Simulation technology for resuscitation training: A systematic review and meta-analysis

Interprofessional team training via telemedicine in medical and nursing education

BACKGROUND

The use of information communication technologies such as telemedicine has increased over the years, offering access to specialized healthcare even in remote locations. However, telemedicine in interprofessional team training is seldom included in medical or nursing programs, and little is known about how to practise these scenarios. This study aimed to explore how medical and nursing students experience teamwork when one team member is participating remotely and digitally.

METHODS

Following interprofessional team training in which one team member participated remotely, focus group interviews were conducted with three teams, each comprising one medical student and two nursing students (n = 9 students in total). The focus group interviews were analysed with thematic content analysis. The Systems Engineering Initiative for Patient Safety model was applied as a theoretical framework and served as a lens in the analysis.

RESULTS

Three themes were identified in the analysis: challenging the dynamic of leadership, becoming familiar with a new setting, and finding new strategies to communicate.

CONCLUSIONS

The results of this study suggest that future physicians and nurses need to enhance their knowledge of practicing teamwork through telemedicine during their education, as the use of telemedicine continues to grow.

Improving Neonatal Resuscitation Knowledge in Advanced Providers Through Simulation: A Quality Improvement Project

BACKGROUND

Advanced neonatal resuscitation events are high-risk, low-volume critical situations. Healthcare systems have placed emphasis on improving resuscitation skills for advanced providers based on evidence showing that it can directly impact patient outcomes. Neonatal resuscitation program (NRP) renewal is only required every 2 years. This gap and low usage of skills can result in lack of competency and expertise leading to an increased risk of poor patient outcomes.

PURPOSE

This project aimed to provide simulation education based on NRP curriculum for a large group of advanced providers at multiple level II, III, and IV neonatal intensive care units (NICUs) and to improve confidence and knowledge in advanced resuscitation.

METHODS

A high-fidelity mannequin was used to simulate a reproducible, critical scenario that spanned the entire NRP algorithm. NRP knowledge and the effectiveness of simulation on confidence and knowledge in neonatal resuscitation were measured.

RESULTS

The average knowledge score from the pretest to the posttest improved by 7%. Based on the simulation evaluation tool-modified (SET-M), debriefing was the most effective in improving confidence and knowledge. The neonatal nurse practitioners (NNPs) with the most years of clinical experience had the largest improvement in knowledge.

IMPLICATIONS FOR PRACTICE AND RESEARCH

With the most experienced NNPs providing majority of coverage in the Level II NICUs, a correlation may be drawn that the effect of simulations on NRP knowledge has a greater impact on these groups due to the low exposure of advanced resuscitation events at these sites. Debriefing stood out as the most critical component of simulation.

Local Anesthetic Systemic Toxicity: Ensuring Sustained Nursing Knowledge in a High-Volume Outpatient Surgery Center

PURPOSE

Local anesthetic systemic toxicity (LAST) is a low-frequency, high-risk event that can occur within minutes of a patient receiving a local anesthetic. The goals of this project were to standardize LAST care management across an academic medical center and sustain an improvement in nurses' knowledge of how to recognize signs and symptoms of LAST and how to competently manage a LAST scenario.

DESIGN

We used a quantitative design to accomplish the goals of the project.

METHODS

Our interdisciplinary team developed a clinical practice guideline based on the LAST Checklist published by the American Society of Regional Anesthesia and Pain Medicine, and used a simulation scaffolded by multimodal education and system changes to ensure sustained knowledge. We measured improvement using a graded knowledge assessment as well as qualitative feedback.

FINDINGS

Scores on the assessment increased from 4.76 to 6.34 (out of seven points) following the intervention and remained significantly higher than the baseline 9 months after the educational intervention (9-month score = 6.19, t = 2.99, P = .004). Nurses reported feeling more confident and knowledgeable following the intervention and requested to have regular sessions of the simulation. To sustain improvements, we developed a computer-based learning module. The module and simulation were integrated into nursing orientation and an annual competency.

CONCLUSIONS

While standardizing LAST care in accordance with evidence-based guidance is critical to patient safety due to its infrequent occurrence, nurses should consider implementing simulation supplemented with multimodal education and system changes to ensure sustained knowledge.

Empowering medical students: bridging gaps with high-fidelity simulations; a mixed-methods study on self-efficacy

BACKGROUND

High-fidelity simulations play a crucial role in preparing for high-mortality events like cardiopulmonary arrest, emphasizing the need for rapid and accurate intervention. Proficiency in cardiopulmonary resuscitation(CPR) requires a strong self-efficacy(SE); training for both is crucial. This study assesses the impact of Advanced Life Support(ALS) simulation on SE changes in final-year medical students.

METHODS

This mixed-methods prospective simulation study involved medical students in emergency medicine internships, examining self-efficacy perceptions regarding ALS technical skills(ALS-SEP). A comparison was made between students who underwent scenario-based ALS simulation training and those who did not. Competencies in chest compression skills were assessed, and the concordance between ALS-SEP scores and observed CPR performances were evaluated. Focus group interviews were conducted and analyzed using content analysis techniques.

RESULTS

The study involved 80 students, with 53 in the experimental group(EG) and 27 in the control group(CG). The EG, underwent simulation training, showed a significantly higher ALS-SEP change than the CG(p < 0.05). However, there was low concordance between pre-simulation SEP and actual performance. Compression skills success rates were inadequate. Qualitative analysis revealed main themes as"learning"(32.6%), "self-efficacy"(29%), "simulation method"(21.3%), and "development"(16.5%).

DISCUSSION

Post-simulation, students reported improved SEP and increased readiness for future interventions. The findings and qualitative statements support the effectiveness of simulation practices in bridging the gap between SEP and performance. Utilizing simulation-based ALS training enhances learners' belief in their capabilities, raises awareness of their competencies, and encourages reflective thinking. Given the importance of high SEP for ALS, simulation trainings correlating self-efficacy perception and performance may significantly reduce potential medical errors stemming from a disparity between perceived capability and actual performance.

Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos

AIMS

To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS.

BACKGROUND

Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed.

DESIGN

A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education.

METHODS

The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting.

RESULTS

Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point.

CONCLUSION

Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.

Learning with our peers: peer-led versus instructor-led debriefing for simulated crises, a randomized controlled trial

BACKGROUND

Although peer-assisted learning is known to be effective for reciprocal learning in medical education, it has been understudied in simulation. We aimed to assess the effectiveness of peer-led compared to instructor-led debriefing for non-technical skill development in simulated crisis scenarios.

