Benefits of computer screen-based simulation in learning cardiac arrest procedures

Virtual Reality in Medical Students' Education: Scoping Review

BACKGROUND

Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education.

OBJECTIVE

The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.

METHODS

We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

RESULTS

Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR.

CONCLUSIONS

Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-046986.

Application of blended learning approach in clinical skills to stimulate active learning attitudes and improve clinical practice among medical students

BACKGROUND

The recent application of blended educational methods has impacted medical education and has drawn attention to a new teaching method. This teaching style presents unique opportunities and challenges. We investigated the effects of blended learning and traditional teaching methods on clinical skill development.

METHODS

We sorted 200 medical students from Tongji Medical College at Huazhong University of Science and Technology into a control or experimental group. The control group was taught with a traditional lecture-based learning method and the experimental group was taught using a blended learning method. The two groups were compared after training to assess their theoretical and practical differences. A student satisfaction survey was given to participants in both groups.

RESULTS

The results of the experimental group's theoretical and practical assessments were found to be significantly higher (p < 0.05) than that of the control group. The student satisfaction survey showed that blended learning was significantly more effective for acquiring relevant knowledge, enhancing student-centered learning and improving clinical practice.

CONCLUSIONS

Blended learning may address deficiencies in clinical skills, make up for limited time and space, and ensure learning efficiency and quality.

A skills acquisition study on ECMOjo: a screen-based simulator for extracorporeal membrane oxygenation

BACKGROUND

Extracorporeal membrane oxygenation relies heavily on didactic teaching, emphasizing on essential cognitive skills, but overlooking core behavioral skills such as leadership and communication. Therefore, simulation-based training has been adopted to instill clinical knowledge through immersive experiences. Despite simulation-based training's effectiveness, training opportunities are lessened due to high costs. This is where screen-based simulators come into the scene as affordable and realistic alternatives.

AIM

This article evaluates the educational efficacy of ECMOjo, an open-source screen-based extracorporeal membrane oxygenation simulator that aims to replace extracorporeal membrane oxygenation didactic instruction in an interactive and cost-effective manner.

METHOD

A prospective cohort skills acquisition study was carried out. A total of 44 participants were pre-assessed, divided into two groups, where the first group received traditional didactic teaching, and the second used ECMOjo. Participants were then evaluated through a wet lab assessment and two questionnaires.

RESULTS

The obtained results indicate that the two assessed groups show no statistically significant differences in knowledge and efficacy. Hence, ECMOjo is considered an alternative to didactic teaching as per the learning outcomes.

CONCLUSION

The present findings show no significant dissimilarities between ECMOjo and didactic classroom-based teaching. Both methods are very comparable in terms of the learner's reported self-efficacy and complementary to mannequin-based simulations.

Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education.

Objective

The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction.

Methods

We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models.

Results

A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I²=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I²=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence.

Conclusions

Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.

Participant perceptions of virtual simulation to develop non-technical skills in health professionals

Background

Research has identified that virtual simulations may be effective in developing non-technical skills including communication, teamwork and decision making. However, little is known about how participants perceive learning non-technical skills via engagement in virtual simulation.

Aims

The aim of this research was to investigate participant perceptions and the learning experiences when engaging in virtual simulations focused on developing non-technical skills.

Method

A descriptive exploratory approach was used. An online voluntary survey collected qualitative extended responses from participants after each virtual simulation. Ethics approval was obtained for the research and guidelines adhered to throughout the study.

Results

A total of 675 responses were obtained. Participants perceive that engaging with the virtual simulation made them aware of non-technical skills including communication, teamwork, decision making, critical thinking and problem solving, and, to a lesser extent, situational awareness. Additional categories of learning, clinical practice and limitations were identified.

Conclusions

Engaging in virtual simulation can develop awareness of non-technical skills, as well as confidence and vigilance in practice and mindfulness of a person-centred approach to healthcare. Engaging in virtual simulation may support change in the professional performance of the participants through role modelling and learning through error.

Effectiveness of digital resuscitation training in improving knowledge and skills: A systematic review and meta-analysis of randomised controlled trials

AIM

This review aims to evaluate the effectiveness of digital resuscitation training in improving knowledge and skill compared with standard resuscitation training.

METHODS

We searched through the CINAHL, Cochrane Library, EMBASE, ERIC, ProQuest Dissertations and Thesis, PsycINFO, PubMed and Scopus from inception of our review until 5 March 2018. The quality of individual and overall evidence was evaluated according to the risk of bias, Medical Education Research Study Quality Instrument (MERSQI) and Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system, respectively. Meta-analyses were performed with the Review Manger software. Z-statistics were used to evaluate the overall effect of training, and I² test was used to assess heterogeneity. Sensitivity and subgroup analyses were used for additional meta-analyses.

