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Minor KC, Bianco K, Mayo JA, Abir G, Judy AE, Lee HC, Leonard SA, Ayotte S, Hedli LC, Schaffer K, Sie L, Daniels K. Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US. AJOG GLOBAL REPORTS 2024; 4:100357. [PMID: 38975047 PMCID: PMC11227018 DOI: 10.1016/j.xagr.2024.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events. Objective To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals. Study design The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point. Results Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23-16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79-20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly greater for the direct simulation group compared to the train-the-trainer group immediately post-training (89%+/-7 versus 74%+/-8, P-value<.01) and at 3-months (88%+/-7 versus 76%+/-12, P-value<.01). Comparisons between groups showed no difference in confidence and attitude scores at these timepoints. Both direct simulation participants and train-the-trainer instructors preferred virtual education, or a hybrid structure, over in-person education. Conclusion Virtual education for obstetric simulation training is feasible, acceptable, and effective. Utilizing a direct simulation model for postpartum hemorrhage management resulted in enhanced knowledge acquisition and retention compared to a train-the-trainer model.
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Affiliation(s)
- Kathleen C. Minor
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Jonathan A. Mayo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Gillian Abir
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Obstetric Anesthesiology, Stanford University School of Medicine, Stanford, CA (Dr Abir)
| | - Amy E. Judy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Henry C. Lee
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA (Dr Lee and Ms Schaffer)
| | - Stephanie A. Leonard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine & Obstetrics, Stanford University School of Medicine, Stanford, CA (Dr Minor, Dr Bianco, Mr Mayo, Dr Judy, and Dr Leonard)
| | - Stephany Ayotte
- Johnson Center for Pregnancy and Newborn Services, Lucile Packard Children's Hospital, Stanford, CA (Ms Ayotte)
| | - Laura C. Hedli
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA (Ms Hedli and Ms Sie)
| | - Kristen Schaffer
- Department of Pediatrics, Division of Neonatology, University of California San Diego, La Jolla, CA (Dr Lee and Ms Schaffer)
| | - Lillian Sie
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA (Ms Hedli and Ms Sie)
| | - Kay Daniels
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, CA (Dr Daniels)
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Schwartze JT, Das S, Suggitt D, Baxter J, Tunstall S, Ronan N, Stannard H, Rezgui A, Jafar W, Baxter DN. Ward-based in situ simulation: lessons learnt from a UK District General Hospital. BMJ Open Qual 2024; 13:e002571. [PMID: 38749539 PMCID: PMC11097843 DOI: 10.1136/bmjoq-2023-002571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/02/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION In situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS impact on teamwork, technical skill performance, healthcare staff perception and latent error identification during simulated medical emergencies. MATERIALS AND METHODS Unannounced ISS sessions (n=14, n=75 staff members) using a high-fidelity mannequin were conducted in medical, paediatric and rehabilitation wards at Stepping Hill Hospital (Stockport National Health Service Foundation Trust, UK). Each session encompassed a 15 min simulation followed by a 15 min faculty-led debrief. RESULTS The clinical team score revealed low overall teamwork performances during simulated medical emergencies (mean±SEM: 4.3±0.5). Linear regression analysis revealed that overall communication (r=0.9, p<0.001), decision-making (r=0.77, p<0.001) and overall situational awareness (r=0.73, p=0.003) were the strongest statistically significant predictors of overall teamwork performance. Neither the number of attending healthcare professionals, their professional background, age, gender, degree of clinical experience, level of resuscitation training or previous simulation experience statistically significantly impacted on overall teamwork performance. ISS positively impacted on healthcare staff confidence and clinical training. Identified safety threats included unknown location of intraosseous kits, poor/absent airway management, incomplete A-E assessments, inability to activate the major haemorrhage protocol, unknown location/dose of epinephrine for anaphylaxis management, delayed administration of epinephrine and delayed/absence of attachment of pads to the defibrillator as well as absence of accessing ALS algorithms, poor chest compressions and passive behaviour during simulated cardiac arrests. CONCLUSION Poor demonstration of technical/non-technical skills mandate regular ISS interventions for healthcare professionals of all levels. ISS positively impacts on staff confidence and training and drives identification of latent errors enabling improvements in workplace systems and resources.
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Affiliation(s)
- Julian Tristan Schwartze
- Stroke Medicine, National Hospital for Neurology and Neurosurgery, London, UK
- Medical Education, Stepping Hill Hospital, Stockport, UK
| | - Souvik Das
- Emergency Department, Stepping Hill Hospital, Stockport, UK
| | | | | | - Simon Tunstall
- Department of Anaesthetics, Stepping Hill Hospital, Stockport, UK
| | - Nicholas Ronan
- Royal Stoke University Hospital Acute Medical Unit, Stoke-on-Trent, UK
| | | | - Amina Rezgui
- Acute Medicine, Stepping Hill Hospital, Stockport, UK
| | - Wisam Jafar
- Gastroenterology, Stepping Hill Hospital, Stockport, UK
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Levy N, Saeed S, Gbagornah PF, Benavides-Zora D, Winterton D, Jackson CD, Sharkey A, Levy L, Neves S, Walsh DP, Matyal R. Implementation of Routine In Situ Simulation in Residency Curriculum Targeting Competency in Technical and Decision-Making Skills. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00297-0. [PMID: 38955619 DOI: 10.1053/j.jvca.2024.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To describe the development and implementation of a comprehensive in situ simulation-based curriculum for anesthesia residents. DESIGN This is a prospective study. SETTING This study was conducted at a university hospital. PARTICIPANTS This single-center prospective study included all 53 anesthesia residents enrolled in the anesthesia residency program. INTERVENTIONS Introduction of a routine, high-fidelity, in situ simulation program that incorporates short sessions to train residents in the necessary skill sets and decision-making processes required in the operating room. MEASUREMENTS AND MAIN RESULTS Our team conducted 182 individual 15-minute simulation sessions over 3 months during regular working hours. All 53 residents in our program actively participated in the simulations. Most residents engaged in at least 3 sessions, with an average participation rate of 3.4 per resident (range, 1-6 sessions). Residents completed an online anonymous survey, with a response rate of 71.7% (38 of 53 residents) over the 3-month period. The survey aimed to assess their overall impression and perceived contribution of this project to their training. CONCLUSIONS Our proposed teaching method can bridge the gap in resident training and enhance their critical reasoning to manage diverse clinical situations they may not experience during their residency.
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Affiliation(s)
- Nadav Levy
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Shirin Saeed
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Peva F Gbagornah
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - David Benavides-Zora
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Dario Winterton
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Cullen D Jackson
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Lior Levy
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Sara Neves
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Daniel P Walsh
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215
| | - Robina Matyal
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215.
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Edwards GF, Mierisch C, Mutcheson B, Strauss A, Coleman K, Horn K, Parker SH. Developing medical simulations for opioid overdose response training: A qualitative analysis of narratives from responders to overdoses. PLoS One 2024; 19:e0294626. [PMID: 38547079 PMCID: PMC10977769 DOI: 10.1371/journal.pone.0294626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/06/2023] [Indexed: 04/02/2024] Open
Abstract
Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders' behavior, were used to create four example simulations of out-of-hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.
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Affiliation(s)
- G. Franklin Edwards
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Cassandra Mierisch
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Brock Mutcheson
- Office of Assessment and Program Evaluation, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Allison Strauss
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
| | - Keel Coleman
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
- Department of Emergency Medicine, Carilion Clinic, Roanoke, Virginia, United States of America
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
- Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States of America
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Buckley E, Barrett A, Power D, Whelton H, Cooke J. A competitive edge: Developing a simulation faculty using competition. CLINICAL TEACHER 2024; 21:e13641. [PMID: 37622413 DOI: 10.1111/tct.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Emily Buckley
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
| | | | - David Power
- ASSERT Centre University College Cork, Cork, Ireland
| | - Helen Whelton
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - John Cooke
- Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland
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Calhoun AW, Cook DA, Genova G, Motamedi SMK, Waseem M, Carey R, Hanson A, Chan JCK, Camacho C, Harwayne-Gidansky I, Walsh B, White M, Geis G, Monachino AM, Maa T, Posner G, Li DL, Lin Y. Educational and Patient Care Impacts of In Situ Simulation in Healthcare: A Systematic Review. Simul Healthc 2024; 19:S23-S31. [PMID: 38240615 DOI: 10.1097/sih.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT This systematic review was performed to assess the effectiveness of in situ simulation education. We searched databases including MEDLINE and Embase for studies comparing in situ simulation with other educational approaches. Two reviewers screened articles and extracted information. Sixty-two articles met inclusion criteria, of which 24 were synthesized quantitatively using random effects meta-analysis. When compared with current educational practices alone, the addition of in situ simulation to these practices was associated with small improvements in clinical outcomes, including mortality [odds ratio, 0.66; 95% confidence interval (CI), 0.55 to 0.78], care metrics (standardized mean difference, -0.34; 95% CI, -0.45 to -0.21), and nontechnical skills (standardized mean difference, -0.52; 95% CI, -0.99 to -0.05). Comparisons between in situ and traditional simulation showed mixed learner preference and knowledge improvement between groups, while technical skills showed improvement attributable to in situ simulation. In summary, available evidence suggests that adding in situ simulation to current educational practices may improve patient mortality and morbidity.
