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Kaddoura R, Faraji H, Otaki F, Radhakrishnan R, Stanley A, Paulus A, Jackson L, Al Jayyousi R, Mascarenhas S, Sudhir M, Alfroukh J, Ghelani H, Azar AJ, Khamis AH, Jan RK. High-fidelity simulation versus case-based tutorial sessions for teaching pharmacology: Convergent mixed methods research investigating undergraduate medical students' performance and perception. PLoS One 2024; 19:e0302609. [PMID: 39150900 PMCID: PMC11329139 DOI: 10.1371/journal.pone.0302609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/30/2024] [Indexed: 08/18/2024] Open
Abstract
INTRODUCTION Medical educators strive to improve their curricula to enhance the student learning experience. The use of high-fidelity simulation within basic and clinical medical science subjects has been one of these initiatives. However, there is paucity of evidence on using simulation for teaching pharmacology, especially in the Middle East and North Africa region, and the effectiveness of this teaching modality, relative to more traditional ones, have not been sufficiently investigated. Accordingly, this study compares the effects of high-fidelity simulation, which is designed in alignment with adult and experiential learning theories, and traditional case-based tutorial sessions on the performance and perception of undergraduate Year 2 medical students in pharmacology in Dubai, United Arab Emirates. METHODS This study employed a convergent mixed methods approach. Forty-nine medical students were randomly assigned to one of two groups during the 16-week pharmacology course. Each group underwent one session delivered via high-fidelity simulation and another via a case-based tutorial. A short multiple-choice question quiz was administered twice (immediately upon completion of the respective sessions and 5 weeks afterwards) to assess knowledge retention. Furthermore, to explore the students' perceptions regarding the two modes of learning delivery (independently and in relation to each other), an evaluation survey was administered following the delivery of each session. Thereafter, the iterative joint display analysis was used to develop a holistic understanding of the effect of high-fidelity simulation in comparison to traditional case-based tutorial sessions on pharmacology learning in the context of the study. RESULTS There was no statistically significant difference in students' knowledge retention between high-fidelity simulation and case-based tutorial sessions. Yet, students expressed a greater preference for high-fidelity simulation, describing the corresponding sessions as more varied, better at reinforcing learning, and closer to reality. As such, the meta-inferences led to expansion of the overall understanding around students' satisfaction, to both confirmation and expansion of the systemic viewpoint around students' preferences, and lastly to refinement in relation to the perspective around retained knowledge. CONCLUSION High-fidelity simulation was found to be as effective as case-based tutorial sessions in terms of students' retention of knowledge. Nonetheless, students demonstrated a greater preference for high-fidelity simulation. The study advocates caution in adapting high-fidelity simulation, where careful appraisal can lend itself to identifying contexts where it is most effective.
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Affiliation(s)
- Rachid Kaddoura
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Hanan Faraji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Adrian Stanley
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Mediclinic Middle East, Middle East, United Arab Emirates
| | - Agnes Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Lisa Jackson
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Reem Al Jayyousi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Sharon Mascarenhas
- Institute of Learning, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- School of Health Professions Education (SHE), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Meghana Sudhir
- Institute of Learning, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Jalal Alfroukh
- Institute of Learning, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Hardik Ghelani
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Aida Joseph Azar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Amar Hassan Khamis
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Reem Kais Jan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
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Cin MD, Koka K, Darragh J, Nourmohammadi Z, Hamdan U, Zopf DA. Pilot Evaluation of Silicone Surrogates for Oral Mucosa Simulation in Craniofacial Surgical Training. Biomimetics (Basel) 2024; 9:464. [PMID: 39194443 DOI: 10.3390/biomimetics9080464] [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: 05/24/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Surgical simulators are crucial in early craniofacial and plastic surgical training, necessitating synthetic materials that accurately replicate tissue properties. Recent critiques of our lab's currently deployed silicone surrogate have highlighted numerous areas for improvement. To further refine our models, our group's objective is to find a composition of materials that is closest in fidelity to native oral mucosa during surgical rehearsal by expert craniofacial surgeons. Fifteen platinum silicone-based surrogate samples were constructed with variable hardness and slacker percentages. These samples underwent evaluation of tactile sensation, hardness, needle puncture, cut resistance, suture retention, defect repair, and tensile elasticity. Expert craniofacial surgeon evaluators provided focused qualitative feedback on selected top-performing samples for further assessment and statistical comparisons. An evaluation revealed surrogate characteristics that were satisfactory and exhibited good performance. Sample 977 exhibited the highest performance, and comparison with the original surrogate (sample 810) demonstrated significant improvements in critical areas, emphasizing the efficacy of the refined composition. The study identified a silicone composition that directly addresses the feedback received by our team's original silicone surrogate. The study underscores the delicate balance between biofidelity and practicality in surgical simulation. The need for ongoing refinement in surrogate materials is evident to optimize training experiences for early surgical learners.
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Affiliation(s)
- Mitchell D Cin
- College of Medicine, Central Michigan University, 1632 Stone St, Saginaw, MI 48602, USA
| | - Krishna Koka
- Department of Biomedical Engineering, University of Michigan, Carl A. Gerstacker Building, 2200 Bonisteel Blvd Room 1107, Ann Arbor, MI 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 7744 Medical Science II, 1137 Catherine St, Ann Arbor, MI 48109, USA
| | - Justin Darragh
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 7744 Medical Science II, 1137 Catherine St, Ann Arbor, MI 48109, USA
| | - Zahra Nourmohammadi
- Department of Biomedical Engineering, University of Michigan, Carl A. Gerstacker Building, 2200 Bonisteel Blvd Room 1107, Ann Arbor, MI 48109, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI 48109, USA
| | - Usama Hamdan
- Global Smile Foundation, 106 Access Rd #209, Norwood, MA 02062, USA
| | - David A Zopf
- Department of Biomedical Engineering, University of Michigan, Carl A. Gerstacker Building, 2200 Bonisteel Blvd Room 1107, Ann Arbor, MI 48109, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, 1540 E Hospital Dr, Ann Arbor, MI 48109, USA
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Brennan LJ, Balakumar R, Waite S, Bennett WO. An update on simulation training in rhinology: a systematic review of evidence. J Laryngol Otol 2024:1-7. [PMID: 38602176 DOI: 10.1017/s0022215124000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. METHODS Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. RESULTS Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. CONCLUSION Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.
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Affiliation(s)
- Laura J Brennan
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Ramkishan Balakumar
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Seren Waite
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Warren O Bennett
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
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Biniok M, Forbrig TA, Gellert P, Gräske J. Analysis of cybersickness in virtual nursing simulation: a German longitudinal study. BMC Nurs 2024; 23:187. [PMID: 38509512 PMCID: PMC10953248 DOI: 10.1186/s12912-024-01833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Innovative educational approaches such as simulation-based nursing education using virtual reality (VR) technologies provide new opportunities for nursing education. However, there is a lack of information on side effects, especially health-related side effects, of head-mounted displays (HMDs) on the human body when using VR devices for nursing simulation. This study aims to validate the German version of the Virtual Reality Sickness Questionnaire (VRSQ) and to evaluate its associations with sex and age, as reflected in the VRSQG scores (total score, oculomotor, and disorientation) over time. METHODS A longitudinal-sectional study was conducted. In addition to the VRSQG (pre-, post-, and 20 min post-intervention), participants (all nursing students) completed data on personal characteristics. Participants completed a VR simulation of a blood draw. Confirmatory factor analysis (CFA) was used to evaluate whether the measured construct was consistent with the original. In addition to the validity, internal consistency was analyzed and generalized linear models (GLMs) were used for data analysis. RESULTS A total of 38 nursing students (mean age 26.8 years; SD = 7.1, 79.0% female) participated. The mean time spent in the VR simulation was 21 min. All participants completed the entire simulation. The CFA indicates (CFI = 0.981, SRMR = 0.040) VRSQG structure is given. Internal consistency showed low values for the subdomain Oculomotor (Cronbach alpha 0.670). For Disorientation and the Total score values showed a sufficient internal consistency. GLMs showed significant between subject associations with age over time with VRSQG total score, oculomotor, and disorientation. Older nursing students start with higher VRSQG-Scores. Over time, an approximation occurs, so that all participants reach a similar level by the final measurement point. No associations were found between sex (male/female) and VRSQG scores. CONCLUSIONS The VRSQG is a reliable and valid self-assessment for measuring cybersickness in VR based nursing simulations, with cybersickness symptoms positively associated with age. However, in depth-evaluation regarding age-associations with cybersickness should be done. As well as studies to explore additional associations and emphasizes the importance of establishing cut-off values to assess the clinical relevance of the scores.
