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Sahi N, Humphrey-Murto S, Brennan EE, O'Brien M, Hall AK. Current use of simulation for EPA assessment in emergency medicine. CAN J EMERG MED 2024; 26:179-187. [PMID: 38374281 DOI: 10.1007/s43678-024-00649-9] [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: 01/04/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Approximately five years ago, the Royal College emergency medicine programs in Canada implemented a competency-based paradigm and introduced the use of Entrustable Professional Activities (EPAs) for assessment of units of professional activity to assess trainees. Many competency-based medical education (CBME) based curricula, involve assessing for entrustment through observations of EPAs. While EPAs are frequently assessed in clinical settings, simulation is also used. This study aimed to characterize the use of simulation for EPA assessment. METHODS A study interview guide was jointly developed by all study authors and followed best practices for survey development. A national interview was conducted with program directors or assistant program directors across all the Royal College emergency medicine programs across Canada. Interviews were conducted over Microsoft Teams, interviews were recorded and transcribed, using Microsoft Teams transcribing service. Sample transcripts were analyzed for theme development. Themes were then reviewed by co-authors to ensure they were representative of the participants' views. RESULTS A 64.7% response rate was achieved. Simulation has been widely adopted by EM training programs. All interviewees demonstrated support for the use of simulation for EPA assessment for many reasons, however, PDs acknowledged limitations and thematic analysis revealed certain themes and tensions for using simulation for EPA assessment. Thematic analysis revealed six major themes: widespread support for the use of simulation for EPA assessment, concerns regarding the potential for EPA assessment to become a "tick- box" exercise, logistical barriers limiting the use of simulation for EPA assessment, varied perceptions about the authenticity of using simulation for EPA assessment, the potential for simulation for EPA assessment to compromise learner psychological safety, and suggestions for the optimization of use of simulation for EPA assessment. CONCLUSIONS Our findings offer insight for other programs and specialties on how simulation for EPA assessment can best be utilized. Programs should use these findings when considering using simulation for EPA assessment.
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Affiliation(s)
- Nidhi Sahi
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, ON, Canada.
| | - Susan Humphrey-Murto
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Tier 2 Research Chair in Medical Education and Fellowship Director, Medical Education Research, University of Ottawa, Ottawa, ON, Canada
| | - Erin E Brennan
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Michael O'Brien
- Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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Alam F, LeBlanc VR, Baxter A, Tarshis J, Piquette D, Gu Y, Filipowska C, Krywenky A, Kester-Greene N, Cardinal P, Andrews M, Chartier F, Burrows C, Houzé-Cerfon CH, Burns JK, Kaustov L, Au S, Lam S, DeSousa S, Boet S. Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study. Br J Anaesth 2024; 132:383-391. [PMID: 38087740 DOI: 10.1016/j.bja.2023.10.040] [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: 04/14/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians. METHODS Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3-6 months later (retention post-test). RESULTS For the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=-0.30, P<0.05) and technical checklist scores (r=-0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3-6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=-0.30, P<0.05). CONCLUSIONS A reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3-6 months, regardless of age or years in practice.
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Affiliation(s)
- Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine University of Toronto, Toronto, ON, Canada.
| | - Vicki R LeBlanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Simulation & Skills Centre, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Alan Baxter
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jordan Tarshis
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine University of Toronto, Toronto, ON, Canada
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yuqi Gu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Caroline Filipowska
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ashley Krywenky
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Kester-Greene
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Pierre Cardinal
- Department of Critical Care Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Meghan Andrews
- Department of Anesthesiology and Pain Medicine, Montfort Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Francois Chartier
- Le Centre Hospitalier Affilié Universitaire Régional (CHAUR), Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ), Trois-Rivière, QC, Canada
| | - Claire Burrows
- Department of Anaesthesia, Western Health, Melbourne, VIC, Australia; Western Health Anaesthesia and Critical Care Simulation, Melbourne, VIC, Australia
| | - Charles-Henri Houzé-Cerfon
- Department of Emergency Medicine, Toulouse University Hospital, Toulouse, France; Toulouse Institute of Simulation Healthcare, Toulouse University Hospital, Toulouse, France
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lilia Kaustov
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shelly Au
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandy Lam
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Susan DeSousa
- Sunnybrook Canadian Simulation Centre, Toronto, ON, Canada
| | - Sylvain Boet
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Domínguez-Torres LC, Vega-Peña NV. Pyramids in medical education: Their conceptualization and utility summarized. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:163-174. [PMID: 37523683 PMCID: PMC10419883 DOI: 10.18597/rcog.3994] [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: 01/27/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023]
Abstract
Objectives To examine the conceptual underpinnings of learning pyramids, their limitations and some proposed modifications, and to describe their utility. Materials and methods Starting with a selection of pyramids based on whether graphic design was part of their original design and on their conceptual description, we examined the criticisms they have received and the modifications derived from those observations, and the use given to the pyramids most commonly used in medical education. Results Five pyramids were included, namely, George Miller, Edgar Dale, Donald Kirkpatrick, Benjamín Bloom and Abraham Maslow. Pyramids describe different aspects of medical education evaluation, either of individuals or of training programs, including competencies, identity, reliability, learning, behavior, results, cognitive complexity and self-realization. Conclusions As theoretical models, the pyramids examined have contributed to support learning processes in health professions. Their practical utility extends to different specialties and education levels given that they can help faculty optimize curricular design, teaching and evaluation processes. It is important to conduct a local assessment of the effects on health science programs built on these theoretical models.
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Tavares W, Piquette D, Luong D, Chiu M, Dyte C, Fraser K, Clark M. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:188-197. [PMID: 36728972 DOI: 10.1097/ceh.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD. METHODS A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted. RESULTS The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993-2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement. DISCUSSION Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.
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Affiliation(s)
- Walter Tavares
- Dr. Tavares: Assistant Professor and Scientist, Wilson Centre for Health Professions Education, Temerty Faculty of Medicine, Institute for Health Policy Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada, and York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket Ontario, Canada. Dr. Piquette: Assistant Professor, Inter-Department Division of Critical Care Medicine, University of Toronto, Staff Physician, Sunnybrook Health Sciences Centre, Centre Researcher, The Wilson Centre, Toronto, Ontario, Canada. Ms. Luong: Research Associate II, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Dr. Chiu: Associate Professor, Department of Anesthesiology and Pain Medicine, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Dyte: Clinical Lecturer and Anesthesiologist, Department of Anesthesia, Perioperative and Pain Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Fraser: Clinical Professor of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Clark: Clinical Associate Professor of Surgery, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
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Bregman S, Thau E, Pusic M, Perez M, Boutis K. A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 44:28-34. [PMID: 36728983 DOI: 10.1097/ceh.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/19/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION There is limited knowledge on pediatric chest radiograph (pCXR) interpretation skill among practicing physicians. We systematically determined baseline interpretation skill, the number of pCXR cases physicians required complete to achieve a performance benchmark, and which diagnoses posed the greatest diagnostic challenge. METHODS Physicians interpreted 434 pCXR cases via a web-based platform until they achieved a performance benchmark of 85% accuracy, sensitivity, and specificity. Interpretation difficulty scores for each case were derived by applying one-parameter item response theory to participant data. We compared interpretation difficulty scores across diagnostic categories and described the diagnoses of the 30% most difficult-to-interpret cases. RESULTS 240 physicians who practice in one of three geographic areas interpreted cases, yielding 56,833 pCXR case interpretations. The initial diagnostic performance (first 50 cases) of our participants demonstrated an accuracy of 68.9%, sensitivity of 69.4%, and a specificity of 68.4%. The median number of cases completed to achieve the performance benchmark was 102 (interquartile range 69, 176; min, max, 54, 431). Among the 30% most difficult-to-interpret cases, 39.2% were normal pCXR and 32.3% were cases of lobar pneumonia. Cases with a single trauma-related imaging finding, cardiac, hilar, and diaphragmatic pathologies were also among the most challenging. DISCUSSION At baseline, practicing physicians misdiagnosed about one-third of pCXR and there was up to an eight-fold difference between participants in number of cases completed to achieve the standardized performance benchmark. We also identified the diagnoses with the greatest potential for educational intervention.
