The Deteriorating Patient: a realistic but ‘low-tech’ simulation of emergency decision-making

International Pediatric Emergency Medicine and Critical Care Fellow Education: Utilizing Virtual Resuscitation Simulation in Settings With Differing Resources

Pediatric Emergency and Critical Care-Kenya (PECC-Kenya) is an international collaboration between the University of Nairobi and the University of Washington (UW) supporting a combined fellowship program in pediatric emergency medicine (PEM) and pediatric critical care medicine (PCCM) in Kenya. Typically, PEM/PCCM faculty from UW travel to Kenya to support in-person simulation, which was cancelled due to COVID-19 travel restrictions. This presented a need for alternative modalities to continue simulation-based education. This technical report describes the use of virtual simulation for pediatric emergency and critical care fellow education on the management of hypovolemic and septic shock, utilizing international guidelines and being based on resource availability.

"It's Only Brain Surgery": Using 3D Printing and Simulation to Prepare Rural Physicians for the Management of Acute Epidural Hematoma

Patients presenting to rural emergency departments with increased intracranial pressure (ICP) can be challenging to diagnose, manage, and treat and although the presentation is rare, it is associated with high morbidity and mortality. In areas such as Newfoundland and Labrador, Canada, where the majority of the province is located far from tertiary care, this problem can be compounded by adverse weather impeding transport, necessitating that the problem is handled by rural physicians instead of neurosurgical care. However, many rural medical personnel do not receive any formal training in treating increased ICP. In this technical report, we use a low-tech, low-cost, high fidelity 3D printed skull to outline a simulation of increased ICP to better prepare rural physicians and emergency department teams who may encounter such a scenario in their practice in a rural area.

Optimizing Perimortem Cesarean Section Outcomes Using Simulation: A Technical Report

Simulation-based medical education (SBME) is an educational technique that enables participants to experience an immersive representation of a clinical event for the purpose of practice, learning, and evaluation. This experience is intended to improve trainees’ competency and confidence in both procedural tasks, as well as team-based and interpersonal skills when responding to real-world clinical encounters. Moreover, SBME improves procedural exposure and competency in low-frequency, high-stakes clinical procedures without the risk of adverse consequences, error, or patient harm - a priority for physician training at all levels.

This technical report describes a novel bi-phasic maternal cardiac arrest simulation that can be used to teach and train post-graduate year one (PGY1) emergency medicine and obstetrics and gynecology trainees in the use of perimortem cesarean sections (PMCS) prior to in-situ exposure. Using a high-fidelity simulation protocol employing training manikins and 3-D printed models of gravid uteri, this bi-phasic simulation, completed over two sessions, six months apart, will equip trainees with the knowledge, skills, and professionalism behaviors necessary for difficult clinical decisions and time-critical procedures.

The Pain Interprofessional Curriculum Design Model

Objective

Although the University of Toronto Centre for the Study of Pain has successfully implemented an Interfaculty Pain Curriculum since 2002, we have never formalized the process in a design model. Therefore, our primary aim was to develop a model that provided an overview of dynamic, interrelated elements that have been important in our experience. A secondary purpose was to use the model to frame an interactive workshop for attendees interested in developing their own pain curricula.

Methods

The faculties from Dentistry, Medicine, Nursing, Occupational Therapy, Pharmacy, and Physical Therapy met to develop the model components. Discussion focused on patient-centered pain assessment and management in an interprofessional context, with pain content being based on the International Association for the Study of Pain-Interprofessional Pain Curriculum domains and related core pain competencies. Profession-specific requirements were also considered, including regulatory/course requirements, level of students involved, type of course delivery, and pedagogic strategies.

Results

The resulting Pain Interprofessional Curriculum Design Model includes components that are dynamic, competency-based, collaborative, and interrelated. Key questions important to developing curricular components guide the process. The Model framed two design workshops with very positive responses from international and national attendees.

Conclusions

The Pain Interprofessional Curriculum Design Model is based on established pain curricula and related competencies that are relevant to all health science students at the prelicensure (entry-to-practice) level. The model has been developed from our experience, and the components resonated with workshop attendees from other regions. This Model provides a basis for future interventions in curriculum design and evaluation.

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning

BACKGROUND

High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students.

OBJECTIVES

To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance.

DESIGN AND SETTING

Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses.

PARTICIPANTS

A population of 489 final-year nursing students in programs of study leading to license to practice.

METHODS

Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis.

RESULTS

Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001.

DISCUSSION

The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning.

CONCLUSION

The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.

Current challenges in pain education

SUMMARY The continuing high prevalence of pain, both acute and persistent, is a public health problem. Improving pain curricula for health professionals is essential if we are to change the current ineffective practices related to pain prevention and management. An important question for all educators is whether our graduates are sufficiently competent in pain knowledge and skills to give appropriate pain care. In addition, deficiencies in our current education approaches need to be examined, including the key challenges that limit our moving the pain agenda forward. Limiting factors considered in this article include issues related to regulatory system requirements, curriculum priorities and resources, faculty qualifications and the need for collaboration with clinicians, traditional beliefs about patients and opportunities for interprofessional learning. Recent innovative advances are discussed related to curriculum resources, development of core pain competencies and creative learning models, including interprofessional ones. Suggested approaches to advocating for pain education changes are also included.

Managing patient deterioration: a protocol for enhancing undergraduate nursing students' competence through web-based simulation and feedback techniques

AIMS

To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.

BACKGROUND

There are international concerns regarding the management of deteriorating patients with issues around the 'failure to rescue'. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.

DESIGN/METHODS

A mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.

CONCLUSION

This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.