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Lembo D, Abate Daga F, Calì C, Garbossa D, Manfredi M, Odetto L, Ostacoli L, Paccotti P, Raimondo S, Reimondo G, Sciascia S. Early introduction of simulation in the medical curriculum: the MedInTo perspective. Front Med (Lausanne) 2024; 10:1280592. [PMID: 38239607 PMCID: PMC10794325 DOI: 10.3389/fmed.2023.1280592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
Despite the increasing body of evidence supporting the use of simulation in medicine, a question remains: when should we introduce it into the medical school's curriculum? We present the experience and future perspectives of the MD program in Medicine and Surgery of University of Turin-MedInTo. Since its launch, MedInTo has been dedicated to integrating innovative teaching approaches at the early stages into the medical curriculum. Herewith, we describe a case-based approach for our activities, which includes the utilization of simulation for emergency medical care training for students and the integration of virtual and augmented reality technology. Dedicated surgical training activities using virtual-augmented reality and life-like simulator for students are also described.
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Affiliation(s)
- David Lembo
- MD Program in Medicine and Surgery of University of Turin-MedInTo, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Clifford E, Stourton F, Willers J, Colucci G. Development of a Low-Cost, High-Fidelity, Reusable Model to Simulate Clamshell Thoracotomy. Surg Innov 2023; 30:739-744. [PMID: 37876028 PMCID: PMC10656785 DOI: 10.1177/15533506231208572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Clamshell thoracotomy (CST) is an emergency procedure performed during traumatic cardiac arrest. Emergency physicians and surgeons are expected to perform this procedure in the Emergency Department. However, the procedure has a low occurrence rate, therefore physicians are often poorly prepared. Current teaching methods include expensive simulators and anatomically inaccurate animal models. The goal of this study was to design, produce and test, a low-cost, high-fidelity model for the teaching of CST. DESIGN, SETTING AND PARTICIPANTS The model was produced from inexpensive, commercially available materials as well as ADAMgel; a custom, recyclable, inexpensive tissue analogue. The model was tested across 19 physicians, mostly consultants and senior registrars in emergency medicine, anaesthesia and surgery. Participants completed comparative questionnaires before and after testing the model. The questionnaires were adapted from previous anaesthetic-based simulation studies and used a modified Likert scale to assess prior knowledge, anatomical realism and the teaching benefits of the model. RESULTS Participants had varied prior knowledge and experience before testing the model. Results showed that 89.47% (n = 17) of trainees felt the model was a reasonable substitute for practice and 100% (n = 19) agreed that the model was a good training aid for inexperienced trainees and would recommend it to others. CONCLUSIONS The model proved a successful teaching tool, improving physicians' knowledge and confidence with performing CST. This high fidelity, low cost model demonstrated that a high standard simulation teaching tool can be made which improves teaching of CST.
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Affiliation(s)
| | - Frederick Stourton
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Johann Willers
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Gianluca Colucci
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
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Church HR, Murdoch-Eaton D, Sandars J. Under- and post-graduate training to manage the acutely unwell patient: a scoping review. BMC MEDICAL EDUCATION 2023; 23:146. [PMID: 36869334 PMCID: PMC9983517 DOI: 10.1186/s12909-023-04119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Junior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach. METHODS The review, informed by the Arksey and O'Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022. RESULTS Seventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study. CONCLUSIONS The results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.
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Affiliation(s)
- Helen R Church
- Faculty of Medicine and Health Sciences, University of Nottingham, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK.
| | - Deborah Murdoch-Eaton
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, England, UK
| | - John Sandars
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, England, UK
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Clark B, Blanchard EE, Rafield G, Riesenberg LA, Patel BN, Hackney A, Tubinis M. Effects of an Experiential Trauma Bootcamp on PGY 3 Anesthesiology Residents' Knowledge and Confidence Levels. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2023; 25:E696. [PMID: 36960033 PMCID: PMC10029110 DOI: 10.46374/volxxv_issue1_blanchard] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Bootcamp-style education involves short, intense educational sessions and is a proven educational modality in anesthesia medical education. However, rarely has it been used with senior anesthesiology residents and never in exposing these residents to a curriculum aimed at care of the trauma patient. The purpose of this study was to design and implement an experiential bootcamp to prepare anesthesiology residents to take senior trauma call at a Level 1 trauma center in the Southeastern United States. METHODS Before taking senior trauma call, 21 postgraduate year 3 anesthesiology residents took part in an 8-hour trauma bootcamp that combined flipped classroom-style education with immersive, procedural, and augmented reality simulation facilitated by subject matter experts. Before and after the bootcamp, residents completed 17-item confidence and 20-item knowledge questionnaires developed by the study authors. Results were compared before and after the bootcamp to determine overall change in confidence and knowledge levels pertaining to caring for trauma patients and taking senior trauma call. Additionally, residents completed an evaluation measuring their perceptions of the benefit of the educational offering. RESULTS Statistically significant increases were seen in 16 out of 17 confidence questions (P < .001) and 12 out of 20 knowledge questions (P < .001). Additionally, respondents indicated that they found the content to be valuable and likely to improve their care delivery within the clinical setting. CONCLUSIONS Following this bootcamp, postcourse surveys demonstrated that residents' knowledge and confidence increased significantly through simulation combined with a flipped-classroom approach in preparation for senior trauma call.