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Affiliation(s)
- Stacey Bregman
- Dr. Bregman: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Dr. Thau: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. Dr. Pusic: Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard University; Boston, MA. Dr. Perez: Department of Diagnostic Imaging, University of Toronto, Ontario, Canada. Dr. Boutis: Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Castellanos-Ortega Á, Broch MJ, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga MJ, Sancho E, Fuentes-Dura MDC, Sancerni-Beitia MD, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022; 46:491-500. [PMID: 36057440 DOI: 10.1016/j.medine.2022.01.001] [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: 12/07/2021] [Accepted: 01/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. DESIGN Observational multicenter study. SETTING Thirteen Spanish ICU Departments. PARTICIPANTS Thirty six R3. INTERVENTION The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. MAIN VARIABLES OF INTEREST Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. RESULTS A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. CONCLUSION The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency. TRIAL REGISTRATION COBALIDATION. NCT04278976. (https://register. CLINICALTRIALS gov).
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Affiliation(s)
- Á Castellanos-Ortega
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Broch
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - V Gómez-Tello
- Intensive Care Department, University Hospital Moncloa, Madrid, Spain
| | - M Valdivia
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - C Vicent
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - I Madrid
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - N Martinez
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - M J Párraga
- Intensive Care Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - E Sancho
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M D C Fuentes-Dura
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - M D Sancerni-Beitia
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - R García-Ros
- Department of Developmental and Educational Psychology, University of Valencia, Spain.
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Herrera-Aliaga E, Estrada LD. Trends and Innovations of Simulation for Twenty First Century Medical Education. Front Public Health 2022; 10:619769. [PMID: 35309206 PMCID: PMC8929194 DOI: 10.3389/fpubh.2022.619769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
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Affiliation(s)
| | - Lisbell D. Estrada
- Faculty of Health Sciences, Universidad Bernardo O'Higgins, Santiago, Chile
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Castellanos-Ortega Á, Broch M, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga M, Sancho E, Fuentes-Dura M, Sancerni-Beitia M, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rees SE, Spadaro S, Dalla Corte F, Dey N, Brohus JB, Scaramuzzo G, Lodahl D, Winding RR, Volta CA, Karbing DS. Transparent decision support for mechanical ventilation using visualization of clinical preferences. Biomed Eng Online 2022; 21:5. [PMID: 35073928 PMCID: PMC8785460 DOI: 10.1186/s12938-021-00974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Systems aiding in selecting the correct settings for mechanical ventilation should visualize patient information at an appropriate level of complexity, so as to reduce information overload and to make reasoning behind advice transparent. Metaphor graphics have been applied to this effect, but these have largely been used to display diagnostic and physiologic information, rather than the clinical decision at hand. This paper describes how the conflicting goals of mechanical ventilation can be visualized and applied in making decisions. Data from previous studies are analyzed to assess whether visual patterns exist which may be of use to the clinical decision maker. Materials and methods The structure and screen visualizations of a commercial clinical decision support system (CDSS) are described, including the visualization of the conflicting goals of mechanical ventilation represented as a hexagon. Retrospective analysis is performed on 95 patients from 2 previous clinical studies applying the CDSS, to identify repeated patterns of hexagon symbols. Results Visual patterns were identified describing optimal ventilation, over and under ventilation and pressure support, and over oxygenation, with these patterns identified for both control and support modes of mechanical ventilation. Numerous clinical examples are presented for these patterns illustrating their potential interpretation at the bedside. Conclusions Visual patterns can be identified which describe the trade-offs required in mechanical ventilation. These may have potential to reduce information overload and help in simple and rapid identification of sub-optimal settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-021-00974-5.
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Khalil H, Liu C. Design and Implementation of a Contemporary Health Administration Program for Health Managers. Front Public Health 2021; 9:735055. [PMID: 34692625 PMCID: PMC8530165 DOI: 10.3389/fpubh.2021.735055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background: While there are core competencies required in health administration programs, little is known about how they are taught in health administration programs to support/change practises. This discussion paper describes an educational innovation to design a contemporary Master of Health Administration program to meet the current needs of health managers in Australia based on evidence-based practise. Method: A detailed gap analysis of health managers educational needs was undertaken with various stakeholders to design a contemporary health managers' program. Stakeholders surveyed in the course design included prospective students, international students' agencies, prospective employers, Alumni evaluation, mapping of health managers courses in Australia and faculty feedback. An integrative pedagogical approach was used to implement the program into action. Results: Various themes were emerged from the stakeholder consultations including the importance of basic knowledge of key subjects and the significance of learning new skills such as strategic planning and emotional intelligence in the workplace. The integrative pedagogical approach used is based on adult teaching principles, which were identified by Knowles. The subjects in the new course incorporate several knowledge-based presentations along with interactive activities, including use of general ability-based outcomes to define learning opportunities, case-based and problem-based learning, experiential learning, and comprehensive assessments. Conclusion: The results of this intensive consultation led to the design of a contemporary Master of Health Administration Course that included eight core subjects and multiple options of specialisations for students to choose from. Examples of specialisations include aged care and ageing, health promotion, data for decision making, public health, international development and Health Strategy and decision making.
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Affiliation(s)
- Hanan Khalil
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Dalinghaus K, Regehr G, Nimmon L. Intersections of power: videoconferenced debriefing of a rural interprofessional simulation team by an urban interprofessional debriefing team. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:286-292. [PMID: 34106435 PMCID: PMC8505583 DOI: 10.1007/s40037-021-00669-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Simulation as an educational tool is known to have benefits. Moreover, the use of simulation in continuing interprofessional development is vital in rural and remote communities with limited case volumes and resources. This study explored power dynamics between rural simulation participants and urban expert co-debriefers during a simulated operating room crisis and debriefing. The aim is to gain a rich understanding of rural/urban relational dynamics embedded within the constraints and affordances of videoconferencing technology. METHODS In situ observations of a videoconference-enabled simulation and debriefing were conducted, followed by seven semi-structured interviews, in this qualitative case study. A sociomateriality lens with additional sensitizing concepts of power from critical theory was employed to explore human and nonhuman interactions between rural learners, urban co-debriefers, and videoconferencing technology. RESULTS The interviews exposed subtle expressions of power dynamics at play that were curiously not observable in the enactment of the exercise. Rural learners appreciated the objectivity of the urban debriefers as well as the nurse/physician dyad. However, rural participants appeared to quietly dismiss feedback when it was incongruent with their context. Videoconference technology added both benefits and constraints to these relational dynamics. DISCUSSION Awareness of power relationships, and insights into affordances and constraints of videoconferencing may enhance operationalization of interprofessional simulation-based education (SBE) in rural and remote contexts.