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Affiliation(s)
- Aaron W Calhoun
- From the University of Louisville (A.C., G.G., A.H.), Louisville, KY; Mayo Multidisciplinary Simulation Center (D.A.C.), Mayo Clinic College of Medicine and Science, Rochester, MN; Indiana University School of Medicine (S.M.K.M.), Indianapolis, IN; Lincoln Medical Center (M.W.), Bronx New York, NY; University of Saskatchewan (R.C.), Saskatoon, Canada; The Chinese University of Hong Kong (J.C.K.C.), Hong Kong SAR; Center for Clinical Excellence (C.C., T.M.), Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH; Pediatric Critical Care Medicine (I.H.-G.), Bernard and Millie Duker Children's Hospital, Albany, NY; Boston University Chobanian & Avedisian School of Medicine (B.W.), Boston, MA; University of Alabama at Birmingham (M.W.), Birmingham, AL; Cincinnati Children's Hospital (G.G.), Cincinnati, OH; Center for Simulation, Advanced Education, and Innovation (A.M.M.), Children's Hospital of Philadelphia, Philadelphia, PA; University of Ottawa Skills & Simulation Centre (G.P.), University of Ottawa, Ontario, Canada; Department of Critical Care (D.L.L.), Zhongnan Hospital of Wuhan University, Wuhan, China; and University of Calgary (Y.L.), Calgary, Canada
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Mileder LP, Schwaberger B, Baik-Schneditz N, Ribitsch M, Pansy J, Raith W, Rohrleitner A, Mesaric G, Urlesberger B. Sustained decrease in latent safety threats through regular interprofessional in situ simulation training of neonatal emergencies. BMJ Open Qual 2023; 12:e002567. [PMID: 38154819 PMCID: PMC10759052 DOI: 10.1136/bmjoq-2023-002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023] Open
Abstract
Simulation training at trainees' actual workplace offers benefits over traditional simulation-based team training. We prospectively investigated whether regular in situ simulation training of neonatal emergencies in an interprofessional and interdisciplinary team could be used to identify and rectify latent safety threats (LSTs).For this purpose, we conducted 1-day in situ simulation trainings at the Department of Gynaecology and Obstetrics, Feldbach, Austria, targeting anaesthesiologists, obstetricians, midwives, nurses and consultant paediatricians. Using published criteria for categorising LSTs, we collected LSTs, either recognised by trainers or training participants, categorised them qualitatively (medication, equipment, resource/system) and based on their potential for harm, discussed them with training participants, and reported them to hospital leadership.We conducted 13 trainings between June 2015 and April 2023, identifying 67 LSTs, most in the category of equipment (42/67, 62.7%), followed by resource/system (14/67, 20.9%) and medication (11/67, 16.4%). Sixty-one (91.0%) of the LSTs could be rectified by the next training. We observed a significant negative correlation between the number of delivered trainings and the frequency of identified LSTs (Pearson correlation coefficient r= -0,684, p=0.01).While we identified a higher number of LSTs in comparison to previously published studies, regular in situ simulation training of neonatal emergencies over a period of almost 8 years positively impacted patient safety, as the majority of LSTs was rectified by the next training. Even more important, the decrease in LSTs with the increasing number of delivered in situ simulation trainings underlines the sustained effect of this educational intervention.
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Affiliation(s)
- Lukas Peter Mileder
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Mirjam Ribitsch
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Angelika Rohrleitner
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Günter Mesaric
- Department of Anaesthesiology and Intensive Care Medicine, State Hospital Feldbach-Fürstenfeld, Feldbach, Styria, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Styria, Austria
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Lien RY, Cheng CG, Hung SH, Wang CY, Lin HC, Lu SF, Chin SI, Kuo YW, Liu CW, Yung MC, Cheng CA. The Effect of the Knowledge, Skills, and Attitudes from Nurse Training Using In Situ Simulation in an Intensive Care Unit. Healthcare (Basel) 2023; 11:2851. [PMID: 37957996 PMCID: PMC10649282 DOI: 10.3390/healthcare11212851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. METHODS This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. RESULTS The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. CONCLUSIONS In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field.
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Affiliation(s)
- Ru-Yu Lien
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Emergency, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan
| | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Chang Jung Christian University, Tainan 711301, Taiwan
| | - Chien-Ying Wang
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Division of Trauma, Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
| | - Shu-Fen Lu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Shu-I Chin
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yi-Wen Kuo
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Chia-Wen Liu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Ming-Chi Yung
- Department of Cardiovascular Surgery, Taiwan Adventist Hospital, Taipei 10556, Taiwan
| | - Chun-An Cheng
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Schram A, Jensen HI, Gamborg M, Lindhard M, Rölfing J, Kjaergaard-Andersen G, Bie M, Jensen RD. Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites. BMJ Open 2023; 13:e076163. [PMID: 37899150 PMCID: PMC10618977 DOI: 10.1136/bmjopen-2023-076163] [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] [Received: 05/31/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave. DESIGN Cohort study. SETTING AND INTERVENTION Five Danish hospitals. PARTICIPANTS A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study. INTERVENTION From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group. OUTCOME MEASURES Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention). RESULTS Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group. CONCLUSION The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.
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Affiliation(s)
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital-University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maria Gamborg
- MidtSim, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Morten Lindhard
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Paediatrics, Randers Regional Hospital, Randers, Denmark
| | - Jan Rölfing
- MidtSim, Central Denmark Region, Aarhus N, Denmark
- Department of Orthopaedics, Aarhus Universitet, Aarhus, Denmark
| | - Gunhild Kjaergaard-Andersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Magnus Bie
- MidtSim, Central Denmark Region, Aarhus N, Denmark
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Cuesta-Montero P, Navarro-Martínez J, Yedro M, Galiana-Ivars M. Sepsis and Clinical Simulation: What Is New? (and Old). J Pers Med 2023; 13:1475. [PMID: 37888086 PMCID: PMC10608191 DOI: 10.3390/jpm13101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Sepsis is a critical and potentially fatal condition affecting millions worldwide, necessitating early intervention for improved patient outcomes. In recent years, clinical simulation has emerged as a valuable tool for healthcare professionals to learn sepsis management skills and enhance them. METHODS This review aims to explore the use of clinical simulation in sepsis education and training, as well as its impact on how healthcare professionals acquire knowledge and skills. We conducted a thorough literature review to identify relevant studies, analyzing them to assess the effectiveness of simulation-based training, types of simulation methods employed, and their influence on patient outcomes. RESULTS Simulation-based training has proven effective in enhancing sepsis knowledge, skills, and confidence. Simulation modalities vary from low-fidelity exercises to high-fidelity patient simulations, conducted in diverse settings, including simulation centers, hospitals, and field environments. Importantly, simulation-based training has shown to improve patient outcomes, reducing mortality rates and hospital stays. CONCLUSION In summary, clinical simulation is a powerful tool used for improving sepsis education and training, significantly impacting patient outcomes. This article emphasizes the importance of ongoing research in this field to further enhance patient care. The shift toward simulation-based training in healthcare provides a safe, controlled environment for professionals to acquire critical skills, fostering confidence and proficiency when caring for real sepsis patients.