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Affiliation(s)
- Brittney Clark
- The following authors are in the Department of Anesthesiology and Perioperative Medicine at the Heersink School of Medicine, University of Alabama at Birmingham in Birmingham, AL: and are Assistant Professors; is a Professor; is a Postgraduate Year 4 resident; and is an Associate Professor
| | - Erin E Blanchard
- is an Assistant Professor in the Department of Health Services Administration, School of Health Professions, at the University of Alabama at Birmingham in Birmingham, AL
| | - Grace Rafield
- The following authors are in the Department of Anesthesiology and Perioperative Medicine at the Heersink School of Medicine, University of Alabama at Birmingham in Birmingham, AL: and are Assistant Professors; is a Professor; is a Postgraduate Year 4 resident; and is an Associate Professor
| | - Lee Ann Riesenberg
- The following authors are in the Department of Anesthesiology and Perioperative Medicine at the Heersink School of Medicine, University of Alabama at Birmingham in Birmingham, AL: and are Assistant Professors; is a Professor; is a Postgraduate Year 4 resident; and is an Associate Professor
| | - Bhavika N Patel
- is an Assistant Professor in the Department of Health Services Administration, School of Health Professions, at the University of Alabama at Birmingham in Birmingham, AL
| | - Andrew Hackney
- The following authors are in the Department of Anesthesiology and Perioperative Medicine at the Heersink School of Medicine, University of Alabama at Birmingham in Birmingham, AL: and are Assistant Professors; is a Professor; is a Postgraduate Year 4 resident; and is an Associate Professor
| | - Michelle Tubinis
- The following authors are in the Department of Anesthesiology and Perioperative Medicine at the Heersink School of Medicine, University of Alabama at Birmingham in Birmingham, AL: and are Assistant Professors; is a Professor; is a Postgraduate Year 4 resident; and is an Associate Professor
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Deters DR, Hunninghake J, Ruiz J, Marquez DJ, Ramirez DJ, Coffman RV. Increase Intensive Care Staff Comfort and Proficiency With Emergent Re-sternotomy in the Post-Open-Heart Patient by Using SynDaver® Simulation. Cureus 2022; 14:e20875. [PMID: 35145782 PMCID: PMC8803376 DOI: 10.7759/cureus.20875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/05/2022] Open
Abstract
Simulation training has been used in many avenues such as aeronautics, law enforcement, and healthcare to assist in training personnel to learn a new task and perform highly technical procedures. Simulation training has demonstrated beneficial for providing low-use, high-risk jobs such as landing a plane with a complete engine failure, performing reconstructive surgery, and even emergent lifesaving procedures. Our simulation training group chose to develop our custom hands-on training to perform emergent re-sternotomy on the post-open-heart patient based upon this belief. The goal of this project was to assist the bedside intensive care nurse in their self-perception of being comfortable and proficient in helping the physician with the procedure of an emergent re-sternotomy on the post-surgical open-heart patient. Measurement of self-perception of comfort and proficient was measured with a pre/post-questionnaire. The pre/post-questionnaire results showed improvement ranging from an increase in self-scoring from 1.2 to 1.7, with statistical significance demonstrated with a p <0.05.
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Park C, Lin IC, Grant JL, Dultz LA, Johnson D, Jeter S, Abdelfattah K, Luk S, Cripps M, Dumas RP. Monthly Trauma Training and Simulation Are Associated With Improved Resident Skill and Leadership. J Trauma Nurs 2022; 29:29-33. [PMID: 35007248 DOI: 10.1097/jtn.0000000000000632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Training for trauma procedures has been limited to infrequent courses with little data on longitudinal performance, and few address procedural and leadership skills with granular assessment. We implemented a novel training program that emphasized an assessment of trauma resuscitation and procedural skills. OBJECTIVE This study aimed to determine whether this program could demonstrate improvement in both skill sets in surgical trainees over time. METHODS This was a prospective, observational study at a Level I trauma center between November 2018 and May 2019. A procedural skill and simulation program was implemented to train and evaluate postgraduate year (PGY) 1-5 residents. All residents participated in an initial course on procedures such as tube thoracostomy and vascular access, followed by a final evaluation. Skills were assessed by the Likert scale (1-5, 5 noting mastery). PGY 3s and above were additionally evaluated on resuscitation. A paired t test was performed on repeat learners. RESULTS A total of 40 residents participated in the structured procedural skills and simulation program. Following completion of the program, PGY-2 scores increased from a Mdn [interquartile range, IQR] 3.0 [2.5-4.0] to 4.5 [4.2-4.5]. The PGY-3 scores increased from a Mdn [IQR] 3.95 [3.7-4.6] to 4.8 [4.6-5.0]. Eighteen residents underwent repeat simulation training, with Mdn [IQR] score increases in PGY 2s (3.7 [2.5-4.0] to end score 4.47 [4.0-4.5], p = .03) and PGY 3s (3.95 [3.7-4.6] to end score 4.81 [4.68-5.0], p = .04). Specific procedural and leadership skills also increased over time.