RESULTS

Amongst the 15,528 studies retrieved, 20 randomised controlled trials (RCTs) were selected from 13 countries across different ethnicities. More than half (52%) of the trials had a low risk of bias, and MERSQI scores ranged from 13.5 to 15.5. The overall quality of evidence was very low according to GRADE criteria. Meta-analyses revealed that trainees in digital resuscitation training had better knowledge scores but poorer chest compression rates than that of trainees in standard resuscitation training. Digital resuscitation trainings were non-inferior to standard resuscitation trainings in skill performance scores. Subgroup analyses suggested that digital resuscitation training might consider using blended learning approach with virtual patient, computer-screen based, learning theories and video-recorded assessment, especially for basic life support trainings amongst health professionals.

CONCLUSION

Despite the wide variation in digital resuscitation trainings, evidence suggesting the use of digital resuscitation training for improving knowledge and skills is inadequate. Well-designed non-inferiority RCTs in multiple settings with follow-up data and large sample size are needed to ensure the robustness of the evidence.

The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine: A Systematic Review and Meta-Analysis

STATEMENT

We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).

Development and validation of simulated virtual patients to impart early clinical exposure in endocrine physiology

In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. Med Educ 40: 867-876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain ( P < 0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.

Development and Testing of Screen-Based and Psychometric Instruments for Assessing Resident Performance in an Operating Room Simulator

Introduction. Medical simulators are used for assessing clinical skills and increasingly for testing hypotheses. We developed and tested an approach for assessing performance in anesthesia residents using screen-based simulation that ensures expert raters remain blinded to subject identity and experimental condition. Methods. Twenty anesthesia residents managed emergencies in an operating room simulator by logging actions through a custom graphical user interface. Two expert raters rated performance based on these entries using custom Global Rating Scale (GRS) and Crisis Management Checklist (CMC) instruments. Interrater reliability was measured by calculating intraclass correlation coefficients (ICC), and internal consistency of the instruments was assessed with Cronbach's alpha. Agreement between GRS and CMC was measured using Spearman rank correlation (SRC). Results. Interrater agreement (GRS: ICC = 0.825, CMC: ICC = 0.878) and internal consistency (GRS: alpha = 0.838, CMC: alpha = 0.886) were good for both instruments. Subscale analysis indicated that several instrument items can be discarded. GRS and CMC scores were highly correlated (SRC = 0.948). Conclusions. In this pilot study, we demonstrated that screen-based simulation can allow blinded assessment of performance. GRS and CMC instruments demonstrated good rater agreement and internal consistency. We plan to further test construct validity of our instruments by measuring performance in our simulator as a function of training level.

Effectiveness of a Web-Based Simulation in Improving Nurses' Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

Background

Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting.

Objective

The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure.

Methods

A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention.

Results

The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation.

Conclusions

This study provides evidence on the effectiveness of Web-based simulation in improving nursing practice when recognizing and responding to deteriorating patients. This educational tool could be implemented by nurse educators worldwide to address the educational needs of a large group of hospital nurses responsible for patients in clinical deterioration.

Changes in adherence to cardiopulmonary resuscitation guidelines in a single referral center from January 2009 to June 2013 and assessment of factors contributing to the observed changes

BACKGROUND

This retrospective study reviewed compliance to cardiopulmonary resuscitation (CPR) teaching at a small animal referral center from January 2009 to June 2013. CPR training commenced in October 2009. This was a lecture format by European specialists in veterinary anesthesia and analgesia. Teaching was originally based on published guidelines. Changes made to the content of the lectures after publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012 are discussed.

KEY FINDINGS

Data regarding basic life support and monitoring equipment were collected from all cases requiring CPR. A Mann-Kendall test for trend showed a significant increased use of both capnography (P = 0.017) and suction to aid tracheal intubation (P = 0.017) over the period of study. There was a significant increase in capnography use in 2011 (P = 0.046), 2012 (P = 0.002), and 2013 (P = 0.002) compared to 2009 (1/15).

SIGNIFICANCE

The sequential increase in capnography use without any change to the number or availability of capnography units provides evidence that CPR teaching has altered clinical practice. The publication of the RECOVER guidelines provided an evidence base upon which to refine and improve teaching of CPR.