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Affiliation(s)
- Pablo Cuesta-Montero
- Department of Clinical Simulation (SimIA Lab), Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Jose Navarro-Martínez
- Department of Clinical Simulation (SimIA Lab), Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Melina Yedro
- Department of Clinical Simulation (SimIA Lab), Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - María Galiana-Ivars
- Department of Anesthesiology and Surgical Critical Care, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
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Grace MA, O'Malley R. Using In Situ Simulation to Identify Latent Safety Threats in Emergency Medicine: A Systematic Review. Simul Healthc 2023:01266021-990000000-00084. [PMID: 37725494 DOI: 10.1097/sih.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
SUMMARY STATEMENT This review aimed to explore existing literature on the use of in situ simulation to identify latent safety threats in emergency medicine. Studies were required to take place in a clinically active emergency department and have either a primary or secondary aim of identifying latent safety threats. A total of 2921 articles were retrieved through database searches and a total of 15 were deemed to meet the inclusion criteria.Latent safety threats were detected by a variety of methods including documentation during debrief/discussion (66%), during the simulation itself (33%), participant surveys (20%), and video analysis (20%). Using a multimodality approach with input from observers and participants from different professional backgrounds yielded the highest number of threats per simulation case (43 per case). Equipment was the most commonly reported threat (83%), followed by teamwork/communication (67%). Some studies did not report on mitigation of identified risks; formal processes should be implemented for the management of latent safety threats identified by in situ simulation. Future research should focus on translational outcomes to further strengthen the position of in situ simulation in emergency medicine.
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Affiliation(s)
- Margaret A Grace
- From the Mater Misericordiae University Hospital, Dublin (M.G.); and National University of Ireland, Galway, Ireland (R.O.M.)
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12
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Minors AM, Yusaf TC, Bentley SK, Grueso D, Campbell-Taylor K, Harford M, Mehri S, Williams LJ, Bajaj K. Enhancing Safety of a System-Wide In Situ Simulation Program Using No-Go Considerations. Simul Healthc 2023; 18:226-231. [PMID: 36630489 DOI: 10.1097/sih.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION A large-scale in situ simulation initiative on cardiac arrest in pregnancy was implemented across NYC Health + Hospitals. In situ simulation must be safely balanced with clinical conditions such as through application of no-go considerations or standardized reasons to cancel or postpone the simulation. Our objective is to describe our findings on the application of no-go considerations during this simulation initiative. METHODS NYC Health + Hospitals/Simulation Center developed an in situ simulation program focused on cardiac arrest in pregnancy, implemented at 11 acute care facilities. The program's toolkit included no-go considerations for in situ simulation safety: situations prompting a need to cancel, reschedule, or postpone a simulation to ensure patient and/or staff safety. RESULTS Data were collected from June 2018 through December 2019. The simulation sites reviewed the 13 established no-go considerations before each simulation event to assess if the simulation was safe to "go". After the conclusion of the initiative, all data related to no-go considerations were analyzed.Two hundred seventy-four in situ simulations were scheduled and 223 simulations (81%) were completed. Fifty-one no-go events were reported, with 78% identifying a reason by category. Twenty-two percent did not report a reason or category. Four of the 13 suggested no-go considerations were not reported. CONCLUSIONS The no-go considerations framework promotes standardized and strategic scheduling of in situ simulation. Analysis of no-go consideration application during this system-wide initiative provides a model for the usage of tracking no-go data to enhance safety and inform future simulation planning.
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Affiliation(s)
- Anjoinette M Minors
- From the NYC Health + Hospitals/Jacobi; Albert Einstein College of Medicine (A.M.M., K.B.), New York, NY; NYC Health + Hospitals/Jacobi & Simulation Center (T.C.Y.), New York, NY; NYC Health + Hospitals/Elmhurst & Simulation Center; Icahn School of Medicine at Mount Sinai (S.K.B.), New York, NY; NYC Health + Hospitals/Kings (D.G.), New York, NY; NYC Health + Hospitals/Simulation Center (K.C.-T., M.H.), New York, NY; NYC Health + Hospitals/Bellevue (S.M.), New York, NY; and NYC Health + Hospitals/Central Office (L.J.W.), New York, NY
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Arrogante Ó, Raurell-Torredà M, Zaragoza-García I, Sánchez-Chillón FJ, Aliberch-Raurell AM, Amaya-Arias A, Rojo-Rojo A. TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study. ENFERMERIA INTENSIVA 2023; 34:126-137. [PMID: 37246108 DOI: 10.1016/j.enfie.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/03/2022] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®". OBJECTIVES To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course. METHODS A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively. RESULTS Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®. CONCLUSIONS TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).
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Affiliation(s)
- Ó Arrogante
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain; Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain
| | - M Raurell-Torredà
- Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Departament Infermeria Fonamental i Mèdico Quirúrgica, Universitat de Barcelona, Barcelona, Spain.
| | - I Zaragoza-García
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain; Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - F J Sánchez-Chillón
- Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Centro de simulación, Hospital 12 de Octubre, Madrid, Spain
| | - A M Aliberch-Raurell
- Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Amaya-Arias
- Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Universidad de Antioquia, Antioquia, Colombia
| | - A Rojo-Rojo
- Grupo de simulación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain; Universidad Católica de Murcia, Murcia, Spain
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Barbosa MDS, Ferreira LML, Costa RRDO, Almeida RGDS, Carbogim FDC, Coelho ADCO. Construction and validation of simulated scenarios in the emergency care of patients with chest pain. Rev Gaucha Enferm 2023; 44:e20220186. [PMID: 37377271 DOI: 10.1590/1983-1447.2023.20220186.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/29/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To construct and validate clinical simulation scenarios for emergency care for patients with chest pain. METHODS A methodological study carried out in two stages: construction and validity. The construction took place through the survey of evidence from national and international literature. The validity stage took place through instrument assessment by judges, according to the Content Validity Index and application of a pilot test with the target audience. Fifteen judges with expertise in simulation, teaching and/or care participated in the research, in addition to 18 nursing students, in the pilot test. RESULTS Two scenarios of clinical simulation were constructed, and all the assessed items obtained a value above 0.80, showing evidence of validity, being considered instruments suitable for application. CONCLUSION The research contributed to the development and validity of instruments that can be applied for teaching, assessment and training in clinical simulation in emergency care for patients with chest pain.
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Affiliation(s)
- Mayara Dos Santos Barbosa
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Juiz de Fora, Minas Gerais, Brasil
| | - Lívia Maria Lopes Ferreira
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Juiz de Fora, Minas Gerais, Brasil
| | - Raphael Raniere de Oliveira Costa
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Educação, Trabalho e Inovação em Medicina. Natal, Rio Grande do Norte, Brasil
| | | | - Fábio da Costa Carbogim
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem, Departamento de Enfermagem Aplicada. Juiz de Fora, Minas Gerais, Brasil
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15
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Kim J, Dan H. Experiences of Advanced Health Assessment Simulation Based on the Education Needs of Gerontological Nurse Practitioner Students. Healthcare (Basel) 2023; 11:healthcare11081162. [PMID: 37107996 PMCID: PMC10137989 DOI: 10.3390/healthcare11081162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/15/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
There is an insufficient exploration of how simulation educational approaches improve the job performance of students in gerontological nurse practitioner (GNP) courses. To increase the effectiveness of simulation education in GNP courses, it is necessary to explore the advanced health assessment simulation curriculum. This study aimed to investigate GNP students' educational experiences with the advanced health assessment simulation program by reflecting the needs of GNPs. A qualitative study design was employed for this study; focus group interviews were conducted among eight GNP students who participated in this simulation program. The focus group interview identified three theme clusters: 'a high-fidelity simulator that reproduces a real-life setting', 'experience with standardized patients as a reference for normal older people', and 'application in the clinical field'. Through simulation education, GNP students were able to safely demonstrate knowledge and use what they learned for clinical practice. The development and utilization of simulation education for the GNP program would help to enhance the clinical competency of students.
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Affiliation(s)
- Jiyoung Kim
- Department of Nursing, Inha University, Incheon 22212, Republic of Korea
| | - Hyunju Dan
- Department of Nursing, Gangdong University, Eumseong-gun 27600, Republic of Korea
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16
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Finstad AS, Aase I, Bjørshol CA, Ballangrud R. In situ simulation-based team training and its significance for transfer of learning to clinical practice-A qualitative focus group interview study of anaesthesia personnel. BMC MEDICAL EDUCATION 2023; 23:208. [PMID: 37013537 PMCID: PMC10071610 DOI: 10.1186/s12909-023-04201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Anaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel's experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel's experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice. METHODS Follow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed. RESULTS Anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, 'interprofessional in situ SBTT as a contributor to enhance anaesthesia practice' and three generic categories, 'interprofessional in situ SBTT motivates learning and improves NTS', 'realism in SBTT is important for learning outcome', and 'SBTT increases the awareness of teamwork' illustrated their experiences. CONCLUSIONS Participants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.