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Affiliation(s)
- Maria Biniok
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany.
| | - Theresa A Forbrig
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Gräske
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Ebm C, Del Pozo C, Barbarello A, Poli G, Brusa S. Unleashing excellence: using a project management approach to effectively implement a simulation curriculum to improve residents' preparedness. BMC MEDICAL EDUCATION 2024; 24:234. [PMID: 38438940 PMCID: PMC10913544 DOI: 10.1186/s12909-024-05166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Integrating innovative, simulation-based training programs into medical curricula frequently encounters familiar challenges, including scepticism, limited faculty time, and financial constraints. Recognized for its success in business projects, the Harvard Project Management Theory emerges as a promising approach to optimizing the implementation process and achieving sustainable success. This study endeavours to elucidate the application of project management theory in our implementation process and assess its impact on the clinical preparedness of novice residents. METHODS The research utilized a structured four-phase implementation strategy-Planning, Build-up, Execution, and Closing-to develop a simulation-based education curriculum. Incorporating project management tools like project charters and risk management tools played a crucial role in facilitating the effective implementation of standardized processes and improved clinical outcomes. Essential components of this innovative management approach encompass stakeholder engagement, milestone definition, and the alignment of institutional policies and processes. RESULTS A collective of 395 residents actively engaged in eight monthly simulation-based events, reflecting an average participation rate of 39 residents per lecture (± 19). A noteworthy enhancement was observed in the average rating for knowledge gain, with a significant improvement from 5.9/10 to 8.8/10 (p = 0.0001). Participants highlighted the program's considerable impact on future clinical practice (4.7/5) and teamwork (4.8/5) as particularly valuable aspects. The introduction of a novel organizational structure received favourable feedback from faculty members, with a notable rating of 4.8/5 for predictive time planning. Qualitative insights from the evaluation highlighted the significance of targeted incentive schemes in optimizing the implementation process. CONCLUSION This project underscores the constructive influence of project management principles in designing simulation-based curricula, explicitly focusing on stakeholder engagement, faculty motivation, and data utilization. Adopting the Harvard Project Management Approach emerges as a catalyst for heightened success in curriculum design, contributing to enhanced emergency preparedness among novice residents. The positive outcomes observed in this study provide valuable insights for future implementations, offering a foundation for refining and optimizing medical education programs to meet the evolving needs of learners and stakeholders alike.
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Affiliation(s)
- Claudia Ebm
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Carolina Del Pozo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Giovani Poli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefania Brusa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Kim DH, Yang HK, Baek C, Seo J, Hwang JM. Efficacy of 3D-printed eye model to enhance retinoscopy skills. Sci Rep 2024; 14:4207. [PMID: 38378728 PMCID: PMC10879193 DOI: 10.1038/s41598-024-53321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
We conducted a prospective study to evaluate the efficacy of simulation-based education using a three-dimensional (3D)-printed schematic eye model in improving the retinoscopy refraction skills of medical students. A schematic eye model was printed using a fused deposition modeling-based 3D printer. Twenty medical students randomized into 3D (n = 10) and control (n = 10) groups received a 1-h lecture on the principles and methods of manifest refraction and were shown how to use the retinoscope and sciascope bars. The 3D group additionally attended a tutorial on the schematic eye. Both groups performed refractive examinations on four eyes of volunteer patients, and the results were recorded as a baseline. Instructor feedback and refraction practice was provided with the 3D group or with control group. To account for subject fatigue, patients spent no more than 8 min on the examination. After a 1-h break to allow for fatigue and familiarity, refraction tests were repeated on four randomly selected eyes of patients. Students' refraction readings were compared with the autorefractor values using a spherical equivalent value and blur strength. All participants measured the time required to complete the refraction test and reported their subjective confidence in the results of each refraction test. Refractive errors before and after training did not differ between the control and 3D groups, with a significant improvement in errors observed in both groups (p = 0.005 and 0.008, respectively). The time to complete refraction before and after training did not differ between the two groups, both of which showed a significant reduction in time (p = 0.005 and 0.028, respectively). Pre- and post-training confidence scores for the accuracy of each refraction on a 10-point Likert scale were not significantly different. However, when comparing score changes between pre- and post-training, only the control group showed a significant increase in confidence (p = 0.005). Tests for the non-inferiority of refractive errors after training indicated that the 3D group was non-inferior to the control group. In conclusion, training in retinoscopy refraction skills using a 3D-printed eye model resulted in significant improvement in accuracy and speed compared to practice with real patients. Except for better confidence in the control group, schematic eye model training was not inferior to practice with real patients.
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Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhoon Baek
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jongmo Seo
- Department of Electrical and Computer Engineering, Seoul National University College of Engineering, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Kumar ES, Parameswari A, Manickam A, Purva M. Establishment of a simulation centre: Challenges and solutions. Indian J Anaesth 2024; 68:45-51. [PMID: 38406339 PMCID: PMC10893810 DOI: 10.4103/ija.ija_1232_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 02/27/2024] Open
Abstract
The change in curriculum and increasing need for active healthcare professionals providing quality patient care has emphasised simulation-based regular training, reskilling and simulation centres to deliver these. However, there is limited literature on how to establish a simulation centre and overcome the challenges relating to developing faculty and maintaining the financial viability of these centres. Our review focuses on this gap in the current literature. The findings are presented as 1) identification of the methods of establishing a simulation centre, 2) setting up the resource in a simulation centre and 3) faculty development and curricular integration in a simulation centre. The space of a simulation centre depends on the organisation's or training body's needs. There is no single design which is recommended. Establishing a simulation centre should consider the needs of the organisation, educators and learners along with the available resources and ensure that curriculum integration and standards are met.
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Affiliation(s)
- E.J. Sree Kumar
- Department of Anesthesiology and Pain Medicine, SRIHER, Chennai, Tamil Nadu, India
| | - Aruna Parameswari
- Department of Anesthesiology and Pain Medicine, SRIHER, Chennai, Tamil Nadu, India
| | | | - Makani Purva
- Department of Anaesthesiology, Hull Teaching Hospitals NHS Trust and Professor of Simulation, Hull York Medical School, Hull, UK
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Kiegaldie D, Shaw L. Virtual reality simulation for nursing education: effectiveness and feasibility. BMC Nurs 2023; 22:488. [PMID: 38114940 PMCID: PMC10729454 DOI: 10.1186/s12912-023-01639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
Virtual Reality simulation (VRS) is an innovative and emerging technology that has the potential to offer increased numbers of pre-registration students authentic learning experiences compared to traditional simulation- based education (SBE) with simulated participants. The aim was to evaluate learner outcomes of SBE compared to 4 fully immersive VRS scenarios, for vocational and higher education nursing students at a training and further education institute in Melbourne, Australia. A mixed methods quasi-experimental design study was conducted over two semesters from 2019 to 2020. Participants were 675 pre-registration nursing students. The intervention group (VRS n = 393) received 4 three-dimensional, immersive VRS modules. The control group (SBE n = 282) received 4 face-to-face large group immersive simulations. In the VRS group 95% of students actively participated, compared to SBE (on average 15%). Knowledge test scores were initially significantly greater (p < 0.01) for VRS versus SBE students, but not maintained post clinical placement. Intervention students found VRS to be realistic and prepared them for clinical practice. Some technical difficulties were identified with VRS. VRS was found to be more cost effective than SBE. VRS fostered critical thinking and provided an efficient and sustainable platform for learning about complex clinical situations.
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Affiliation(s)
- Debra Kiegaldie
- Eastern Health Clinical School, Monash University, Victoria, 3128, Australia
| | - Louise Shaw
- Centre for Digital Transformation of Health, University of Melbourne, Grattan Street, Parkville, Vic, 3010, Australia.