Perception of Simulation-based Learning among Medical Students in South India

Background:

Traditional methods of educating medical students are no longer sufficient in the current era largely influenced by multimedia. Simulation-based techniques may play a pivotal role in bridging this educational gap.

Aim:

This study was conducted to explore the perception of medical students towards simulation based learning (SBL).

Subjects and Methods:

This cross-sectional study was conducted in May 2013 in a private medical college in Mangalore, Karnataka, India. A total of 247 participants from fourth, sixth, eighth semester and internship were chosen by convenience sampling method. Attitudinal data on perception towards SBL were collected using a self-administered questionnaire with responses in a 5-point Likert's scale.

Results:

The mean age of students was 21.3 (standard deviation 1.9) years, and males constituted 55.5% (137/247). Most participants 72.5% (179/247) had favorable perceptions of SBL, with scores of92–118 out of a possible 118 points. Favorable perception towards SBL was seen significantly more among female students (P = 0.04) and senior MBBS students of sixth and eighth semesters (P = 0.05). Nearly, all students (90.7%; 224/247) agreed that simulation supports the development of clinical skills. As many as 29.6% (73/247) agreed that real patients might be replaced with simulated patients in practical examinations.

Conclusion:

SBL was perceived as favorable by a large number of participants in this study indicating a bright prospect for its implementation in the medical curriculum.

Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial

Background

Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice.

Objective

This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care.

Methods

Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants’ clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool.

Results

The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving.

Conclusions

Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses’ competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.

Randomized trial of a novel ACLS teaching tool: does it improve student performance?

Introduction

Mounting evidence suggests that high-fidelity mannequin-based (HFMBS) and computer-based simulation are useful adjunctive educational tools for advanced cardiac life support (ACLS) instruction. We sought to determine whether access to a supplemental, online computer-based ACLS simulator would improve students’ performance on a standardized Mega Code using high-fidelity mannequin based simulation (HFMBS).

Methods

Sixty-five third-year medical students were randomized. Intervention group subjects (n = 29) each received a two-week access code to the online ACLS simulator, whereas the control group subjects (n = 36) did not. Primary outcome measures included students’ time to initiate chest compressions, defibrillate ventricular fibrillation, and pace symptomatic bradycardia. Secondary outcome measures included students’ subjective self-assessment of ACLS knowledge and confidence.

Results

Students with access to the online simulator on average defibrillated ventricular fibrillation in 112 seconds, whereas those without defibrillated in 149.9 seconds, an average of 38 seconds faster [p<.05]. Similarly, those with access to the simulator paced symptomatic bradycardia on average in 95.14 seconds whereas those without access paced on average 154.9 seconds a difference of 59.81 seconds [p<.05]. On a subjective 5-point scale, there was no difference in self-assessment of ACLS knowledge between the control (mean 3.3) versus intervention (mean 3.1) [p-value =.21]. Despite having outperformed the control group subjects in the standardized Mega Code test scenario, the intervention group felt less confident on a 5-point scale (mean 2.5) than the control group. (mean 3.2) [p<.05]

Conclusion

The reduction in time to defibrillate ventricular fibrillation and to pace symptomatic bradycardia among the intervention group subjects suggests that the online computer-based ACLS simulator is an effective adjunctive ACLS instructional tool.

Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial

Background

Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients.

Objective

The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students’ performances in assessing and managing patients with clinical deterioration.

Methods

A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants’ clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation.

Results

Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively.

Conclusions

A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated to be effective refresher learning strategies for improving nursing students’ clinical performance. Given the greater resource requirements of mannequin-based simulation, the virtual patient simulation provides a more promising alternative learning strategy to mitigate the decay of clinical performance over time.

The Effect of Computer-Based Resuscitation Simulation on Nursing Students’ Performance, Self-Efficacy, Post-Code Stress, and Satisfaction

Computer-based simulation has intuitive appeal to both educators and learners with the flexibility of time, place, immediate feedback, and self-paced and consistent curriculum. The purpose of this study was to assess the effects of computer-based simulation on nursing students’ performance, self-efficacy, post-code stress, and satisfaction between computer-based simulation plus instructor-led cardiopulmonary resuscitation training group and instructor-led resuscitation training-only group. This study was a nonequivalent control group posttest-only design. There were 213 second year nursing students randomly assigned to one of two groups: 109 nursing students with computer-based simulation or 104 with control group. Overall nursing students’ performance score was higher in the computer-based simulation group than in the control group but reached no statistical significance (t = 1.086, p = .283). There were no significant differences in resuscitation-specific self-efficacy, post-code stress, and satisfaction between the two groups. Computer-based simulation combined with hands-on practice did not affect in nursing students’ performance, self-efficacy, post-code stress, and satisfaction in nursing students. Further study must be conducted to inform instructional design and help integrate computer-based simulation and rigorous scoring rubrics.