METHODS

Sixty-one undergraduate medical students were randomized into the control group (instructor-led debriefing) or an intervention group (peer debriefer or peer debriefee group). After the pre-test simulation, the participants underwent two more simulation scenarios, each followed by a debriefing session. After the second debriefing session, the participants underwent an immediate post-test simulation on the same day and a retention post-test simulation two months later. Non-technical skills for the pre-test, immediate post-test, and retention tests were assessed by two blinded raters using the Ottawa Global Rating Scale (OGRS).

RESULTS

The participants' non-technical skill performance significantly improved in all groups from the pre-test to the immediate post-test, with changes in the OGRS scores of 15.0 (95% CI [11.4, 18.7]) in the instructor-led group, 15.3 (11.5, 19.0) in the peer-debriefer group, and 17.6 (13.9, 21.4) in the peer-debriefee group. No significant differences in performance were found, after adjusting for the year of medical school training, among debriefing modalities (P = 0.147) or between the immediate post-test and retention test (P = 0.358).

CONCLUSIONS

Peer-led debriefing was as effective as instructor-led debriefing at improving undergraduate medical students' non-technical skill performance in simulated crisis situations. Peer debriefers also improved their simulated clinical skills. The peer debriefing model is a feasible alternative to the traditional, costlier instructor model.

A comparison between the effects of simulation of basic CPR training and workshops on firefighters' knowledge and skills: experimental study

BACKGROUND

One of the most common causes of death worldwide is cardiopulmonary arrest. Firefighters are among the first responders at the scenes of accidents and can, therefore, play a key part in performing basic cardiopulmonary resuscitation (CPR) for victims who need it. The present study was conducted to compare the effects of simulation training against workshops on the CPR knowledge and skills of firefighters in the south of Iran.

METHODS

This experimental (Interventional) study was conducted on 60 firefighters of south of Fars province, Iran. The study was undertaken from March to July 2023. Through random allocation, the participants were divided into two groups: simulation-based training (30 members) and traditional workshop training (30 members). The participants' CPR knowledge and practical skills were measured before, immediately after, and three months after intervention.

RESULTS

The findings of the study revealed a statistically significant difference between the pretest and posttest CPR knowledge and skill mean scores of the simulation groups as compared to the workshop group (p < 0.001). As measured three months after the intervention, the firefighters' knowledge and skill mean scores were still significantly different from their pretest mean scores (p < 0.001); however, they had declined, which can be attributed to the fact that the study population did not frequently exercise CPR.

CONCLUSION

Based on the findings of the study, even though both methods of education were effective on enhancing the firefighters' CPR knowledge and skill, simulation training had a far greater impact than training in workshops. In view of the decline in the participants' knowledge and skill scores over time, it is recommended that short simulation training courses on CPR should be repeated on a regular basis.

Improving the self-efficacy of caregivers of children with seizures using evidence-based practice

BACKGROUND

Epilepsy is considered a widespread chronic illness; it is estimated that approximately 1% of all children have the condition. Parents and caregivers of children with seizures experience fear and anxiety relative to their perceived confidence to manage their child's seizures after leaving the hospital. Evidence supports the use of simulation to educate caregivers to improve their perceived level of self-efficacy.

METHODS

The evidence-based practice project examined the impact of utilizing a simulation training session on the self-efficacy of caregivers of children with seizures at a large pediatric medical center in the southern United States. Caregivers of children with newly diagnosed seizures or with a recent change to their seizure treatment plan attended a simulation training session individualized to their discharge instructions. Demographic data, pre- and post-training self-efficacy measurements, and program satisfaction data were collected.

FINDINGS

The 31 caregivers who participated during the 3-month implementation period experienced a statistically significant increase in self-efficacy (p < .0001 to 0.002) and reported being satisfied with the simulation education training.

DISCUSSION

The project outcomes suggested simulation training was an effective method for improving the self-efficacy of caregivers of children with seizures and could be a feasible practice change at organizations with access to simulation technology.

APPLICATION TO PRACTICE

The outcomes of the project aligned with the evidence available in the literature. The results reinforced that education that includes simulated learning opportunities was generally well-received by caregivers and may improve their confidence to care for their child after discharge.

Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis

BACKGROUND

Extensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.

METHODS

A systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses.

RESULTS

The search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity.

CONCLUSION

This review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS.

PROSPERO REGISTRATION NUMBER

CRD42020162600.

Virtual Clinical Simulation for Training Amongst Undergraduate Medical Students: A Pilot Randomised Trial (VIRTUE-Pilot)

BACKGROUND

Clinical virtual simulators are promising new technologies that might facilitate teaching clinical skills.

OBJECTIVE

This study aimed to assess whether a virtual reality simulator might facilitate learning and improve adherence to current clinical guidelines.

METHODOLOGY

A double-masked randomised trial was undertaken among fourth-year medical students at Universidad Andres Bello, Chile. Participants were randomised to a clinical virtual simulator (Body Interact®, Body Interact Inc., Austin, TX) or a small-group discussion session on the management of myocardial infarction. Main outcomes included performance in an objective structured clinical examination (OSCE) and adherence to clinical recommendations. Analyses were undertaken under the intention to treat principle by an independent statistician.

RESULTS

Fifty students volunteered to participate. Most were female (30 students, 58.8%) and had a mean age of 23.0±2.7 years. Thirty-two participants (62.8%) had used virtual reality platforms before. Students allocated to the simulator showed better OSCE scores (mean difference: 2.8 points; 95% confidence interval (CI): -3.2 to +8.7 points, p=0.14) and were faster to implement diagnostic and therapeutic interventions, but not in a statistically significant way.

DISCUSSION

Academic performance was slightly improved by the use the simulator, although the overall effect was smaller than expected.

CONCLUSION

 This study examined the influence of a clinical virtual simulator on the academic performance and guideline adherence of undergraduate medical students, with small group discussions as a point of comparison. The findings revealed that there were no statistically significant distinctions between the two methods, potentially attributed to the selection of the comparator and the relatively brief intervention period.

Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training.

METHODS

A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants' confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software.

RESULTS

Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18-0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21-1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20-0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants' satisfaction and confidence demonstrated no significant benefit for HF simulation.

CONCLUSIONS

Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient's outcomes.

Implementation of a North American pediatric emergency medicine simulation curriculum using the virtual resuscitation room

Background

Simulation provides consistent opportunities for residents to practice high-stakes, low-frequency events such as pediatric resuscitations. To increase standardization across North American residency programs, the Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) was developed. However, access to high-quality simulation/pediatric expertise is not uniform. As the concurrent COVID-19 pandemic necessitated new virtual simulation methods, we adapted the Virtual Resus Room (VRR) to teach EM ReSCu Peds. VRR is an award-winning, low-resource, open-access distance telesimulation platform we hypothesize will be effective and scalable for teaching this curriculum.