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Bouwsema M, Chakraborty A, Rajaram A, Fleming L, Parks A. Contaminated Airway Task Training: How to Adapt an Existing Airway Manikin Head for Active Airway Soiling. Cureus 2023; 15:e51285. [PMID: 38288184 PMCID: PMC10823297 DOI: 10.7759/cureus.51285] [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: 09/06/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
The massively contaminated airway is an important and often daunting entity for airway providers. Although massively contaminated airways are considered high acuity, low-occurrence presentations in emergency medicine and pre-hospital settings, formal training in the management of contaminated airways is heterogeneous and infrequent. To facilitate training and augment simulation, an airway task trainer is critical. To our knowledge, this is the first readily accessible, peer-reviewed, detailed technical report to build a low-cost, high-fidelity, contaminated airway task trainer. This trainer can be seamlessly integrated into simulated resuscitation scenarios and/or airway training workshops, reinforcing skill acquisition and retention for the management of the massively contaminated airway.
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Affiliation(s)
| | - Amar Chakraborty
- Emergency Medicine, Massachusetts General Hospital, Boston, USA
- Emergency Medicine, Queen's University, Kingston, CAN
| | | | - Loren Fleming
- Clinical Simulation Centre, Queen's University, Kingston, CAN
| | - Adam Parks
- Emergency Medicine, Dalhousie University, Halifax, CAN
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Abbas JR, Chu MMH, Jeyarajah C, Isba R, Payton A, McGrath B, Tolley N, Bruce I. Virtual reality in simulation-based emergency skills training: A systematic review with a narrative synthesis. Resusc Plus 2023; 16:100484. [PMID: 37920857 PMCID: PMC10618508 DOI: 10.1016/j.resplu.2023.100484] [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: 06/19/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
Objective An important role is predicted for virtual reality (VR) in the future of medical education. We performed a systematic review of the literature with a narrative synthesis, to examine the current evidence for VR in simulation-based emergency skills training. We broadly define emergency skills as any clinical skill used in the emergency care of patients across all clinical settings. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The data sources accessed during this study included: PubMed, CINAHL, EMBASE, AMED, EMCARE, HMIC, BNI, PsychINFO, Medline, CENTRAL, SCOPUS, Web of Science, BIOSIS Citation Index, ERIC, ACM Digital Library, IEEE Xplore, and ProQuest Dissertations and Thesis Global. Cochrane's Rob 2 and ROBVIS tools were used during study quality assessment. No ethical review was required for this work. Results Thirty-four articles published between 14th March 1998 and 1st March 2022 were included in this review. Studies were predominantly conducted in the USA and Europe and focussed on a variety of healthcare disciplines including medical, nursing, and allied health. VR education was delivered using head-mounted displays, Cave Automatic Virtual Environment systems, and bespoke setups. These systems delivered education in a variety of areas (emergency medicine, equipment training, obstetrics, and basic/advanced life support). Subjective potential advantages of this technology included realism, replayability, and time-effectiveness. Reports of adverse events were low in frequency across the included studies. Whilst clear educational benefit was generally noted, this was not reflected in changes to patient-based outcomes. Conclusion There may be educational benefit to using VR in the context of simulation-based emergency skills training including knowledge gain and retention, skill performance, acceptability, usability, and validity. Currently, there is insufficient evidence to demonstrate clear cost-effectiveness, or direct improvement of patient or institutional outcomes, at this stage.
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Affiliation(s)
- Jonathan R Abbas
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Michael M H Chu
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Ceyon Jeyarajah
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Rachel Isba
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster LA1 4YW, United Kingdom
- Alder Hey Children's NHS Foundation Trust, Eaton Road Liverpool, L12 2AP, United Kingdom
| | - Antony Payton
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- VREvo Ltd, The University of Manchester Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT
| | - Brendan McGrath
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Neil Tolley
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom
| | - Iain Bruce
- The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
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Wespi R, Birrenbach T, Schauber SK, Manser T, Sauter TC, Kämmer JE. Exploring objective measures for assessing team performance in healthcare: an interview study. Front Psychol 2023; 14:1232628. [PMID: 37941756 PMCID: PMC10628530 DOI: 10.3389/fpsyg.2023.1232628] [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: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach. Methods A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question. Results The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures. Discussion The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.
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Affiliation(s)
- Rafael Wespi
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan K. Schauber
- Center for Educational Measurement (CEMO) and Unit for Health Sciences Education, University of Oslo, Oslo, Norway
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts, Northwestern Switzerland, Olten, Switzerland
- Division of Anesthesiology and Intensive Care, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juliane E. Kämmer
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Social and Communication Psychology, University of Göttingen, Göttingen, Germany
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12
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Ng DS, Yip BHK, Young AL, Yip WWK, Lam NM, Li KK, Ko ST, Chan WH, Aryasit O, Sikder S, Ferris JD, Pang CP, Tham CC. Cost-effectiveness of virtual reality and wet laboratory cataract surgery simulation. Medicine (Baltimore) 2023; 102:e35067. [PMID: 37800761 PMCID: PMC10552957 DOI: 10.1097/md.0000000000035067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. METHODS Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained. RESULTS Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost. CONCLUSIONS Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.
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Affiliation(s)
- Danny S. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Hong Kong Baptist Hospital, Hong Kong, China
| | - Benjamin H. K. Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Wilson W. K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Nai M. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kenneth K. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- United Christian Hospital, Hong Kong, China
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - John D. Ferris
- Ophthalmology, Gloucestershire Hospitals, National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Chi P. Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
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Blamey H, Harrison CH, Roddick A, Malhotra T, Saunders KEA. Simulated virtual on-call training programme for improving non-specialised junior doctors' confidence in out-of-hours psychiatry: quantitative assessment. BJPsych Bull 2023; 47:287-295. [PMID: 36073524 PMCID: PMC10764820 DOI: 10.1192/bjb.2022.40] [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: 12/23/2021] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams. RESULTS Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews (P = 0.001), prescribing psychiatric medications for acute presentations (P < 0.001), working in section 136 suites (places of safety) (P = 0.001) and feeling prepared for psychiatric on-call shifts (P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5-7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains (P < 0.001). CLINICAL IMPLICATIONS The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry.
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Affiliation(s)
- Helen Blamey
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Charlotte H. Harrison
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Alistair Roddick
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | | | - Kate E. A. Saunders
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Ward EC, Caird E, Khanal S, Kularatna S, Byrnes J, Penman A, Mcallister S, Baldac S, Cardell E, Davenport R, Davidson B, Hewat S, Howells S, Mccabe P, Purcell A, Walters J, Hill AE. A cost analysis of a 5-day simulation-based learning program for speech-language pathology student training. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:688-696. [PMID: 36062806 DOI: 10.1080/17549507.2022.2115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech-language pathology students. The secondary aim was to consider the economic costs of the model.Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech-language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student.Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683-$1087), however this was almost double ($1461 per student, range $857-$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire.Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context.
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Affiliation(s)
- Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Emma Caird
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Saval Khanal
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Adriana Penman
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sue Mcallister
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Elizabeth Cardell
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Rachel Davenport
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Sally Hewat
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Simone Howells
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Patricia Mccabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison Purcell
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Joanne Walters
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Anne E Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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15
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Tayeb BO, Shubbak FA, Doais KS, Yamani AN, Dhaifallah DG, Alsayed EF, Addas MJ, Boker AM. Uses of simulation-based education for anesthesiology training, certification and recertification: A scoping review. J Taibah Univ Med Sci 2023; 18:1118-1123. [PMID: 37881638 PMCID: PMC10594003 DOI: 10.1016/j.jtumed.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives To conduct a comprehensive scoping review focusing on published anesthesiology-specific training based on simulation to assess up-to-date uses of simulation-based education in anesthesiology training. Our goal was to establish a solid ground for building standardized and accredited curricula for simulation-based education in the specialty of anesthesia in the near future. Methods We searched the PubMed, CINAHL and EMBASE databases on May 10, 2021 for relevant articles. We followed the five-stage scoping review methodology: identifying a research question, identifying relevant studies, study selection, charting the data, and synthesis of results. Results Our initial electronic search identified 5609 potential articles. After abstract screening and removing duplicates, 636 articles were evaluated in full text for inclusion or exclusion. Based on this strategy, 283 articles were included in this review. We mapped the current practice of simulation in training and certification across different anesthesiology subspecialties. Conclusions Significant effort has been placed into the use of simulation for training, certification, and recertification in anesthesiology. Future effort to develop simulation-based training that can be generalized to trainees in this specialty, similar to other fields such as aviation and space sciences, will enhance the standardization of training and hence patient safety.