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Affiliation(s)
- Anne Strand Finstad
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Ingunn Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Conrad Arnfinn Bjørshol
- The Regional Centre for Emergency Medical Research and Development (RAKOS), Stavanger University Hospital, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Randi Ballangrud
- Department of Health Science, Norwegian University of Science and Technology, Gjøvik, Norway
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Regional and clinical guidelines for prevention and care of obstetric anal sphincter injuries - A critical frame analysis. Midwifery 2023; 119:103608. [PMID: 36739637 DOI: 10.1016/j.midw.2023.103608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Policy documents govern how the prevention and care of obstetric anal sphincter injuries (OASIS) are implemented. Thus, in the absence of Swedish national guidelines on OASIS, differing views may be visible in the regional and local policy documents. Therefore, we aimed to analyse regional and local policies, guidelines, and care programs on the prevention of OASIS and care for OASIS-affected women in a Swedish context by applying a critical frame analysis inspired by Verloo. DESIGN AND SETTING A cross-sectional study of existing policy documents from Swedish healthcare regions was performed. The documents were analysed using Verloo's critical frame analysis. FINDINGS We found that OASIS was framed as a preventable problem addressed by skilled protective manoeuvres of the healthcare staff. Education, communication, and teamwork were three frames of crucial solutions to minimise the prevalence of OASIS. However, complicating power dimensions between professional groups and between professionals and birthing women were identified. Furthermore, several discursive struggles were found, predominantly regarding the scientific evidence for the suggested prevention and care. CONCLUSION The policy documents emphasised that OASIS is preventable, and improved education, communication, and teamwork could diminish the OASIS prevalence. Nevertheless, power dimensions and discursive struggles may challenge the preventive efforts. Furthermore, each Swedish region has the sovereignty to develop its policies, which was reflected in our findings and may imply inequities in care provision. Thus, there is an urgent need to develop comprehensive national high-quality guidelines of high quality for OASIS prevention and care so that all women giving birth have access to equal care and treatment in Sweden.
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Black H, Hall T, Hrymak C, Funk D, Siddiqui F, Sokal J, Satoudian J, Foster K, Kowalski S, Dufault B, Leeies M. A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic. CAN J EMERG MED 2023; 25:123-133. [PMID: 36542309 PMCID: PMC9768405 DOI: 10.1007/s43678-022-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba's largest tertiary hospital. During this study, a natural experiment emerged when a standardized "COVID-Protected Rapid Sequence Intubation Protocol" was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a "COVID-Protected Rapid Sequence Intubation Protocol" impact first-pass success or other intubation-related outcomes? METHODS A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack-Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days. RESULTS Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% (n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% (n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack-Lehane view favoring the protocol (p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol (p = 0.0172). CONCLUSION A "COVID-Protected Protocol" implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events.
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Affiliation(s)
- Holly Black
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Thomas Hall
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Carmen Hrymak
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Duane Funk
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Faisal Siddiqui
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - John Sokal
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Jaime Satoudian
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Kendra Foster
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Stephen Kowalski
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Brenden Dufault
- George & Fay Yee Center for Healthcare Innovation, Winnipeg, MB Canada
| | - Murdoch Leeies
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
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Interprofessional In Situ Simulation in a Complex Setting. What Does the Future Hold? Jt Comm J Qual Patient Saf 2022; 48:627-629. [PMID: 36307359 DOI: 10.1016/j.jcjq.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Arrogante Ó, Raurell-Torredà M, Zaragoza-García I, Sánchez-Chillón F, Aliberch-Raurell A, Amaya-Arias A, Rojo-Rojo A. Programa de entrenamiento basado en TeamSTEPPS® mediante simulación clínica en profesionales de cuidados intensivos: un estudio con metodología mixta. ENFERMERÍA INTENSIVA 2022. [DOI: 10.1016/j.enfi.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Cogan ES, Thomas LMB. Improving CPR quality through high-performance resuscitation team training. Nursing 2022; 52:57-59. [PMID: 36006755 DOI: 10.1097/01.nurse.0000854016.95250.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Elizabeth S Cogan
- Elizabeth Cogan completed her DNP at the University of Nevada in Reno, Nev., where Lisa Thomas is an associate professor
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22
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Evans K, Woodruff J, Cowley A, Bramley L, Miles G, Ross A, Cooper J, Baxendale B. GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review. BMC MEDICAL EDUCATION 2022; 22:537. [PMID: 35818052 PMCID: PMC9272657 DOI: 10.1186/s12909-022-03401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. METHODS A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. RESULTS Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. CONCLUSIONS This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
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Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | | | - Alison Cowley
- Nottingham University Hospitals Trust, Research & Innovation, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Giulia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Joanne Cooper
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
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Hovlid E, Husabø G, Valestrand EA, Hartveit M. Learning team-based quality improvement in a virtual setting: a qualitative study. BMJ Open 2022; 12:e061390. [PMID: 35728894 PMCID: PMC9214407 DOI: 10.1136/bmjopen-2022-061390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective was to explore students' perceptions of learning quality improvement (QI) in a virtual setting and identify factors that promote or inhibit virtual learning. DESIGN We used an exploratory case study design with focus group interviews. The data were analysed using a thematic analysis approach, with an analytical framework derived from activity theory and Bloom's revised taxonomy of six categories of cognitive processes of learning. SETTING Postgraduate students participating in a virtual 1-day simulation module to learn QI at two universities in Norway. PARTICIPANTS Four focus groups with a total of 12 participants. RESULTS The students' descriptions of learning outcomes indicate that the learning activity involved a variety of cognitive activities, including higher-order cognitive processes. We identified three themes pertaining to the students' experiences of the virtual learning activity: learning through active participation, constructing a virtual learning opportunity and creating a virtual learning environment. The students described that participation and active engagement led to a greater understanding and an integration of theory and practical improvement skills. They reported that to engage in the virtual learning opportunity, it was necessary to create a learning environment where they felt psychologically safe. CONCLUSION Our findings indicate that it is possible to facilitate collaborative learning integrating theoretical knowledge and practical skills in a virtual setting. Students experienced that engaging in the virtual learning activity contributed to the integration of theoretical knowledge and practical skills. Psychological safety seems to be important for students' engagement in the virtual learning activity. A virtual learning environment alters prior common norms for interaction based on physical presence, which in turn affect students feeling of psychological safety. Educators need to be aware of this and facilitate a virtual learning environment where students feel comfortable to engage.
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Affiliation(s)
- Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences - Sogndal Campus, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences - Sogndal Campus, Sogndal, Norway
| | - Eivind Alexander Valestrand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Education, University of Bergen, Bergen, Norway
| | - Miriam Hartveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Helse Fonna HF, Haugesund, Norway
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Baxendale B, Evans K, Cowley A, Bramley L, Miles G, Ross A, Dring E, Cooper J. GENESISS 1-Generating Standards for In-Situ Simulation project: a scoping review and conceptual model. BMC MEDICAL EDUCATION 2022; 22:479. [PMID: 35725432 PMCID: PMC9208746 DOI: 10.1186/s12909-022-03490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/23/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance. METHODS A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback. RESULTS Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings. CONCLUSIONS ISS presents a promising approach to improve individual and team capabilities and system performance and address the 'practice-theory gap'. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.
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Affiliation(s)
- Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Kerry Evans
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Research and Innovation, Nottingham, UK
| | - Louise Bramley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Guilia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Eleanore Dring
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne Cooper
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Schwindt EM, Stockenhuber R, Kainz T, Stumptner N, Henkel M, Hefler L, Schwindt JC. Neonatal simulation training decreases the incidence of chest compressions in term newborns. Resuscitation 2022; 178:109-115. [PMID: 35700883 DOI: 10.1016/j.resuscitation.2022.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters. METHODS This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions. RESULTS Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001). CONCLUSION Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.
