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Eskola L, Silverman E, Rogers S, Zelenski A. Right-sizing interprofessional team training for serious-illness communication: A strength-based approach. PEC INNOVATION 2024; 4:100267. [PMID: 38414869 PMCID: PMC10897908 DOI: 10.1016/j.pecinn.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Objective Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams. Methods Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice. Results Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team. Conclusions The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings. Innovation We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.
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Affiliation(s)
- Liana Eskola
- Department of Medicine, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, USA
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
| | - Ethan Silverman
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 200 Lothrop St., Suite 933W, Pittsburgh, PA 15213, USA
| | - Sarah Rogers
- Department of Social Work, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
- Department of Mental Health, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
| | - Amy Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
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Perpiñá-Galvañ J, Montoro-Pérez N, Gutiérrez-García AI, José-Alcaide L, García-Aracil N, Juliá-Sanchis R, Escribano S. Development and validation of assessment instruments for cervical collar and spinal board placement in simulated environments for nursing students in the care of polytrauma patients. BMC MEDICAL EDUCATION 2024; 24:1080. [PMID: 39354516 PMCID: PMC11445984 DOI: 10.1186/s12909-024-06061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Multiple trauma injuries are the leading cause of death and disability in people under the age of 45 and require prompt and specialised care. However, medical and nursing education programmes do not always include specific training in emergency pre-hospital care, resulting in a lack of basic practical skills in trauma management. OBJECTIVE To develop and validate two instruments for assessing nursing students' competence in cervical collar and spinal board application in simulated pre-hospital emergency scenarios. METHOD This is an instrumental study that involves the development of two assessment instruments and the evaluation of their psychometric properties in a sample of 392 nursing students. Content validity was assessed using expert judgement, by calculating the content validity ratio (CVR) for each item and the scale level content validity index average (S-CVI/Ave) for the instruments. Exploratory factor analysis using the MINRES extraction method and Promax rotation was performed to analyse the performance of the items and structure of the rubrics. Internal consistency was analysed using the Omega coefficient and inter-rater agreement was assessed using Cohen's Kappa coefficient. RESULTS Initially, two rubrics were obtained: one with six items for cervical collar placement (S-CVI/Ave = 0.86) and one with nine items for spinal board placement (S-CVI/Ave = 0.81). Both had a single-factor structure, with all items having factor loadings greater than 0.34 for the cervical collar rubric and 0.56 for the spinal board rubric, except for item 2 of the cervical collar rubric (λ = 0.24), which was subsequently removed. The final cervical collar rubric (five items) had an overall internal consistency of 0.84 and the spinal board rubric had an overall internal consistency of 0.90, calculated using the Omega statistic. The weighted Kappa coefficient for each item ranged from acceptable (0.32) to substantial (0.79). These results show that we have successfully developed two sufficiently valid instruments to assess the immobilisation competencies proposed in the objective of the study. CONCLUSION Whilst further research is needed to fully establish their psychometric properties, these instruments offer a valuable starting point for evaluating nursing students' competence in cervical collar and spinal board application in simulated pre-hospital scenarios.
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Affiliation(s)
- Juana Perpiñá-Galvañ
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain.
- GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain.
| | | | - Lourdes José-Alcaide
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Noelia García-Aracil
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Rocío Juliá-Sanchis
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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O'Leary F. Simulation based education in paediatric resuscitation. Paediatr Respir Rev 2024; 51:2-9. [PMID: 38851950 DOI: 10.1016/j.prrv.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 06/10/2024]
Abstract
There is increasing use of clinical Simulation Based Education (SBE) in healthcare due to an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardised educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. SBE programs should be evaluated against Kirkpatrick level 3 or 4 criteria to ensure they improve patient or staff outcomes in the real world. SBE programs have been shown to improve outcomes in neonatology - reductions in hypoxic ischaemic encephalopathy, in brachial plexus injury, rates of school age cerebral palsy, reductions in 24hr mortality and improvements in first pass intubation rates. In paediatrics SBE programs have shown improvements in paediatric cardiac arrest survival, PICU survival, reduced PICU admissions, reduced PICU length of stay and reduced time to critical operations. SBE can improve the non-technical tasks of teamwork, leadership and communication (within the team and with patients and carers). Simulation is a useful tool in Quality and Safety and is used to identify latent safety issues that can be addressed by future programs. In high stakes assessment simulation can be a mode of assessment, however, care needs to be taken to ensure the tool is validated carefully.