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Affiliation(s)
- Baraa O. Tayeb
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
- Anesthesiology Services Section, Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, KSA
- Clinical Skills and Simulation Centre, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
| | - Firas A. Shubbak
- Anesthesiology and Perioperative Medicine Administration Department, Faculty of Medicine, King Fahad Medical City, Riyadh, KSA
| | - Khaled S. Doais
- Anesthesiology and Perioperative Medicine Administration Department, Faculty of Medicine, King Fahad Medical City, Riyadh, KSA
| | - Ahad N. Yamani
- Department of Surgery, Anesthesiology Section, Faculty of Medicine, King Abdulaziz University, Rabigh, KSA
| | - Daniah G. Dhaifallah
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
- Anesthesiology Services Section, Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, KSA
| | - Eyad F. Alsayed
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
- Anesthesiology Services Section, Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, KSA
| | - Malik J. Addas
- Internship Department, King Abdulaziz University Hospital, Jeddah, KSA
| | - Abdulaziz M. Boker
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
- Anesthesiology Services Section, Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, KSA
- Clinical Skills and Simulation Centre, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
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Martin R, Mandrusiak A, Russell T, Forbes R. Physiotherapy students' empathy towards Australians living in rural settings: A pre-test post-test evaluation of a stand-alone rural simulation activity. Aust J Rural Health 2023; 31:19-31. [PMID: 35830392 DOI: 10.1111/ajr.12902] [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: 01/20/2022] [Revised: 05/28/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity. SETTING A metropolitan university in Queensland, Australia. PARTICIPANTS Second year undergraduate physiotherapy students. DESIGN A single cohort pre-test post-test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R-CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank-Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses. RESULTS A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra-personal rural empathy increased following the activity as demonstrated by the overall R-CSES score [pre-test: 101.5 (90-110.75) vs post-test 107 (100-120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation. CONCLUSION A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare.
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Affiliation(s)
- Romany Martin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, Surgical, Treatment, and Rehabilitation Service, Herston, Qld, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Qld, Australia
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Clarke S, Skinner J, Drummond I, Wood M. Twelve tips for using tactical decision games to teach non-technical skills. MEDICAL TEACHER 2023; 45:25-31. [PMID: 34882523 DOI: 10.1080/0142159x.2021.2010693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tactical decision games (TDGs) have been used in healthcare and other safety-critical industries to develop non-technical skills training (NTS). TDGs have been shown to be a realistic, feasible, and useful way of teaching NTS such as decision making, task prioritisation, situational awareness, and team working. Our 12-tips for using TDG to teach NTS are based on our experience of integrating them into an undergraduate medical and nursing programme. We cover how to design successful TDGs, how to facilitate and debrief them and how to integrate TDGs into curricula. We have found TDGs to be a cost-effective, low fidelity, and useful method of delivering NTS teaching, ideally as an adjunct to immersive simulation. Learners find them a useful way to be introduced to NTS in a safe and relaxed environment, with particular emphasis on critical decision making and prioritisation.
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Affiliation(s)
- Scott Clarke
- Clinical Skills Centre, University of Edinburgh, Edinburgh, UK
| | - Janet Skinner
- Clinical Skills Centre, University of Edinburgh, Edinburgh, UK
| | - Iain Drummond
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Morwenna Wood
- Department of Renal Medicine, Victoria Hospital, NHS Fife, Kirkcaldy, UK
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Davies H, Robertson S, Sundin D, Jacob E. Impact of pre-registration extended immersive ward-based simulation on student learning in preparation for clinical placement. NURSE EDUCATION TODAY 2022; 119:105575. [PMID: 36179424 DOI: 10.1016/j.nedt.2022.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/14/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Graduate nurses commonly experience significant challenges in transitioning to professional practice. The practice readiness of graduate nurses continues to be a concern for nurse educators and industry partners. Introduction of pre-registration extended immersive ward-based simulation can provide opportunities for students to practice the role of registered nurse before graduation. It is not clear if participation in simulation-based learning transfers to increased preparedness for dealing with real-life situations following entry into the workforce. OBJECTIVE To report on student views on how ward-based immersive simulation assisted in preparing for clinical placement and graduate practice. DESIGN A qualitative, descriptive design was used to conduct a series of face-to-face focus groups. SETTING School of Nursing and Midwifery metropolitan Western Australian university. PARTICIPANTS Final year baccalaureate nursing students who had participated in six four-hour simulation workshops between February and April 2021 were selected through purposive sampling. METHODS Focus group and interview data was transcribed from audio recordings. A six-phase approach was used to analyse data into themes and sub-themes. The study adhered to the consolidated criteria for reporting of qualitative research. RESULTS Three focus groups and one interview were conducted. Eight themes emerged. Student learning was identified as occurring in a variety of ways, such as how to work as a team and was influenced by a number of factors, such as the capacity for students to self-reflect. CONCLUSIONS Learning opportunities for students to practice how to think and work independently as a registered nurse is something that can be supported by pre-registration extended immersive ward-based simulation. Understanding of what will be expected of them once qualified can make students more prepared for professional practice enabling them to apply knowledge gained from simulated experiences to a similar situation as a graduate nurse.
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Affiliation(s)
- Hugh Davies
- School of Nursing and Mideifery, Edith Cowan University, Western Australia, Australia.
| | - Sue Robertson
- School of Nursing and Mideifery, Edith Cowan University, Western Australia, Australia.
| | - Deb Sundin
- School of Nursing and Mideifery, Edith Cowan University, Western Australia, Australia.
| | - Elisabeth Jacob
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Victoria, Australia.
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Jiang Z, Ouyang J, Li L, Han Y, Xu L, Liu R, Sun J. Cost-Effectiveness Analysis in Performance Assessments: A Case Study of the Objective Structured Clinical Examination. MEDICAL EDUCATION ONLINE 2022; 27:2136559. [PMID: 36250891 PMCID: PMC9586649 DOI: 10.1080/10872981.2022.2136559] [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: 06/28/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Medical education assessments are becoming more complex, resulting in the inappropriateness of traditional methods primarily consisting of direct observations, oral examinations, and multiple-choice tests. Advancements in research methods have led to the formation of new modalities, namely performance assessments, which are, on the other hand, always costly in development and implementation. Proposing using the Program Effectiveness and Cost Generalization flow within an assessment context (PRECOG-A), this brief report explores the real financial cost drivers associated with an assessment case in the context of medical education, presents the steps in bridging the effectiveness with its psychometric properties via cost-effectiveness analysis, and evaluates the two-side outcomes for further evaluation decision-making. Referentially providing a framework to investigators and researchers, the illustration of PRECOG-A in this study outlines instructional guidelines for conducting cost-effectiveness analysis in a performance assessment.