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Affiliation(s)
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Mastoras GN, Cheung WJ, Krywenky A, Addleman S, Weitzman B, Frank JR. Faculty Sim: Implementation of an Innovative, Simulation-based Continuing Professional Development Curriculum for Academic Emergency Physicians. AEM EDUCATION AND TRAINING 2021; 5:e10559. [PMID: 34124507 PMCID: PMC8171772 DOI: 10.1002/aet2.10559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Maintaining and enhancing competence in the breadth of emergency medicine (EM) is an ongoing challenge. In particular, resuscitative care in EM involves high-risk clinical encounters that demand strong procedural skills, effective team leadership, and up-to-date clinical knowledge. Simulation-based medical education is an effective modality for enhancing technical and nontechnical skills in crisis situations and has been effectively embedded in undergraduate and postgraduate medical curricula worldwide. To our knowledge, there are few existing systematic department-wide simulation programs to address continuing professional development (CPD) for practicing academic EM faculty. DEVELOPMENT PROCESS We developed our novel, simulation-based CPD program following Kern's six-step model. Based on the results of a multimodal needs assessment, a longitudinal curriculum was mapped and tailored to the available resources. Institutional support was provided in the form of a departmental grant to fund a physician program lead, monthly session instructors, and operating costs. OUTCOMES CPD simulation sessions commenced in January 2017. Our needs assessment identified two key types of educational needs: 1) crisis resource management skills and 2) frequent practice of high-stakes critical care procedures (e.g., surgical airways). Simulation sessions involve two high-fidelity simulated resuscitations and one skills lab per day. To date, 21 sessions have been delivered, reaching 161 practicing EPs. Feedback from our faculty has been positive. REFLECTIVE DISCUSSION We have successfully introduced a curriculum of monthly simulation-based CPD based on the educational needs of our EPs. Future work will include more detailed program evaluation linked to clinical outcomes and program expansion to support nearby institutions.
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Affiliation(s)
- George N. Mastoras
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Warren J. Cheung
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
- and theRoyal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Ashley Krywenky
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sarah Addleman
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Brian Weitzman
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Jason R. Frank
- From theDepartment of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntarioCanada
- and theRoyal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
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14
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Samuel A, Cervero RM, Durning SJ, Maggio LA. Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:913-923. [PMID: 33332905 DOI: 10.1097/acm.0000000000003899] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes? METHOD In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4. RESULTS Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. CONCLUSIONS Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.
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Affiliation(s)
- Anita Samuel
- A. Samuel is assistant professor, Department of Medicine and Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-9488-9565
| | - Ronald M Cervero
- R.M. Cervero is professor, Department of Medicine, and deputy director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Steven J Durning
- S.J. Durning is professor, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lauren A Maggio
- L.A. Maggio is associate professor, Department of Medicine, and associate director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-2997-6133
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15
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Lindsay S, Kolne K, Barker DJ, Colantonio A, Stinson J, Moll S, Thomson N. Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation. JMIR Form Res 2021; 5:e23568. [PMID: 33720023 PMCID: PMC8075068 DOI: 10.2196/23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/15/2020] [Accepted: 01/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Donna J Barker
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicole Thomson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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16
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Grau-Mercier L, Chetioui A, Muller L, Roger C, Genre Grandpierre R, de La Coussaye JE, Cuvillon P, Claret PG, Bobbia X. Magnetic needle-tracking device for ultrasound guidance of radial artery puncture: A randomized study on a simulation model. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:212-217. [PMID: 33196110 DOI: 10.1002/jcu.22945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Ultrasound-guidance of radial artery catheter insertion improves the first attempt success and reduces the occurrence of hematomas. Needle-tracking devices optimize needle-ultrasound beam alignment by displaying in real-time the needle tip position. We compared the median time need by experienced physicians to achieve radial artery puncture using either a conventional ultrasonography device (CUD) or a magnetic needle-tracking ultrasound device (MUD) in a simulation training arm model. METHODS Fifty experienced residents and physicians performed two punctures in randomized order with the CUD and the MUD. The primary outcome was puncture duration; the secondary outcomes were puncture success, rate of accidental vein puncture, and practitioner's comfort (subjective scale 0-10). RESULTS The median [lower-upper quartile] puncture time was 10 [6-14] seconds when using CUD and 4 [3-7] seconds when using MUD (P < .01). In the multivariate analysis, MUD use was associated with decreased puncture duration whatever the puncture order (OR 1.13 [1.07-1.20], P < .01). The participants performed 99 (99%) successful punctures: 50 with the MUD (100%) and 49 with the CUD (98%). There was no accidental venous puncture. The practitioner's comfort level was 6.5 [6, 7] with the CUD and 8 [7-9] with the MUD (P < .01). CONCLUSION MUD reduced radial artery puncture time and improved physician comfort in a simulation training arm model.
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Affiliation(s)
- Laura Grau-Mercier
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Adrien Chetioui
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Laurent Muller
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Romain Genre Grandpierre
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Philippe Cuvillon
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Montpellier University, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
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Gao P, Wang C, Liu S, Tran KC, Wen Q. Simulation of operating room crisis management - hypotension training for pre-clinical students. BMC MEDICAL EDUCATION 2021; 21:60. [PMID: 33461550 PMCID: PMC7814582 DOI: 10.1186/s12909-020-02477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation training is an essential criterion for medical staff. The majority of residents are trained in operating room crisis management (ORCM), but only a few pre-clinical anesthesia undergraduate students are trained. Anesthesia methodology and technology were studied by the anesthesia undergraduate students in theory, but they were not able to practically resolve all clinical problems scientifically and reasonably. Consequently, there is a need to apply their competencies and bring together their technology knowledge practically. The crisis management of operating room emergencies was a method of choice applied and used over time. Here, we designed the scenarios for comprehensive crisis management to train anesthesia undergraduate students. We tried to establish or identify the problems which occurred during attempts to implement these scenarios. METHODS Anesthesia undergraduate students initially examined the basic theory, fundamental practice techniques, and case studies before the simulation training program. Subsequently, they participated in comprehensive ORCM training. Training outcomes were evaluated through different viewpoints: understanding the subject, crisis management, nontechnical skills, and a user experience evaluation. RESULTS Anesthesia undergraduate students performed significantly better with completion of ORCM, indicated by higher scores in all four tests (P < 0.001), as well as clinical crisis management (P = 0.0016) and nontechnical skills (P = 0.0002). Following the simulation, the students described the experience as helpful in "combining theoretical knowledge with clinical practice", helpful with memorization, and in "promoting understanding of the subject," while "learning clinical logic authentically" and "inspiring learning interests." CONCLUSIONS This research indicates that ORCM could be implemented as a useful learning tool for pre-clinical anesthesia undergraduate students. The ORCM could be an excellent training method to help improve students' professional competence in crisis management and nontechnical skills, integrating the knowledge and technology of the field of anesthesiology.
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Affiliation(s)
- Peng Gao
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China.
| | - Chenyu Wang
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China
| | - Shijia Liu
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China
| | - Kevin C Tran
- Department of Physiology and Cell Biology, The Ohio State College of Medicine, 43210, Columbus, Ohio, USA
| | - Qingping Wen
- Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO.222 Zhongshan Road, 116011, Dalian, China.
- Department of Anesthesiology, Dalian Medical University, 116044, Dalian, China.
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18
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Leung JS, Brar M, Eltorki M, Middleton K, Patel L, Doyle M, Ngo Q. Development of an in situ simulation-based continuing professional development curriculum in pediatric emergency medicine. Adv Simul (Lond) 2020; 5:12. [PMID: 32617177 PMCID: PMC7326623 DOI: 10.1186/s41077-020-00129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuing professional development (CPD) activities delivered by simulation to independently practicing physicians are becoming increasingly popular. At present, the educational potential of such simulations is limited by the inability to create effective curricula for the CPD audience. In contrast to medical trainees, CPD activities lack pre-defined learning expectations and, instead, emphasize self-directed learning, which may not encompass true learning needs. We hypothesize that we could generate an interprofessional CPD simulation curriculum for practicing pediatric emergency medicine (PEM) physicians in a single-center tertiary care hospital using a deliberative approach combined with Kern's six-step method of curriculum development. METHODS From a comprehensive core list of 94 possible PEM clinical presentations and procedures, we generated an 18-scenario CPD simulation curriculum. We conducted a comprehensive perceived and unperceived needs assessment on topics to include, incorporating opinions of faculty PEM physicians, hospital leadership, interprofessional colleagues, and expert opinion on patient benefit, simulation feasibility, and value of simulating the case for learning. To systematically rank items while balancing the needs of all stakeholders, we used a prioritization matrix to generate objective "priority scores." These scores were used by CPD planners to deliberately determine the simulation curriculum contents. RESULTS We describe a novel three-step CPD simulation curriculum design method involving (1) systematic and deliberate needs assessment, (2) systematic prioritization, and (3) curriculum synthesis. Of practicing PEM physicians, 17/20 responded to the perceived learning needs survey, while 6/6 leaders responded to the unperceived needs assessment. These ranked data were input to a five-variable prioritization matrix generating priority scores. Based on local needs, the highest 18 scoring clinical presentations and procedures were selected for final inclusion in a PEM CPD simulation curriculum. An interim survey of PEM physician (21/24 respondents) opinions was collected, with 90% finding educational value with the curriculum. The curriculum includes items not identified by self-directed learning that PEM physicians thought should be included. CONCLUSIONS We highlight a novel methodology for PEM physicians that can be adapted by other specialities when designing their own CPD simulation curriculum. This methodology objectively considers and prioritizes the needs of practicing physicians and stakeholders involved in CPD.
