Simulation: Learning From Mistakes While Building Communication and Teamwork

Exploring academic teachers perspectives regarding the impact of using medical simulation in dentistry pre- and post-COVID-19 pandemic: a qualitative study

BACKGROUND

Medical simulation allows for the achievement of many educational goals and the continued education of some practical skills. The COVID-19 pandemic's restrictions have led to a major increase in dental education simulations. The aim of this study was to analyse the perspectives of academic teachers towards dental simulation, their concerns and evaluation of this teaching method, as well as their opinion on the use of medical simulation during the COVID-19 pandemic.

METHOD

A focus study was conducted in a group of 5 academic teachers, comprising 10% of academic teachers of a Dental Faculty using simulation techniques. Prior to and during the COVID-19 pandemic, the interviewed teachers had expertise with medical simulation in dentistry education methods. A facilitator used pre-planned, open-ended questions about the use of simulation in dentistry also with regard to the COVID-19 pandemic period. The group discussion has been managed, monitored, and recorded. The data analysis model was based on Braun and Clarke's six phases of thematic analysis. Five thematic domains/fields were evaluated: (1) Simulation as a didactic method; (2) Simulation during COVID-19 pandemic; (3) General observations and expectations with regard to simulation; (4) Teachers in simulation; (5) Concerns in relation to simulation. Two researchers analysed the data.

RESULTS

Based on interviewed teachers' perspective the simulation allows students to learn basic and complex skills providing the repeatability of the procedures performed. During Covid-19 the simulation methods undoubtedly filled the gap in the training of future dentists. However, interviewed teachers pointed out the high cost of the methods dictated by the need to prepare the simulation environment at a high level, in order to reflect the real clinical situation.

CONCLUSIONS

The use of simulation methods requires adequate preparation of academic teachers, continuous education and updating of knowledge in the field of medical simulation. The COVID-19 pandemic significantly influenced the growth of dental education simulation techniques as well as staff knowledge of the usage of medical simulation.

To Clap or Not to Clap: Relevance of "Applause" in Simulation-Based Learning Sessions

INTRODUCTION

Applause is a common behavior during simulation case learning sessions. Some simulation facilitators believe that this should not be allowed, arguing that it can mislead students when they make mistakes during simulation. This study was conducted to explore the opinions of students about spontaneous applause (initiated by the participants), as a habitual behavior in the simulation sessions, in the undergraduate and postgraduate nursing degrees.

METHODS

A qualitative research study was conducted based on the content analysis of 7 focus groups composed of simulation students (N = 101, both undergraduate and graduate students). The participants were asked to conduct a debate about the following question: What is your opinion about the spontaneous applause given to participants by their peers at the completion of the scenario as they go to the debriefing, and why? An inductive method of content analysis was used to interpret the data.

RESULTS

The majority considered applause as a sign of support; one student disapproved of the practice. For most participants, receiving spontaneous applause from their peers after finishing the simulation represented a spontaneous example of moral support that reduced the participants' stress.

CONCLUSIONS

Applause within the context of clinical simulation is a motivational act, which should not be repressed by the facilitator, as long as it is a spontaneous and genuine act by the participants once the simulation experience ends.

Optimising simulation learning experiences for mature, postgraduate nursing students

Mature students do not always approach learning activities according to expected adult learner behaviour. In addition, they may have never experienced simulation as a learning opportunity before. This creates a unique opportunity for nurse educators to contextualise education principles that are most applicable to mature students' learning needs. Education action research was conducted with two groups of mature postgraduate students, using nominal and focus groups to optimise their simulation learning experiences. Results showed that mature students should be thoroughly oriented beforehand about simulation practice and what is expected of them during participation. Through scaffolding and a succession of at least six to 10 simulation sessions, learner independence and adult learner behaviour can be developed. Begin with less complex scenarios before moving to ones that are more complex - this will prevent cognitive overload. Keeping the simulation environment as authentic and reliable as possible will promote suspension of disbelief. A non-punitive debriefing model is essential for enhancing student engagement and motivating improved performance in follow-up simulation learning sessions. If nurse educators stay open and responsive to the learning needs of mature students, the advantages of learning through simulation can be realised fully.

Guided university debate: Effect of a new teaching-learning strategy for undergraduate nursing students

BACKGROUND

A number of studies have shown that the traditional lecture suffers from limitations in the development of many important competencies such as reasoning ability for nursing professionals.

OBJECTIVES

In view of this issue, the authors present a promising alternative to the traditional lecture: the Guided University Debate (GUD). With regard to this aim a teaching-learning sequence of schizophrenia is described based on the GUD. Next, the improvement in the argumentative and declarative knowledge of the students who have participated in the said methodology is demonstrated.

METHODS

Quasi-experimental study with pre-test and post-test design to measure differences in the improvement of declarative and argumentative knowledge. To determine if there is a statistically significant difference in the score obtained in the pre-test and in the post-test score a parametric t-tests was carried. 64 students participated in the study. Implementation of the study took place during the 2015-2016 academic year in the third year of the Nursing undergraduate degree course in the University of the Basque Country (UPV/EHU) as part of the Mental Health class.