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Affiliation(s)
- Caroline Park
- Department of General Surgery, Division of Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas (Drs Park, Grant, Dultz, Abdelfattah, Luk, and Dumas and Ms Lin); Department of Trauma, Parkland Memorial Hospital, Dallas, Texas (Mss Johnson and Jeter); Department of Surgery, Trauma and Acute Care Surgery, University of Colorado, Boulder (Dr Cripps)
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Vela J, Cárcamo L, Contreras C, Arenas C, Ramos JP, Rebolledo R, Varas J, Martínez J, Jarufe N, Achurra P. SELF-CONFIDENCE ON ACQUIRED SURGICAL SKILLS TO DEAL WITH SEVERE TRAUMA PATIENTS IN RECENTLY GRADUATED SURGEONS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1561. [PMID: 34008705 PMCID: PMC8121062 DOI: 10.1590/0102-672020210001e1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Level of competence by procedure. Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. AIM Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. METHOD Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. RESULTS Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. CONCLUSIONS Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.
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Affiliation(s)
- Javier Vela
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Leonardo Cárcamo
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
| | - Caterina Contreras
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Claudia Arenas
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Juan Pablo Ramos
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Rolando Rebolledo
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Intituto de Ingenería Biológica y Médica, Santiago, Región Metropolitana, Chile
| | - Julián Varas
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Jorge Martínez
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
| | - Nicolas Jarufe
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Pablo Achurra
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
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Caldwell KE, Lulla A, Murray CT, Handa RR, Romo EJ, Wagner JW, Wise PE, Leonard JM, Awad MM. Multi-Disciplinary Trauma Evaluation and Management Simulation (MD-TEAMS) training for emergency medicine and general surgery residents. Am J Surg 2020; 221:285-290. [PMID: 32958156 DOI: 10.1016/j.amjsurg.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Successful trauma resuscitation relies on multi-disciplinary collaboration. In most academic programs, general surgery (GS) and emergency medicine (EM) residents rarely train together before functioning as a team. METHODS In our Multi-Disciplinary Trauma Evaluation and Management Simulation (MD-TEAMS), EM and GS residents completed manikin-based trauma scenarios and were evaluated on resuscitation and communication skills. Residents were surveyed on confidence surrounding training objectives. RESULTS Residents showed improved confidence running trauma scenarios in multi-disciplinary teams. Residents received lower communication scores from same-discipline vs cross-discipline faculty. EM residents scored higher in evaluation and planning domains; GS residents scored higher in action processes; groups scored equally in team management. Strong correlation existed between team leader communication and resuscitative skill completion. CONCLUSION MD-TEAMS demonstrated correlation between communication and resuscitation checklist item completion and communication differences by resident specialty. In the future, we plan to evaluate training-related resident behavior changes and specialty-specific communication differences by residents.
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Affiliation(s)
- Katharine E Caldwell
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States.
| | - Al Lulla
- Division of Emergency Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Collyn T Murray
- Division of Emergency Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Rahul R Handa
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Ernesto J Romo
- Division of Emergency Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Jason W Wagner
- Division of Emergency Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Paul E Wise
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Jennifer M Leonard
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Michael M Awad
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
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Ballesteros M, Feo González M, Suberviola B, Miñambres E. Simulación clínica en el paciente politraumatizado. Aplicación en estudiantes de Medicina. Med Intensiva 2020; 44:389-391. [DOI: 10.1016/j.medin.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
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10
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Weingarten N, Byskosh A, Stocker B, Weiss H, Lee H, Masteller M, Johnston A, Quach G, Devin CL, Issa N, Posluszny J. Simulation-Based Course Improves Resident Comfort, Knowledge, and Ability to Manage Surgical Intensive Care Unit Patients. J Surg Res 2020; 256:355-363. [PMID: 32739618 DOI: 10.1016/j.jss.2020.05.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation-based education can augment residents' skills and knowledge. We assessed the effectiveness of a simulation-based course for surgery interns designed to improve their comfort, knowledge, and ability to manage common surgical critical care (SCC) conditions. MATERIALS AND METHODS For 2 y, all first year residents (n = 31) in general surgery, urology, interventional radiology, and the integrated plastics, vascular, and cardiothoracic surgery training programs at our institution participated in a simulation-based course emphasizing evidence-based management of SCC conditions. Precourse and postcourse surveys and multiple-choice tests, as well as summative simulation tests, assessed interns' comfort, knowledge, and ability to manage SCC conditions. Changes in these measures were assessed with Wilcoxon matched-pairs signed rank tests. Factors associated with summative performance were determined by linear regression. RESULTS The course consisted of four simulation-based teaching sessions in year 1 and six in year 2. The course taught seven of the 18 core SCC conditions in the Surgical Council on Resident Education general surgery curriculum in year 1 and 10 in year 2. Interns' self-reported comfort, knowledge, and ability to manage each condition taught in the course increased (P < 0.02). Their knowledge of each condition, as assessed by written tests, also increased (P < 0.02). Their summative simulation test performance correlated with the number of course sessions attended (P < 0.03) and status as general surgery residents (P < 0.01). CONCLUSIONS A simulation-based SCC training course for surgery interns that emphasizes evidence-based management of SCC conditions improves interns' comfort, knowledge, and ability to manage these conditions.