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Affiliation(s)
- Eva M Schwindt
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria; STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
| | | | - Theresa Kainz
- Medical University Vienna, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Nicola Stumptner
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Henkel
- Department of Paediatrics and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Seilerstaette 4, 4010 Linz, Austria
| | - Lukas Hefler
- Department of Obstetrics and Gynecology, Konventhospital Barmherzige Brueder and Ordensklinikum Linz, Seilerstaette 2-4, 4010 Linz, Austria
| | - Jens C Schwindt
- STAR - SIMCharacters Training and Research, Lehargasse 1, 1090 Vienna, Austria; Neonatal Working Group, Austrian Resuscitation Council, Villefortgasse 22, 8010 Graz, Austria
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Herrera-Aliaga E, Estrada LD. Trends and Innovations of Simulation for Twenty First Century Medical Education. Front Public Health 2022; 10:619769. [PMID: 35309206 PMCID: PMC8929194 DOI: 10.3389/fpubh.2022.619769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
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Affiliation(s)
| | - Lisbell D. Estrada
- Faculty of Health Sciences, Universidad Bernardo O'Higgins, Santiago, Chile
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Manggala SK, Tantri AR, Sugiarto A, Sianipar IR, Prasetyono TOH. In situ simulation training for a better interprofessional team performance in transferring critically ill patients with COVID-19: a prospective randomised control trial. Postgrad Med J 2022; 98:617-621. [PMID: 35101969 PMCID: PMC8814429 DOI: 10.1136/postgradmedj-2021-141426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/15/2022] [Indexed: 11/08/2022]
Abstract
Background Transferring critically ill patients with COVID-19 is a challenging task; therefore, well-trained medical team is needed. This study aimed to determine the role of in situ simulation training during pandemic by using high-fidelity manikin to improve interprofessional communication, skills and teamwork in transferring critically ill patients with COVID-19. Methods This single-blinded randomised control trial included 40 subjects allocated into standard low-fidelity simulator (LFS) and high-fidelity simulator (HFS) groups. Subjects, who were not members of multiprofessional team taking care of patients with COVID-19, in each group were assigned into small groups and joined an online interactive lecture session, two sessions of in-situ simulation and a debriefing session with strict health protocols. The first simulation aimed to teach participants the skills and steps needed. The second simulation aimed to assess transfer skills, communication and teamwork performance, that participants had learnt using a validated, comprehensive assessment tool. Data were analysed using unpaired t test or Mann-Whitney test. Results The HFS group showed significantly better overall transfer and communication skills than LFS group (89.70±4.65 vs 77.19±3.6, <0.05 and 100 vs 88.34 (63.33–100), p=0.022, respectively). The HFS group also demonstrated significantly better teamwork performance than the standard LFS group (90 (80–900) vs 80 (70–90), p=0.028). Conclusion In situ simulation training using HFS significantly showed better performance than the standard training using LFS in regards to overall transfer and communication skills as well as teamwork performance. The training using HFS may provide a valuable adjunct to improve interprofessional skills, communication and teamwork performance in transferring critically ill patients with COVID-19. Trial registration number NCT05113823.
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Affiliation(s)
- Sidharta Kusuma Manggala
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Aida Rosita Tantri
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- SIMUBEAR (Simulation Based Medical Education and Research Center), IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
| | - Adhrie Sugiarto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Imelda Rosalyn Sianipar
- SIMUBEAR (Simulation Based Medical Education and Research Center), IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
- Department of Medical Physiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Theddeus Octavianus Hari Prasetyono
- Department of Plastic Surgery, Departement of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- ICTEC (Indonesian Clinical Training and Education Center), Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- Medical Technology Cluste IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
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Yousef N, Moreau R, Soghier L. Simulation in neonatal care: towards a change in traditional training? Eur J Pediatr 2022; 181:1429-1436. [PMID: 35020049 PMCID: PMC8753020 DOI: 10.1007/s00431-022-04373-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 12/28/2022]
Abstract
UNLABELLED Simulation has traditionally been used in neonatal medicine for educational purposes which include training of novice learners, maintaining competency of health care providers, and training of multidisciplinary teams to handle crisis situations such as neonatal resuscitation. Current guidelines recommend the use of simulation as an education tool in neonatal practice. The place of simulation-based education has gradually expanded, including in limited resource settings, and is starting to show its impact on improving patient outcomes on a global basis. Over the past years, simulation has become a cornerstone in clinical settings with the goal of establishing high quality, safe, reliable systems. The aim of this review is to describe neonatal simulation training as an effective tool to improve quality of care and patient outcomes, and to encourage the use of simulation-based training in the neonatal intensive care unit (NICU) for not only education, but equally for team building, risk management and quality improvement. CONCLUSION Simulation is a promising tool to improve patient safety, team performance, and ultimately patient outcomes, but scarcity of data on clinically relevant outcomes makes it difficult to estimate its real impact. The integration of simulation into the clinical reality with a goal of establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes in neonatology must be a priority. WHAT IS KNOWN • Simulation-based education has traditionally focused on procedural and technical skills. • Simulation-based training is effective in teaching non-technical skills such as communication, leadership, and teamwork, and is recommended in neonatal resuscitation. WHAT IS NEW • There is emerging evidence for the impact of simulation-based training on patient outcomes in neonatal care, but data on clinically relevant outcomes are scarce. • Simulation is a promising tool for establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes.
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Affiliation(s)
- Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, Dept of Perinatal Medicine, "A.Béclère" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.
| | - Romain Moreau
- Division of Pediatrics and Neonatal Critical Care, Dept of Perinatal Medicine, “A.Béclère” Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Lamia Soghier
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC USA ,Department of Neonatology, Children’s National, Washington, DC USA
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Green A, Smith C, Elsheikh M, Razaq A. 133 Establishing An Inter-Professional <i>in situ</i> Simulation (ISS) Programme in District General Hospital Emergency Departments (EDS). Simul Healthc 2021. [DOI: 10.54531/aryj8432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
simulation (ISS) is an effective educational tool that improves patient safety outcomes The aim of the study was to establish a regular programme of inter-professional ISS delivered by a dedicated team in the emergency department (ED).An ED simulation team was created, including consultants, a senior registrar and two newly appointed simulation junior clinical fellows. Sessions run monthly in both EDs in the trust, taking place in the ‘green’ resus area, in the morning when clinical demand is usually lowest. Participants include doctors and nursing staff of all grades, with cross-speciality involvement. Increasing participation required was influenced by senior management and clinical staff agreeing this was a necessary and valuable tool. Faculty include the ED simulation team and a simulation technician. Scenarios are developed by the team with specific intended learning outcomes, e.g. ALS in COVID-19, assessment of the acutely unwell pregnant patient. Intended learning outcomes are influenced by new guidelines, specific emergency cases or skills and suggestions by staff. The patient has been trialled as an actor and/or SimMan3G, depending on the scenario. Clinical equipment is mostly donated and expired. A structured debrief is led by a senior simulation team member. Key learning from each session is summarized in a ‘Sim News’ poster which is tweeted, disseminated via email to all staff and published on the departmental ‘EMBeds’ website. Participants fill in an anonymous feedback form online and receive a certificate of participation.Fifty-nine participants from December 2020 to April 2021 gave feedback (see Feedback form resultsThe
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Machin J, Schofield L, Blackshaw J, Taylor-Jones V, Rimmer N, Parker M, McFarlane H, Harrison M, Taylor J. 114 Latent Environmental Errors Revealed: Using <i>in situ</i> Simulation to Check the Safety of Returning Theatres to Operating After Being Repurposed as a Ventilator Inpatient Unit. Simul Healthc 2021. [DOI: 10.54531/aefu7500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the second wave of the coronavirus pandemic, Day Surgery had been stopped for 6 months at Aintree University Hospital to respond to an influx of COVID patients. Day Surgery theatre staff had been redeployed to other areas of the hospital, including A&E and Intensive Care. The Day Surgery recovery had been repurposed as a ventilatory inpatient unit for coronavirus patients. We felt that this potentially jeopardized the confidence and competence of returning elective care staff. We hypothesized that the theatres themselves had become unsafe to accept patients for elective procedures having been used for a different purpose for such a long time. We used We aimed to improve the confidence and capability of theatre staff returning to work in elective theatres and to perform a systems test of the Day Surgery Unit to identify and rectify any latent errors.The refresher day was split into morning and afternoon sessions. The morning session comprised of two simulation sessions: cardiac arrest in recovery and a difficult airway in theatre. The afternoon comprised of sessions focussing on five anaesthetic emergencies: malignant hyperthermia, local anaesthetic toxicity, massive haemorrhage, anaphylaxis and sepsis. These sessions included locating and studying standard operating procedure (SOP) folders and locating vital equipment in the treatment of these emergencies. Participants then evaluated their confidence in managing emergencies before and after the refresher day using pre- and post-questionnaires. We also encouraged participants to raise concerns and make suggestions in a free-text section.Forty participants took part in the refresher day. Pre- and post-questionnaires indicated that participants had much-improved confidence in dealing with anaesthetic emergencies post-session. We identified several latent errors within the unit including missing and out-of-date SOP folders, missing anaphylaxis bag, no fibrescope available for the difficult airway, no key available for the malignant hyperthermia cupboard and a poorly stocked and unsealed difficult airway trolley.The results show that participants felt more confident to restart work in the Day Surgery Unit, hopefully improving their performance in critical incidents. By running
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Using Systems Thinking to Identify Staff and Patient Safety Issues in Infectious Disease Simulation Scenarios. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sarmasoglu Kilikcier S, Celik N, Elcin M, Keskin G, Senel E. Impact of interprofessional in situ simulations on acute pediatric burn management: Combining technical and non-technical burn team skills. Burns 2021; 48:1653-1661. [PMID: 34955296 DOI: 10.1016/j.burns.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of interprofessional in situ simulations on the technical and non-technical skills of pediatric burn teams in acute burn management. METHODS This quasi-experimental study consisted of a one-group pre- and post-test design conducted in a pediatric burn center in Turkey. The sample consisted of nine interprofessional burn team members. Data collection tools consisted of the following: descriptive data form, burn technical skills checklists, simulation evaluation form, and Anesthesiologists' non-technical skills in Denmark rating form. RESULTS We found no statistically significant difference between the pre- and post-test scores for technical (p = 0.285) and non-technical skill (p = 0.180) scores. Burn team members evaluated the highest score in almost all criteria for in situ simulations. CONCLUSION The interprofessional in situ simulations did not improve the burn teams' acute burn management; however, according to a self-report, burn team members were satisfied with the interprofessional in situ simulation experiences and achieved their own gains.