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Affiliation(s)
- James S. Leung
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Health Sciences Centre, Room 2R014, 1280 Main Street W, Hamilton, ON L8N 3Z5 Canada
| | - Mandeep Brar
- Emergency Department – McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Health Sciences Centre, Room 2R014, 1280 Main Street W, Hamilton, ON L8N 3Z5 Canada
| | - Kevin Middleton
- Simulation and Outreach, McMaster Children’s Hospital, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Leanne Patel
- Emergency Department – McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | - Meagan Doyle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Health Sciences Centre, Room 2R014, 1280 Main Street W, Hamilton, ON L8N 3Z5 Canada
| | - Quang Ngo
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Health Sciences Centre, Room 2R014, 1280 Main Street W, Hamilton, ON L8N 3Z5 Canada
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19
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Mouli TC, Davuluri A, Vijaya S, Priyanka ADY, Mishra SK. Effectiveness of simulation based teaching of ventilatory management among non-anaesthesiology residents to manage COVID 19 pandemic - A Quasi experimental cross sectional pilot study. Indian J Anaesth 2020; 64:S136-S140. [PMID: 32773853 PMCID: PMC7293371 DOI: 10.4103/ija.ija_452_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Simulation is one of the important learning tools when it comes to skill acquisition and as a supplemental tool for training in high stake situations like COVID-19. The aim of this study is to meet the global requirements of knowledge on ventilatory management, prepare and to evaluate the effectiveness of the teaching module for non-anesthesiology trainees on COVID-19 patients. METHODS Quasi experimental cross sectional pilot study was conducted with a sample of twenty-six trainees. A teaching module was prepared and validated which consisted of lectures, audio-video sessions, demonstrations with hands-on training, debriefing, analytical-phase and reflection. Pre and Post evaluations from student t-test and direct observation of procedural skills (DOPS) were used for knowledge and skill assessment respectively and feedback obtained from Likert's score. RESULTS Pre- and Post-tests had a mean score of 7.42 ± 2.12 and 14.92 ± 2.9 respectively (P value 0.00001). DOPS included 16 point score, in which 23 trainees (88.4%) met the expectations and above expectations as per training objectives. A five-point Likert's score feedback revealed satisfactory and highly satisfactory scores of 100% (ABG), 96.1% (mechanical ventilation), and 84.6% (ventilation in COVID-19 patients). Overall satisfaction for the workshop among respondents was 100 per cent. Confidences of handling scores were 84.5% (interpreting ABG), 65.3% (maneuvering mechanical ventilation), and 96.15% (intubation in COVID-19 patients). CONCLUSION A planned teaching module in ventilation management helps to train non-anaesthesiologists more effectively as a part of COVID-19 preparedness. Simulation with debriefing based training to the medical fraternity is the best alternative in the present pandemic and it will also ensure the safety of health care professionals.
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Affiliation(s)
- Tatikonda Chandra Mouli
- Department of Anaesthesiology And Critical Care, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Anjani Davuluri
- Department of Anaesthesiology And Critical Care, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Sana Vijaya
- Department of General Surgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Avala Devi Yamini Priyanka
- Department of Anaesthesiology And Critical Care, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Sushant Kumar Mishra
- Department of Community Medicine, GSL Medical College, Rajahmundry, Andhra Pradesh, India
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20
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Lemarie P, Husser Vidal S, Gergaud S, Verger X, Rineau E, Berton J, Parot-Schinkel E, Hamel JF, Lasocki S. High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial. Anesth Analg 2020; 129:121-128. [PMID: 29933269 DOI: 10.1213/ane.0000000000003581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015). CONCLUSIONS High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.
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Affiliation(s)
- Pierre Lemarie
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Solenne Husser Vidal
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Soizic Gergaud
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Xavier Verger
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France
| | - Emmanuel Rineau
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Jerome Berton
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
| | - Elsa Parot-Schinkel
- L'UBL, Université d'Angers, Maison de la Recherche, CHU d'Angers, Angers, France
| | - Jean-François Hamel
- L'UBL, Université d'Angers, Maison de la Recherche, CHU d'Angers, Angers, France
| | - Sigismond Lasocki
- From the Département d'Anesthésie-Réanimation, L'UBL, Université d'Angers, CHU d'Angers, Angers, France.,L'UBL, Université d'Angers, All'Sims (Angers Loire Learning Simulation en Santé), Angers, France
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21
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Tavares W. Roads less traveled: understanding the "why" in simulation as an integrated continuing professional development activity. Adv Simul (Lond) 2019; 4:24. [PMID: 31741749 PMCID: PMC6849187 DOI: 10.1186/s41077-019-0111-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background The simulation community has experienced significant advances, strengthening the case for the use of simulation in medical education toward improving patient outcomes. However, an underlying assumption particularly regarding utilization of simulation by those who are in practice, is that simulation will be selected as a continuing professional development (CPD) strategy. Exploring reasons for choices of educational formats, particularly regarding simulation, is poorly integrated into CPD research. Discussion Despite significant advances the scientific simulation community has been slow to produce evidence regarding why practitioners may be reserved in engaging in simulation or not. Using examples from related education contexts the author attempts to bridge simulation science, CPD and less commonly used theoretical frameworks to address this issue. The author argues that theoretical perspectives that recognize the use of simulation for CPD as a socio-personal process and/or a personal or group issue (e.g., theories of intelligence, self-determination theory, theory of planned behavior, social identity theory) and that are conceptually distinct from educational mechanisms/ provision are necessary to advance simulation use in CPD contexts. Conclusion Given the close relationship practicing clinicians have to patient outcomes a new imperative may be to focus on the theoretical and practical links informing simulation use for CPD at the level of the individual and individual-among-professional groups. The simulation community may therefore need to engage in research that attempts to further uncover and address underlying issues of “why” clinicians integrate simulation as CPD activities or not.
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Affiliation(s)
- Walter Tavares
- 1The Wilson Centre, University Health Network, 200 Elizabeth St. 1Es-565, Toronto, Ontario M5G 2C4 Canada.,2Post MD Education, Faculty of Medicine, Univeristy of Toronto, Toronto, Ontario Canada.,The Regional Municipality of York, Community and Health Services, Newmarket, Ontario Canada
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22
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Hunt J, Brannan E, Sexson S. Lifelong Learning for Professional Development in Psychiatry: Pedagogy, Innovations, and Maintenance of Certification. Psychiatr Clin North Am 2019; 42:425-437. [PMID: 31358122 DOI: 10.1016/j.psc.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The American Board of Medical Specialties, which includes the American Board of Psychiatry and Neurology, promotes standards focusing on changes in physicians' medical knowledge and skills. The authors describe the literature concerning the effectiveness of lifelong learning. They review the status of the American Board of Psychiatry and Neurology Maintenance of Certification program as an example of a model of lifelong learning, including an innovative pilot. The final sections include a discussion of new innovations to consider in continuing professional development and a reflection about the state of lifelong learning within the context of maintenance of certification in psychiatry.