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Affiliation(s)
- Zhehan Jiang
- Institute of Medical Education, Health Science Center, Peking University, Beijing, Peking, China
- National Center for Health Professions Education Development, Peking University, Beijing, Peking, China
| | - Jinying Ouyang
- Institute of Medical Education, Health Science Center, Peking University, Beijing, Peking, China
- National Center for Health Professions Education Development, Peking University, Beijing, Peking, China
| | - Li Li
- Department of General Practice, Guangzhou First People’s Hospital, Guangzhou, Guangdong, China
| | - Yuting Han
- Institute of Medical Education, Health Science Center, Peking University, Beijing, Peking, China
- National Center for Health Professions Education Development, Peking University, Beijing, Peking, China
| | - Lingling Xu
- Institute of Medical Education, Health Science Center, Peking University, Beijing, Peking, China
- National Center for Health Professions Education Development, Peking University, Beijing, Peking, China
| | - Ren Liu
- Psychological Science, University of California Merced, Merced, CA, USA
| | - Junhua Sun
- Institute of Education, Nanjing University, Nanjing, Jiangsu, China
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Wu JC, Chen HW, Chiu YJ, Chen YC, Kang YN, Hsu YT, O'Donnell JM, Kuo SY. Comparison of simulation-based interprofessional education and video-enhanced interprofessional education in improving the learning outcomes of medical and nursing students: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 118:105535. [PMID: 36084448 DOI: 10.1016/j.nedt.2022.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Use of interprofessional education has greatly expanded and is widely used to foster interprofessional collaborative practice competency in health professionals, especially during medical emergencies. Identifying the interprofessional education delivery mode that can maximize learning outcomes within available resources is crucial for achieving the sustainability of an interprofessional education program. OBJECTIVES To examine the learning outcomes of simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education modules and to analyze the variable costs between these two interprofessional education modules. DESIGN A prospective quasi-experimental study. SETTING A medical university in Northern Taiwan. PARTICIPANTS 24 medical students and 48 nursing students enrolled in a 4-week simulation-based interprofessional education or video-enhanced interactive discussion interprofessional education program. METHODS Students' medical task performance, critical medical task performance, team behavior performance, and interprofessional collaboration attitude were examined at the pretest and posttest by using an objective structured checklist and team performance rating scale with a hands-on simulation model and structured questionnaires. The variable costs for simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education were estimated upon the completion of the course. RESULTS All learning outcomes significantly improved for both the groups from the pretest to posttest. After the intervention, the simulation-based interprofessional education group exhibited significantly higher scores in medical task performance, critical medical task performance and team behavior performance than the video-enhanced interactive discussion interprofessional education group at the posttest. No significant difference was noted in interprofessional collaboration attitude between the groups. Cost analysis revealed that the simulation-based interprofessional education program was approximately two times more expensive in terms of staffing costs and required 1.3 times greater space charges than the video-enhanced interactive discussion interprofessional education program. CONCLUSION Both simulation-based interprofessional education and video-enhanced interactive discussion interprofessional education modules effectively improved medical and nursing students' medical task performance, critical medical task performance and team behavior performance. The simulation-based interprofessional education group had more favorable learning outcomes, but the associated costs were higher. Educators should consider both learning outcomes and cost when choosing a design strategy simulation-based interprofessional education vs. video-enhanced interactive discussion interprofessional education for interprofessional education module development.
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Affiliation(s)
- Jen-Chieh Wu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Hui-Wen Chen
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Jui Chiu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Chun Chen
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-No Kang
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Hsu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - John M O'Donnell
- Department of Nurse Anesthesia, University of Pittsburgh Nurse Anesthesia Program, Pittsburgh, Pennsylvania, USA; Winter Institute for Simulation, Education and Research (WISER), Pittsburgh, Pennsylvania, USA.
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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21
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Osborne C, Brown C, Mostafa A. Effectiveness of high- and low-fidelity simulation-based medical education in teaching cardiac auscultation: a systematic review and meta-analysis. Simul Healthc 2022. [DOI: 10.54531/nzws5167] [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-based medical education (SBME) is an evolving method of teaching cardiac examination skills to healthcare learners. It has been deliberated how effective this teaching modality is and whether high-fidelity methods are more effective than low-fidelity methods. This systematic review aimed to assess the effectiveness of high-fidelity SBME in teaching cardiac auscultation compared with no intervention or another active teaching intervention (low-fidelity SBME) using evidence from randomized controlled trials (RCTs).
Literature searches were performed on Medline, Embase, PsychInfo and Cinahl. RCTs that compared the effectiveness of high-fidelity simulation against no intervention or high-fidelity simulation against low-fidelity simulation in teaching cardiac auscultation to healthcare learners were included. Outcomes were knowledge, skills and satisfaction relating to cardiac auscultation education. Data were analyzed using Review Manager 5.3 software.
Seventeen RCTs (n = 1055) were included. Twelve RCTs (n = 692) compared high-fidelity simulation with no intervention. The pooled effect sizes for knowledge and skills were 1.39 (95% confidence interval [CI], 0.39–2.38;
This review’s findings suggest that high-fidelity SBME is an effective teaching method for cardiac auscultation education. Interestingly, there was no significant difference in knowledge or skills among learners when comparing high-fidelity simulation with low-fidelity simulation. Further research is needed to establish the effectiveness of different forms of SBME as educational interventions.
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Affiliation(s)
- Craig Osborne
- Emergency Department, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Craig Brown
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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22
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Humm G, Mohan H, Fleming C, Harries R, Wood C, Dawas K, Stoyanov D, Lovat LB. The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. BJS Open 2022; 6:zrac086. [PMID: 35849132 PMCID: PMC9291386 DOI: 10.1093/bjsopen/zrac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy. METHODS MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499. RESULTS A total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD -8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis. CONCLUSION Meta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.
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Affiliation(s)
- Gemma Humm
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences. University College London, London, UK
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Helen Mohan
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christina Fleming
- Department of General and Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - Rhiannon Harries
- Department of General Surgery, Swansea Bay University Health Board, Swansea, UK
| | - Christopher Wood
- Department of General Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Khaled Dawas
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences. University College London, London, UK
| | - Laurence B Lovat
- Wellcome/Engineering and Physical Sciences Research Council Centre for Interventional and Surgical Sciences. University College London, London, UK
- UCL Division of Surgery and Interventional Science, University College London, London, UK
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23
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Rutherford-Hemming T, Herrington A, Newsome L. The Use of Simulation-Based Education With New Graduate Nurses in Emergency Department and Acute Care Settings: A Scoping Review. J Contin Educ Nurs 2022; 53:301-306. [PMID: 35858147 DOI: 10.3928/00220124-20220603-05] [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: 11/20/2022]
Abstract
Background The literature questions if newly graduated nurses are truly ready to practice at the bedside. Simulation has been shown to bridge the gap between theory and practice. The purpose of this study was to investigate what is known about the use of simulation education with novice graduate nurses in critical care settings in the hospital. Method A scoping review was conducted using the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Articles published in English between 2015 and September 2021 that focused on simulation education with novice graduate nurses in a critical care setting were included. Results The review yielded six articles. Conclusion The literature is scant on the use of simulation in critical care areas with novice graduate nurses. Additional inquiry is needed related to the role of learners, cost, timing, setting, and educational practices. More studies with stronger research designs and valid and reliable measurement instruments are also needed. Finally, there is a need to better understand the effects of simulation on novice nurse graduates' knowledge and skills as well as patient outcomes. [J Contin Educ Nurs. 2022;53(7):301-306.].