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Affiliation(s)
- Senay Sarmasoglu Kilikcier
- Hacettepe University, Faculty of Nursing, Department of Fundamentals of Nursing/Graduate School of Health Sciences, Department of Simulation in Healthcare, 06100 Ankara, Turkey.
| | - Nazmiye Celik
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Burn Center, 06110 Ankara, Turkey.
| | - Melih Elcin
- Hacettepe University, Faculty of Medicine, Department of Medical Education and Informatics/Graduate School of Health Sciences, Department of Simulation in Healthcare 06100 Ankara, Turkey.
| | - Gulsen Keskin
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Anesthesia, 06110 Ankara, Turkey.
| | - Emrah Senel
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Pediatric Surgery,06110 Ankara, Turkey.
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Bredmose PP, Hagemo J, Østergaard D, Sollid S. Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept. BMC MEDICAL EDUCATION 2021; 21:579. [PMID: 34781954 PMCID: PMC8594198 DOI: 10.1186/s12909-021-03015-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. METHODS Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the study period, semi-structured interviews were performed with a sample of HEMS crew members and facilitators to further explore the experience with the concept. Numerical data about the sessions were recorded continuously. RESULTS A total of 78 training sessions were attempted, with 46 (59%) of the simulations conducted as planned. Of the remaining, 23 (29%) were not started because the crew had other duties (fatigued crew or crew called for a mission where observation was inappropriate/impossible), and 9 (12%) training sessions were converted to observed live missions. In total, 43 (55%), 16 (21%) and 19 (24%) attempts to facilitate simulation training were undertaken on the three bases, respectively. The facilitators considered mission observation more challenging than simulation. The interviews identified local know-how, clinical skills, and excellent communication skills as important prerequisites for the facilitators to conduct live mission observation successfully. Participating crews and facilitators found simulation both valuable and needed. Being observed was initially perceived as unpleasant but later regarded as a helpful way of learning. CONCLUSION Live mission observation and debriefing seems a feasible and well-received alternative to an in-situ simulation program in HEMS to maximise invested resources and maintain the learning outcome. Furthermore, additional training of simulation facilitators to handle the context of live mission observation may further improve the learning output.
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Affiliation(s)
- Per P. Bredmose
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Postboks 414, Sentrum, 0103 Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jostein Hagemo
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Postboks 414, Sentrum, 0103 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Sollid
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Temsah MH, Alrabiaah A, Al-Eyadhy A, Al-Sohime F, Al Huzaimi A, Alamro N, Alhasan K, Upadhye V, Jamal A, Aljamaan F, Alhaboob A, Arabi YM, Lazarovici M, Somily AM, Boker AM. COVID-19 Critical Care Simulations: An International Cross-Sectional Survey. Front Public Health 2021; 9:700769. [PMID: 34631644 PMCID: PMC8500233 DOI: 10.3389/fpubh.2021.700769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the utility and patterns of COVID-19 simulation scenarios across different international healthcare centers. Methods: This is a cross-sectional, international survey for multiple simulation centers team members, including team-leaders and healthcare workers (HCWs), based on each center's debriefing reports from 30 countries in all WHO regions. The main outcome measures were the COVID-19 simulations characteristics, facilitators, obstacles, and challenges encountered during the simulation sessions. Results: Invitation was sent to 343 simulation team leaders and multidisciplinary HCWs who responded; 121 completed the survey. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Regarding the themes of the simulation sessions, they were COVID-19 patient arrival to ER (69.4%), COVID-19 patient intubation due to respiratory failure (66.1%), COVID-19 patient requiring CPR (53.7%), COVID-19 transport inside the hospital (53.7%), COVID-19 elective intubation in OR (37.2%), or Delivery of COVID-19 mother and neonatal care (19%). Among participants, 55.6% reported the team's full engagement in the simulation sessions. The average session length was 30-60 min. The debriefing process was conducted by the ICU facilitator in (51%) of the sessions followed by simulation staff in 41% of the sessions. A total of 80% reported significant improvement in clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 sessions. Most perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. Conclusion: Simulation centers team leaders and HCWs reported positive feedback on COVID-19 simulation sessions with multidisciplinary personnel involvement. These drills are a valuable tool for rehearsing safe dynamics on the frontline of COVID-19. More research on COVID-19 simulation outcomes is warranted; to explore variable factors for each country and healthcare system.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alrabiaah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Infectious Disease Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad Al-Sohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Clinical Skills & Simulation Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Huzaimi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Pediatric Cardiology, Department of Cardiac Sciences, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Nurah Alamro
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Nephrology Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Vaibhavi Upadhye
- Clinical Lead in Simulation, Dr. Indumati Amodkar Simulation Center, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marc Lazarovici
- Ludwig-Maximilians-University, Munich University Hospital, Munich, Germany
| | - Ali M. Somily
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M. Boker
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Centre, King Abdulaziz University, Jeddah, Saudi Arabia
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Sterz J, Gutenberger N, Stefanescu MC, Zinßer U, Bepler L, Linßen S, Schäfer V, Carstensen P, Verboket RD, Adili F, Ruesseler M. Manikins versus simulated patients in emergency medicine training: a comparative analysis. Eur J Trauma Emerg Surg 2021; 48:3793-3801. [PMID: 34331074 PMCID: PMC9532276 DOI: 10.1007/s00068-021-01695-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Every physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism. METHODS The study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units ('chest pain', 'impaired consciousness', 'dyspnea'), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training. RESULTS 126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for 'chest pain' and 'impaired consciousness', students who trained with a manikin scored less in the OSCE station than the simulated patients-group. CONCLUSION Simulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.
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Affiliation(s)
- Jasmina Sterz
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany.,Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Niklas Gutenberger
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Maria-Christina Stefanescu
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Uwe Zinßer
- Medical Faculty, SP Training Center, Goethe University, Frankfurt, Germany
| | - Lena Bepler
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Svea Linßen
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Verena Schäfer
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Patrick Carstensen
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - René Danilo Verboket
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Farzin Adili
- Division of Vascular and Endovascular Surgery, Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany
| | - Miriam Ruesseler
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany. .,Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany.
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Andre A, Reed A, Ananthakrishnan S, Korczak P. An Evaluation of Simulation Techniques in Audiology and Allied Health Professions. Am J Audiol 2021; 30:295-308. [PMID: 33872515 DOI: 10.1044/2021_aja-20-00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aims to investigate the experiences and opinions of clinical educators from various allied health care fields, including audiology, related to the use of simulation as a teaching technique and determine the status of clinical simulation techniques in training audiology graduate students nationwide. Method An interview was conducted with nine faculty members in the College of Health Professions at Towson University to discuss advantages and challenges of incorporating clinical simulation techniques into student learning. A thematic analysis was used to analyze the interview responses. Additionally, a web-based questionnaire was sent to all audiology graduate program directors nationwide, yielding a response rate of 63%. These data were analyzed using descriptive statistics. Results Interview responses revealed a number of benefits and barriers related to simulation use at the graduate level. Benefits included its use as a learning tool, a quality control measure, and an aid in professional development. It also increases students' confidence levels in clinical procedures and counseling skills and exposes them to a variety of clinical pathologies not routinely seen. Barriers included lack of training with simulators, lack of funding to purchase simulator technology, and lack of resources, such as time and space. At present, only 50% of audiology program directors reported using clinical simulation to train their students. Conclusions The field of audiology is embracing simulation techniques in training its preprofessional work force. To date, there has been limited guidance from professional organizations regarding the role of simulation in audiology. Additional assistance focusing on best practices for these techniques is warranted.