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Affiliation(s)
- Jeffrey Hunt
- Child and Adolescent Psychiatry Fellowship and Triple Board Program, Division of Child and Adolescent Psychiatry, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.
| | - Elizabeth Brannan
- Division of Child and Adolescent Psychiatry, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Sandra Sexson
- Child, Adolescent and Family Psychiatry, CAP Residency Training, Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, 997 St. Sebastian Way, Augusta, GA 30912, USA
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Houzé-Cerfon CH, Boet S, Marhar F, Saint-Jean M, Geeraerts T. [Simulation-based interprofessional education for critical care teams: Concept, implementation and assessment]. Presse Med 2019; 48:780-787. [PMID: 31383383 DOI: 10.1016/j.lpm.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/06/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022] Open
Abstract
Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.
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Affiliation(s)
- Charles-Henri Houzé-Cerfon
- University hospital of Toulouse, emergency department, SAMU 31, 31059 Toulouse, France; Institut Toulousain de Simulation en Santé, University Hospital of Toulouse, 31059 Toulouse, France; Université Toulouse Jean-Jaurès, département sciences de l'éducation et de la formation, Unité mixte de recherche éducation, formation, travail, savoirs (UMR EFTS), 31058 ToulouseFrance.
| | - Sylvain Boet
- University of Ottawa and The Ottawa Hospital, Department of Anesthesiology and Pain Medicine, K1Y 4E9 Ottawa, Ontario, Canada; University of Ottawa, Department of Innovation in Medical Education, K1Y 4E9 Ottawa, Ontario, France
| | - Fouad Marhar
- Institut Toulousain de Simulation en Santé, University Hospital of Toulouse, 31059 Toulouse, France; University Hospital of Toulouse, Department of Anaesthesia and Intensive Care, 31059 Toulouse, France
| | - Michèle Saint-Jean
- Université Toulouse Jean-Jaurès, département sciences de l'éducation et de la formation, Unité mixte de recherche éducation, formation, travail, savoirs (UMR EFTS), 31058 ToulouseFrance
| | - Thomas Geeraerts
- Institut Toulousain de Simulation en Santé, University Hospital of Toulouse, 31059 Toulouse, France; University Hospital of Toulouse, Department of Anaesthesia and Intensive Care, 31059 Toulouse, France
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Chetioui A, Masia T, Claret PG, Markarian T, Muller L, Lefrant JY, de La Coussaye JE, Roger C, Bobbia X. Pocket-sized ultrasound device for internal jugular puncture: A randomized study of performance on a simulation model. J Vasc Access 2018; 20:404-408. [DOI: 10.1177/1129729818812733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Adrien Chetioui
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaud Masia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
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Abelsson A, Lundberg L. Simulation as a means to develop firefighters as emergency care professionals. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018; 25:650-657. [PMID: 30362390 DOI: 10.1080/10803548.2018.1541122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective. The aim of this study was to evaluate the simulated emergency care performed by firefighters and their perception of simulation as an educational method. Methods. This study had a mixed method with both a quantitative and a qualitative approach. Data were collected by simulation assessment, a questionnaire and written comments. Descriptive analysis was conducted on the quantitative data whereas a qualitative content analysis was conducted on the qualitative data. Finally, a contingent analysis was used where a synthesis configured both the quantitative and the qualitative results into a narrative result. Results. The cognitive workload that firefighters face during simulated emergency care is crucial for learning. In this study, the severity and complexity of the scenarios provided were higher than expected by the firefighters. Clearly stated conditions for the simulation and constructive feedback were considered positive for learning. Patient actors induced realism in the scenario, increasing the experience of stress, in comparison to a manikin. Conclusion. Simulation in a realistic on-scene environment increases firefighters' cognitive ability to critically analyze problems and manage emergency care. Simulation of emergency care developed the firefighters as professionals.
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Affiliation(s)
- Anna Abelsson
- a School of Health Sciences, Jönköping University , Sweden
| | - Lars Lundberg
- b Swedish Armed Forces Centre for Defence Medicine , Sweden.,c PreHospen - Centre for Prehospital Research, University of Borås , Sweden
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Simulation Training for Residents Focused on Mechanical Ventilation: A Randomized Trial Using Mannequin-Based Versus Computer-Based Simulation. Simul Healthc 2018; 12:349-355. [PMID: 28825930 PMCID: PMC5768222 DOI: 10.1097/sih.0000000000000249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Supplemental digital content is available in the text. Introduction Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances in knowledge into better therapeutic performance in real-life clinical settings continues to lag. High-fidelity simulation with a mannequin allows students to interact in lifelike situations; this may be a valuable addition to traditional didactic teaching. The purpose of this study is to compare computer-based and mannequin-based approaches for training residents on MV. Methods This prospective randomized single-blind trial involved 50 residents. All participants attended the same didactic lecture on respiratory pathophysiology and were subsequently randomized into two groups: the mannequin group (n = 25) and the computer screen–based simulator group (n = 25). One week later, each underwent a training assessment using five different scenarios of acute respiratory failure of different etiologies. Later, both groups underwent further testing of patient management, using in situ high-fidelity simulation of a patient with acute respiratory distress syndrome. Results Baseline knowledge was not significantly different between the two groups (P = 0.72). Regarding the training assessment, no significant differences were detected between the groups. In the final assessment, the scores of only the mannequin group significantly improved between the training and final session in terms of either global rating score [3.0 (2.5–4.0) vs. 2.0 (2.0–3.0), P = 0.005] or percentage of key score (82% vs. 71%, P = 0.001). Conclusions Mannequin-based simulation has the potential to improve skills in managing MV.
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Husebø SE, Silvennoinen M, Rosqvist E, Masiello I. Status of Nordic research on simulation-based learning in healthcare: an integrative review. Adv Simul (Lond) 2018; 3:12. [PMID: 30002918 PMCID: PMC6032768 DOI: 10.1186/s41077-018-0071-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Based on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research. Methods An integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis. Results The Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety. Conclusion This review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings. Electronic supplementary material The online version of this article (10.1186/s41077-018-0071-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sissel Eikeland Husebø
- 1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,2Department of Surgery, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Social Sciences, University of Southeast Norway, Porsgrunn, Norway
| | - Minna Silvennoinen
- 4School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland.,5Department of Teacher Education, University of Jyväskylä, Jyväskylä, Finland
| | - Eerika Rosqvist
- 6Department of Education and Science, The Center of Medical Expertise, Central Finland Healthcare District, Jyväskylä, Finland
| | - Italo Masiello
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Henriksen K, Rodrick D, Grace EN, Brady PJ. Challenges in Health Care Simulation: Are We Learning Anything New? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:705-708. [PMID: 28817431 DOI: 10.1097/acm.0000000000001891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The growth of health care simulation in schools of medicine and nursing is noteworthy, as is the increasingly sophisticated simulation technology, support from funding agencies and foundations for research, well-attended annual conferences, and continued interest of accreditation and certification groups. Yet there are concerns preventing the full value of health care simulation to be realized when examined from a patient safety perspective. Basic questions are asked by funders of patient safety research when assessing past simulation projects undertaken to advance patient safety: Are the safety and quality of care to patients actually improved, and is something new being learned regarding the optimal use of simulation? Concerns focus on pursuing the right research questions to learn something new about the most effective use of simulation; doing more with simulation than simply providing an interesting, stand-alone educational experience; attending more seriously to how skill acquisition, maintenance, and progression get managed; and encouraging investigators, funders, and reviewers to expand their vision regarding what constitutes important inquiry and evidence in health care simulation. Patient safety remains a multifaceted challenge in the United States, requiring multifaceted approaches. Simulation training is considered a promising approach for improving the safety and quality of health services delivery. While it takes time for any new approach to gain momentum and learn from past efforts, it also will require addressing a systematic range of essential questions to improve existing knowledge on the optimal use of simulation, and to realize similar gains in safety that other high-risk industries have made.