Mastery learning for health professionals using technology-enhanced simulation: a systematic review and meta-analysis

PURPOSE

Competency-based education requires individualization of instruction. Mastery learning, an instructional approach requiring learners to achieve a defined proficiency before proceeding to the next instructional objective, offers one approach to individualization. The authors sought to summarize the quantitative outcomes of mastery learning simulation-based medical education (SBME) in comparison with no intervention and nonmastery instruction, and to determine what features of mastery SBME make it effective.

METHOD

The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. They included original research in any language evaluating mastery SBME, in comparison with any intervention or no intervention, for practicing and student physicians, nurses, and other health professionals. Working in duplicate, they abstracted information on trainees, instructional design (interactivity, feedback, repetitions, and learning time), study design, and outcomes.

RESULTS

They identified 82 studies evaluating mastery SBME. In comparison with no intervention, mastery SBME was associated with large effects on skills (41 studies; effect size [ES] 1.29 [95% confidence interval, 1.08-1.50]) and moderate effects on patient outcomes (11 studies; ES 0.73 [95% CI, 0.36-1.10]). In comparison with nonmastery SBME instruction, mastery learning was associated with large benefit in skills (3 studies; effect size 1.17 [95% CI, 0.29-2.05]) but required more time. Pretraining and additional practice improved outcomes but, again, took longer. Studies exploring enhanced feedback and self-regulated learning in the mastery model showed mixed results.

CONCLUSIONS

Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time.

The effects of simulation-based resuscitation training on nurses' self-efficacy and satisfaction

BACKGROUND

Nurses are often the first responders in clinical emergencies that require effective training to ensure high-quality resuscitation and patient safety. The aim of the study was to evaluate the efficacy of simulation-based resuscitation training by assessing two different training modalities (computer-based simulation versus mannequin-based simulation) with practicing nurses.

METHOD

The study used a comparative study design with random assignment to two simulation-based training modalities. A total of 38 nurses participated in the study: 18 nurses with computer-based simulation, and 20 nurses with mannequin-based simulation. Participants rated their self-efficacy and satisfaction after participating in a simulated scenario involving managing a cardiac arrest patient.

RESULTS

On a 10-point scale, the participants' overall self-efficacy rating was 6.50 (SD=1.66), and satisfaction rating was 7.53 (SD=1.20) for both groups. There were no significant differences between the groups. The computer-based simulation group had significant higher satisfaction ratings in 'Setting priorities for nursing intervention' and 'Implementing nursing skills as protocol' compared to the mannequin-based simulation group. Most nurses felt the simulation experience was useful for future performance in their workplace, but rated realism of simulation as unsatisfactory.

CONCLUSION

The introduction of simulation-based resuscitation training as an active-learning format was positively embraced by nurses. Computer-based simulation might be beneficial for acquiring nursing skills and decision making skills in resuscitation. Further study is needed to verify the effects of simulation-based resuscitation training with more rigorous outcomes.

Comparison of a modified longitudinal simulation-based advanced cardiovascular life support to a traditional advanced cardiovascular life support curriculum in third-year medical students

BACKGROUND

Simulation is an effective tool for teaching medical students in cardiac arrest management.

PURPOSE

The purpose of this article is to compare the efficacy of a traditional Advanced Cardiovascular Life Support (ACLS) course versus a modified longitudinal ACLS course using high-fidelity simulation in medical students.

METHODS

One group enrolled in a 2-day traditional ACLS course while another group participated in independent learning over 2 weeks and 2 simulation sessions using Laerdal Sim-Man. The modified curriculum also included environmental fidelity with simulation, access to materials electronically, smaller class sizes, and integration of real experiences in the Emergency Department into their learning. Student performance was measured with a scripted, videotaped mega code, followed by a survey.

RESULTS

We enrolled 21 students in a traditional ACLS program and 29 students in the simulation-based program (15 and 26 videos available for analysis). There was no difference in Time to Initiate CPR or Time to Shock between the groups, but the modified curriculum group demonstrated higher performance scores. They also felt better prepared to run the code during a simulation and in a hospital setting compared to students in the traditional ACLS curriculum.

CONCLUSIONS

Students in a modified longitudinal simulation-based ACLS curriculum demonstrated better proficiency in learning ACLS compared to a traditional curriculum.