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Affiliation(s)
- Alexandra Andre
- Department of Speech-Language Pathology and Audiology, Towson University, MD
- Chesapeake Ear, Nose, and Throat, a division of The Centers for Advanced ENT Care, LLC, Owings Mills, MD
| | - Amanda Reed
- Department of Speech-Language Pathology and Audiology, Towson University, MD
- Live Better Hearing + Balance, Frederick, MD
| | | | - Peggy Korczak
- Department of Speech-Language Pathology and Audiology, Towson University, MD
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Turner D, Picton G, Harrod E, Bossy M. Using a breathing simulator to improve simulation-based education for noninvasive ventilation. Breathe (Sheff) 2021; 17:200285. [PMID: 34295417 PMCID: PMC8291930 DOI: 10.1183/20734735.0285-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/14/2021] [Indexed: 11/05/2022] Open
Abstract
Simulation-based medical education is recognised as a highly effective training tool. Novel technologies such as breathing simulators have the potential to revolutionise how we train healthcare professionals to manage patients requiring NIV. https://bit.ly/3f4Hnt1.
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Affiliation(s)
| | | | | | - Michele Bossy
- Medisim, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
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Paganini M, Mormando G, Savino S, Garetto G, Tiozzo G, Camporesi EM, Fabris F, Bosco G. Emergency Medicine Cases in Underwater and Hyperbaric Environments: The Use of in situ Simulation as a Learning Technique. Front Physiol 2021; 12:666503. [PMID: 34093229 PMCID: PMC8176206 DOI: 10.3389/fphys.2021.666503] [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: 02/10/2021] [Accepted: 04/13/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine. METHODS We implemented the curriculum of the Master's degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight in situ simulation scenarios. RESULTS For the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome ("taravana/samba") in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver. CONCLUSION With this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants.
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Affiliation(s)
- Matteo Paganini
- Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy
- Emergency Medicine, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Giulia Mormando
- Emergency Medicine, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Sandro Savino
- Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Giacomo Garetto
- Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy
- Emergency Medicine, Department of Medicine (DIMED), University of Padova, Padua, Italy
- Department of Medicine (DIMED), University of Padova, Padua, Italy
- ATIP Center for Hyperbaric Medicine, Padua, Italy
| | - Giulia Tiozzo
- Emergency Medicine, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Enrico M. Camporesi
- Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy
- Emergency Medicine, Department of Medicine (DIMED), University of Padova, Padua, Italy
- Department of Medicine (DIMED), University of Padova, Padua, Italy
- ATIP Center for Hyperbaric Medicine, Padua, Italy
- TEAMHealth Research Institute, Tampa General Hospital, Tampa, FL, United States
| | - Fabrizio Fabris
- Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Gerardo Bosco
- Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy
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Bredmose PP, Røislien J, Østergaard D, Sollid S. National Implementation of In Situ Simulation-Based Training in Helicopter Emergency Medical Services: A Multicenter Study. Air Med J 2021; 40:205-210. [PMID: 34172225 DOI: 10.1016/j.amj.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Medical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation, we aimed to evaluate the degree of implementation, the barriers to completing simulation training, and the crew's attitude toward this form of training. METHODS This was a 1-year prospective study on simulation at all 14 Norwegian helicopter emergency services bases and 1 search and rescue base. Local facilitators were educated and conducted simulations at their discretion. RESULTS All bases agreed to participate initially, but 1 opted out because of technical difficulties. The number of simulations attempted at each base ranged from 1 to 46 (median = 17). Regardless of the base and the number of attempted simulations, participating crews scored self-evaluated satisfaction with this form of training highly. Having 2 local facilitators increased the number of attempted simulations, whereas facilitators' travel distance to work seemed to make no difference on the number of attempted simulations. CONCLUSION Our study reveals considerable differences in the number of attempted simulations between bases despite being given the same prerequisites. The busiest bases completed fewer simulations than the rest of the bases. Our findings suggest that conditions related to the local facilitator are important for the successful implementation of simulation-based training in helicopter emergency services.
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Affiliation(s)
- Per P Bredmose
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Jo Røislien
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Stephen Sollid
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Gatwood J, Renfro C, Hagemann T, Chiu CY, Kapan S, Frederick K, Hohmeier KC. Facilitating pneumococcal vaccination among high-risk adults: Impact of an assertive communication training program for community pharmacists. J Am Pharm Assoc (2003) 2021; 61:572-580.e1. [PMID: 33935021 DOI: 10.1016/j.japh.2021.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/19/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community pharmacies are vital access points to provide a range of vaccines to adults, including pneumococcal vaccines; however, despite a growth in the number of vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below the goals set by Health People 2020. Low patient awareness is a leading reason for suboptimal vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults. OBJECTIVES To evaluate the impact of a communication training program to improve pharmacist promotion of the pneumococcal vaccine among high-risk adults in Tennessee. METHODS A multiphase training program was initiated in partnership with 2 regions of a nationwide community pharmacy chain (n = 100) focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of 3 arms on the basis of training intensity: (1) no training; (2) online training only; and (3) online and in-person simulation training. The program focused on improving evidence-based, pharmacist vaccine recommendations using health behavior theories, sales techniques, and improvisation provided through online and in-person simulation training. Changes in vaccinations (compared with the same 6-month period in the previous year) and provider self-efficacy were evaluated by Mann-Whitney U tests, chi-square tests, and general linear models. RESULTS Completing the full training program led to nominal changes in pharmacist self-efficacy across the 6 items measured (P > 0.05). Overall counts of all pneumococcal vaccines were lower (-11.3%) across all stores in the period after training; however, a small increase (2.1%) was observed in the stores that underwent the full training, versus changes of -22.0% (P = 0.084) and -9.4% (P = 0.199) in control and online-only training comparisons, respectively. CONCLUSIONS Pharmacists' vaccine-related self-efficacy may be improved through an evidence-based communication training program, but a more holistic focus on all recommended adult vaccines may be necessary to realize meaningful improvements.
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Weiss ME, Piacentine LB, Candela L, Bobay KL. Effectiveness of using a simulation combined with online learning approach to develop discharge teaching skills. Nurse Educ Pract 2021; 52:103024. [PMID: 33774567 DOI: 10.1016/j.nepr.2021.103024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 01/19/2021] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite evidence of the impact of discharge teaching on patient outcomes, nursing students are poorly prepared in the pedagogical skills necessary for their role as patient and family educators in clinical practice. This study evaluated the effectiveness of simulation combined with online learning to improve nursing students' discharge teaching skills. METHODS The module included simulations before and after an online module on patient/family teaching for hospital discharge. Evaluation measures were student and independent rater evaluations using the Quality of Discharge Teaching Scale- Evaluation form (QDTS-E). RESULTS Students (n = 153) improved their performance on both content and delivery subscales of the QDTS-E by 20% (student self-evaluations) and 18% (independent raters). However, correlations between student and rater scores were low (r = 0.08-0.22). CONCLUSION Use of simulation with online learning in a discharge teaching module can help students build patient education skills to improve post-discharge patient outcomes, contributing to national health priorities to reduce hospital readmissions. With further refinement and testing, the learning module and QDTS-E evaluation form may also be useful for evaluation and continuing education of clinical nursing staff.
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Affiliation(s)
- Marianne E Weiss
- College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Linda B Piacentine
- College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Lori Candela
- School of Nursing, University of Nevada Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA.
| | - Kathleen L Bobay
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 South First Avenue, Maywood, IL, 60153, USA.
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Haji FA. Simulation in Neurosurgical Education During the COVID-19 Pandemic and Beyond. Can J Neurol Sci 2021; 48:152-154. [PMID: 33077011 PMCID: PMC8060615 DOI: 10.1017/cjn.2020.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Faizal A. Haji
- Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Kjaergaard-Andersen G, Ibsgaard P, Paltved C, Irene Jensen H. An in situ simulation program: a quantitative and qualitative prospective study identifying latent safety threats and examining participant experiences. Int J Qual Health Care 2021; 33:5964063. [PMID: 33166380 DOI: 10.1093/intqhc/mzaa148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/24/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the impact of in situ simulation training in regard to identification of latent safety threats and participant experiences. DESIGN A prospective study including quantitative and qualitative measures. SETTING A Danish hospital shifted from simulation training in centers outside the hospital to training where simulation was conducted where the situations normally took place and with the normal working teams. PARTICIPANTS A total of 58 local instructors were educated and subsequently conducted in situ simulations in own departments. After each simulation, a log file was completed containing information on location, the scenario, who took part, time, learning points and findings. Furthermore, interviews were conducted with leaders, instructors and simulation participants. MAIN OUTCOME MEASURES Identified latent safety threats and participant experiences. RESULTS From June 2017 until December 2018, 323 simulations were conducted representing 35 different wards. They consisted of 40 different scenarios and had both technical and non-technical learning goals. A total of 35 organizational issues were uncovered via the in situ simulation and practice was adjusted accordingly. A total of 11 interviews were conducted. Four themes emerged from the analysis: practice-orientation, endorsement, sense of security and additional impact. CONCLUSION Transferring simulation to in situ training resulted in a substantial number of organizational findings. The subsequent follow-up and changes in practice made awareness of what could be latent safety threats. Leaders, instructors and simulation participants experienced in situ simulation as relevant and profitable.