Methods

EM residents completed six VRR EM ReSCu Peds simulation cases and received immediate facilitator-led teledebriefing. Learners completed retrospective pre-post surveys after each case. Learners and facilitators completed end-of-day surveys. Primary outcomes were learning effectiveness measured by a composite of the Simulation Effectiveness in Teaching Modified (SET-M) tool and self-reported changes in learner comfort with case objectives. Secondary outcome was VRR scalability to teach EM ReSCu Peds using a composite outcome of net promoter scores (NPS), resource utilization, open-text feedback, and technical issues.

Results

Learners reported significantly increased comfort with 95% (54/57) of EM ReSCu Peds-defined case objectives (91% cognitive, 9% psychomotor), with moderate (Cohen's d 0.71, 95% CI 0.67-0.76) overall effect size. SET-M responses indicated simulation effectiveness, particularly with debriefing. Ninety EM residents from three North American residency programs were taught by 59 pediatric faculty from six programs over 4 days-more than possible if simulations were conducted in person. Learners (39) and faculty (68) NPS were above software industry benchmarks (13). Minor, quickly resolved, technical issues were reported by 18% and 29% of learners and facilitators, respectively.

Conclusions

Learners and facilitators report that the VRR is an effective and scalable platform to teach EM ReSCu Peds. This low-cost, accessible distance simulation intervention could increase equitable, global access to high-quality pediatric emergency education.

Technology-enhanced simulation in emergency medicine: Updated systematic review and meta-analysis 1991-2021

Background

Over the past decade, the use of technology-enhanced simulation in emergency medicine (EM) education has grown, yet we still lack a clear understanding of its effectiveness. This systematic review aims to identify and synthesize studies evaluating the comparative effectiveness of technology-enhanced simulation in EM.

Methods

We searched MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Web of Science, and Scopus to identify EM simulation research that compares technology-enhanced simulation with other instructional modalities. Two reviewers screened articles for inclusion and abstracted information on learners, clinical topics, instructional design features, outcomes, cost, and study quality. Standardized mean difference (SMD) effect sizes were pooled using random effects.

Results

We identified 60 studies, enrolling at least 5279 learners. Of these, 23 compared technology-enhanced simulation with another instructional modality (e.g., living humans, lecture, small group), and 37 compared two forms of technology-enhanced simulation. Compared to lecture or small groups, we found simulation to have nonsignificant differences for time skills (SMD 0.33, 95% confidence interval [CI] -0.23 to 0.89, n = 3), but a large, significant effect for non-time skills (SMD 0.82, 95% CI 0.18 to 1.46, n = 8). Comparison of alternative types of technology-enhanced simulation found favorable associations with skills acquisition, of moderate magnitude, for computer-assisted guidance (compared to no computer-assisted guidance), for time skills (SMD 0.50, 95% CI -1.66 to 2.65, n = 2) and non-time skills (SMD 0.57, 95% CI 0.33 to 0.80, n = 6), and for more task repetitions (time skills SMD 1.01, 95% CI 0.16 to 1.86, n = 2) and active participation (compared to observation) for time skills (SMD 0.85, 95% CI 0.25 to 1.45, n = 2) and non-time skills (SMD 0.33 95% CI 0.08 to 0.58, n = 3).

Conclusions

Technology-enhanced simulation is effective for EM learners for skills acquisition. Features such as computer-assisted guidance, repetition, and active learning are associated with greater effectiveness.

Efficacy of Virtual Reality Simulation in Teaching Basic Life Support and Its Retention at 6 Months

Educational efficiency is the predetermining factor for increasing the survival rate of patients with cardiac arrest. Virtual reality (VR) simulation could help to improve the skills of those undergoing basic life support-automated external defibrillation (BLS-AED) training. Our purpose was to evaluate whether BLS-AED with virtual reality improves the skills and satisfaction of students enrolled in in-person training after completing the course and their retention of those skills 6 months later. This was an experimental study of first-year university students from a school of health sciences. We compared traditional training (control group-CG) with virtual reality simulation (experimental group-EG). The students were evaluated using a simulated case with three validated instruments after the completion of training and at 6 months. A total of 241 students participated in the study. After the training period, there were no statistically significant differences in knowledge evaluation or in practical skills when assessed using a feedback mannequin. Statistically significant results on defibrillation were poorer in the EG evaluated by the instructor. Retention at 6 months decreased significantly in both groups. The results of the teaching methodology using VR were similar to those obtained through traditional methodology: there was an increase in skills after training, and their retention decreased over time. Defibrillation results were better after traditional learning.

From training to education: Understanding and responding to the resuscitation education issues with ideas and theory

BACKGROUND

Alongside medical science, educational efficiency and local implementation have been identified as the three leading themes that influence cardiac arrest survival outcomes. Where the medical science domain continues to inform the contemporary evidence for the optimal practice, the remaining two education themes continue to face criticism linked to the poor sustainability of clinician resuscitation skills, with a rapid decay in abilities often evident soon after training and certification. The European Resuscitation Council recently reasserted the importance of programmes to reflect educational best practices and learning theory.

DISCUSSION

This paper discusses a selection of key contemporary theoretical themes, which directly relate to several specific ongoing education concerns.

RECCOMENDATIONS

Beyond questioning the effectiveness of current conventions to achieve sustainable knowledge and skills for the long term, it is suggested that common approaches may not be sufficient to prepare clinicians or certify competency for the complexities of these future events and that a major pedagogical shift may be required to teaching and assessment.

Utilization of a novel mobile application, "HBB Prompt", to reduce Helping Babies Breathe skills decay

BACKGROUND

Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact.

OBJECTIVE

To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training.

METHODS

HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training.

RESULTS

Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02).

CONCLUSION

HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

Effect of a hybrid team-based advanced cardiopulmonary life support simulation program for clinical nurses

BACKGROUND

During in-hospital cardiac arrest events, clinical nurses are often the first responders; therefore, nurses require sufficient advanced cardiac life support (ACLS) competency. This study aimed to verify the effects of a hybrid team-based ACLS simulation (HTAS) program (developed in this study) on nurses' ACLS performance, specifically ACLS knowledge, cardiopulmonary resuscitation (CPR) self-efficacy, and CPR-related stress.

METHODS

The developed HTAS comprised four lecture videos, one team-based skills training video, and a team-based ACLS simulation. A quasi-experimental pretest-posttest design with a comparison group (CG) was used to evaluate the effectiveness of the HTAS. Of the 226 general ward nurses with more than 6 months of clinical experience, 117 were allocated to the intervention group (IG), which attended the HTAS, and 109 to the CG, which attended only basic ACLS training.

RESULTS

The IG's ACLS performance significantly improved (t = 50.8, p < 0.001) after the training. Relative to the respective pretest conditions, posttest ACLS knowledge (t = 6.92, p < 0.001) and CPR self-efficacy (t = 6.97, p < 0.001) of the IG also significantly increased. However, when the mean difference values were compared, there was no significant difference between the two groups with respect to ACLS knowledge (t = 1.52, p = 0.130), CPR self-efficacy (t = -0.42, p = 0.673), and CPR stress (t = -0.88, p = 0.378).