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Affiliation(s)
- Fenton O'Leary
- Department of Paediatric Emergency Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School Westmead, NSW, Australia.
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Hanke LI, Vradelis L, Boedecker C, Griesinger J, Demare T, Lindemann NR, Huettl F, Chheang V, Saalfeld P, Wachter N, Wollstädter J, Spranz M, Lang H, Hansen C, Huber T. Immersive virtual reality for interdisciplinary trauma management - initial evaluation of a training tool prototype. BMC MEDICAL EDUCATION 2024; 24:769. [PMID: 39026193 PMCID: PMC11264734 DOI: 10.1186/s12909-024-05764-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Emergency care of critically ill patients in the trauma room is an integral part of interdisciplinary work in hospitals. Live threatening injuries require swift diagnosis, prioritization, and treatment; thus, different medical specialties need to work together closely for optimal patient care. Training is essential to facilitate smooth performance. This study presents a training tool for familiarization with trauma room algorithms in immersive virtual reality (VR), and a first qualitative assessment. MATERIALS AND METHODS An interdisciplinary team conceptualized two scenarios and filmed these in the trauma room of the University Medical Center Mainz, Germany in 3D-360°. This video content was used to create an immersive VR experience. Participants of the Department of Anesthesiology were included in the study, questionnaires were obtained and eye movement was recorded. RESULTS 31 volunteers participated in the study, of which 10 (32,2%) had completed specialist training in anesthesiology. Participants reported a high rate of immersion (immersion(mean) = 6 out of 7) and low Visually Induced Motion Sickness (VIMS(mean) = 1,74 out of 20). Participants agreed that VR is a useful tool for medical education (mean = 1,26; 1 very useful, 7 not useful at all). Residents felt significantly more secure in the matter after training (p < 0,05), specialist showed no significant difference. DISCUSSION This study presents a novel tool for familiarization with trauma room procedures, which is especially helpful for less experienced residents. Training in VR was well accepted and may be a solution to enhance training in times of low resources for in person training.
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Affiliation(s)
- Laura Isabel Hanke
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lukas Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jan Griesinger
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Tim Demare
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Nicola Raphaele Lindemann
- Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Florentine Huettl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Vuthea Chheang
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Patrick Saalfeld
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Nicolas Wachter
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jochen Wollstädter
- Department of Orthopedics and Trauma Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Marike Spranz
- Department of Diagnostic and Interventional Radiology, University Medical Center Johannes Gutenberg-University, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christian Hansen
- Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany.
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Goins SM, Thornton S, Horne E, Hoehn B, Brush E, Thamby J, Hemesath A, Cantrell S, Greenwald E, Tracy E. Educational Strategies in Pediatric Trauma Resuscitation Across Disciplines: A Scoping Review. J Surg Res 2024; 298:230-239. [PMID: 38626721 DOI: 10.1016/j.jss.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Trauma is the leading cause of death and disability in children. Differences in mechanism, injury pattern, severity, and physiology in this population distinguish pediatric trauma patients from adults. Educational techniques including simulation and didactics may improve pediatric readiness in this setting. We summarize the literature across disciplines, highlighting the curricular approaches, target provider population, educational content, content delivery method, and Kirkpatrick level for pediatric trauma resuscitation education. METHODS The MEDLINE (via Ovid), Embase (via Elsevier), Cumulative Index to Nursing & Allied Health Literature Complete (via EBSCO), Education Database (via ProQuest), and Web of Science Social Science Citation Index and Science Citation Index (via Clarivate) were searched. We reviewed 90 manuscripts describing pediatric trauma resuscitation education programs. When available, target provider population, curricular content, delivery method, and Kirkpatrick level were obtained. RESULTS Nurses (50%), residents (45%), and attending physicians (43%) were the most common participants. Airway management (25%), shock (25%), and general trauma (25%) were the most frequently taught concepts, and delivery of content was more frequently via simulation (65%) or didactics (52%). Most studies (39%) were Kirkpatrick Level 1. CONCLUSIONS This review suggests that diverse strategies exist to promote pediatric readiness. Most training programs are interdisciplinary and use a variety of educational techniques. However, studies infrequently report examining the impact of educational interventions on patient-centered outcomes and lack detail in describing their curriculum. Future educational efforts would benefit from heightened attention to such outcome measures and a rigorous description of their curricula to allow for reproducibility.