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Affiliation(s)
- Noah Weingarten
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Alexandria Byskosh
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin Stocker
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah Weiss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Howard Lee
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Masteller
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alex Johnston
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Giang Quach
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney L Devin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nabil Issa
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph Posluszny
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fiorentino M, Mosenthal AC, Bryczkowski S, Lamba S. Teaching Residents Communication Skills around Death and Dying in the Trauma Bay. J Palliat Med 2020; 24:77-82. [PMID: 32716675 DOI: 10.1089/jpm.2020.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Background: Traumatic events are sudden, unexpected, and often devastating. The delivery of difficult news to patients and families in the trauma setting has unique challenges that necessitate communication skills that may differ from those used in other clinical environments. Objective: Design and implement a novel curriculum to teach, assess, and provide feedback to trauma residents on the communication skills necessary for delivering difficult news to patients and families in the trauma setting. Methods: This communication curriculum was delivered in three separate phases: (1) didactics using a video education e-module, (2) simulated practice of trauma resuscitation with a high-fidelity mannequin followed by role play of delivering difficult news, (3) an observed skills assessment using standardized patients (SPs). Each phase focused on delivery of difficult news of death and of uncertain/poor prognosis after a resuscitation in the trauma bay. Learners were trauma residents that included postgraduate year (PGY) 1-2 general surgery residents and PGY 1-4 emergency medicine residents at a level 1 trauma center. Outcomes include resident comfort, knowledge, and confidence in delivering difficult news in the trauma setting. Results: Thirty-nine trauma residents participated in the three-phase curriculum. There was an increase in the mean scores of resident-reported comfort, knowledge, and confidence in delivering difficult news for the seriously injured. SPs rated 78% of residents as competent to perform delivery of difficult news in the trauma bay independently. Conclusions: A curriculum to teach and assess trauma residents in the skills necessary to deliver difficult news in the trauma setting is both feasible and effective.
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Affiliation(s)
| | | | | | - Sangeeta Lamba
- Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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Marrs R, Horsley TL, Hackbarth D, Landon E. High consequence infectious diseases training using interprofessional simulation and TeamSTEPPS. Am J Infect Control 2020; 48:615-620. [PMID: 31759766 DOI: 10.1016/j.ajic.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The comfort level of health care workers to respond to an infectious disease outbreak or epidemic is likely directly related to the amount of education, training, and experience they have in responding to these events. METHODS A quasi-experimental study evaluated health care workers' state anxiety, self-efficacy, and interprofessional teamwork when working with patients simulated to have a potentially high consequence infectious disease. RESULTS Pretest-posttest 1 scores revealed a significant decrease in state anxiety (P < .0001) and an increase in self-efficacy (P < .0001). Overall state anxiety preintervention (pretest) to postintervention (posttest 3) significantly decreased (P = .0265). Overall TeamSTEPPS knowledge significantly increased (P < .0001) from baseline. CONCLUSIONS Simulation exercises are an effective strategy to increase self-efficacy and decrease state anxiety for health care workers. Positive teamwork scores indicate that the subjects value interprofessional teamwork.
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Marcks V, Hayes K, Stawicki SP. Operating room trauma simulation: The St. Luke's University Health Network experience. Int J Crit Illn Inj Sci 2020; 10:4-8. [PMID: 32322547 PMCID: PMC7170348 DOI: 10.4103/ijciis.ijciis_17_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victoria Marcks
- Department of Surgical Services, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
| | - Kathryn Hayes
- Department of Surgery, Level I Regional Resource Trauma Center, Bethlehem, Fountain Hill, Pennsylvania, USA
| | - Stanislaw P Stawicki
- Department of Surgery, Level I Regional Resource Trauma Center, Bethlehem, Fountain Hill, Pennsylvania, USA.,Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Fountain Hill, Pennsylvania, USA
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Pilar MR, Proctor EK, Pineda JA. Development, implementation, and evaluation of a novel guideline engine for pediatric patients with severe traumatic brain injury: a study protocol. Implement Sci Commun 2020; 1:31. [PMID: 32885190 PMCID: PMC7427929 DOI: 10.1186/s43058-020-00012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a leading cause of death and disability for children. The Brain Trauma Foundation released evidence-based guidelines, a series of recommendations regarding care for pediatric patients with severe TBI. Clinical evidence suggests that adoption of guideline-based care improves outcomes in patients with severe TBI. However, guideline implementation has not been systematic or consistent in clinical practice. There is also a lack of information about implementation strategies that are effective given the nature of severe TBI care and the complex environment in the intensive care unit (ICU). Novel technology-based strategies may be uniquely suited to the fast-paced, transdisciplinary care delivered in the ICU, but such strategies must be carefully developed and evaluated to prevent unintended consequences within the system of care. This challenge presents a unique opportunity for intervention to more appropriately implement guideline-based care for pediatric patients with severe TBI. METHODS This mixed-method study will develop a novel technology-based bedside guideline engine (the implementation strategy) to facilitate uptake of evidence-based guidelines (the intervention) for management of severe TBI. Group model building and systems dynamics will inform the guideline engine design, and bedside functionality will be initially assessed through patient simulation. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework, we will determine the feasibility of incorporating the guideline engine in the ICU. Study participants will include pediatric patients with severe TBI and providers at three trauma centers. Quantitative data will include measures of guideline engine acceptance and organizational readiness for change. Qualitative data will include semi-structured interviews from clinicians. We will test the feasibility of incorporating the guideline engine in "real life practice" in preparation for a future clinical trial that will assess clinical and implementation outcomes, including feasibility, acceptability, and adoption of the guideline engine. DISCUSSION This study will lead to the development and feasibility testing of an adaptable strategy for implementing guideline-based care for severe TBI, a strategy that meets the needs of individual critical care environments and patients. A future study will test the adaptability and impact of the bedside guideline engine in a randomized clinical trial.