CONCLUSION

The HTAS for ward nurses was effective at enhancing the nurses' ACLS performance. It is necessary to develop effective training methods for team-based ACLS and verify the sustained effects of such training.

Effectiveness of peer teaching in health professions education: A systematic review and meta-analysis

BACKGROUND

The reform in health professions education requires the focus to shift from fact memorization to exploring, analyzing, assimilating, and synthesizing information to promote active and collaborative learning. Peer teaching is one of the educational strategies.

AIMS

This review aimed to explore and synthesize quantitative evidence to determine the overall effect of peer teaching in enhancing students' theoretical knowledge and practical skills (e.g., procedural skills and resuscitation) in health professions education.

METHODS

PubMed, ScienceDirect, CINAHL, ERIC, ProQuest, reference lists of relevant studies, and reviews were searched till November 2021. Results were pooled using random-effects meta-analysis or narrative synthesis.

RESULTS

A total of 44 RCTs were included. This review showed a significant effect of peer teaching on procedural skills improvement and a comparable effect on theoretical knowledge and resuscitation skills acquisition compared to the conventional teaching method. Near-peer teaching seemed to be the most effective method for skill improvement. Subgroup analysis showed no significant differences between peer teaching and conventional teaching groups (e.g., expert/faculty teaching, self-study or lectures).

CONCLUSIONS

Peer teaching seems to be a promising teaching and learning strategy in health professions education, positively affecting theoretical knowledge and procedural skills. Future research should explore the effect of peer teaching in developing countries to provide a comprehensive picture of peer teaching.

Avatar and distance simulation as a learning tool - virtual simulation technology as a facilitator or barrier? A questionnaire-based study on behalf of Netzwerk Kindersimulation e.V

Background

Virtual simulation modalities have been implemented widely since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic restrictions in March 2020, as educators face persistent restrictions to face-to-face education of medical students and healthcare professionals.There is paucity of published data regarding the benefits and barriers of distance and avatar simulation training modalities.

Methods

Following a 2-day virtual pediatric simulation competition facilitated by Netzwerk Kindersimulation e.V., using remote human avatars and distance simulation, we conducted a multicenter survey to explore the advantages and challenges of avatar and distance simulation among participants. We used a modified Delphi approach to draft and develop the 32-item online questionnaire with 7-point Likert-like scales (7 being the highest rating).

Results

Twenty participants answered our questionnaire. Respondents indicated both a high overall satisfaction (median of 5.0 [Q25-Q75: 4.0-6.0] ) for avatar and distance simulation 6.0 (5.0-6.0), respectively, as well as a high achieved psychological safety with both simulation types (5.0 [4.0-6.0] vs. 5.0 [4.0-6.0]). The most frequently reported profits of avatar and distance simulation included the elimination of travel distances, associated lower costs, less time spent attending the education activity, and effective communication and leadership training, especially with avatar simulation. Most often named challenges were technical problems, limited reception of non-verbal cues and a spatial distance from the team/educator.

Discussion

Based on the results of this pilot study, avatar and distance simulation can be employed successfully and appear to be good supplements to face-to-face simulation. Other studies are warranted to further explore the effectiveness of various types of virtual simulation compared to conventional presential simulation. We suggest using avatar-based simulation for targeted communication and leadership skills training and the application of distance simulation to bring simulation experts virtually to remote places where educator resources are lacking.

Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4-10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards. In this paper, we propose the following: (1) this monitoring be assigned to independent medical education units (MEUs), rather than to an infrastructure of the dean's office, and such MEUs to be part of the school governance and draw their authority from university institutions; and (2) the differences in the importance of the accreditation standards be addressed by discerning between the "most important" standards that have been shown to improve student well-being and/or patient health outcomes; "important" standards associated with student learning and/or performance; "possibly important" standards with face validity or conflicting evidence for validity; and "least important" standards that may lead to undesirable consequences. According to this proposal, MEUs will evolve into entities dedicated to ongoing monitoring of the education program for compliance with accreditation standards, with an authority to implement interventions. Hopefully, this will provide MEUs and faculty with the common purpose of meeting accreditation requirements, and an agreed-upon prioritization of accreditation standards will improve their communication and recommendations to faculty.

The effect of a structured ECPR protocol aided by specific simulation training in a quaternary ECMO centre: A retrospective pre-post study

Background

There is limited literature exploring the relationship between simulation training and extracorporeal cardiopulmonary resuscitation (ECPR) outcomes. We examined whether there was an association between the implementation of an in situ simulation training program and ECPR utilisation, time to extracorporeal membrane oxygenation (ECMO), and neurologically intact survival.

Methods

In this retrospective pre-post study of in-hospital cardiac arrests (IHCA) and out-of-hospital cardiac arrests (OHCA), we analysed data for all patients recorded as receiving ECPR from September 2009 to December 2020 at our institution, relative to the implementation of an in situ ECPR simulation training program and a standardised procedure for high-quality ECPR. The primary outcome was Cerebral Performance Category (CPC) 1 or 2 at hospital discharge.

Results

There were 27 patients in the pre-intervention period and 39 patients in the post-intervention period. The median ECPR rate per year was 2 pre-intervention and 7 post-intervention (p = 0.073). There was an association between the implementation of the program and decreased median time from OHCA to ECMO flow, from 87 (IQR 78–95) minutes pre-intervention to 70 (IQR 69–72) minutes post-intervention (p = 0.002). Median time from IHCA to ECMO flow was 40 (IQR 20–75) minutes pre-intervention and 28 (IQR 16–41) minutes post-intervention (p = 0.134). Survival with CPC 1 or 2 was 7/27 (25.9%) pre-intervention and 15/39 (38.5%) post-intervention (p = 0.288).

Conclusion

We observed an association between the implementation of an ECPR-specific simulation program and decreased time from OHCA to ECMO flow. There was no association between the implementation of the program and neurologically intact survival at hospital discharge.

Randomized controlled trial comparing pit crew resuscitation model against standard advanced life support training

Objectives

Pit crew models are designed to improve teamwork in critical medical situations, like advanced life support (ALS). We investigated if a pit crew model training improves performance assessment and ALS skills retention when compared to standard ALS education.

Methods

This was a prospective, blinded, randomized, and controlled, parallel-group trial. We recruited students to 4-person resuscitation teams. We video recorded simulated ALS-situations after the ALS education and after 6-month follow-up. We analyzed technical skills (TS) and non-technical skills (NTS) demonstrated in them with an instrument measuring TS and NTS, and used a linear mixed model to model the difference between the groups in the TS and NTS. Another linear model was used to explore the difference between the groups in hands-on ratio and hands-free time. The difference in the total assessment score was analyzed with the Mann-Whitney U-test. The primary outcome was the difference in the total assessment score between the groups at follow-up. ALS skills were considered to be a secondary outcome.

