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Arnold J, Vijayakumar N, Levy P. Advanced imaging and modeling in neonatal simulation. Semin Perinatol 2023; 47:151825. [PMID: 37940437 DOI: 10.1016/j.semperi.2023.151825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Advances in modeling and imaging have resulted in realistic tools that can be applied to education and training, and even direct patient care. These include point-of-care ultrasound (POCUS), 3-dimensional and digital anatomic modeling, and extended reality. These technologies have been used for the preparation of complex patient care through simulation-based clinical rehearsals, direct patient care such as the creation of patient devices and implants, and for simulation-based education and training for health professionals, patients and families. In this section, we discuss these emerging technologies and describe how they can be utilized to improve patient care.
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Tzamaras HM, Martinez J, Brown DC, Gonzalez-Vargas JM, Moore JZ, Miller SR. FUN AND GAMES: DESIGNING A GAMIFIED CENTRAL VENOUS CATHETERIZATION TRAINING SIMULATOR. PROCEEDINGS OF THE INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE. INTERNATIONAL SYMPOSIUM OF HUMAN FACTORS AND ERGONOMICS IN HEALTHCARE 2021; 65:267-271. [PMID: 35155712 PMCID: PMC8830596 DOI: 10.1177/1071181321651108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Gamification, or adding elements of games to training systems, has the potential to increase learner engagement and information retention. However, the use of gamification has yet to be explored in Central Venous Catheterization (CVC) trainers which teach a commonly performed medical procedure with high incidence rates. In order to combat these errors, a Dynamic Haptic Robotic Trainer (DHRT) was developed, which focuses on vessel identification and access. A DHRT+ system is currently under development that focuses on whole procedure training (e.g. sterilization and catheter insertion), including a gamified Graphical User Interface. The goal of this paper was to (1) develop a game-like, patient-centered interface to foster personalized learning and (2) understand the perceived utility of gamification for CVC skill development with expert doctors. This paper outlines some of the potential benefits and deficits of the use of gamification in medical trainers that can be used to drive simulation design.
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Ruud MN, Demma JM, Woll A, Miller JM, Hoffman S, Avery MD. Health History Skills for Interprofessional Learners in Transgender and Nonbinary Populations. J Midwifery Womens Health 2021; 66:778-786. [PMID: 34431202 DOI: 10.1111/jmwh.13278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Transgender and nonbinary peoplehave been identified as vulnerable and clinically underserved and experience health disparities. Lack of health care provider knowledge about transgender and gender diverse populations is a barrier to care, impacting health outcomes. The aim of this project was to develop, implement, and evaluate a simulation learning activity for midwifery and women's health nurse practitioner students and obstetrics and gynecology residents to interact with transgender and nonbinary individuals, with the goal of enhancing health history taking comfort and skills. METHODS A partnership was formed among University faculty and simulation educators, a community clinic providing gender-affirming care, and members of transgender and gender diverse populations who served as patient-teachers. Two cases frequently encountered in clinics providing care to transgender individuals were developed for the simulation. Learners were divided into interprofessional groups of 3 and completed one of 2 case scenarios with a patient-teacher. Learners and patient-teachers debriefed after the simulation to discuss and reflect on the experience. RESULTS Thirty-three learners participated in the simulation, 12 midwifery students, 16 women's health nurse practitioner students and 5 obstetrics and gynecology residents. Significant differences were observed for all comfort and skills questions, showing increased perceived comfort and skills from pre- to postsimulation. There were no significant differences in attitude responses. DISCUSSION We successfully created and implemented a new sexual and reproductive history taking skills simulation in partnership with community clinic staff and transgender and nonbinary persons. The session was well received by learners and patient-teachers. Learners demonstrated significant improvements in comfort and skills in history taking in this setting and provided favorable feedback about the experience. This simulation can serve as a guide to others providing education to future midwives, women's health nurse practitioners, and obstetrician-gynecologists.
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Affiliation(s)
- Maria N Ruud
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Anne Woll
- M Simulation, University of Minnesota, Minneapolis, Minnesota
| | - Joseph M Miller
- M Simulation, University of Minnesota, Minneapolis, Minnesota
| | - Samantha Hoffman
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Melissa D Avery
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
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Picketts L, Warren MD, Bohnert C. Diversity and inclusion in simulation: addressing ethical and psychological safety concerns when working with simulated participants. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:590-599. [DOI: 10.1136/bmjstel-2020-000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/19/2021] [Accepted: 04/07/2021] [Indexed: 11/03/2022]
Abstract
Healthcare learners can gain necessary experience working with diverse and priority communities through human simulation. In this context, simulated participants (SPs) may be recruited for specific roles because of their appearance, lived experience or identity. Although one of the benefits of simulation is providing learners with practice where the risk of causing harm to patients in the clinical setting is reduced, simulation shifts the potential harm from real patients to SPs. Negative effects of tokenism, misrepresentation, stereotyping or microaggressions may be amplified when SPs are recruited for personal characteristics or lived experience. Educators have an ethical obligation to promote diversity and inclusion; however, we are also obliged to mitigate harm to SPs.The goals of simulation (fulfilling learning objectives safely, authentically and effectively) and curricular obligations to address diverse and priority communities can be in tension with one another; valuing educational benefits might cause educators to deprioritise safety concerns. We explore this tension using a framework of diversity practices, ethics and values and simulation standards of best practice. Through the lens of healthcare ethics, we draw on the ways clinical research can provide a model for how ethical concerns can be approached in simulation, and suggest strategies to uphold authenticity and safety while representing diverse and priority communities. Our objective is not to provide a conclusive statement about how values should be weighed relative to each other, but to offer a framework to guide the complex process of weighing potential risks and benefits when working with diverse and priority communities.
