Simulation-based medical training for paediatric residents in Italy: a nationwide survey

Not only for caregivers: intranasal glucagon for severe hypoglycaemia in a simulation study

AIMS

To evaluate: (i) the propensity of paediatrics and emergency medicine residents to select different therapeutic options and (ii) the speed and administration success in a high-fidelity simulation of severe hypoglycaemia in a child with type 1 diabetes (T1DM).

METHODS

In this single-centre high-fidelity simulation study, 51 paediatrics or emergency medicine residents were exposed to a scenario of severe hypoglycaemia in a T1DM child attending an ambulatory setting, before and after a training on the preparation and administration of both injectable and IN glucagon. Time for drug delivery and its effectiveness were collected.

RESULTS

Before training, 45.1% of participants chose to administer injectable glucagon, 43.1% intravenous glucose solution, 5.9% intranasal (IN) glucagon, and 5.9% took no action. Administration was successful in 74% of injectable glucagon, 33.3% intravenous glucose solution, and 22.7% IN glucagon. After training, 58.8% of participants chose IN and 41.2% injectable glucagon, with 100% of successful administrations for IN glucagon and 90.5% for injectable glucagon. Time to successful administration was shorter for IN than injectable glucagon (23 ± 10 vs. 38 ± 7 s, p < 0.0001).

CONCLUSIONS

IN glucagon is an easy and effective option for severe hypoglycaemia treatment, with an almost zero possibility of failure provided that adequate training is imparted.

Simulação realística como estratégia de ensino na graduação médica

Objetivo: avaliar a eficácia da simulação realística (SR) na graduação em medicina com base no conhecimento adquirido e na melhoria do desempenho clínico e analisar a percepção dos estudantes quanto à aplicabilidade do método como ferramenta de ensino. Métodos: foi realizada uma revisão sistemática de artigos científicos nas bases de dados PubMed, Lilacs e SciELO, em inglês e português, publicados no período de 2015 a 2020, utilizando a seguinte estratégia de busca: (simulation training OR simulation patient) AND (students medical AND education, medical, undergraduate). Resultados: dos 261 artigos identificados, apenas sete atenderam aos critérios de inclusão e exclusão estabelecidos, 57,2% deles com baixo ou moderado nível de evidência. Todos demonstraram que a SR promove modificações positivas no processo de construção acadêmica dos estudantes, contribuindo para o desenvolvimento de habilidades e competências essenciais para a formação médica. Além disso, houve majoritária percepção positiva dos estudantes quanto à utilização da SR como método de ensino durante a formação médica. Conclusão: houve evidências de eficácia da SR na aprendizagem e favorável percepção dos estudantes de medicina quanto à sua utilização. Todavia, os desafios relativos à sua implantação e execução, bem como o restrito número de artigos de alto rigor metodológico, limitam a inferência inequívoca de sua eficácia na educação médica.

The effectiveness of emergency knowledge training of pediatric medical workers based on the knowledge, skills, simulation model: a quasi-experimental study

BACKGROUND

Basic life support and advanced life support are essential emergency management skills for medical workers, and pediatricians' first aid skills can be improved through emergency knowledge training.

METHODS

A controlled pre-post-intervention quasi-experimental study design was used. The study setting was a tertiary children's hospital in China. In November 2019, a KSS model of emergency knowledge learning was developed and tested, and pediatric medical workers (N = 1448) were trained with it. The outcome measures were based on an emergency knowledge questionnaire devised by the authors that measured the effectiveness of training by comparing the pre-and post-training scores of the particpants.

RESULTS

Pediatric medical workers scored significantly higher in total emergency knowledge after the training course than before [75.00 (62.50, 85.00) versus 100.00 (95.00, 100.00); P = 0.00]. Basic life support and advanced life support knowledge score significantly improved after training. Teamwork scores were significantly higher after the training than before [5.00 (5.00, 10.00) versus 10.00 (10.00, 10.00); P = 0.00]. Scores were significantly higher after the training (P < 0.001), especially for case analysis questions (P = 0.00). The attitudes of the medical workers towards the training were all positive and affirmative.

CONCLUSION

The KSS model was shown to be effective in improving the emergency knowledge of pediatric medical workers. Future research will be to explore the effectiveness of the model with different participants and at other hospitals or other institutions such as schools, encouraging more people to participate in and evaluate the model to promote its optimization.

TRIAL REGISTRATION

Hunan Children's Hospital, HCHLL-2018-03.

Characterization of simulation centers and programs in Latin America according to the ASPIRE and SSH quality criteria

BACKGROUND

Latin American clinical simulation has had an important development; there are no studies that characterize simulation centers and programs in the entire region. The aims of this work are to characterize the current state of simulation-based education in the health sciences, to determine the structure of Latin American simulation centers in terms of teaching, research, and continuing medical education (CME), as well as to determine the perception of quality based on international standards of simulation practices for the directors of Latin American centers.

METHODS

A quantitative, descriptive, cross-sectional study with a demographic questionnaire and a Likert-type survey was conducted to the directors of the simulation centers found in Latin America.

RESULTS

Four hundred eight simulation centers were documented, the survey was answered by 240 directors, and the data from 149 were complete responses on the 42 quality self-perception scale and considered valid on further analyses related to the quality of the programs. Most of the centers that responded correspond to Chile, Brazil, and Mexico (37.5%, 18.1%, 12.7%). 84% of the centers are university-based, and 71% of the centers are medium-sized, with less than 10 instructors (54%). The directors are mostly women (61.7%), medical doctors (50%), and nurses (40%), with clinical specialization (37%), master's degree (53%), and doctorate (13%). 75% have completed a simulation instructor course, and 6% have developed a fellowship. Most consider the maintenance of international quality standards to be relevant in their centers, mainly in reflective training techniques, ethical aspects, and adequate learning environments.

CONCLUSIONS

Simulation-based education in health sciences has had an increasing development in Latin America, within a university environment, in an important academic specialization process that seeks to adhere to high-quality standards to improve training and development of clinical skills, human factors, and critical thinking. We recommend starting accreditation processes in Latin America and studies that measure the quality of simulation-based education in our region, based on objective observations more than in self-reporting.

The RETAIN Simulation-Based Serious Game-A Review of the Literature

Background: Each year, over 13 million babies worldwide need help to breathe at birth. While guidelines recommend the Neonatal Resuscitation Program course, medical errors remain common. Frequent simulation training and assessment is needed to address this competence gap; however, alternative approaches are needed to overcome barriers to access. The RETAIN (REsuscitation TrAINing) simulation-based serious game (Retain Labs Medical Inc., Edmonton, AB, Canada) may provide a solution to supplement traditional training. This paper aims to review the available evidence about RETAIN for improving neonatal resuscitation education. Method: Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and EMBASE databases were performed to identify studies examining the RETAIN serious game for neonatal resuscitation training. All of the studies describing the RETAIN board game and computer game were included. Results: Three papers and one conference proceeding were identified. Two studies described the RETAIN board game, and two studies described the RETAIN computer game. RETAIN was reported as usable and clinically relevant. RETAIN also improved knowledge of neonatal resuscitation by 12% and functioned as a summative assessment. Further, performance on RETAIN was moderated by players' self-reported mindset. Conclusion: RETAIN can be used for the training and assessment of experienced neonatal resuscitation providers. Further studies are needed to understand the effectiveness of RETAIN to (i) improve other cognitive and non-cognitive skills, (ii) in diverse populations of neonatal resuscitation providers, (iii) in comparison to current standard training approaches, and (iv) in improving clinical outcomes in the delivery room.