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Affiliation(s)
- Meagan R. Pilar
- Washington University in St. Louis, Brown School, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Enola K. Proctor
- Washington University in St. Louis, Brown School, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Jose A. Pineda
- Children’s Hospital Los Angeles/University of Southern California, Keck School of Medicine, 4650 Sunset Blvd, Los Angeles, CA 90027 USA
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Htet NN, Gordon AJ, Mitarai T. Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents. Cureus 2020; 12:e6785. [PMID: 32140345 PMCID: PMC7045984 DOI: 10.7759/cureus.6785] [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] [Indexed: 11/07/2022] Open
Abstract
Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.
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Affiliation(s)
- Natalie N Htet
- Emergency Medicine, Stanford University Medical Center, Palo Alto, USA
| | | | - Tsuyoshi Mitarai
- Emergency Medicine, Stanford University Medical Center, Palo Alto, USA
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16
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Ansquer R, Mesnier T, Farampour F, Oriot D, Ghazali DA. Long-term retention assessment after simulation-based-training of pediatric procedural skills among adult emergency physicians: a multicenter observational study. BMC MEDICAL EDUCATION 2019; 19:348. [PMID: 31510979 PMCID: PMC6739955 DOI: 10.1186/s12909-019-1793-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/05/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND One of the primary goals of simulation-based education is to enable long-term retention of training gains. However, medical literature has poorly contributed to understanding the best timing for repetition of simulation sessions. There is heterogeneity in re-training recommendations. OBJECTIVES This study assessed, through simulation-based training in different groups, the long-term retention of rare pediatric technical procedures. METHODS This multicenter observational study included 107 emergency physicians and residents. Eighty-eight were divided into four groups that were specifically trained for pediatric emergency procedures at different points in time between 2010 and 2015 (< 0.5 year prior for G1, between 0.5 and 2 years prior for G2, between 2 and 4 years prior for G3, and ≥ 4 years prior for G4). An untrained control group (C) included 19 emergency physicians. Participants were asked to manage an unconscious infant using a low-fidelity mannequin. Assessment was based on the performance at 6 specific tasks corresponding to airway (A) and ventilation (B) skills. The performance (scored on 100) was evaluated by the TAPAS scale (Team Average Performance Assessment Scale). Correlation between performance and clinical level of experience was studied. RESULTS There was a significant difference in performance between groups (p < 0.0001). For G1, 89% of the expected tasks were completed but resulted in longer delays before initiating actions than for the other groups. There was no difference between G4 and C with less than half of the tasks performed (47 and 43% respectively, p = 0.57). There was no correlation between clinical level of experience and performance (p = 0.39). CONCLUSION Performance decreased at 6 months after specific training for pediatric emergency skills, with total loss at 4 years after training, irrespective of experience. Repetition of simulation sessions should be implemented frequently after training to improve long-term retention and the optimal rate of refresher courses requires further research.
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Affiliation(s)
- Raihei Ansquer
- Emergency Department and EMS, University Hospital of Poitiers, 86000, Poitiers, France
| | - Thomas Mesnier
- Emergency Department and EMS, General Hospital of Angouleme, 16000, Angouleme, France
| | - Farnam Farampour
- Emergency Department and EMS, General Hospital of Niort, Niort, France
| | - Denis Oriot
- Pediatric Emergency Department, University Hospital of Poitiers, 86000, Poitiers, France
- ABS Lab - Simulation Laboratory, Faculty of Medicine, University of Poitiers, Poitiers, France
| | - Daniel Aiham Ghazali
- Emergency Department and EMS, University Hospital of Bichat and Beaujon, Paris, France.
- Ilumens- Simulation Laboratory, Faculty of Medicine, University of Paris-Diderot, 75018, Paris, France.
- Simulation center, University Paris-Diderot, 20 rue du Département, 75018, Paris, France.
- Emergency Medical Service and Emergency Department, University Hospital of Bichat and Beaujon, 46 rue Huchard, 75018, Paris, France.
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17
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Bengiamin DI, Toomasian C, Smith DD, Young TP. Emergency Department Thoracotomy: A Cost-Effective Model for Simulation Training. J Emerg Med 2019; 57:375-379. [PMID: 31378446 DOI: 10.1016/j.jemermed.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation provides a safe learning environment where high-stakes, low-frequency procedures can be practiced without the fear of being unsuccessful or causing harm. Emergency department thoracotomy (EDT) is one such procedure. Realistic thoracotomy models are expensive and not readily available. OBJECTIVE Our objective is to describe a cost-effective, realistic, reproducible, and reusable thoracotomy model for simulation training. METHODS We modified a commercially available clothes mannequin torso to expose the chest and abdominal cavity. A plastic skeleton composed of a spinal cord and ribs was placed inside the torso. Tubing was used to simulate the aorta and esophagus; both tubes were secured to the distal spine with zip ties. Commercially available lungs and heart were placed inside the chest cavity. A small rubber ball simulated the left lung to be able to maneuver the lung. The heart was covered with plastic wrap to simulate the pericardium. Thick tape was used to simulate the pleural cavity. Yoga mats were used to simulate the intercostal muscles, subcutaneous tissue, and skin. RESULTS This model was tested with Emergency Medicine (EM) residents during a simulation session. A voluntary survey was available for residents to provide feedback. Survey results confirmed that the model provided valuable education, with overall positive feedback. CONCLUSION This EDT model provides a valuable teaching opportunity to EM residents who otherwise might not have the opportunity to perform this procedure. Residents agreed that the model improved their confidence and is an effective method in providing the opportunity to practice this low-frequency, high-stakes procedure.