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24
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Toale C, Morris M, Kavanagh DO. Training to proficiency in surgery using simulation: is there a moral obligation? JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2021-107678. [PMID: 34992083 DOI: 10.1136/medethics-2021-107678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The 'learning curve' in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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25
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Enhancing Cultural Capabilities Amongst Health Professions Students: A Pilot Study of Interprofessional Tag Team Simulation. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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26
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Curtis K, Sivabalan P, Bedford DS, Considine J, D'Amato A, Shepherd N, Fry M, Munroe B, Shaban RZ. Implementation of a structured emergency nursing framework results in significant cost benefit. BMC Health Serv Res 2021; 21:1318. [PMID: 34886873 PMCID: PMC8655998 DOI: 10.1186/s12913-021-07326-y] [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: 06/10/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia. .,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia. .,George Institute for Global Health, University of NSW, Kensington, Australia. .,Faculty of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Prabhu Sivabalan
- Business School, University of Technology Sydney, Sydney, NSW, Australia
| | - David S Bedford
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Geelong, NSW, Australia.,Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Alfa D'Amato
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia.,System Financial Performance, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Nada Shepherd
- Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Research & Practice Development Unit, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - Belinda Munroe
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Ramon Z Shaban
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.,Division of Infectious Diseases and Sexual Health, Westmead Hospital and the New South Wales Biocontainment Centre, Western Sydney Local Heath District and New South Wales Ministry of Health, Westmead, NSW, Australia
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27
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Berger-Estilita J, Lüthi V, Greif R, Abegglen S. Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis. MEDICAL TEACHER 2021; 43:1381-1390. [PMID: 34260335 DOI: 10.1080/0142159x.2021.1948521] [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] [Indexed: 06/13/2023]
Abstract
BACKGROUND Debriefing is an indispensable component of simulation-based medical education, and it has great potential for contributions to reflective learning. Little is known about the relevance of communication during debriefings. We developed a category framework to assess the communication content of debriefings, which we used to analyze possible relationships to participant learning outcomes. METHOD We deductively and inductively developed a category framework for qualitative content analysis of debriefings. We coded 20 debriefings using this framework, and correlated debriefing frequency with learning outcomes (i.e. engagement, satisfaction, individual and team learning success). RESULTS The category framework comprised 9 main and 81 subcategories (48 debriefers, 27 participants, 6 simulated patients), which yielded good intercoder agreement. Debriefers and participants communicated equally using mostly advocacy, inquiry, illustration, and confirmation. Debriefer questions and participant inputs were positively related to learning outcomes. In contrast, guess-what-I-am-thinking, apologies, observations, use of materials, participant descriptions, simple repetition of statements, and evaluation by other participants were not positively associated with learning outcomes. CONCLUSION This study provides important new information about communication content during debriefings. The association between communication content and learning outcomes appears particularly relevant to further enhance efficacy of debriefings and simulation-based medical education.
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Affiliation(s)
- Joana Berger-Estilita
- Department of Anaesthesiology and Pain Medicine, Bern Simulation and CPR Centre (BeSiC), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valérie Lüthi
- Department of Health Psychology and Behavioural Medicine, University of Bern, Bern, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern Simulation and CPR Centre (BeSiC), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Sandra Abegglen
- Department of Health Psychology and Behavioural Medicine, University of Bern, Bern, Switzerland
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28
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Ajmi SC, Kurz MW, Ersdal H, Lindner T, Goyal M, Issenberg SB, Vossius C. Cost-effectiveness of a quality improvement project, including simulation-based training, on reducing door-to-needle times in stroke thrombolysis. BMJ Qual Saf 2021; 31:569-578. [PMID: 34599087 DOI: 10.1136/bmjqs-2021-013398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rapid revascularisation in acute ischaemic stroke is crucial to reduce its total burden including societal costs. A quality improvement (QI) project that included streamlining the stroke care pathway and simulation-based training was followed by a significant reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes after stroke thrombolysis at our centre. Here, we present a retrospective cost-effectiveness analysis of the QI project. METHODS Costs for implementing and sustaining QI were assessed using recognised frameworks for economic evaluations. Effectiveness was calculated from previously published outcome measures. Cost-effectiveness was presented as incremental cost-effectiveness ratios including costs per minute door-to-needle time reduction per patient, and costs per averted death in the 13-month post-intervention period. We also estimated incremental cost-effectiveness ratios for a projected 5-year post-intervention period and for varying numbers of patients treated with thrombolysis. Furthermore, we performed a sensitivity analysis including and excluding costs of unpaid time. RESULTS All costs including fixed costs for implementing the QI project totalled US$44 802, while monthly costs were US$2141. We calculated a mean reduction in door-to-needle time of 13.1 min per patient and 6.36 annual averted deaths. Across different scenarios, the estimated costs per minute reduction in door-to-needle time per patient ranged from US$13 to US$29, and the estimated costs per averted death ranged from US$4679 to US$10 543. CONCLUSIONS We have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions.
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Affiliation(s)
- Soffien Chadli Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway .,Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hege Ersdal
- Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Lindner
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - S Barry Issenberg
- The Gordon Centre for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Corinna Vossius
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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29
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Avraham R, Shor V, Kimhi E. The influence of simulated medication administration learning on the clinical performance of nursing students: A comparative quasi-experimental study. NURSE EDUCATION TODAY 2021; 103:104947. [PMID: 33992957 DOI: 10.1016/j.nedt.2021.104947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medication administration is a main role of nurses, and by mastering this skill, medication errors can be reduced. Simulation provides a safe environment for learning and improving medication administration. Simulation design may influence the students' learning curve and ability to transfer skills into the clinical setting. OBJECTIVE To examine the influence of simulation-based learning of the medication administration process, on satisfaction, self-perception of preparedness, and clinical performance of students who practice simulation either individually or in a group. DESIGN A comparative quasi-experimental study. SETTING A public university in southern Israel. PARTICIPANTS Third-year nursing students in two consecutive academic years (78 in the individual sample and 50 in the group sample). METHODS Nursing students participated in a scenario-based simulation for medication administration either individually or in a group. Self-reported questionnaires evaluated participants' satisfaction with the simulation experience, and perception of preparedness before and after the simulation. Faculty members observed and evaluated participants' medication administration during the simulation and in the clinical setting. Paired t-tests were performed to compare preparedness before and after the simulation experience. Linear regression models were formulated to elicit the predictors of preparedness after simulation and evaluations for medication administration in the clinical setting. RESULTS The simulation experience increased participants' preparedness both when designed for an individual student and for a group of students. Simulation performance was the main contributor to the participant preparedness among the individual sample (β = 0.51, p < 0.01), whereas previous preparedness was the main contributor among the group sample (β = 0.42, p < 0.01). The association between simulation performance and clinical performance was mediated by preparedness after simulation in the individual sample, but not in the group sample. CONCLUSIONS Simulation improves students' preparedness for medication administration. Individual simulation also impacts clinical performance, via preparedness. Further research is needed to identify other factors that facilitate skills transfer into the clinical setting.
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Affiliation(s)
- Rinat Avraham
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Vlada Shor
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Einat Kimhi
- Department of Nursing, Recanati School of Community Health Professions, Faculty of Health sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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30
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Szalai C, Herbstreit S, Novosadova K, Somerville S. Learning by doing: To explore the influence of Simulation on Clinical Decision-Making Approaches on Final Year Medical Students at the University of Duisburg-Essen, Germany. MEDEDPUBLISH 2021; 10:124. [PMID: 38486523 PMCID: PMC10939537 DOI: 10.15694/mep.2021.000124.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Final year medical students at the University Duisburg-Essen, Germany, are unsatisfied with their clinical judgement skills in common elective and emergency clinical situations. A competency based medical curriculum determines that clinical judgement is an essential tool in effective patient care, patient safety and limiting clinical error. Approaches to clinical judgement include either analytical, intuitive or a combination of both approaches. Novices show specific factors, which are typical in inexperienced clinicians. Simulation provides opportunities in a competency-based medical education curriculum. There is limited evidence showing that simulation can provide an effective environment for teaching and learning clinical decision-making skills. This project explores how final year medical students at the University of Duisburg-Essen approach the clinical decision-making process as well as how simulation influences this process. Methods: Ethics approval was obtained from the local ethics committee. After completing a 10-week simulation course,thirty-five students completed a clinical decision-making instrument to categorise their clinical decision-making approaches. The Novice Decision Making Model and the Cognitive Continuum Model were combined with learning theories in Simulation (Social Cognitive Theory) and used to explore and interpret data collected through questionnaires, interviews and observation. Results: The majority (60%) of students employed a predominantly analytic approach, some students showed intuitive tendencies in clinical situations. During interviews students displayed typical novice approaches to decision-making and expressed positive comments relating to simulation. Conclusions: Simulation presents an opportunity for teaching and learning clinical decision-making. Results show the need for further inquiry into learning clinical decision-making through simulation. This research provides initial evidence that simulation can be incorporated into curricular teaching of clinical decision-making.