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Affiliation(s)
- Stacy M Goins
- Duke University School of Medicine, Durham, North Carolina.
| | | | | | - Brooke Hoehn
- Duke University School of Medicine, Durham, North Carolina
| | - Erin Brush
- Duke University School of Medicine, Durham, North Carolina
| | - Julie Thamby
- Duke University School of Medicine, Durham, North Carolina
| | | | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina; Duke University Medical Center Library & Archives, Durham, North Carolina
| | - Emily Greenwald
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Cristina DN, Robert A, Matthew C, Kirsty FJ, Sabrina K, Gabriel R, Jayne S, Pier IL, Francisco MM, Barry I. Global consensus statement on simulation-based practice in healthcare. Simul Healthc 2024; 19:e52-e59. [PMID: 38771674 DOI: 10.1097/sih.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
ABSTRACT Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally. KEY RECOMMENDATIONS Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field. CALL FOR ACTION We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.
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Diaz-Navarro C, Armstrong R, Charnetski M, Freeman KJ, Koh S, Reedy G, Smitten J, Ingrassia PL, Matos FM, Issenberg B. Global consensus statement on simulation-based practice in healthcare. Adv Simul (Lond) 2024; 9:19. [PMID: 38769577 PMCID: PMC11106913 DOI: 10.1186/s41077-024-00288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.
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Affiliation(s)
| | - Robert Armstrong
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Matthew Charnetski
- Simulation-Based Education and Research, Dartmouth Health, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Kirsty J Freeman
- The Rural Clinical School of Western Australia, The University of Western Australia, Perth, Australia
| | - Sabrina Koh
- SingHealth Duke-NUS Institute of Medical Simulation, SingHealth Academy, Singapore, Singapore
- Nursing Education and Development, Sengkang General Hospital, Singapore, Singapore
| | - Gabriel Reedy
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Jayne Smitten
- School of Nursing, Hawai'i Pacific University, Honolulu, Hawaii, USA
| | | | - Francisco Maio Matos
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, FMUC, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - Barry Issenberg
- University of Miami Miller School of Medicine, Miami, FL, USA
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Vrablik L, Wing R. Pediatric Polytrauma Fire Victim Simulation. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11383. [PMID: 38414645 PMCID: PMC10897059 DOI: 10.15766/mep_2374-8265.11383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/20/2023] [Indexed: 02/29/2024]
Abstract
Introduction Pediatric trauma has long been one of the primary contributors to pediatric mortality. There are multiple cases in the literature involving cyanide (CN) toxicity, carbon monoxide (CO) toxicity, and smoke inhalation with thermal injury, but none in combination with mechanical trauma. Methods In this 45-minute simulation case, emergency medicine residents and fellows were asked to manage a pediatric patient with multiple life-threatening traumatic and metabolic concerns after being extracted from a van accident with a resulting fire. Providers were expected to identify and manage the patient's airway, burns, hemoperitoneum, and CO and CN toxicities. Results Forty learners participated in this simulation, the majority of whom had little prior clinical experience managing the concepts highlighted in it. All agreed or strongly agreed that the case was relevant to their work. After participation, learner confidence in the ability to manage each of the learning objectives was high. One hundred percent of learners felt confident or very confident in managing CO toxicity and completing primary and secondary surveys, while 97% were similarly confident in identifying smoke inhalation injury, preparing for a difficult airway, and managing CN toxicity. Discussion This case was a well-received teaching tool for the management of pediatric trauma and metabolic derangements related to fire injuries. While this specific case represents a rare clinical experience, it is within the scope of expected knowledge for emergency medicine providers and offers the opportunity to practice managing multisystem trauma.
