Just-In-Time Simulation Training for Nasopharyngeal Specimen Collection During the SARS-CoV-2 Pandemic

Just-in-Time Simulation Training to Augment Overnight ICU Resident Education

Background Patients who decompensate overnight experience worse outcomes than those who do so during the day. Just-in-time (JIT) simulation could improve on-call resident preparedness but has been minimally evaluated in critical care medicine (CCM) to date. Objective To determine whether JIT training can improve residents' performance in simulation and if those skills would transfer to better clinical management in adult CCM. Methods Second-year medicine residents participated in simulated decompensation events aligned to common medical intensive care unit (MICU) emergencies predicted to occur overnight by their attending intensivist. Simulation faculty scored their performance via critical action checklists. If the event occurred, MICU attendings rated residents' clinical management as well. At the rotation's conclusion, a variant of one previously trained scenario was simulated to assess for performance improvement. Resident perceptions were surveyed before, during, and after completion of the study. Results Twenty-eight residents participated; 22 of 28 (79%) completed the curriculum. Management of simulated decompensations improved following training (initial simulation checklist completion rate 60% vs 80% final simulation, P≤.001, Wilcoxon r=0.5). Predicted events occurred in 27 (45%) of the 60 shifts evaluated, with no observed difference in faculty ratings of overnight performance (median rating 4.5 if trained vs 3.0 if untrained; U=58.50; P=.12; Mann-Whitney r=0.30). Residents' self-reported preparedness to manage MICU emergencies improved significantly following training, from a median of 3.0 to 4.0 (P=.006, Wilcoxon r=0.42). Conclusions JIT simulation training improved residents' performance in simulation.

The Impact of Just-in-Time Simulation Training for Healthcare Professionals on Learning and Performance Outcomes: A Systematic Review

ABSTRACT

Although just-in-time training (JIT) is increasingly used in simulation-based health professions education, its impact on learning, performance, and patient outcomes remains uncertain. The aim of this study was to determine whether JIT simulation training leads to improved learning and performance outcomes. We included randomized or nonrandomized interventional studies assessing the impact of JIT simulation training (training conducted in temporal or spatial proximity to performance) on learning outcomes among health professionals (trainees or practitioners). Of 4077 citations screened, 28 studies were eligible for inclusion. Just-in-time training simulation training has been evaluated for a variety of medical, resuscitation, and surgical procedures. Most JIT simulation training occurred immediately before procedures and lasted between 5 and 30 minutes. Despite the very low certainty of evidence, this systematic review suggests JIT simulation training can improve learning and performance outcomes, in particular time to complete skills. There remains limited data on better patient outcomes and collateral educational effects.

Novel Three-Dimensionally Printed Ultrasound Probe Simulator and Heart Model for Transthoracic Echocardiography Education

Simulation-based training is an essential component in the education of transthoracic echocardiography (TTE). Nevertheless, current TTE teaching methods may be subject to certain limitations. Hence, the authors in this study aimed to invent a novel TTE training system employing three-dimensional (3D) printing technology to teach the basic principles and psychomotor skills of TTE imaging more intuitively and understandably. This training system comprises a 3D-printed ultrasound probe simulator and a sliceable heart model. The probe simulator incorporates a linear laser generator to enable the visualization of the projection of the ultrasound scan plane in a 3D space. By using the probe simulator in conjunction with the sliceable heart model or other commercially available anatomic models, trainees can attain a more comprehensive understanding of probe motion and related scan planes in TTE. Notably, the 3D-printed models are portable and low-cost, suggesting their potential utility in various clinical scenarios, particularly for just-in-time training.

Novel Three-Dimensional Printed Human Heart Models and Ultrasound Omniplane Simulator for Transesophageal Echocardiography Training

Simulation-based training plays an essential role in transesophageal echocardiography (TEE) education. Using 3-dimensional printing technology, the authors invented a novel TEE teaching system consisting of a series of heart models that can be segmented according to actual TEE views, and an ultrasound omniplane simulator to demonstrate how ultrasound beams intersect the heart at different angles and generate images. This novel teaching system is able to provide a more direct way to visualize the mechanics of obtaining TEE images than traditional online or mannequin-based simulators. It can also provide tangible feedback of both an ultrasound scan plane and a TEE view of the heart, which has been proven to improve trainees' spatial awareness and can significantly help in understanding and memorizing complex anatomic structures. This teaching system itself is also portable and inexpensive, making it conducive to teaching TEE in regions of diverse economic status. This teaching system also can be expected to be used for just-in-time training in a variety of clinical scenarios, including operating rooms, intensive care units, etc.