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31
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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32
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Finocchiaro M, Cortegoso Valdivia P, Hernansanz A, Marino N, Amram D, Casals A, Menciassi A, Marlicz W, Ciuti G, Koulaouzidis A. Training Simulators for Gastrointestinal Endoscopy: Current and Future Perspectives. Cancers (Basel) 2021; 13:cancers13061427. [PMID: 33804773 PMCID: PMC8004017 DOI: 10.3390/cancers13061427] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Over the last decades, visual endoscopy has become a gold standard for the detection and treatment of gastrointestinal cancers. However, mastering endoscopic procedures is complex and requires long hours of practice. In this context, simulation-based training represents a valuable opportunity for acquiring technical and cognitive skills, suiting the different trainees’ learning pace and limiting the risks for the patients. In this regard, the present contribution aims to present a critical and comprehensive review of the current technology for gastrointestinal (GI) endoscopy training, including both commercial products and platforms at a research stage. Not limited to it, the recent revolution played by the technological advancements in the fields of robotics, artificial intelligence, virtual/augmented reality, and computational tools on simulation-based learning is documented and discussed. Finally, considerations on the future trend of this application field are drawn, highlighting the impact of the most recent pandemic and the current demographic trends. Abstract Gastrointestinal (GI) endoscopy is the gold standard in the detection and treatment of early and advanced GI cancers. However, conventional endoscopic techniques are technically demanding and require visual-spatial skills and significant hands-on experience. GI endoscopy simulators represent a valid solution to allow doctors to practice in a pre-clinical scenario. From the first endoscopy mannequin, developed in 1969, several simulation platforms have been developed, ranging from purely mechanical systems to more complex mechatronic devices and animal-based models. Considering the recent advancement of technologies (e.g., artificial intelligence, augmented reality, robotics), simulation platforms can now reach high levels of realism, representing a valid and smart alternative to standard trainee/mentor learning programs. This is particularly true nowadays, when the current demographic trend and the most recent pandemic demand, more than ever, the ability to cope with many patients. This review offers a broad view of the technology available for GI endoscopy training, including platforms currently in the market and the relevant advancements in this research and application field. Additionally, new training needs and new emerging technologies are discussed to understand where medical education is heading.
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Affiliation(s)
- Martina Finocchiaro
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.M.); (G.C.)
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain; (A.H.); (A.C.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence:
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, 43126 Parma, Italy;
| | - Albert Hernansanz
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain; (A.H.); (A.C.)
| | - Nicola Marino
- Department of Medical and Surgical Sciences University of Foggia, 71121 Foggia, Italy;
| | - Denise Amram
- LIDER-Lab, DIRPOLIS Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy;
| | - Alicia Casals
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain; (A.H.); (A.C.)
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.M.); (G.C.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-252 Szczecin, Poland;
- The Centre for Digestive Diseases Endoklinika, 70-535 Szczecin, Poland
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pisa, Italy; (A.M.); (G.C.)
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, 71-252 Szczecin, Poland;
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Abstract
BACKGROUND Healthcare simulation has expanded dramatically; however, little is known about the scope of simulation in acute care hospitals. METHODS A descriptive, cross-sectional online survey was used. Participants included nurse executives from acute care hospitals in California. RESULTS Most organizations (96%) used simulation primarily for education, 37% used simulation for health system integration and systems testing, 30% used it for error investigation, 15% used it for research, and 15% used it for patient/family education. CONCLUSIONS Organizations have a substantial opportunity to increase the scope of simulation beyond education to include systems integration, clinical systems testing, and other translational simulation activities. This targeted focus on patient safety and quality will allow hospitals to improve financial performance and maximize scarce resources.
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Affiliation(s)
- Marie Gilbert
- Author Affiliations: Director (Dr M. Gilbert), Central California Center for Excellence in Nursing, California State University, Fresno; Associate Professor and Director (Dr Waxman), Executive Leadership Doctor of Nursing Practice Program, School of Nursing & Health Professions, University of San Francisco, California; Director (Dr Waxman), California Simulation Alliance, HealthImpact, Oakland; Biostatistician (Dr G.E. Gilbert), ΣigmaΣtats Consulting, LLC, Charleston, South Carolina; Senior Statistical Analyst (Dr G.E. Gilbert), Biostatistics and Medical Writing, Real World Evidence Strategy & Analytics, ICON Commercialisation & Outcomes Services, North Wales, Pennsylvania; and System Simulation Education Specialist (Ms Congenie), Advocate Aurora Health, Downers Grove, Illinois
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The Impact of Coronavirus Disease 2019 on Maxillofacial Surgery Training in Portugal: The Resident’s Perspective. J Craniomaxillofac Surg 2021. [PMCID: PMC7879161 DOI: 10.1016/j.jcms.2021.02.003] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Discussion Conclusion
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Sawaya RD, Mrad S, Rajha E, Saleh R, Rice J. Simulation-based curriculum development: lessons learnt in Global Health education. BMC MEDICAL EDUCATION 2021; 21:33. [PMID: 33413346 PMCID: PMC7792073 DOI: 10.1186/s12909-020-02430-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation based medical education (SBME) allows learners to acquire clinical skills without exposing patients to unnecessary risk. This is especially applicable to Emergency Medicine training programs where residents are expected to demonstrate proficiency in the management of time critical, low frequency, and highly-morbidity conditions. This study aims to describe the process through which a SBME curriculum was created, in a limited simulation resource setting at a 4-year Emergency Medicine (EM) residency program at the American University of Beirut Medical Center. METHODS A case-based pilot simulation curriculum was developed following Kern's 6 step approach to curriculum design. The curricular objectives were identified through an anonymous survey of the program's residents and faculty. Curriculum outcomes were assessed, and the curriculum was revised to address curricular barriers. Evaluations of the revised curriculum were collected during the simulation sessions and through a whole revised curriculum evaluation at the end of the first year of its implementation. RESULTS 14/20 residents (70%) and 8/8 faculty (100%) completed the needs assessment from which objectives for the pilot curriculum were developed and implemented through 6 2-h sessions over a 1-year period. Objectives were not met and identified barriers included cost, scheduling, resources, and limited faculty time. The revised curriculum addressed these barriers and 24 40-min sessions were successfully conducted during the following year. The sessions took place 3 at a time, in 2-h slots, using the same scenario to meet the objectives of the different learners' levels. 91/91 evaluations were collected from participants with overall positive results. The main differences between the pilot and the revised curricula included: a better understanding of the simulation center resources and faculty's capabilities. CONCLUSION Simulation-based education is feasible even with limited-resources. However, understanding the resources available, and advocating for protected educator time are essential to implementing a successful EM simulation curriculum.
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Affiliation(s)
- Rasha D. Sawaya
- Department of Emergency Medicine, The American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandra Mrad
- Department of Emergency Medicine, The American University of Beirut Medical Center, Beirut, Lebanon
| | - Eva Rajha
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Rana Saleh
- Department of Emergency Medicine, The American University of Beirut Medical Center, Beirut, Lebanon
| | - Julie Rice
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21205 USA
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Svellingen AH, Søvik MB, Røykenes K, Brattebø G. The effect of multiple exposures in scenario-based simulation-A mixed study systematic review. Nurs Open 2021; 8:380-394. [PMID: 33318846 PMCID: PMC7729777 DOI: 10.1002/nop2.639] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022] Open
Abstract
Aims To examine the use and effects of multiple simulations in nursing education. Design A mixed study systematic review. Databases (CINAHL, Medline, PubMed, EMBASE, ERIC, Education source and Science Direct) were searched for studies published until April 2020. Method Researchers analysed the articles. Bias risk was evaluated using the Critical Appraisal Skills Programme and Cochrane Risk of Bias tool. Results In total, 27 studies were included and four themes identified. Students participated in multiple simulation sessions, over weeks to years, which included 1-4 scenarios in various nursing contexts. Simulations were used to prepare for, or partly replace, students' clinical practice. Learning was described in terms of knowledge, competence and confidence. Conclusion Multiple scenario-based simulation is a positive intervention that can be implemented in various courses during every academic year to promote nursing students' learning. Further longitudinal research is required, including randomized studies, with transparency regarding study design and instruments.