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Affiliation(s)
- Lauren Vrablik
- Third-Year Fellow, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University
| | - Robyn Wing
- Associate Professor, Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Sule AZ, Alayande BT, Ojo EO, Taiwo FO, Riviello RR, Chirdan LB, Ezeome ER, Mshelbwala PM, Ugwu BT, Yawe KDT. The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course. World J Surg 2023; 47:1919-1929. [PMID: 37069318 PMCID: PMC10109223 DOI: 10.1007/s00268-023-07004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. METHODS A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. RESULTS The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. CONCLUSIONS Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.
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Affiliation(s)
- Augustine Z Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Barnabas T Alayande
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Femi O Taiwo
- Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lohfa B Chirdan
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Philip M Mshelbwala
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Benjamin T Ugwu
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - King-David T Yawe
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
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Baudou E, Guilbeau-Frugier C, Tack I, Muscari F, Claudet I, Mas E, Taillefer A, Breinig S, Bréhin C. Clinical decision-making training using the Script Concordance Test and simulation: A pilot study for pediatric residents. Arch Pediatr 2023:S0929-693X(23)00056-8. [PMID: 37147153 DOI: 10.1016/j.arcped.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/06/2022] [Accepted: 03/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Each year, new pediatric residents begin their shifts in the pediatric emergency room. While technical skills are often acquired during workshops, non-technical skills such as communication, professionalism, situational awareness, or decision-making are rarely tested. Simulation enables non-technical skills to be developed in situations frequently encountered in pediatric emergencies. Adopting an innovative approach, we combined two pedagogical methods: the Script Concordance Test (SCT) and simulation to improve clinical reasoning and non-technical skills of first-year pediatric residents in dealing with clinical situations involving febrile seizures. The aim of this work is to report the feasibility of such a combined training. METHODS The first-year pediatric residents participated in a training session on how to manage a child attending the emergency department with a febrile seizure. At the beginning of the session, the trainees had to complete the SCT (seven clinical situations) and then participated in three simulation scenarios. Student satisfaction was assessed by means of a questionnaire at the end of the session. RESULTS In this pilot study, 20 residents participated in the training. The SCT scores for the first-year pediatric residents were lower and more widely distributed than those of the experts with better concordance for diagnostic items compared to investigation or treatment items. All were satisfied with the teaching methods employed. Further sessions on additional topics relating to the management of pediatric emergency cases were requested. CONCLUSION Although limited by the small size of our study, this combination of teaching methods was possible and seemed promising for the development of non-technical skills of pediatric residents. These methods are in line with the changes being made to the third cycle of medical studies in France and can be adapted to other situations and other specialties.
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Affiliation(s)
- E Baudou
- Unité de Neurologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | | | - I Tack
- Explorations Fonctionnelles Physiologiques, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - F Muscari
- Unité de Chirurgie Digestive, CHU de Toulouse, Toulouse, France
| | - I Claudet
- Unité d'Urgences et Infectiologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - E Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, F-31300, IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - A Taillefer
- Unité d'Urgences et Infectiologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - S Breinig
- Unité de Réanimation Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - C Bréhin
- Unité d'Urgences et Infectiologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France.
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Alegret N, Usart M, Valle A, De la Flor AR, Subirana L, Valero R. Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool. JOURNAL OF SURGICAL EDUCATION 2023; 80:706-713. [PMID: 36882339 DOI: 10.1016/j.jsurg.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. DESIGN Pre-and postintervention study. SETTING Acute-care teaching hospital in Sabadell, Barcelona (Spain). PARTICIPANTS Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. RESULTS Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. CONCLUSIONS Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.