Results

Twenty-six teams underwent randomization. Twenty-two teams received the allocated education. Fifteen teams were evaluated at 6-month follow-up: 7 in the intervention group and 8 in the control group. At 6-month follow-up, the median (Q1-Q3) total assessment score for the control group was 6.5 (6-8) and 7 (6.25-8) for the intervention group but the difference was not significant (U = 133, P = 0.373). The intervention group performed better in terms of chest compression quality (interaction term, β3 = 0.23; 95% confidence interval, 0.01-0.50; P = 0.043) at follow-up.

Conclusion

We found no difference in overall performance between the study arms. However, trends indicate that the pit crew model may help to retain ALS skills in different areas like chest compression quality.

Early or late booster for basic life support skill for laypeople: a simulation-based randomized controlled trial

PURPOSE

Retention of skills and knowledge has been shown to be poor after resuscitation training. The effect of a "booster" is controversial and may depend on its timing. We compared the effectiveness of an early versus late booster session after Basic Life Support (BLS) training for skill retention at 4 months.

METHODS

We performed a single-blind randomized controlled trial in a simulation environment. Eligible participants were adult laypeople with no BLS training or practice in the 6 months prior to the study. We provided participants with formal BLS training followed by an immediate BLS skills post-test. We then randomized participants to one of three groups: control, early booster, or late booster. Based on their group allocation, participants attended a brief BLS refresher at either 3 weeks after training (early booster), at 2 months after training (late booster), or not at all (control). All participants underwent a BLS skills retention test at 4 months. We measured BLS skill performance according to the Heart and Stroke Foundation's skills testing checklist for adult CPR and the use of an automated external defibrillator.

RESULTS

A total of 80 laypeople were included in the analysis (control group, n = 28; early booster group, n = 23; late booster group, n = 29). The late booster group achieved better skill retention (mean difference in checklist score at retention compared to the immediate post-test = - 0.8 points out of 15, [95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6, 0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001).

CONCLUSION

A late booster session improves BLS skill retention at 4 months in laypeople.

TRIAL REGISTRATION NUMBER

NCT02998723.

The effectiveness of emergency knowledge training of pediatric medical workers based on the knowledge, skills, simulation model: a quasi-experimental study

BACKGROUND

Basic life support and advanced life support are essential emergency management skills for medical workers, and pediatricians' first aid skills can be improved through emergency knowledge training.

METHODS

A controlled pre-post-intervention quasi-experimental study design was used. The study setting was a tertiary children's hospital in China. In November 2019, a KSS model of emergency knowledge learning was developed and tested, and pediatric medical workers (N = 1448) were trained with it. The outcome measures were based on an emergency knowledge questionnaire devised by the authors that measured the effectiveness of training by comparing the pre-and post-training scores of the particpants.

RESULTS

Pediatric medical workers scored significantly higher in total emergency knowledge after the training course than before [75.00 (62.50, 85.00) versus 100.00 (95.00, 100.00); P = 0.00]. Basic life support and advanced life support knowledge score significantly improved after training. Teamwork scores were significantly higher after the training than before [5.00 (5.00, 10.00) versus 10.00 (10.00, 10.00); P = 0.00]. Scores were significantly higher after the training (P < 0.001), especially for case analysis questions (P = 0.00). The attitudes of the medical workers towards the training were all positive and affirmative.

CONCLUSION

The KSS model was shown to be effective in improving the emergency knowledge of pediatric medical workers. Future research will be to explore the effectiveness of the model with different participants and at other hospitals or other institutions such as schools, encouraging more people to participate in and evaluate the model to promote its optimization.

TRIAL REGISTRATION

Hunan Children's Hospital, HCHLL-2018-03.

Virtual Reality Simulation Training for Cardiopulmonary Resuscitation After Cardiac Surgery: Face and Content Validity Study

BACKGROUND

Cardiac arrest after cardiac surgery commonly has a reversible cause, where emergency resternotomy is often required for treatment, as recommended by international guidelines. We have developed a virtual reality (VR) simulation for training of cardiopulmonary resuscitation (CPR) and emergency resternotomy procedures after cardiac surgery, the Cardiopulmonary Resuscitation Virtual Reality Simulator (CPVR-sim). Two fictive clinical scenarios were used: one case of pulseless electrical activity (PEA) and a combined case of PEA and ventricular fibrillation. In this prospective study, we researched the face validity and content validity of the CPVR-sim.

OBJECTIVE

We designed a prospective study to assess the feasibility and to establish the face and content validity of two clinical scenarios (shockable and nonshockable cardiac arrest) of the CPVR-sim partly divided into a group of novices and experts in performing CPR and emergency resternotomies in patients after cardiac surgery.

METHODS

Clinicians (staff cardiothoracic surgeons, physicians, surgical residents, nurse practitioners, and medical students) participated in this study and performed two different scenarios, either PEA or combined PEA and ventricular fibrillation. All participants (N=41) performed a simulation and completed the questionnaire rating the simulator's usefulness, satisfaction, ease of use, effectiveness, and immersiveness to assess face validity and content validity.

RESULTS

Responses toward face validity and content validity were predominantly positive in both groups. Most participants in the PEA scenario (n=26, 87%) felt actively involved in the simulation, and 23 (77%) participants felt in charge of the situation. The participants thought it was easy to learn how to interact with the software (n=24, 80%) and thought that the software responded adequately (n=21, 70%). All 15 (100%) expert participants preferred VR training as an addition to conventional training. Moreover, 13 (87%) of the expert participants would recommend VR training to other colleagues, and 14 (93%) of the expert participants thought the CPVR-sim was a useful method to train for infrequent post-cardiac surgery emergencies requiring CPR. Additionally, 10 (91%) of the participants thought it was easy to move in the VR environment, and that the CPVR-sim responded adequately in this scenario.

CONCLUSIONS

We developed a proof-of-concept VR simulation for CPR training with two scenarios of a patient after cardiac surgery, which participants found was immersive and useful. By proving the face validity and content validity of the CPVR-sim, we present the first step toward a cardiothoracic surgery VR training platform.

Evaluation of Pediatric Immediate Life Support Courses by the Students

A retrospective analysis was performed of 1637 questionnaires among students of immediate pediatric life support (IPLS) courses. All theory and practice classes and organization and methods received an average score higher than 8.5 except for the schedule and time devoted to developing contents. All parameters evaluating instructors’ skills received a score higher than 9. Participants requested more time to practice and for course adaptation to their specific professionals needs. IPLS courses are highly valued by students. The duration of IPLS practice sessions should be increased and the course should be adapted to the specific professional needs of participants.