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Affiliation(s)
- Gunhild Kjaergaard-Andersen
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Pernille Ibsgaard
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Charlotte Paltved
- Corporate HR MidtSim, The Central Region of Denmark, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3 5000 Odense C, Denmark
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Barbato AL, Wetzel EA, Li W, Bo N, Mayer L, Byrne BJ. Simulation Education for Preterm Infant Delivery Room Management at Community Hospitals. Pediatrics 2020; 146:peds.2019-3688. [PMID: 33208495 DOI: 10.1542/peds.2019-3688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm infants are at risk for hypothermia in the delivery room (DR). Hypothermia and community hospital delivery are factors associated with increased morbidities and mortality in preterm infants. Community hospital providers have less experience with preterm deliveries and thermoregulation methods in the DR. METHODS Community hospital DR providers in Indiana completed a cognitive test evaluating preterm infant DR management. A simulation-based team assessment was evaluated by using a scoring tool. After debriefing, the simulation performance was repeated and rescored. Afterward, providers completed a cognitive knowledge posttest. Eleven to eighteen months later, sites were revisited with cognitive knowledge and team simulated scenarios reassessed. RESULTS Twenty-five community hospitals with >400 multidisciplinary providers participated in the initial study visit. Average pre- and posttest scores were 48.8% and 94.1% respectively (P value <.001). Participants performed an average of 22.8 of 36 scoring items during a simulated preterm delivery including 4.4 of 8 thermoregulation related actions. Performance immediately improved in a statistically significant manner during the repeat scenario. When sites were revisited, participants performed an average of 26.7 of 36 scoring items including 6.1 of 8 thermoregulation actions during a simulated preterm delivery a statistically significant (P <.001) improvement from the initial visit. CONCLUSIONS Simulation education regarding preterm infant DR management improved community providers immediate knowledge and skills and also follow-up performance at ∼1 year. In simulation, providers performed thermoregulation maneuvers more often and efficiently, critical to resuscitation because delays in thermoregulation can significantly adversely affect outcomes.
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Affiliation(s)
- Alana L Barbato
- Riley Children's Health, Indiana University Health, Indianapolis, Indiana; and .,School of Medicine, Indiana Indianapolis, Indiana; and
| | - Elizabeth A Wetzel
- Riley Children's Health, Indiana University Health, Indianapolis, Indiana; and.,School of Medicine, Indiana Indianapolis, Indiana; and
| | | | - Na Bo
- Department of Biostatistics and
| | - Lisa Mayer
- Riley Children's Health, Indiana University Health, Indianapolis, Indiana; and.,School of Medicine, Indiana Indianapolis, Indiana; and
| | - Bobbi J Byrne
- Riley Children's Health, Indiana University Health, Indianapolis, Indiana; and.,School of Medicine, Indiana Indianapolis, Indiana; and
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Abstract
Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.
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Martin A, Cross S, Attoe C. The Use of in situ Simulation in Healthcare Education: Current Perspectives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:893-903. [PMID: 33273877 PMCID: PMC7707431 DOI: 10.2147/amep.s188258] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/10/2020] [Indexed: 06/01/2023]
Abstract
In situ simulation is the practice of using simulated scenarios in a clinical environment itself rather than in training facilities to promote learning and improved clinical care. The use of in situ simulation has been increasingly used to train healthcare staff in dealing with emergencies, resuscitation and clinical skills. The aim of this study is to provide an overview of the themes, perspectives and approaches to in situ simulation for educational purposes with healthcare staff. The literature search included studies describing and evaluating in situ simulations with an educational component. We carried out a narrative synthesis and extracted data on the clinical setting, the simulation purpose, design, evaluation method and impact. In situ simulation has proved useful in a range of different specialties for skills improvement and team development. Simulation design ranges in terms of fidelity, duration and topic. No specific design has shown to be the most efficient. However, adopting a design that fits into the specific centers resources, educational needs and clinical demands is the most important consideration.
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Affiliation(s)
- Anastasia Martin
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Sean Cross
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
| | - Chris Attoe
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
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Hong G, Zhang L, Kong X, Herbertl L. Artificial Intelligence Image-Assisted Knee Ligament Trauma Repair Efficacy Analysis and Postoperative Femoral Nerve Block Analgesia Effect Research. World Neurosurg 2020; 149:492-501. [PMID: 33253951 DOI: 10.1016/j.wneu.2020.11.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To analyze artificial intelligence image-assisted knee ligament injury repair and femoral nerve block analgesia after surgery. METHODS Data-driven and artificial intelligence methods were adopted to systematically study magnetic resonance imaging image reconstruction, processing, and analysis. First, knee ligament reconstruction and femoral arteriography images were studied. Using the prior knowledge that the full width at half maximum of the contrast image does not change with the resolution, a constrained data exploration algorithm was proposed combined with the iterative algorithm. The algorithm could reconstruct high-resolution images using the collected low-frequency data of k-space. The experimental data and results were simulated with the enhanced knee ligaments and femoral nerve angiography images. Combining the spatial continuity of knee ligaments and femoral nerve, a multilayer input segmentation network was designed. The multisupervised network was adopted for output and had good segmentation results for the knee ligaments and femoral nerve. On this basis, a multiparametric image input speaker net was proposed to detect knee ligament injuries. RESULTS The area under the receiver operating characteristic curve of the constructed model under the test set was 0.824, and the sensitivity and specificity were 0.800 and 0.836, respectively. The image was better than compressed sensing to reconstruct the image, which was more accurate for knee ligament and femoral nerve stenosis. The network also had higher sensitivity for knee joint trauma detection, which could aid clinicians. The postoperative femoral nerve block had a good detection effect, which could provide important information for clinical analgesia. CONCLUSIONS The artificial intelligence image-assisted diagnosis system for analysis and processing of multiparametric magnetic resonance images is useful for clinical decision making, reducing physicians' labor intensity, improving efficiency, and lowering the rate of misdiagnosis.
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Affiliation(s)
- Gang Hong
- Department of Orthopaedics, West Campus, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le Zhang
- Department of Orthopaedics, West Campus, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopaedics, West Campus, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Lucien Herbertl
- Department of Computer Information System, Monash University, Melbourne, Australia
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Gormley GJ, Kajamaa A, Conn RL, O’Hare S. Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development? Adv Simul (Lond) 2020; 5:29. [PMID: 33106760 PMCID: PMC7582418 DOI: 10.1186/s41077-020-00148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The healthcare needs of our societies are continual changing and evolving. In order to meet these needs, healthcare provision has to be dynamic and reactive to provide the highest standards of safe care. Therefore, there is a continual need to generate new evidence and implement it within healthcare contexts. In recent times, in situ simulation has proven to have been an important educational modality to accelerate individuals' and teams' skills and adaptability to deliver care in local contexts. However, due to the increasing complexity of healthcare, including in community settings, an expanded theoretical informed view of in situ simulation is needed as a form of education that can drive organizational as well as individual learning. MAIN BODY Cultural-historical activity theory (CHAT) provides us with analytical tools to recognize and analyse complex health care systems. Making visible the key elements of an in situ simulation process and their interconnections, CHAT facilitates development of a system-level view of needs of change. CONCLUSION In this paper, we theorize how CHAT could help guide in situ simulation processes-to generate greater insights beyond the specific simulation context and bring about meaningful transformation of an organizational activity.
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Affiliation(s)
- Gerard J. Gormley
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Anu Kajamaa
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Richard L. Conn
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Sarah O’Hare
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
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Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty KN, Diederich E, Lin Y, Leary M, Mahgoub M, Mancini ME, Navarro K, Donoghue A. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S551-S579. [PMID: 33081527 DOI: 10.1161/cir.0000000000000903] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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