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Affiliation(s)
- Deena I Bengiamin
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Cory Toomasian
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Dustin D Smith
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Timothy P Young
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
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18
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Jensen AR, Bullaro F, Falcone RA, Daugherty M, Young LC, McLaughlin C, Park C, Lane C, Prince JM, Scherzer DJ, Maa T, Dunn J, Wining L, Hess J, Santos MC, O'Neill J, Katz E, O'Bosky K, Young T, Christison-Lagay E, Ahmed O, Burd RS, Auerbach M. EAST multicenter trial of simulation-based team training for pediatric trauma: Resuscitation task completion is highly variable during simulated traumatic brain injury resuscitation. Am J Surg 2019; 219:1057-1064. [PMID: 31421895 DOI: 10.1016/j.amjsurg.2019.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Best practices for benchmarking the efficacy of simulation-based training programs are not well defined. This study sought to assess feasibility of standardized data collection with multicenter implementation of simulation-based training, and to characterize variability in pediatric trauma resuscitation task completion associated with program characteristics. METHODS A prospective multicenter observational cohort of resuscitation teams (N = 30) was used to measure task completion and teamwork during simulated resuscitation of a child with traumatic brain injury. A survey was used to measure center-specific trauma volume and simulation-based training program characteristics among participating centers. RESULTS No task was consistently performed across all centers. Teamwork skills were associated with faster time to computed tomography notification (r = -0.51, p < 0.01). Notification of the operating room by the resuscitation team occurred more frequently in in situ simulation than in laboratory-based simulation (13/22 versus 0/8, p < 0.01). CONCLUSIONS Multicenter implementation of a standardized pediatric trauma resuscitation simulation scenario is feasible. Standardized data collection showed wide variability in simulated resuscitation task completion.
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Affiliation(s)
- Aaron R Jensen
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
| | - Francesca Bullaro
- Cohen Children's Medical Center of Northwell Health, New Hyde Park, NY, USA.
| | | | - Margot Daugherty
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | | | - Caron Park
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, USA.
| | - Christianne Lane
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, USA.
| | - Jose M Prince
- Cohen Children's Medical Center of Northwell Health, New Hyde Park, NY, USA.
| | | | - Tensing Maa
- Nationwide Children's Hospital, Columbus, OH, USA.
| | - Julie Dunn
- University of Colorado Health-Medical Center of the Rockies, Loveland, CO, USA.
| | - Laura Wining
- University of Colorado Health-Medical Center of the Rockies, Loveland, CO, USA.
| | - Joseph Hess
- Penn State Children's Hospital, Hershey, PA, USA.
| | | | | | - Eric Katz
- Wake Forest Baptist Health, Winston-Salem, NC, USA.
| | - Karen O'Bosky
- Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
| | - Timothy Young
- Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
| | | | - Omar Ahmed
- Children's National Medical Center, Washington, DC, USA.
| | - Randall S Burd
- Children's National Medical Center, Washington, DC, USA.
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20
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Abstract
Well-educated ambulance staff is a prerequisite for high-quality prehospital trauma care. The aim of this study was to examine how nurses in the ambulance service experienced participation in trauma simulation. Sixty-one nurses, working in an emergency ambulance service, performed simulated trauma care on four different occasions and afterward rated three statements on a 5-point Likert scale. A descriptive and inferential analysis was conducted. There are statistically significant increases between the pre- and posttests regarding all three statements: "I think simulation of severe trauma with manikins is realistic" (0.23 or 6% increase), "Simulation is a suitable method for learning severe trauma care" (1.3 or 38% increase), and "I am comfortable in the situation learning severe trauma care through simulation" (0.74 or 19% increase). With the experience of realism in simulation, participants become more motivated to learn and prepare for future events. If the participants instead feel uncomfortable during simulation training, they focus on their own feelings instead of learning. In a realistic simulated environment, participants are prepared to understand and manage the emergency care situation in clinical work. Participants learn during simulation when they are outside their comfort zone but without being uncomfortable or experiencing anxiety.