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Affiliation(s)
- Núria Alegret
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Mireia Usart
- Education and Information Technology, University Rovira i Virgili, Tarragona, Spain
| | - Anna Valle
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | | | - Laura Subirana
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Ricard Valero
- Service of Anesthesiology and Resuscitation, Hospital Clinic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Center for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain
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Sudden Collapse During Upper Gastrointestinal Endoscopy: Expect the Unexpected. AORN J 2022; 116:600-602. [DOI: 10.1002/aorn.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
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13
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Mallory LA, Doughty CB, Davis KI, Cheng A, Calhoun AW, Auerbach MA, Duff JP, Kessler DO. A Decade Later-Progress and Next Steps for Pediatric Simulation Research. Simul Healthc 2022; 17:366-376. [PMID: 34570084 DOI: 10.1097/sih.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research. This exercise produced 6 domains critical to progress in the field: (1) prioritization, (2) research methodology and outcomes, (3) academic collaboration, (4) integration/implementation/sustainability, (5) technology, and (6) resources/support/advocacy. This article reflects on and summarizes a decade of progress in the field of pediatric simulation research and suggests next steps in each domain as we look forward, including lessons learned by our collaborative grass roots network that can be used to accelerate research efforts in other domains within healthcare simulation science.
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Affiliation(s)
- Leah A Mallory
- From the Tufts University School of Medicine (L.A.M.), Boston, MA; Department of Medical Education (L.A.M.), The Hannaford Center for Simulation, Innovation and Education; Section of Hospital Medicine (L.A.M.), Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Section of Emergency Medicine (C.B.D.), Department of Pediatrics, Baylor College of Medicine; Simulation Center (C.B.D.), Texas Children's Hospital, Pediatric Emergency Medicine, Baylor College of Medicine; Section of Critical Care Medicine (K.I.D.), Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Departments of Pediatrics and Emergency Medicine (A.C.), University of Calgary, Calgary, Canada; Division of Pediatric Critical Care (A.W.C.), University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY; Section of Emergency Medicine (M.A.A.), Yale University School of Medicine, New Haven, CT; Division of Critical Care (J.P.D.), University of Alberta, Alberta, Canada; and Columbia University Vagelos College of Physicians and Surgeons (D.O.K.), New York, NY
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14
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Managing a Team in the Operating Room: The Science of Teamwork and Non-Technical Skills for Surgeons. Curr Probl Surg 2022; 59:101172. [DOI: 10.1016/j.cpsurg.2022.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
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15
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Bhangu A, Stevenson C, Szulewski A, MacDonald A, Nolan B. A scoping review of nontechnical skill assessment tools to evaluate trauma team performance. J Trauma Acute Care Surg 2022; 92:e81-e91. [PMID: 34908024 DOI: 10.1097/ta.0000000000003492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this scoping review was to identify assessment tools of trauma team performance (outside of technical skills) and assess the validity and reliability of each tool in assessing trauma team performance. METHODS We searched Embase, Cochrane Library, Web of Science, Ovid Medline, and Cumulative Index to Nursing and Allied Health Literature from inception to June 1, 2021. English studies that evaluated trauma team performance using nontechnical skill assessment tools in a simulation or real-world setting were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Data regarding team assessment tools were extracted and synthesized into behavior domains. Each tool was then assessed for validity and reliability. RESULTS The literature search returned 4,215 articles with 29 meeting inclusion criteria. Our search identified 12 trauma team performance assessment tools. Most studies were conducted in the United States (n = 20 [69%]). Twenty studies (69%) assessed trauma team performance in a simulation setting; Team Emergency Assessment Measure (TEAM) and Trauma Nontechnical Skills Scale (T-NOTECHS) were the only tools to be applied in a simulation and real-world setting. Most studies assessed trauma team performance using video review technology (n = 17 [59%]). Five overarching themes were designed to encompass behavioral domains captured across the 12 tools: (1) Leadership, (2) Communication, (3) Teamwork, (4) Assessment, and (5) Situation Awareness. The reliability and validity of T-NOTECHS were investigated by the greatest number of studies (n = 13); however, TEAM had the most robust evidence of reliability and validity. CONCLUSION We identified 12 trauma team performance tools that assessed nontechnical skills to varying degrees. Trauma Nontechnical Skills Scale and TEAM tools had the most evidence to support their reliability and validity. Considering the limited research in the impact of trauma team performance on patient outcomes, future studies could use video review technology in authentic trauma cases to further study this important relationship. LEVEL OF EVIDENCE Systematic reviews and meta-analyses, level IV.