The Physiologic and Emotional Effects of 360-Degree Video Simulation on Head-Mounted Display Versus In-Person Simulation: A Noninferiority, Randomized Controlled Trial

INTRODUCTION

A key simulation component is its capability to elicit physiological changes, improving recall. The primary aim was to determine whether parasympathetic responses to head-mounted display simulations (HMDs) were noninferior to in-person simulations. The secondary aims explored sympathetic and affective responses and learning effectiveness.

METHODS

The authors conducted a noninferiority trial. Hospital providers who did not use chronotropic medications, have motion sickness, or have seizures were included. The authors randomized participants to in-person or HMD simulation. Biometric sensors collected respiratory sinus arrhythmia and skin conductance levels to measure parasympathetic and sympathetic states at baseline, during, and after the simulation. Affect was measured using a schedule. The authors measured 3-month recall of learning points and used split-plot analysis of variance and Mann-Whitney U tests to analyze.

RESULTS

One hundred fifteen participants qualified, and the authors analyzed 56 in each group. Both groups experienced a significant change in mean respiratory sinus arrhythmia from baseline to during and from during to afterward. The difference of change between the groups from baseline to during was 0.134 (95% confidence interval = 0.142 to 0.410, P = 0.339). The difference of change from during the simulation to after was -0.060 (95% confidence interval = -0.337 to 0.217, P = 0.670). Noninferiority was not established for either period. Sympathetic arousal did not occur in either group. Noninferiority was not established for the changes in affect that were demonstrated. The mean scores of teaching effectiveness and achievement scores were not different.

CONCLUSIONS

Although a parasympathetic and affective response to the video simulation on an HMD did occur, it was not discernibly noninferior to in-person in this study.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings

Globally, intrapartum-related complications account for approximately 2 million perinatal deaths annually. Adequate skills in neonatal resuscitation are required to reduce perinatal mortality. NeoNatalie Live is a newborn simulator providing immediate feedback, originally designed to accomplish Helping Babies Breathe training in low-resource settings. The objectives of this study were to describe changes in staff participation, skill-training frequency, and simulated ventilation quality before and after the introduction of “local motivators” in a rural Tanzanian hospital with 4000–5000 deliveries annually. Midwives (n = 15–27) were encouraged to perform in situ low-dose high-frequency simulation skill-training using NeoNatalie Live from September 2016 through to August 2018. Frequency and quality of trainings were automatically recorded in the simulator. The number of skill-trainings increased from 688 (12 months) to 8451 (11 months) after the introduction of local motivators in October 2017. Staff participation increased from 43% to 74% of the midwives. The quality of training performance, measured as “well done” feedback, increased from 75% to 91%. We conclude that training frequency, participation, and performance increased after introduction of dedicated motivators. In addition, the immediate constructive feedback features of the simulator may have influenced motivation and training quality performance.

Airborne Isolation Cardiac Arrest: A Simulation Program for Interdisciplinary Code Blue Team Training

INTRODUCTION

In-hospital cardiac arrest in patients with COVID-19 presents significant challenges to health care teams. Airborne precautions can delay patient care, place providers at high risk of virus exposure, and exacerbate an already stressful environment. Within the constraints of an ongoing pandemic, an efficient educational program is required to prepare health care teams for airborne isolation code blue.

METHODS

This simulation was conducted in a room on the target unit using a CPR manikin to represent the patient. A "talk-through walk-through" scripted simulation directed learners (internal medicine residents, unit nurses, and other code blue responders) through a resuscitation using an airborne isolation code blue protocol. Key scripted events prompted role identification, communication, and item transfer. Learners self-assessed their airborne isolation code blue knowledge and skills and their confidence in providing quality care while maintaining safety using a pre-/posttraining 5-point Likert-scale survey.

RESULTS

We trained 100 participants over a 5-month period, with 65 participants surveyed (43 respondents; 16 residents, 22 nurses). Following training, participants had a statistically significant (p < .001) increase in percentage selecting agree/strongly agree for all statements related to knowledge and skills specific to airborne isolation code blue protocol, as well as confidence in providing care while keeping themselves and their colleagues safe.

DISCUSSION

Our simulation program allowed a small number of educators to feasibly train a large number of learners, let learners practice required skills, and improved learners' self-assessed knowledge, skills, and confidence regarding quality and safety of care.

Video recording emergency care and video-reflection to improve patient care; a narrative review and case-study of a neonatal intensive care unit

As the complexity of emergency care increases, current research methods to improve care are often unable to capture all aspects of everyday clinical practice. Video recordings can visualize clinical care in an objective way. They can be used as a tool to assess care and to reflect on care with the caregivers themselves. Although the use of video recordings to reflect on medical interventions (video-reflection) has increased over the years, it is still not used on a regular basis. However, video-reflection proved to be of educational value and can improve teams' management and performance. It has a positive effect on guideline adherence, documentation, clinical care and teamwork. Recordings can also be used for video-reflexivity. Here, caregivers review recordings together to reflect on their everyday practice from new perspectives with regard to context and conduct in general. Although video-reflection in emergency care has proven to be valuable, certain preconditions have to be met and obstacles need to be overcome. These include gaining trust of the caregivers, having a proper consent-procedure, maintaining confidentiality and adequate use of technical equipment. To implement the lessons learned from video-reflection in a sustainable way and to continuously improve care, it should be integrated in regular simulation training or education. This narrative review will describe the development of video recording in emergency care and how video-reflection can improve patient care and safety in new ways. On our own department, the NICU at the LUMC, video-reflection has already been implemented and we want to further expand this. We will describe the use of video-reflection in our own unit. Based on the results of this narrative review we will propose options for future research to increase the value of video-reflection.

Competency-based medical education in radiotherapy treatment planning

PURPOSE

To develop a technology-enhanced education methodology with competency-based evaluation for radiotherapy treatment planning. The education program is designed for integration in the existing framework of Commission on Accreditation of Medical Physics Education Programs (CAMPEP) accredited medical physics residency programs.

MATERIALS AND METHODS

This education program pairs an accessible, multi-institutional infrastructure with established medical education evaluation tools to modernize treatment planning education. This program includes three evaluation components: (i) competency-based evaluation, (ii) inter- and intra-modality comparison, and (iii) learner feedback. For this study, synchronous bilateral breast cancer was selected to demonstrate a complex treatment site and non-standardized technique. Additionally, an online study was made available to a public cohort of worldwide participants of certified Medical Dosimetrists and Medical Physicists to benchmark performance. Prior to evaluation, learners were given a disease site-specific education session on potential clinical treatment strategies. During the assessment, learners generated treatment plans in their institutional planning system under the direct observation of an expert evaluator. Qualitative proficiency was evaluated for all learners on a five-point scale of graduated task independence. Quantitative dosimetry was compared between the learner cohort and public cohort. A feedback session provided learners context of multi-institutional experience through multimodality and technique comparison. After study completion, learners were provided a survey that was used to gauge their perception of the education program.