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21
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Bohnen JD, Demetri L, Fuentes E, Butler K, Askari R, Anand RJ, Petrusa E, Kaafarani HMA, Yeh DD, Saillant N, King D, Briggs S, Velmahos GC, Moya MD. High-Fidelity Emergency Department Thoracotomy Simulator With Beating-Heart Technology and OSATS Tool Improves Trainee Confidence and Distinguishes Level of Skill. JOURNAL OF SURGICAL EDUCATION 2018; 75:1357-1366. [PMID: 29496361 DOI: 10.1016/j.jsurg.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Resuscitative Thoracotomy or Emergency Department Thoracotomy (EDT) is a time-sensitive and potentially life-saving procedure. Yet, trainee experience with this procedure is often limited in both clinical and simulation settings. We sought to develop a high-fidelity EDT simulation module and assessment tool to facilitate trainee education. DESIGN Using the Kern model for curricular development, a group of expert trauma surgeons identified EDT as a high-stakes, low-frequency procedure. Task analysis identified 5 key steps of EDT: (1) opening chest/rib spreader utilization; (2) pericardiotomy/cardiac repair; (3) open cardiac massage; (4) clamping aorta; and (5) control of pulmonary hilum. A high-fidelity simulator with beating-heart technology was built. The previously validated Objective Structured Assessment of Technical Skills (OSATS) was adapted to create the "EDT-OSATS" which assessed performance along several domains: (1) Surgical technique (key steps); (2) general skills; and (3) global rating. A pilot test was performed to compare board-certified trauma surgeons (i.e., Experts) with categorical general surgery interns (i.e., Novices). Each subject received preparatory materials, completed a presimulation quiz, performed a videotaped procedure on the EDT simulator, and completed a postmodule survey. Two independent raters scored performances using the EDT-OSATS. Groups were compared in descriptive and unadjusted analyses. We hypothesized that our EDT simulation module would distinguish between expert vs novice performance and improve trainee confidence. SETTING Simulation laboratory at Massachusetts General Hospital in Boston, MA. PARTICIPANTS Trauma surgeons (Experts, n = 6) and categorical general surgery interns (Novices, n = 8). RESULTS Experts scored significantly higher than Novices on nearly all components of the EDT-OSATS, including: (1) surgical technique: pericardiotomy (4.2 vs 3.4, p = 0.040), cardiac massage (3.6 vs 2.4, p = 0.028), clamping aorta (4.1 vs 3.3, p = 0.035), control of pulmonary hilum (4.8 vs 3.4, p < 0.001); (2) general skills: time/motion (4.1 vs 2.9, p = 0.011), knowledge and handling of instruments (4.3 vs 3.1, p = 0.004), and (3) global rating (3.9 vs 2.9, p = 0.026). There was no statistical difference between groups on opening chest/rib spreader utilization (3.8 vs 3.3, p = 0.352) or procedure time (204sec vs 227sec, p = 0.401), though Experts scored numerically higher than Novices on every measure. Novices reported significantly increased confidence after the simulation (3.1 vs 1.4, p = 0.001). Ninety-three percent (13/14) of participants found the simulator realistic. CONCLUSIONS Our novel high-fidelity beating-heart EDT simulator is realistic and improves trainee confidence in this low-frequency, high-stakes emergency procedure. The EDT-OSATS tool differentiates between performances of experienced surgeons vs novice trainees on the beating-heart simulator. This training module and accompanying assessment instrument hold promise as a learning tool for clinicians who may perform emergency department thoracotomy.
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Affiliation(s)
- Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Leah Demetri
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Eva Fuentes
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Kathryn Butler
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts; Learning Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Susan Briggs
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin-Froedtert Trauma Center, Milwaukee, Wisconsin.
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Sullivan S, Campbell K, Ross JC, Thompson R, Underwood A, LeGare A, Osman I, Agarwal SK, Jung HS. Identifying Nontechnical Skill Deficits in Trainees Through Interdisciplinary Trauma Simulation. JOURNAL OF SURGICAL EDUCATION 2018; 75:978-983. [PMID: 29100919 PMCID: PMC5955804 DOI: 10.1016/j.jsurg.2017.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The goal of this study was to investigate nontechnical skills in a simulated trauma setting both before and after a debriefing session in order to better understand areas to target for the development of educational interventions. DESIGN Wilcoxon signed rank tests were used to compare scores on the 5 domains of the T-NOTECHS pre- and postdebriefings. A qualitative analysis using the PEARLS debriefing framework was performed to provide a rich description of the strategies used by the debriefing facilitators. SETTING The Joint Trauma Simulation Program is an interdisciplinary project designed to improve the quality of trauma care through simulation exercises emphasizing nontechnical skills development. PARTICIPANTS Thirteen teams of 5 trauma trainees participated in trauma resuscitation simulations: a surgical chief resident, a surgical junior resident, an emergency medicine resident, and 2 emergency medicine nurses. RESULTS Teams significantly improved on communication and interaction skills in the simulation scenarios from pre- to postdebriefing. The debrief facilitators spent most of their time engaged in Directive Performance Feedback (56.13%). CONCLUSIONS Interprofessional team simulation in trauma resuscitation scenarios followed by debriefing differently affected individual nontechnical skills domains. Additional facilitation strategies, such as focused facilitation and encouraging learner self-assessment, may target other nontechnical skills in different ways.
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Affiliation(s)
- Sarah Sullivan
- Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | | | - Joshua C Ross
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Ryan Thompson
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Alyson Underwood
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Anne LeGare
- Nursing, UWHC Emergency Services, Madison, Wisconsin
| | - Ingie Osman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Suresh K Agarwal
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Chen J, Yang J, Hu F, Yu SH, Yang BX, Liu Q, Zhu XP. Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study. Intensive Crit Care Nurs 2018; 46:51-56. [PMID: 29550157 DOI: 10.1016/j.iccn.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. OBJECTIVE To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. DESIGN Two-group, non-randomised quasi-experimental design. SETTING A simulation centre in a Chinese University School of Nursing. PARTICIPANTS Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). METHODS The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). RESULTS Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. CONCLUSION A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation.
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Affiliation(s)
- Jie Chen
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China; University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA
| | - Jian Yang
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Fen Hu
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Si-Hong Yu
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Bing-Xiang Yang
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Qian Liu
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Xiao-Ping Zhu
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China.