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Affiliation(s)
- Avneesh Bhangu
- From the Faculty of Health Sciences (A.B.), School of Medicine, Queen's University, Kingston, Ontario, Canada; School of Medicine (C.S.), University of Limerick, Limerick, Ireland; Department of Emergency Medicine (A.S.) and Department of Psychology (A.S.), Queen's University, Kingston, Ontario; Department of Biological Sciences (A.M.), Bishop's University, Sherbrooke, Quebec; Division of Emergency Medicine, Department of Medicine (B.N.), University of Toronto; Li Ka Shing Knowledge Institute (B.N.), St. Michael's Hospital; and Department of Emergency Medicine (B.N.), St. Michael's Hospital, Toronto, Ontario, Canada
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16
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Outcomes of Simulation-Based Experiences Related to Family Presence During Resuscitation: A Systematic Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/fqax8042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/ijohs/ijaa015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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19
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Yan DH, Slidell MB, McQueen A. Rapid Cycle Deliberate Practice Simulation Curriculum Improves Pediatric Trauma Performance: A Prospective Cohort Study. Simul Healthc 2021; 16:e94-e99. [PMID: 33156257 DOI: 10.1097/sih.0000000000000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation-based medical education allows learners to refine and maintain clinical skills especially for high-stake situations such as trauma resuscitation. Despite the primary and secondary survey being its foundation, literature shows poor adherence with overall rates as low as 13%. This study evaluates the impact of rapid cycle deliberate practice (RCDP) on primary and secondary survey skill retention. We hypothesized that RCDP-trained surgery residents will have real-world clinical improvement in their survey completion in pediatric trauma resuscitations. METHODS We developed an RCDP trauma resuscitation curriculum. Videos of trauma resuscitations before and after curriculum implementation were scored by 2 blinded reviewers using a modified Pediatric Trauma Assessment Scoring Tool. Actual trauma care by residents who had received the curriculum (study group) was compared with care provided by residents who had not received the curriculum (precurriculum historical control group and a concurrent control group who provided care without receiving the curriculum). RESULTS One hundred eighty-eight videos were scored with 98 in study group, 33 in concurrent control group, and 57 in historical control group. There was a significant improvement in primary survey performance between study group and historical control group (P < 0.001), but no difference between study group and concurrent control group. There was a significant improvement between study group and 2 control groups in secondary survey performance (both P < 0.001). CONCLUSIONS The RCDP curriculum led to significant improvement in surgical residents' trauma survey performance and had clinical impact on actual patients, which is rare in pediatric trauma simulation literature.
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Affiliation(s)
- Diana Hou Yan
- From the Department of Pediatrics, Section of Emergency Medicine (D.H.Y., A.M.), University of Chicago Medicine, Comer Children's Hospital; and Department of Surgery, Section of Pediatric Surgery (M.B.S.), University of Chicago Medicine, Chicago, IL
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20
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Sarmasoglu Kilikcier S, Celik N, Elcin M, Keskin G, Senel E. Impact of interprofessional in situ simulations on acute pediatric burn management: Combining technical and non-technical burn team skills. Burns 2021; 48:1653-1661. [PMID: 34955296 DOI: 10.1016/j.burns.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of interprofessional in situ simulations on the technical and non-technical skills of pediatric burn teams in acute burn management. METHODS This quasi-experimental study consisted of a one-group pre- and post-test design conducted in a pediatric burn center in Turkey. The sample consisted of nine interprofessional burn team members. Data collection tools consisted of the following: descriptive data form, burn technical skills checklists, simulation evaluation form, and Anesthesiologists' non-technical skills in Denmark rating form. RESULTS We found no statistically significant difference between the pre- and post-test scores for technical (p = 0.285) and non-technical skill (p = 0.180) scores. Burn team members evaluated the highest score in almost all criteria for in situ simulations. CONCLUSION The interprofessional in situ simulations did not improve the burn teams' acute burn management; however, according to a self-report, burn team members were satisfied with the interprofessional in situ simulation experiences and achieved their own gains.