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Affiliation(s)
- Kerm Henriksen
- K. Henriksen is senior advisor, Human Factors and Patient Safety, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland. D. Rodrick is health scientist administrator, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland. E.N. Grace is deputy director, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland. P.J. Brady is director, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
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Alam F, LeBlanc VR, Baxter A, Tarshis J, Piquette D, Gu Y, Filipkowska C, Krywenky A, Kester-Greene N, Cardinal P, Au S, Lam S, Boet S, Clinical Trials Group PA. Does the age of acute care physicians impact their (1) crisis management performance and (2) learning after simulation-based education? A protocol for a multicentre prospective cohort study in Toronto and Ottawa, Canada. BMJ Open 2018; 8:e020940. [PMID: 29680811 PMCID: PMC5914762 DOI: 10.1136/bmjopen-2017-020940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/09/2018] [Accepted: 04/06/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The proportion of older acute care physicians (ACPs) has been steadily increasing. Ageing is associated with physiological changes and prospective research investigating how such age-related physiological changes affect clinical performance, including crisis resource management (CRM) skills, is lacking. There is a gap in the literature on whether physician's age influences baseline CRM performance and also learning from simulation. We aim to investigate whether ageing is associated with baseline CRM skills of ACPs (emergency, critical care and anaesthesia) using simulated crisis scenarios and to assess whether ageing influences learning from simulation-based education. METHODS AND ANALYSIS This is a prospective cohort multicentre study recruiting ACPs from the Universities of Toronto and Ottawa, Canada. Each participant will manage an advanced cardiovascular life support crisis-simulated scenario (pretest) and then be debriefed on their CRM skills. They will then manage another simulated crisis scenario (immediate post-test). Three months after, participants will return to manage a third simulated crisis scenario (retention post-test). The relationship between biological age and chronological age will be assessed by measuring the participants CRM skills and their ability to learn from high-fidelity simulation. ETHICS AND DISSEMINATION This protocol was approved by Sunnybrook Health Sciences Centre Research Ethics Board (REB Number 140-2015) and the Ottawa Health Science Network Research Ethics Board (#20150173-01H). The results will be disseminated in a peer-reviewed journal and at scientific meetings. TRIAL REGISTRATION NUMBER NCT02683447; Pre-results.
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Affiliation(s)
- Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Vicki R LeBlanc
- Department of Innovation in Medical Education and University of Ottawa Skillssy, University of Ottawa, Ottawa, Ontario, Canada
- Simulation Centre, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Baxter
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Toronto, Ontario, Canada
| | - Jordan Tarshis
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yuqi Gu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Toronto, Ontario, Canada
| | - Caroline Filipkowska
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Krywenky
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Kester-Greene
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Cardinal
- Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Shelly Au
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandy Lam
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Toronto, Ontario, Canada
| | - Sylvain Boet
- Department of Innovation in Medical Education and University of Ottawa Skillssy, University of Ottawa, Ottawa, Ontario, Canada
- Simulation Centre, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Toronto, Ontario, Canada
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Chen J, Yang J, Hu F, Yu SH, Yang BX, Liu Q, Zhu XP. Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study. Intensive Crit Care Nurs 2018; 46:51-56. [PMID: 29550157 DOI: 10.1016/j.iccn.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. OBJECTIVE To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. DESIGN Two-group, non-randomised quasi-experimental design. SETTING A simulation centre in a Chinese University School of Nursing. PARTICIPANTS Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). METHODS The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). RESULTS Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. CONCLUSION A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation.
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Affiliation(s)
- Jie Chen
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China; University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026, USA
| | - Jian Yang
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Fen Hu
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Si-Hong Yu
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Bing-Xiang Yang
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Qian Liu
- Wuhan University School of Health Sciences, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Xiao-Ping Zhu
- Nursing Department, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan 430071, China.
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Dettinger JC, Kamau S, Calkins K, Cohen SR, Cranmer J, Kibore M, Gachuno O, Walker D. Measuring movement towards improved emergency obstetric care in rural Kenya with implementation of the PRONTO simulation and team training program. MATERNAL AND CHILD NUTRITION 2018; 14 Suppl 1. [PMID: 29493898 DOI: 10.1111/mcn.12465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Abstract
As the proportion of facility-based births increases, so does the need to ensure that mothers and their newborns receive quality care. Developing facility-oriented obstetric and neonatal training programs grounded in principles of teamwork utilizing simulation-based training for emergency response is an important strategy for improving the quality care. This study uses 3 dimensions of the Kirkpatrick Model to measure the impact of PRONTO International (PRONTO) simulation-based training as part of the Linda Afya ya Mama na Mtoto (LAMMP, Protect the Health of mother and child) in Kenya. Changes in knowledge of obstetric and neonatal emergency response, self-efficacy, and teamwork were analyzed using longitudinal, fixed-effects, linear regression models. Participants from 26 facilities participated in the training between 2013 and 2014. The results demonstrate improvements in knowledge, self-efficacy, and teamwork self-assessment. When comparing pre-Module I scores with post-training scores, improvements range from 9 to 24 percentage points (p values < .0001 to .026). Compared to baseline, post-Module I and post-Module II (3 months later) scores in these domains were similar. The intervention not only improved participant teamwork skills, obstetric and neonatal knowledge, and self-efficacy but also fostered sustained changes at 3 months. The proportion of facilities achieving self-defined strategic goals was high: 95.8% of the 192 strategic goals. Participants rated the PRONTO intervention as extremely useful, with an overall score of 1.4 out of 5 (1, extremely useful; 5, not at all useful). Evaluation of how these improvements affect maternal and perinatal clinical outcomes is forthcoming.
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Affiliation(s)
- Julia C Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Kimberly Calkins
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Susanna R Cohen
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - John Cranmer
- School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Minnie Kibore
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Dilys Walker
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Stanley C, Lindsay S, Parker K, Kawamura A, Samad Zubairi M. Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:184-189. [PMID: 29746322 DOI: 10.1097/ceh.0000000000000198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection. METHODS Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration. RESULTS The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles. DISCUSSION A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.
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Affiliation(s)
- Claire Stanley
- Ms. Claire Stanley: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dr. Sally Lindsay: Scientist, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, and Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada. Dr. Kathryn Parker: Senior Director, Academic Affairs and Simulation Lead, Teaching and Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada. Dr. Anne Kawamura: Developmental Pediatrician, Department of Pediatrics, Division of Developmental Pediatrics, University of Toronto, and Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada. Dr. Mohammad Samad Zubairi: Developmental Pediatrician, Department of Pediatrics, Division of Developmental Pediatrics, University of Toronto, and Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists. Anesthesiology 2017; 127:475-489. [DOI: 10.1097/aln.0000000000001739] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods.
Methods
A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant’s technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist.
Results
Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance.
Conclusions
Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.