RESULTS

In the public study, 34 participants submitted treatment plans. Across three CAMPEP-accredited residency programs, six learners participated in the education and evaluation program. All learners successfully completed treatment plans that met the dosimetric constraints described in the case study. All learners favourably reviewed the study either comprehensively or in specified domains.

CONCLUSION

The competency-based education and evaluation program developed in this work has been incorporated in CAMPEP-accredited residency programs and is adaptable to other residency programs with minimal resource commitment.

Effectiveness of simulation-based training for obstetric internal medicine: Impact of cognitive load and emotions on knowledge acquisition and retention

Background

Simulation-based training’s impact on learning outcomes may be related to cognitive load or emotions during training. We evaluated the association of validated measures of cognitive load and emotion with learning outcomes in simulation-based obstetric internal medicine cases.

Methods

All internal medicine learners (n = 15) who completed the knowledge test pre-training, post-training (knowledge acquisition), and at 3–6 months (knowledge retention) for all three simulation cases were included.

Results

Mean knowledge scores differed over time in all three cases (p < 0.0001 for all). Knowledge retention scores were significantly higher only for cases 1 and 3. Cognitive load associated with frustration was positively associated with knowledge acquisition for case 2 (beta = 5.18, P = 0.007), while excitement was negatively associated with knowledge retention in case 1 (beta = –33.07, p = 0.04).

Conclusion

Simulation-based education for obstetric internal medicine can be effective in select cases. Attention to cognitive load and emotion may optimize learning outcomes.

Simulation and Active Learning Decreases Training Time of an Emergency Triage Assessment and Treatment Course in Pilot Study in Malawi: Implications for Increasing Efficiency and Workforce Capacity in Low-Resource Settings

OBJECTIVES

The aim of the Emergency Triage Assessment and Treatment (ETAT) plus trauma course is to improve the quality of care provided to infants and children younger than 5 years. The curriculum was revised and shortened from 5 to 2.5 days by enhancing simulation and active learning opportunities. The aim of this study was to examine the feasibility and value of the new short-form ETAT course by assessing postcourse knowledge and satisfaction.

METHODS

We delivered the short-form ETAT course to a group of interdisciplinary health workers in Malawi. Precourse and postcourse knowledge was assessed using a standardized 20 questions short answer test used previously in the 5-day courses. A 13-statement survey with 2 open-ended questions was used to examine participant satisfaction.

RESULTS

Participants' postcourse knowledge improved significantly (P < 0.001) after the shorter ETAT course. Participants reported high levels of satisfaction with the short-form ETAT.

CONCLUSIONS

Simulation and other active learning strategies reduced training time by 50% in the short-form ETAT course. Participants with and without previous ETAT training improved their knowledge after participating in the short-form ETAT course. Reduced training time is beneficial in settings already burdened by scarce human resources, may facilitate better access to in-service training, and build capacity while conserving resources in low-resource settings.

Training junior doctors to lead rapid responses

BACKGROUND

Transitions during medical training are a significant source of stress, and junior doctors (residents) primarily learn new skills through on-the-job training. As residents transition from postgraduate year (PGY) 1 to 2, they take on new responsibilities, including the management of clinically unstable patients in rapid response (RR) scenarios.

APPROACH

In 2018, the internal medicine training programme at Brigham and Women's Hospital implemented a 'Transitions Retreat' to prepare PGY-1s for Year 2. In an informal survey, residents endorsed feeling underprepared to lead RRs. We designed a simulation-based curriculum to teach these skills. Participants completed a questionnaire pre-simulation and post-simulation exploring their perceived preparedness. Volunteer residents assessed performance on the simulation using skills checklists and led structured debriefing sessions. We audiotaped, transcribed and thematically analysed these sessions.

EVALUATION

Forty-eight of 58 (82%) PGY-1s participated. Pre-intervention, 12.5% felt 'well-prepared' or 'very well-prepared' to lead RRs, compared with 33% post-intervention. Through qualitative analysis, we identified four key themes in our post-simulation debriefing conversations: (1) the chaos of RRs, (2) emotional reactions during RRs, (3) challenges and goals of task management and (4) value of interdisciplinary collaboration.

IMPLICATIONS

Though the majority of residents indicated that the curriculum enabled their preparedness to lead RRs and allowed them to process complex emotions in a safe space, we do not know how well this experience translates to the clinical setting. Therefore, we aim to collect follow-up data 6 months into the PGY-2 to explore residents' reflections on real-life experiences as well as whether the simulation impacted their preparedness to lead real-life RRs.

Évaluation des éléments perturbateurs lors de réanimation cardiopulmonaire aux urgences

Introduction : La simulation est un outil d’enseignement en médecine qui a montré un bénéfice entre autres pour l’apprentissage de la réanimation cardiopulmonaire (RCP). Cependant, la RCP simulée peut différer grandement de la RCP en conditions réelles. Le but de cette étude exploratoire était d’identifier des éléments perturbateurs susceptibles d’intervenir lors d’une RCP.

Méthodes : Il s’agit d’une étude transversale anonyme par questionnaire distribué par courrier électronique aux urgentistes de cinq services d’urgences à Paris. Le questionnaire comprenait des questions sur les éléments perturbateurs lors d’une RCP. D’autres questions ont exploré les différences perçues entre la RCP simulée et la RCP réelle. Les résultats sont exprimés sous forme de pourcentages et moyennes (± écart-type).

Résultats : Sur 100 médecins interrogés, 43 (43 %) réponses ont été analysées. Cinquante-trois pour cent étaient des femmes âgées en moyenne de 32 ± 3 ans. Les éléments perturbateurs de la RCP dans la vie réelle étaient principalement les interruptions de tâches provenant du personnel non médical (n = 16 ; 37 %), de la famille du patient (n = 5 ; 12 %), des autres spécialistes (n = 5 ; 12 %) et des appels téléphoniques (n = 2 ; 5 %). La saturation du flux patient des urgences (n = 12 ; 28 %) a également été mentionnée comme perturbateur. Les médecins ont aussi déclaré que certaines compétences techniques et non techniques étaient plus difficiles à réaliser dans la vie réelle que lors de simulations.

Conclusion : Cette étude exploratoire a permis d’identifier des éléments perturbateurs rencontrés dans des cas réels de RCP qui pourront être intégrés aux sessions de simulation afin d’en augmenter le réalisme.