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Affiliation(s)
- Senay Sarmasoglu Kilikcier
- Hacettepe University, Faculty of Nursing, Department of Fundamentals of Nursing/Graduate School of Health Sciences, Department of Simulation in Healthcare, 06100 Ankara, Turkey.
| | - Nazmiye Celik
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Burn Center, 06110 Ankara, Turkey.
| | - Melih Elcin
- Hacettepe University, Faculty of Medicine, Department of Medical Education and Informatics/Graduate School of Health Sciences, Department of Simulation in Healthcare 06100 Ankara, Turkey.
| | - Gulsen Keskin
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Anesthesia, 06110 Ankara, Turkey.
| | - Emrah Senel
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Pediatric Surgery,06110 Ankara, Turkey.
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Paige JT, Garbee DD, Yu Q, Zahmjahn J, Baroni de Carvalho R, Zhu L, Rusnak V, Kiselov VJ. Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:360-365. [PMID: 35515739 PMCID: PMC8936698 DOI: 10.1136/bmjstel-2020-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
Background The evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants. Methods Forty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores. Results Statistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥ 3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis. Conclusions Quality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.
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Affiliation(s)
- John T Paige
- School of Medicine, Department of Surgery, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - Deborah D Garbee
- School of Nursing, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - Qingzhao Yu
- School of Public Health, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | - John Zahmjahn
- School of Allied Health Professions, LSU Health New Orleans Health Sciences Center, New Orleans, Louisiana, USA
| | | | - Lin Zhu
- Bristol-Myers Squibb Co, New York, New York, USA
| | - Vadym Rusnak
- School of Medicine, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
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Alexandrino H, Baptista S, Vale L, Júnior JHZ, Espada PC, Junior DS, Vane LA, Carvalho VH, Marcelo L, Madeira F, Duarte R, Ferreira L, Pereira J, Pinheiro LF, Fraga GP, Mesquita C. Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses. World J Surg 2021; 44:1856-1862. [PMID: 32072223 DOI: 10.1007/s00268-020-05421-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
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Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal. .,Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Sérgio Baptista
- Centro Hospitalar Médio Tejo, EPE, Av. Maria de Lurdes Melo e Castro, Ap. 118, 2304-909, Tomar, Portugal
| | - Luís Vale
- Hospital Nélio Mendonça and Regional Emergency Service (SRPC/IPRAM) - Serviço de Saúde da RAM, E.P.E, Avenida Luís de Camões, no 57, 9004-514, Funchal, Portugal
| | - José Hélio Zen Júnior
- Hospital e Maternidade Galileo, Valinhos, São Paulo, Brazil.,Faculdade de Ciências Médicas, Pós Graduação em Ciências Médicas, Universidade Estadual de Campinas/UNICAMP, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil
| | - Paulo César Espada
- Departamento de Cirurgia Geral, Faculdade Medicina de São José do Rio Preto-FAMERP, São José de Rio Preto, Brazil
| | | | - Luiz Antonio Vane
- Faculdade de Ciências Médicas, Avenida Brigadeiro Faria Lima, 811, Putim, São José dos Campos, São Paulo, Brazil
| | - Vanessa Henriques Carvalho
- School of Medical Science - Unicamp - Campinas-Brazil School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Lara Marcelo
- Centro Hospitalar Universitário do Porto, EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Madeira
- Department of Anesthesiology, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | | | - Luís Ferreira
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Viseu, Portugal
| | | | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Carlos Mesquita
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
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Abulebda K, Thomas A, Whitfill T, Montgomery EE, Auerbach MA. Simulation Training for Community Emergency Preparedness. Pediatr Ann 2021; 50:e19-e24. [PMID: 33450035 DOI: 10.3928/19382359-20201212-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].