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Pérez Alonso N, Pardo Rios M, Juguera Rodriguez L, Vera Catalan T, Segura Melgarejo F, Lopez Ayuso B, Martí Nez Riquelme C, Lasheras Velasco J. Randomised clinical simulation designed to evaluate the effect of telemedicine using Google Glass on cardiopulmonary resuscitation (CPR). Emerg Med J 2017; 34:734-738. [PMID: 28768700 DOI: 10.1136/emermed-2016-205998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 04/20/2017] [Accepted: 06/11/2017] [Indexed: 01/13/2023]
Abstract
AIM Through a clinical simulation, this study aims to assess the effect of telematics support through Google Glass (GG) from an expert physician on performance of cardiopulmonary resuscitation (CPR) performed by a group of nurses, as compared with a control group of nurses receiving no assistance. METHODS This was a randomised study carried out at the Catholic University of Murcia (November 2014-February 2015). Nursing professionals from the Emergency Medical Services in Murcia (Spain) were asked to perform in a clinical simulation of cardiac arrest. Half of the nurses were randomly chosen to receive coaching from physicians through GG, while the other half did not receive any coaching (controls). The main outcome of the study expected was successful defibrillation, which restores sinus rhythm. RESULTS Thirty-six nurses were enrolled in each study group. Statistically significant differences were found in the percentages of successful defibrillation (100% GG vs 78% control; p=0005) and CPR completion times: 213.91 s for GG and 250.31 s for control (average difference=36.39 s (95% CI 12.03 to 60.75), p=0.004). CONCLUSIONS Telematics support by an expert through GG improves success rates and completion times while performing CPR in simulated clinical situations for nurses in simulated scenarios.
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Affiliation(s)
- Nuria Pérez Alonso
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Manuel Pardo Rios
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Laura Juguera Rodriguez
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Tomas Vera Catalan
- Nursing Faculty, Master's degree in Cardiovascular Risk of the Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Belen Lopez Ayuso
- Computer Engineering Faculty, Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Joaquin Lasheras Velasco
- Computer Engineering Faculty, Catholic University of Murcia (UCAM), Murcia, Spain.,Center of Information Technologies and Communications (CENTIC) of Murcia, Murcia, Spain
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Dias RD, Scalabrini-Neto A. Acute stress in residents playing different roles during emergency simulations: a preliminary study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:239-243. [PMID: 28658657 PMCID: PMC5511741 DOI: 10.5116/ijme.5929.60f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate acute stress response in residents playing nurse and physician roles during emergency simulations. METHODS Sixteen second-year internal medicine residents participated in teams of four (two playing physician roles and two playing nurse roles). Stress markers were assessed in 24 simulations at baseline (T1) and immediately after the scenario (T2), using heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary cortisol and salivary interleukin-1β. The State-Trait Anxiety Inventory was applied at T2. Continuous data were summarized for the median (1st-3rd interquartile ranges), and the Mann-Whitney U Test was used to compare the groups. RESULTS The percent variations of the stress markers in the physician and nurse roles, respectively, were the following: heart rate: 70.5% (46.0-136.5) versus 53.0% (29.5-117.0), U=89.00, p=0.35; systolic blood pressure: 3.0% (0.0-10.0) versus 2.0% (-2.0-9.0), U=59.50, p=0.46; diastolic blood pressure: 5.5% (0.0-13.5) versus 0.0% (0.0-11.5), U=91.50, p=0.27; α-amylase: -5.35% (-62.70-73.90) versus 42.3% (12.4-133.8), U=23.00, p=0.08; cortisol: 35.3% (22.2-83.5) versus 42.3% (12.4-133.8), U=64.00, p=0.08); and interleukin-1β: 54.4% (21.9-109.3) versus 112.55% (29.7-263.3), U= 24.00, p=0.277. For the physician and nurse roles, respectively, the average heart rate was 101.5 (92.0-104.0) versus 91.0 (83.0-99.5) beats per minute, U=96.50, p=0.160; and the state anxiety inventory score was 44.0 (40.0-50.0) versus 42.0 (37.50-48.0) points, U= 89.50, p=0.319. CONCLUSIONS Different roles during emergency simulations evoked similar participants' engagement, as indicated by acute stress levels. Role-play strategies can provide high psychological fidelity for simulation-based training, and these results reinforce the potential of role-play methodologies in medical education.
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Affiliation(s)
- Roger Daglius Dias
- Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Augusto Scalabrini-Neto
- Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Noveanu J, Amsler F, Ummenhofer W, von Wyl T, Zuercher M. Assessment of Simulated Emergency Scenarios: Are Trained Observers Necessary? PREHOSP EMERG CARE 2017; 21:511-524. [DOI: 10.1080/10903127.2017.1302528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Raurell-Torredà M, Gómez-Ibañez R. La simulación de alta fidelidad: ¿quién tiene el laboratorio más impactante? ENFERMERIA INTENSIVA 2017; 28:45-47. [DOI: 10.1016/j.enfi.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
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DeMaria S, Levine A, Petrou P, Feldman D, Kischak P, Burden A, Goldberg A. Performance gaps and improvement plans from a 5-hospital simulation programme for anaesthesiology providers: a retrospective study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:37-42. [DOI: 10.1136/bmjstel-2016-000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 01/08/2023]
Abstract
BackgroundSimulation is increasingly employed in healthcare provider education, but usage as a means of identifying system-wide practitioner gaps has been limited. We sought to determine whether practice gaps could be identified, and if meaningful improvement plans could result from a simulation course for anaesthesiology providers.MethodsOver a 2-year cycle, 288 anaesthesiologists and 67 certified registered nurse anaesthetists (CRNAs) participated in a 3.5 hour, malpractice insurer-mandated simulation course, encountering 4 scenarios. 5 anaesthesiology departments within 3 urban academic healthcare systems were represented. A real-time rater scored each individual on 12 critical performance items (CPIs) representing learning objectives for a given scenario. Participants completed a course satisfaction survey, a 1-month postcourse practice improvement plan (PIP) and a 6-month follow-up survey.ResultsAll recorded course data were retrospectively reviewed. Course satisfaction was generally positive (88–97% positive rating by item). 4231 individual CPIs were recorded (of a possible 4260 rateable), with a majority of participants demonstrating remediable gaps in medical/technical and non-technical skills (97% of groups had at least one instance of a remediable gap in communication/non-technical skills during at least one of the scenarios). 6 months following the course, 91% of respondents reported successfully implementing 1 or more of their PIPs. Improvements in equipment/environmental resources or personal knowledge domains were most often successful, and several individual reports demonstrated a positive impact on actual practice.ConclusionsThis professional liability insurer-initiated simulation course for 5 anaesthesiology departments was feasible to deliver and well received. Practice gaps were identified during the course and remediation of gaps, and/or application of new knowledge, skills and resources was reported by participants.
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Isaranuwatchai W, Alam F, Hoch J, Boet S. A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2017; 13:44. [PMID: 28028288 PMCID: PMC5286203 DOI: 10.3352/jeehp.2016.13.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/25/2016] [Indexed: 05/22/2023]
Abstract
PURPOSE High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. RESULTS Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. CONCLUSION With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada
- The Wilson Centre for Research in Medical Education, University of Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Centre for Excellence in Economic Analysis Research, The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Sylvain Boet
- Department of Anesthesiology, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ontario, Canada
- Department of Innovation in Medical Innovation, University of Ottawa, Ontario, Canada
- *Corresponding
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Visioning Report 2017: A Preferred Path Forward for the Nutrition and Dietetics Profession. J Acad Nutr Diet 2017; 117:110-127. [DOI: 10.1016/j.jand.2016.09.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 01/17/2023]
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Vaisman A, Cram P. Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:31-34. [PMID: 27465227 PMCID: PMC5191975 DOI: 10.1097/acm.0000000000001327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increasingly, faculty are taking on more direct responsibilities in patient care because of reductions in resident work hours, increasing admissions, and an endless push for efficiency. Furthermore, the rise of different career tracks in academia (i.e., patient care, research, education, or administration) and a drive for efficiency and subspecialization have placed additional strains on academic health centers. Combined, these factors have led to faculty increasingly being placed in the position of supervising bedside procedures that they may have not performed in years or with tools they have never trained with at all. Despite these challenges, procedural retraining for faculty remains nonstandardized across most academic health centers. The resulting lack of procedural competence among faculty creates a number of challenges for the different parties involved.In this Perspective, the authors discuss the nature of the current problem of faculty procedural competence and the challenges it poses for faculty and academic health centers, medicolegal ramifications, and the challenges it poses to the faculty-trainee relationship. The authors then suggest several strategies to delineate and resolve this problem. To delineate the problem, they suggest single-center surveys to address the current paucity of data. To resolve the problem, they suggest the consideration of some modest, low-cost interventions such as having backup systems in place for procedure supervision (e.g., procedural service teams or interventional radiologists) and providing faculty with opportunities to retrain.