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Khobrani A, Patel NH, George RL, McNinch NL, Ahmed RA. Pediatric Trauma Boot Camp: A Simulation Curriculum and Pilot Study. Emerg Med Int 2018; 2018:7982315. [PMID: 29535873 PMCID: PMC5817262 DOI: 10.1155/2018/7982315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/16/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022] Open
Abstract
Trauma is a leading cause of morbidity and mortality in infants and children worldwide. Trauma education is one of the most commonly reported deficiencies in pediatric emergency medicine (PEM) training. In this study, we describe the creation of a pediatric trauma boot camp in which trainees' basic knowledge, level of confidence, teamwork, and communication skills are assessed. The primary goal of this pilot study was to create a simulation-based pediatric trauma curriculum for PEM fellows and emergency medicine residents utilizing Kern's curricular conceptual framework. This was a pilot, prospective, single cohort, exploratory, observational study utilizing survey methodology and a convenience sample. The curriculum consisted of a two-day experience that included confidence surveys, a cognitive multiple-choice questionnaire, and formative and summative simulation scenarios. At the conclusion of this intensive simulation-based trauma boot camp participants reported increased confidence and demonstrated significant improvement in the basic knowledge and performance of the management of pediatric trauma cases in a simulated environment.
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Affiliation(s)
- Ahmad Khobrani
- Department of Pediatric Emergency Medicine, King Faisal Medical City Southern Regions, Ministry of Health, Abha, Saudi Arabia
- Summa Health System, Akron, OH, USA
| | - Nirali H. Patel
- Department of Pediatric Emergency Medicine, Akron Children's Hospital, Akron, OH, USA
| | - Richard L. George
- Division of Trauma, Department of Surgery, Summa Health, Akron, OH, USA
- Northeast Ohio Medical University, Akron, OH, USA
| | - Neil L. McNinch
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Rami A. Ahmed
- Northeast Ohio Medical University, Akron, OH, USA
- Department of Medical Education, Summa Health, Akron, OH, USA
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Abstract
BACKGROUND Simulation is becoming a more common modality in medical education. The data regarding effectiveness of simulation in critical care neurology education are limited. METHODS We administered a three-scenario simulation course to critical care fellowship trainees at a large academic medical center as a part of their core curriculum requirement. Pre- and posttests assessing medical knowledge and trainee confidence in managing neurologic disease were completed by all trainees. Overall satisfaction and effectiveness were evaluated following the course. Change in trainee knowledge and confidence before and after the course was assessed for improvement. RESULTS Sixteen trainees completed the simulation course. Prior to completion, medical knowledge was 5.2 ± 0.9 (of 8 possible correct answers) and following the course was 6.4 ± 1.3 (p = 0.002). Overall confidence improved from 15.4 ± 4.9 (of 30 possible points) to 20.7 ± 3.3 (p = <0.0001). Confidence was significantly improved for neurologic diseases directly assessed during the course (p = <0.0001) as well as for those not directly assessed (p = 0.004). CONCLUSIONS Simulation is an effective means of neurologic education for critical care trainees, with improvement in both medical knowledge and trainee confidence after completion of a three-scenario simulation experience. This course ensures the exposure of critical care trainees to neurologic diseases that are required curricular milestones to successfully complete the fellowship training program.
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Alsaad AA, Davuluri S, Bhide VY, Lannen AM, Maniaci MJ. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:481-486. [PMID: 28765717 PMCID: PMC5524701 DOI: 10.2147/amep.s134235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM) residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. OBJECTIVE To compare IM residents' performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs) as compared to mannequin. METHODS Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis). Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score). RESULTS Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01). When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002). CONCLUSIONS Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents.
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Affiliation(s)
| | | | | | - Amy M Lannen
- J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA
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Ortiz Figueroa F, Moftakhar Y, Dobbins Iv AL, Khan R, Dasgupta R, Blanda R, Marchand T, Ahmed R. Trauma Boot Camp: A Simulation-Based Pilot Study. Cureus 2016; 8:e463. [PMID: 26929890 PMCID: PMC4762770 DOI: 10.7759/cureus.463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Interns are often unprepared to effectively communicate in the acute trauma setting. Despite the many strengths of the Advanced Trauma Life Support (ATLS) program, the main shortcoming within the course is the deficiency of teamwork and leadership training. In this study, we describe the creation of an interdisciplinary boot camp in which interns' basic trauma knowledge, level of confidence, and teamwork skills are assessed. Methods: We designed a one-day, boot camp curriculum for interns of various specialties with the purpose of improving communication and teamwork skills for effective management of acute trauma patients. Our curriculum consisted of a one-day, twelve-hour experience, which included trauma patient simulations, content expert lectures, group discussion of video demonstrations, and skill development workstations. Baseline and acquired knowledge were assessed through the use of confidence surveys, cognitive questionnaires, and a validated evaluation tool of teamwork and leadership skills for trauma Results: Fifteen interns entered the boot camp with an overall confidence score of 3.2 (1-5 scale) in the management of trauma cases. At the culmination of the study, there was a significant increase in the overall confidence level of interns in role delegation, leadership, Crisis Resource Management (CRM) principles, and in the performance of primary and secondary surveys. No significant changes were seen in determining and effectively using the Glasgow Coma Scale, Orthopedic splinting/reduction skills, and effective use of closed-loop communication. Conclusion: An intensive one-day trauma boot camp demonstrated significant improvement in self-reported confidence of CRM concepts, role delegation, leadership, and performance of primary and secondary surveys. Despite the intensive curriculum, there was no significant improvement in overall teamwork and leadership performance during simulated cases. Our boot camp curriculum offers educators a unique framework to which they can apply to their own training program as a foundation for effective leadership and teamwork training for interns.
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Affiliation(s)
| | | | | | | | | | | | | | - Rami Ahmed
- Emergency Medicine, Summa Akron City Hospital
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