clinical practice.
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Affiliation(s)
- Debra Wagner
- University of North Florida, Jacksonville, FL 32224, USA.
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27
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Blunt E. Expanding NP students' skills: learning minor procedures. J Emerg Nurs 2008; 34:516-8. [PMID: 19022073 DOI: 10.1016/j.jen.2007.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 08/13/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Elizabeth Blunt
- Villanova University, 701 Ivins Road, Philadelphia, PA 19128, USA.
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28
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Hassan ZU, D'Addario M, Sloan PA. Human patient simulator for training oral and maxillofacial surgery residents in general anesthesia and airway management. J Oral Maxillofac Surg 2007; 65:1892-7. [PMID: 17719422 DOI: 10.1016/j.joms.2007.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 11/30/2006] [Accepted: 04/08/2007] [Indexed: 11/23/2022]
Affiliation(s)
- Zaki-Udin Hassan
- Department of Anesthesiology, University of Kentucky, Lexington, KY 40536, USA.
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29
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Goldman RD, Ho K, Peterson R, Kissoon N. Bridging the knowledge-resuscitation gap for children: Still a long way to go. Paediatr Child Health 2007; 12:485-489. [PMID: 19030414 DOI: 10.1093/pch/12.6.485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2007] [Indexed: 11/13/2022] Open
Abstract
The American Heart Association, along with the International Liaison Committee on Resuscitation, recently made changes to the paediatric resuscitation guidelines.Knowledge translation (KT) is imperative, but there is a lack of sufficient evidence for appropriate methodologies for implementation of these guidelines. Paediatric resuscitation presents many challenges; cases happen infrequently, affording few opportunities for implementation of the new guidelines, and are highly stressful and filled with uncertainty. Some KT strategies have shown some success in causing a notable degree of change in behaviour, but none have shown a striking difference when used alone.Previous efforts to disseminate current guidelines centred on development of courses for health care providers and preparing paediatric residents and paediatricians for circumstances they could encounter with paediatric acute illness. None of the studies assessing these techniques measured direct patient outcomes, and only a few demonstrated some long-term knowledge acquisition among trainees. The purpose of the present review was to illuminate the challenges, offer future directions for KT and outline potentially more effective methodologies and strategies to overcome current barriers.
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Affiliation(s)
- Ran D Goldman
- Pediatric Research in Emergency Therapeutics Program, The Hospital for Sick Children, Toronto, Ontario
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