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Affiliation(s)
- Alon Vaisman
- A. Vaisman is a licensed physician in internal medicine and current trainee in adult infectious diseases, Division of General Internal Medicine and Geriatrics, University Health Network, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. P. Cram is director, Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, and professor of medicine, University of Toronto, Toronto, Ontario, Canada
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Brunette V, Thibodeau-Jarry N. Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit. Can J Cardiol 2016; 33:119-127. [PMID: 28024550 DOI: 10.1016/j.cjca.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
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Affiliation(s)
- Véronique Brunette
- Critical Care Department, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
| | - Nicolas Thibodeau-Jarry
- Masters of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, Massachusetts, USA
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Fischer-Cartlidge E, Romanoff S, Thom B, Burrows Walters C. Comparing Self-Injection Teaching Strategies for Patients With Breast Cancer and Their Caregivers: A Pilot Study. Clin J Oncol Nurs 2016; 20:515-21. [DOI: 10.1188/16.cjon.515-521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Calhoun AW, Bhanji F, Sherbino J, Hatala R. Simulation for High-Stakes Assessment in Pediatric Emergency Medicine. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Validity and Feasibility Evidence of Objective Structured Clinical Examination to Assess Competencies of Pediatric Critical Care Trainees. Crit Care Med 2016; 44:948-53. [PMID: 26862709 DOI: 10.1097/ccm.0000000000001604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to provide validity and feasibility evidence for the use of an objective structured clinical examination in the assessment of pediatric critical care medicine trainees. DESIGN This was a validation study. Validity evidence was based on Messick's framework. SETTING A tertiary, university-affiliated academic center. SUBJECTS Seventeen pediatric critical care medicine fellows were recruited in 2012 and 2013 academic year. INTERVENTIONS None. All subjects completed an objective structured clinical examination assessment. MEASUREMENTS AND MAIN RESULTS Seventeen trainees were assessed. Simulation scenarios were developed for content validity by pediatric critical care medicine and education experts using CanMEDS competencies. Scenarios were piloted before the study. Each scenario was evaluated by two interprofessional raters. Inter-rater agreement, measured using intraclass correlations, was 0.91 (SE = 0.09) across stations. Generalizability theory was used to evaluate internal structure and reliability. Reliability was moderate (G-coefficient = 0.67, Φ-coefficient = 0.52). The greatest source of variability was from participant by station variance (40.6%). Pearson correlation coefficients were used to evaluate the relationship of objective structured clinical examination with each traditional assessment instruments: multisource feedback, in-training evaluation report, short-answer questions, and Multidisciplinary Critical Care Knowledge Assessment Program. Performance on the objective structured clinical examination correlated with performance on the Multidisciplinary Critical Care Knowledge Assessment Program (r = 0.52; p = 0.032) and multisource feedback (r = 0.59; p = 0.017), but not with the overall performance on the in-training evaluation report (r = 0.37; p = 0.143) or short-answer questions (r = 0.08; p = 0.767). Consequences were not assessed. CONCLUSION Validity and feasibility evidence in this study indicate that the use of the objective structured clinical examination scores can be a valid way to assess CanMEDS competencies required for independent practice in pediatric critical care medicine.
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Bajow N, Djalali A, Ingrassia PL, Ragazzoni L, Ageely H, Bani I, Corte FD. Evaluation of a new community-based curriculum in disaster medicine for undergraduates. BMC MEDICAL EDUCATION 2016; 16:225. [PMID: 27562428 PMCID: PMC5000399 DOI: 10.1186/s12909-016-0746-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 08/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Nowadays, many medical schools include training in disaster medicine in undergraduate studies. This study evaluated the efficacy of a disaster medicine curriculum recently designed for Saudi Arabian medical students. METHODS Participants were 15 male and 14 female students in their fourth, fifth or sixth year at Jazan University Medical School, Saudi Arabia. The course was held at the Research Center in Emergency and Disaster Medicine and Computer Sciences Applied to the Medical Practice in Novara, Italy. RESULTS The overall mean score on a test given before the course was 41.0 % and it increased to 67.7 % on the post-test (Wilcoxon test for paired samples: z = 4.71, p < 0.0001). There were no significant differences between the mean scores of males and females, or between students in their fourth, fifth or sixth year of medical school. CONCLUSIONS These results show that this curriculum is effective for teaching disaster medicine to undergraduate medical students. Adoption of this course would help to increase the human resources available for dealing with disaster situations.
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Affiliation(s)
- Nidaa Bajow
- CRIMEDIM - Research Centre in Emergency and Disaster Medicine and Computer Science Applied to Medical Practice, University of Eastern Piedmont, Novara, Italy.
- Disaster Medicine Unit, Mohammad Bin Naif Medical Center, King Fahd Security College, P O Box 89489, Riyadh, 11682, Saudi Arabia.
| | - Ahmadreza Djalali
- CRIMEDIM - Research Centre in Emergency and Disaster Medicine and Computer Science Applied to Medical Practice, University of Eastern Piedmont, Novara, Italy
| | - Pier Luigi Ingrassia
- CRIMEDIM - Research Centre in Emergency and Disaster Medicine and Computer Science Applied to Medical Practice, University of Eastern Piedmont, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Research Centre in Emergency and Disaster Medicine and Computer Science Applied to Medical Practice, University of Eastern Piedmont, Novara, Italy
| | | | - Ibrahim Bani
- Medical School of Jazan University, Jazan, Saudi Arabia
| | - Francesco Della Corte
- CRIMEDIM - Research Centre in Emergency and Disaster Medicine and Computer Science Applied to Medical Practice, University of Eastern Piedmont, Novara, Italy
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Stress levels during emergency care: A comparison between reality and simulated scenarios. J Crit Care 2016; 33:8-13. [PMID: 26987261 DOI: 10.1016/j.jcrc.2016.02.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/19/2016] [Accepted: 02/14/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE Medical simulation is fast becoming a standard of health care training throughout undergraduate, postgraduate and continuing medical education. Our aim was to evaluate if simulated scenarios have a high psychological fidelity and induce stress levels similarly to real emergency medical situations. MATERIALS AND METHODS Medical residents had their stress levels measured during emergency care (real-life and simulation) in baseline (T1) and immediately post-emergencies (T2). Parameters measuring acute stress were: heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary interleukin-1β, and State-Trait Anxiety Inventory score. RESULTS Twenty-eight internal medicine residents participated in 32 emergency situations (16 real-life and 16 simulated emergencies). In the real-life group, all parameters increased significantly (P < .05) between T1 and T2. In the simulation group, only heart rate and interleukin-1β increased significantly after emergencies. The comparison between groups demonstrates that acute stress response (T2 - T1) and State-Trait Anxiety Inventory score (in T2) did not differ between groups. CONCLUSIONS Acute stress response did not differ between both groups. Our results indicate that emergency medicine simulation may create a high psychological fidelity environment similarly to what is observed in a real emergency room.
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Calhoun AW, Sigalet E, Burns R, Auerbach M. Simulation Along the Pediatric Healthcare Education Continuum. COMPREHENSIVE HEALTHCARE SIMULATION: PEDIATRICS 2016. [DOI: 10.1007/978-3-319-24187-6_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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