RESULTS

The results showed a statistically-significant improvement in the students' scores for all learning outcomes analysed: Identifies symptoms of schizophrenia (p≤0.001), identifies the nursing interventions (p≤0.001), provides a rationale for nursing interventions (p≤0.001) and provides evidence of nursing interventions (p≤0.001). That is, the declarative and argumentative capacity of the group improved significantly with the Guided University Debate methodology.

CONCLUSIONS

Although the teaching design feasibility and outcomes may vary in different contexts, based on this studies' positive outcome, the authors call today's educators to be able to use GUD as a teaching method.

Addressing critical gaps in the treatment of eating disorders

Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.

Informal learning from error in hospitals: what do we learn, how do we learn and how can informal learning be enhanced? A narrative review

Learning from error is not just an individual endeavour. Organisations also learn from error. Hospitals provide many learning opportunities, which can be formal or informal. Informal learning from error in hospitals has not been researched in much depth so this narrative review focuses on five learning opportunities: morbidity and mortality conferences, incident reporting systems, patient claims and complaints, chart review and prospective risk analysis. For each of them we describe: (1) what can be learnt, categorised according to the seven CanMEDS competencies; (2) how it is possible to learn from them, analysed against a model of informal and incidental learning; and (3) how this learning can be enhanced. All CanMEDS competencies could be enhanced, but there was a particular focus on the roles of medical expert and manager. Informal learning occurred mostly through reflection and action and was often linked to the learning of others. Most important to enhance informal learning from these learning opportunities was the realisation of a climate of collaboration and trust. Possible new directions for future research on informal learning from error in hospitals might focus on ways to measure informal learning and the balance between formal and informal learning. Finally, 12 recommendations about how hospitals could enhance informal learning within their organisation are given.

Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82

Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in simulation for training, such as aviation, the military and space exploration. Increased demands on training hours, limited patient encounters, and a focus on patient safety have led to a new paradigm of education in healthcare that increasingly involves technology and innovative ways to provide a standardized curriculum. A robust body of literature is growing, seeking to answer the question of how best to use simulation in healthcare education. Building on the groundwork of the Best Evidence in Medical Education (BEME) Guide on the features of simulators that lead to effective learning, this current Guide provides practical guidance to aid educators in effectively using simulation for training. It is a selective review to describe best practices and illustrative case studies. This Guide is the second part of a two-part AMEE Guide on simulation in healthcare education. The first Guide focuses on building a simulation program, and discusses more operational topics such as types of simulators, simulation center structure and set-up, fidelity management, and scenario engineering, as well as faculty preparation. This Guide will focus on the educational principles that lead to effective learning, and include topics such as feedback and debriefing, deliberate practice, and curriculum integration - all central to simulation efficacy. The important subjects of mastery learning, range of difficulty, capturing clinical variation, and individualized learning are also examined. Finally, we discuss approaches to team training and suggest future directions. Each section follows a framework of background and definition, its importance to effective use of simulation, practical points with examples, and challenges generally encountered. Simulation-based healthcare education has great potential for use throughout the healthcare education continuum, from undergraduate to continuing education. It can also be used to train a variety of healthcare providers in different disciplines from novices to experts. This Guide aims to equip healthcare educators with the tools to use this learning modality to its full capability.

Fostering cultural and interdisciplinary awareness with "low-tech" simulation in a fundamentals nursing course to prepare student nurses for critical care clinical rotations

This article focuses on the advancement of nursing education and practice through implementing "low-tech" simulation in a fundamentals nursing course to foster an awareness of scope of practice and interdisciplinary teamwork and collaboration to prepare student nurses for their critical care clinical experience. The integration of low-tech simulation during the students' first clinical course at 2 different times during the semester was utilized to accomplish this awareness. This article was added to the scant published articles that highlight the benefits of low-tech simulation in a fundamentals of nursing course.

Using Low-Fidelity Simulation to Maintain Competency in Central Line Care

Purpose: Many healthcare facilities require staff nurses to complete annual competency assessments on central line care. However, the question arises, could simulation provide a better assessment of competency and possibly help nurses retain competence longer?

Review of Relevant Literature: A thorough review of the literature revealed that limited investigation has been done regarding the perception or effectiveness of simulation as a tool for competency evaluation. Multiple authors have identified simulation as an advantageous method for training health care providers in central line care. Several studies have linked simulation based training with decreased central line associated bacteremia rates. There is also evidence in the literature that simulation has great potential as a competency validation technique.

Discussion: A sample of staff nurses participated in one of four central line care scenarios in a simulation environment. The participants were asked to complete a demographics survey as well as a self-assessment on central line competency prior to the simulation experience. Debriefing followed the simulation, offering the participant feedback on performance and verification of correct and incorrect actions. The self-assessment was then repeated to measure participant perception post-simulation.

Implications for Clinical Practice: No significant difference of performance in the simulation was inferred from baccalaureate-prepared nurses versus diploma or associate-prepared nurses. Almost all participants rated their competence in caring for a central line as either “competent” or “highly competent.” However upon demonstration of central line skills in the simulation, all but two participants omitted a critical step. Omitting these steps places the patient at risk for infection or other complications.