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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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Hillman E, Paul J, Neustadt M, Reddy M, Wooldridge D, Dall L, Drees B. Establishing a Multi-Institutional Quality and Patient Safety Consortium: Collaboration Across Affiliates in a Community-Based Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1864-1873. [PMID: 32590471 PMCID: PMC7678654 DOI: 10.1097/acm.0000000000003552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The landscape of health care delivery and medical education is evolving. Institutions must continually reassess priorities, strategies, and partnerships to align the knowledge and skills of the health care workforce with the delivery of quality, socially accountable, collaborative health care that meets the needs of diverse populations in communities. This article describes the development, implementation, and early outcomes of the University of Missouri-Kansas City's Health Care Quality and Patient Safety Consortium. Inspired by an actual patient safety event, the consortium aimed to improve patient outcomes by establishing quality improvement and patient safety (QIPS) education and scholarship as foundational within its unique, horizontal-matrix academic health center, which comprises 6 affiliated hospitals and 4 university-based health sciences schools. The consortium established a governance structure with leaders who, collectively, represent the diverse members and stakeholders of the consortium. The members share a common agenda and mutual goals. The consortium measures success by applying published conceptual frameworks for evaluating the outcomes of educational programs on learners (Kirkpatrick) and patients (Bzowyckyj and colleagues). Consortium learner and patient outcomes span all levels of these frameworks. Undergraduate and graduate QIPS-based projects with meaningful health system or improved individual health outcomes signify a Level 4 outcome (the highest level) for learners and patients alike. Factors critical to success include a financial gift, leadership buy-in and support, a clear champion, shared goals and a united vision, a willingness to collaborate across health systems with varied strengths and priorities, and a stable communication platform. Aspirational goals of the consortium include increasing involvement across health professional schools, incorporating simulation into QIPS activities, and aligning the consortium's projects with broader community needs.
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Affiliation(s)
- Emily Hillman
- E. Hillman is assistant professor of emergency medicine and director, Simulation, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri; ORCID: http://orcid.org/0000-0001-7557-9879
| | - Joann Paul
- J. Paul was, during the development of the consortium described, vice president, Quality and Patient Safety, Department of Quality, Saint Luke’s Health System, and director, Quality, Quality Resources, Saint Luke’s Hospital of Kansas City, Kansas City, Missouri
| | - Maggie Neustadt
- M. Neustadt is director, Risk Management, and associate general counsel, Saint Luke’s Hospital of Kansas City, Kansas City, Missouri
| | - Mamta Reddy
- M. Reddy is associate professor of pediatrics, University of Missouri–Kansas City School of Medicine, and medical director, Quality and Performance Improvement, Center for Clinical Effectiveness, Children’s Mercy Hospital of Kansas City, Kansas City, Missouri; ORCID: http://orcid.org/0000-0001-5345-2631
| | - David Wooldridge
- D. Wooldridge is associate professor of medicine and program director, Internal Medicine Residency, Department of Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri; ORCID: http://orcid.org/0000-0003-2082-0949
| | - Lawrence Dall
- L. Dall is professor of medicine and assistant dean, Medical Student Research, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
| | - Betty Drees
- B. Drees is professor of medicine, dean emerita, program director, Endocrinology, Diabetes, and Metabolism Fellowship, University of Missouri–Kansas City School of Medicine, and president, Graduate School of the Stowers Institute for Medical Research, Kansas City, Missouri; ORCID: http://orcid.org/0000-0003-3673-7509
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Waweru E, Sarkar NDP, Ssengooba F, Gruénais ME, Broerse J, Criel B. Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry. PLoS One 2019; 14:e0221649. [PMID: 31461495 PMCID: PMC6713356 DOI: 10.1371/journal.pone.0221649] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders' views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda. METHODS This qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data. FINDINGS AND CONCLUSION While Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing-important components of PCC-translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts.
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Affiliation(s)
- Everlyn Waweru
- Department of Public Health–Health Systems and Equity unit, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health–Quality of Care, Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
- Faculty of Social Anthropology and Ethnology, University of Bordeaux, Bordeaux, France
| | - Nandini D. P. Sarkar
- Department of Public Health–Health Systems and Equity unit, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health–Quality of Care, Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
- ISGlobal, Hospital Clinic—University of Barcelona, Barcelona, Spain
| | - Freddie Ssengooba
- Department of Health Policy Planning & Management, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marc- Eric Gruénais
- Faculty of Social Anthropology and Ethnology, University of Bordeaux, Bordeaux, France
| | - Jacqueline Broerse
- Department of Public Health–Quality of Care, Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
| | - Bart Criel
- Department of Public Health–Health Systems and Equity unit, Institute of Tropical Medicine, Antwerp, Belgium
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Daley C, Al-Abdulmunem M, Holden RJ. Knowledge among patients with heart failure: A narrative synthesis of qualitative research. Heart Lung 2019; 48:477-485. [PMID: 31227224 DOI: 10.1016/j.hrtlng.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/15/2019] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience. OBJECTIVES We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease. METHODS We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria. RESULTS Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge. CONCLUSION The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
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Affiliation(s)
- Carly Daley
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA.
| | | | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
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Horstman MJ, Salas E. Web Exclusive. Annals for Hospitalists Inpatient Notes - Caregiver Engagement in Hospital Medicine-The Next Frontier. Ann Intern Med 2019; 170:HO2-HO3. [PMID: 30641571 DOI: 10.7326/m18-3614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Molly J Horstman
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt),Michael E. DeBakey VA Medical Center, Houston, Texas, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas (M.J.H.)
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, Texas (E.S.)
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