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Tallón-Aguilar L, Durán-Muñoz-Cruzado VM, Martínez-Casas I, Aranda-Narváez JM, Pérez-Díaz MD, Montón-Condón S, Turégano-Fuentes F, Pareja-Ciuró F. Are Spanish surgeons prepared to treat trauma patients? Multicentre descriptive observational study. Eur J Trauma Emerg Surg 2020; 48:901-906. [PMID: 32920673 DOI: 10.1007/s00068-020-01492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Specific training in the management of trauma patients is beneficial for surgeons. Training through specific courses in this area has a direct impact on the care of these patients. The aim of this work is to understand the participation and specific training in the care of trauma patients by Spanish surgeons. METHODS A national survey was conducted and administered to all members of the Spanish Association of Surgeons. The survey assessed their degree of participation in emergency surgery, and therefore the probability of attending trauma patients, their assessment of the initial care of trauma patients in their centre, and their specific training in this field. RESULTS The survey was completed by 510 surgeons from 47 Spanish provinces, with Catalonia and Andalusia being the most represented regions. In total, 456 (89.41%) of those surveyed work in the emergency department on a routine basis. Only 171 (33.53%) refer to having a registry of trauma patients in their hospital. While 79.02% of surgeons reported that general surgeons are not involved in care of severe trauma from the outset, only 66.47% have completed the ATLS course, 40.78% the DSTC course and 18.82% the MUSEC course. Despite this, 85.69% believe that the ATLS course should be compulsory during residency and 43.33% believe that severe trauma care in their hospital is poor or very poor. CONCLUSION Only 40% have received specific training in definitive surgical management of severe trauma. Despite this, a large percentage of surgeons work in the emergency department on a routine basis and potentially face the challenge of managing these patients.
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Carlson JN, Zocchi MS, Allen C, Denmark TK, Fisher JD, Wilkinson M, Remick K, Sullivan A, Pines JM, Venkat A. Critical procedure performance in pediatric patients: Results from a national emergency medicine group. Am J Emerg Med 2020; 38:1703-1709. [PMID: 32721781 DOI: 10.1016/j.ajem.2020.06.009] [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] [Received: 04/27/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022] Open
Abstract
STUDY OBJECTIVE We sought to examine the frequency of pediatric critical procedures performed in a national group of emergency physicians. METHODS We performed a retrospective analysis of an administrative billing and coding dataset for procedural performance documentation verification from 2014 to 2018. We describe and compare incident rates of pediatric (age <18 years) patient critical procedure performance by emergency physicians in general emergency departments (EDs), pediatric EDs, and freestanding ED/urgent care centers. Critical procedures were endotracheal intubation, electrical cardioversion, central venous placement, intraosseous access, and chest tube insertion. RESULTS Among 2290 emergency physicians working in 186 EDs (1844 working in 129 general EDs, 125 in 8 pediatric EDs, and 321 in 49 freestanding EDs/urgent cares), a total of 2233 pediatric critical procedures were performed during the study period. Many physicians at general EDs and freestanding EDs/urgent cares performed zero pediatric procedures per year (53.9% and 89% respectively). Per 1000 ED visits seen (All patient ages), physicians working in general EDs performed fewer pediatric critical procedures than physicians in pediatric EDs (0.12/1000 visits vs 0.68/1000 visits; rate difference = 0.56, 95% confidence interval [CI] 0.51-0.61). Per 1000 clinical hours worked, physicians working in general EDs performed 0.26 procedures compared to 1.66 for physicians in pediatric EDs (rate difference = 1.39; 95% CI 1.27-1.52). CONCLUSION Pediatric critical procedures are rarely performed by emergency physicians and are exceedingly rare in general EDs and freestanding EDs/urgent cares. The rarity of performance of these skills has implications for ED pediatric readiness.
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Affiliation(s)
- Jestin N Carlson
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America
| | - Coburn Allen
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - T Kent Denmark
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Oklahoma State University, Tulsa, OK, United States of America
| | - Jay D Fisher
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, United States of America
| | - Matthew Wilkinson
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - Katherine Remick
- US Acute Care Solutions, Canton, OH, United States of America; Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Department of Surgery and Perioperative Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Abbie Sullivan
- US Acute Care Solutions, Canton, OH, United States of America
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, United States of America.
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Walsh BM, Wong AH, Ray JM, Frallicciardi A, Nowicki T, Medzon R, Bentley S, Stapleton S. Practice Makes Perfect. Emerg Med Clin North Am 2020; 38:363-382. [DOI: 10.1016/j.emc.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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27
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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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