Learner reflections on a postgraduate emergency medicine simulation curriculum: a qualitative exploration based on focus group interviews

OBJECTIVES

To describe postgraduate emergency medicine (EM) residents' perceptions of simulation-based curriculum immediately post-simulation training.

METHODS

This interpretive qualitative study explores residents' reflections on a city-wide, adult EM simulation-based curriculum. Focus group interviews gather residents' insights immediately post-simulation. Postgraduate trainees from the University of Toronto EM residency program were eligible to participate. We explored participants' perceptions of how well learning objectives were addressed, helpful/challenging aspects of the simulations, feelings during sessions, debriefing/pre-briefing, simulation integration into the broader EM curriculum, and anticipated changes in practice after the session.

RESULTS

Our findings indicate that EM residents' learning goals for the simulation sessions evolve as they progress through residency training. Junior trainees report performance-oriented goals while senior trainees report learning-oriented goals. Differing motivations may affect residents' perceptions of the quality of the simulation experience. Junior residents want to feel prepared for the scenario and primed with the appropriate knowledge to manage the case. Senior residents focus on developing teamwork competencies and on mastering new clinical skills in the simulation environment.

CONCLUSIONS

Junior and senior emergency medicine residents differ in their goal orientation during simulation-based training. Educators who develop simulation-based curricula should be mindful that junior residents may benefit from preparatory materials while senior residents prefer to be challenged. Resident reflections may significantly contribute to improvement of simulation-based curricula.

European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.

Simulation training programs for acute stroke care: Objectives and standards of methodology

The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.

Operating room team training using simulation: Hope or hype?

BACKGROUND

This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training.

METHOD

Two-wave survey study (immediate post-training survey 2010-2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests.

RESULTS

Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations.

CONCLUSIONS

Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored.

Implementation of Simulation Training During the COVID-19 Pandemic: A New York Hospital Experience

SUMMARY STATEMENT

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Social distancing in advanced emergency medicine courses - can it work?

Introduction: The corona virus pandemic rendered most live education this spring term impossible. Many classes were converted into e-learning formats. But not all learning content and outcomes can readily be transferred into digital space. Project outline: Emergency medicine teaching relies on hands-on simulation training. Therefore, we had to devise a catalogue of measures, that would enable us to offer simulation training for Advanced Life Support. Summary of work: Strict hygienic rules including disinfection of hands, wearing personal protective gear at all times and disinfection of equipment were implemented. Group size and number of staff was reduced, introducing fixed student teams accompanied by the same teacher. Only large rooms with good ventilation were used. Under these conditions, we were allowed to carry out core Advanced Life Support simulations. Other content had to be transferred to online platforms. Discussion: Heeding general hygiene advise and using personal protective gear, a central cluster of simulations was carried out. Students and staff adhered to rules without complaint. No infections within faculty or student body were reported. Conclusion: It seems feasible to conduct core simulations under strict hygienic protocol.

Evaluation of the pediatric life support instructors courses

OBJECTIVE

To evaluate the results and quality of pediatric cardiopulmonary resuscitation (CPR) instructor training courses.

METHODS

A retrospective analysis was performed of the results of 24 pediatric CPR instructor courses held over 21 years (1999 to 2019). The results of participants' evaluation of theory and practice sessions were analyzed. In addition, participants were asked to answer an anonymous survey to assess their opinion on the quality of theory and practice lessons, course organization and methodology, and instructor training. The results were compared by professional groups.

RESULTS

A total of 560 participants completed the instructor course. Of them, 554 passed theory and practice tests (98.9 %). The mean score obtained in theory tests was 9.2 (0.8) out of 10. The mean score obtained in all practice tests was > 3.5 out of 5. Participants evaluated all the aspects of the course (theory and practice content, organization, teaching methodology, and instructors) with mean scores over 8 out of 10.

CONCLUSIONS

Specific pediatric and neonatal CPR instructor courses are a cornerstone in the process of CPR training and ensuring the homogeneity and quality of training. Most of the participants obtained the qualification of instructors and their evaluation of the course was very positive.

Simulation-based training in cardiology: State-of-the-art review from the French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology

In our healthcare system, mindful of patient safety and the reduction of medical errors, simulation-based training has emerged as the cornerstone of medical education, allowing quality training in complete safety for patients. Initiated by anaesthesiologists, this teaching mode effectively allows a gradual transfer of learning, and has become an essential tool in cardiology teaching. Cardiologists are embracing simulation to master complex techniques in interventional cardiology, to manage crisis situations and unusual complications and to develop medical teamwork. Simulation methods in cardiology include high-fidelity simulators, clinical scenarios, serious games, hybrid simulation and virtual reality. Simulation involves all fields of cardiology: transoesophageal echocardiography, cardiac catheterization, coronary angioplasty and electrophysiology. Beyond purely technical issues, simulation can also enhance communication skills, by using standardized patients, and can improve the management of situations related to the announcement of serious diseases. In this review of recent literature, we present existing simulation modalities, their applications in different fields of cardiology and their advantages and limitations. Finally, we detail the growing role for simulation in the teaching of medical students following the recent legal obligation to use simulation to evaluate medical students in France.

[Newborn resuscitation and support of transition of infants at birth]

The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.

Simulation-based training for increasing health service board members' effectiveness: a cluster randomised controlled trial

OBJECTIVES

There is a paucity of research on how to improve the functioning of health service boards, despite their importance in influencing patient care. We examined the impact of simulation-based training on health service board members' perceptions of their skills in communicating during board meetings and of board meeting processes.

DESIGN

Prospective, cluster randomised controlled trial.

SETTING

Health service boards in Victoria, Australia.

PARTICIPANTS

Twelve boards were randomised, and pre- and post-intervention data were collected and analysed from 57 members of these boards.

INTERVENTIONS

Boards were randomly allocated to either a treatment condition in which they received a 2-hour simulation-based training session or to a wait list control condition.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome variables were board members' perceptions regarding: (1) their skill and confidence in communicating during board meetings and (2) processes at their board meetings. Measures were collected in the intervention group before and 3 months post-training and compared with a wait list control group.

RESULTS

Skills and confidence in communicating during board meetings was higher after training (control marginal mean=5.11, intervention marginal mean=5.42, mean difference=0.31, 90% CI (-0.03 to 0.66), one-sided p=0.068, d=0.40). Board meeting processes were also improved after training (control marginal mean=4.97, intervention marginal mean=5.37, mean difference=0.40, 90% CI (0.14 to 0.65), one-sided p=0.005, d=0.54).

CONCLUSIONS

Simulation-based training appeared to improve board members' skills and confidence, and perceptions of board meeting processes. A larger scale trial is needed to examine possible impacts on patient outcomes.

TRIAL REGISTRATION

Open Science Framework: http://osf.io/jaxt6/; Pre-results.