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Affiliation(s)
- Alette H. Svellingen
- Centre of Diaconia and Professional PracticeVID Specialized UniversityOsloNorway
- Faculty of Health StudiesVID Specialized UniversityBergenNorway
| | | | - Kari Røykenes
- Faculty of Health StudiesVID Specialized UniversityBergenNorway
| | - Guttorm Brattebø
- Department of Anaesthesia & Intensive CareHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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Pritchard SA, Keating JL, Nestel D, Blackstock FC. Physiotherapy students can be educated to portray realistic patient roles in simulation: a pragmatic observational study. BMC MEDICAL EDUCATION 2020; 20:471. [PMID: 33243213 PMCID: PMC7689969 DOI: 10.1186/s12909-020-02382-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cannot portray authentic and realistic patient roles. The aim of this study was to investigate whether targeted education was associated with observable changes to physiotherapy students' abilities to portray patient roles in SBE. METHODS Second year pre-registration physiotherapy students (n = 40) participated. Students completed online and face-to-face education about SBE, patient portrayal skills, and how to portray a specific patient role. Students were video-recorded portraying patient roles in practical exams before and after the program. Three blinded independent assessors rated the overall quality of portrayals using a purpose-developed assessment instrument. RESULTS Twenty-three sets of pre- and post-program videos were analysed. Correlations between assessor scores spanned 0.62 to 0.82 for analyses of interest, which justified using average assessor ratings in analysis. Statistically significant higher scores were seen for post-program assessments for overall portrayal scores (mean difference 6.5, 95%CI [1.51-11.45], p = 0.013), accuracy (mean difference 3.4, 95%CI [0.69-6.13], p = 0.016) and quality (mean difference 3.1, 95%CI [0.64-5.49], p = 0.016). CONCLUSIONS Physiotherapy students appear capable of playing realistic patient roles. Peer simulation can be embedded into health professional programs, and education in patient role portrayal appears to be associated with improvements in portrayal quality and realism. Given these findings, further investigation, including testing program effects in a randomised study, is warranted.
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Affiliation(s)
- Shane A. Pritchard
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Debra Nestel
- Monash Institute for Health and Clinical Education (MIHCE), Monash University, Clayton, Victoria Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria Australia
| | - Felicity C. Blackstock
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales Australia
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Computer based simulation in CT and MRI radiography education: Current role and future opportunities. Radiography (Lond) 2020; 27:733-739. [PMID: 33243566 DOI: 10.1016/j.radi.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI. KEY FINDINGS Journal articles published between 2010 and 2020 were reviewed (n = 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics. CONCLUSION The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach. IMPLICATIONS FOR PRACTICE Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.
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Miranda C, Altermatt F, Villagrán I, Goñi J. Developing an Innovative Medical Training Simulation Device for Peripheral Venous Access: A User-Centered Design Approach. Healthcare (Basel) 2020; 8:healthcare8040420. [PMID: 33105754 PMCID: PMC7712721 DOI: 10.3390/healthcare8040420] [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: 09/11/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Nurses and other health students may lack the proper time for training procedural tasks, such as peripheral venous access. There is a need to develop these abilities in novices so that errors can be avoided when treating real patients. Nonetheless, from an experiential point of view, the simulation devices offered in the market do not always make sense for educators and trainees. This could make the adoption of new technology difficult. The purpose of this case study is to describe the development of an innovative simulation device and to propose concrete tactics for the involvement of the educators and trainees. We used a participative design based approach, with an ethnographic basis, where incremental cycles of user testing, development and iteration were involved. The study showcases methods from the field of design and anthropology that can be used to develop future simulation devices that resonate with students and educators to achieve a long term learning experience. Results could shed a light on new ways for the involvement of educators and students to create devices that resonate with them, making learning significant and effective.
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Affiliation(s)
- Constanza Miranda
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Correspondence: ; Tel.: +56-2-23545253
| | - Fernando Altermatt
- Department of Anestesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Ignacio Villagrán
- Health Sciences Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Julián Goñi
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
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Akselbo I, Killingberg H, Aune I. Simulation as a pedagogical learning method for critical paediatric nursing in Bachelor of Nursing programmes: a qualitative study. Adv Simul (Lond) 2020; 5:24. [PMID: 32963816 PMCID: PMC7499857 DOI: 10.1186/s41077-020-00140-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the national education plan for Bachelor of Nursing in Norway, it is emphasized that focus areas for practical studies must include experience related to paediatric nursing. However, given the paucity of children's wards in Norwegian hospitals, few students are offered this. The purpose of this study is to explore undergraduate nursing student's perception of using simulation as a learning method to obtain knowledge and skills in delivering quality healthcare to children and their parents in emergencies. METHOD A total of 36 students participated in focus groups. The students were asked to reflect on their learning outcomes regarding the educational method during the simulation. In addition, the students were encouraged to discuss whether this pedagogical method was useful in preparing them to deal with critical medical situations in relation to children and their parents. The interviews were transcribed and analyzed using qualitative content analysis. RESULTS Three subjects emerged from the analysis. The first, simulation as an educational method, showed that the students thought that simulation gave a greater degree of realism and seriousness than other learning activities. The second subject, preparedness for later practice, showed that the students perceived simulation as one of the ways in which they were best prepared for the profession as a nurse. The students emphasized the benefit of having concentrated on children and their parents. The third subject, stress and leadership, showed that simulation as a method was stressful to most students, and lack of knowledge and anxiety about conducting other students kept them from taking the lead. However, the students experienced that they learned a lot about themselves and how they appear as nurses. CONCLUSION The bachelor-level student nurses experienced simulation as a realistic and effective educational method for gaining knowledge in the critical healthcare of children and their parents. Simulation made them reflect on a nurse's area of responsibility in emergencies. When offered practical experience in children's wards, the use of simulation as a didactic method may help students develop sufficient competence to act appropriately and expediently in critical paediatric nursing settings. TRIAL REGISTRATION The study (number 52776) was approved by the Norwegian Centre for Research Data.
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Affiliation(s)
- Iben Akselbo
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), 7004 Trondheim, Norway
| | - Heidi Killingberg
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), 7004 Trondheim, Norway
| | - Ingvild Aune
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU (Norwegian University of Science and Technology), 7004 Trondheim, Norway
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Whitfill T, Auerbach M, Diaz MCG, Walsh B, Scherzer DJ, Gross IT, Cicero MX. Cost-effectiveness of a video game versus live simulation for disaster training. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:268-273. [DOI: 10.1136/bmjstel-2019-000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
IntroductionDisaster triage training for emergency medical service (EMS) providers is unstandardised. We hypothesised that disaster triage training with the paediatric disaster triage (PDT) video game ‘60 s to Survival’ would be a cost-effective alternative to live simulation-based PDT training.MethodsWe synthesised data for a cost-effectiveness analysis from two previous studies. The video game data were from the intervention arm of a randomised controlled trial that compared triage accuracy in a live simulation scenario of exposed vs unexposed groups to the video game. The live simulation and feedback data were from a prospective cohort study evaluating live simulation and feedback for improving disaster triage skills. Postintervention scores of triage accuracy were measured for participants via live simulations and compared between both groups. Cost-effectiveness between the live simulation and video game groups was assessed using (1) A net benefit regression model at various willingness-to-pay (WTP) values. (2) A cost-effectiveness acceptability curve (CEAC).ResultsThe total cost for the live simulation and feedback training programme was $81 313.50 and the cost for the video game was $67 822. Incremental net benefit values at various WTP values revealed positive incremental net benefit values, indicating that the video game is more cost-effective compared with live simulation and feedback. Moreover, the CEAC revealed a high probability (>0.6) at various WTP values that the video game is more cost-effective.ConclusionsA video game-based simulation disaster triage training programme was more cost-effective than a live simulation and feedback-based programme. Video game-based training could be a simple, scalable and sustainable solution to training EMS providers.
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Peddle M, Livesay K, Marshall S. Preliminary report of a simulation community of practice needs analysis. Adv Simul (Lond) 2020; 5:11. [PMID: 32626603 PMCID: PMC7329516 DOI: 10.1186/s41077-020-00130-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
Aim To understand the current needs related to education and training, and other investment priorities, in simulated learning environments in Australia following a significant period of government funding for simulation-based learning. Methods A mixed methods study, comprising qualitative focus groups and individual interviews, followed by a quantitative cross-sectional survey informed by themes emerging from the qualitative data. Findings Two focus groups and 22 individual interviews were conducted. Participants included simulation educators, technical users and new adopters. Survey data were collected from 152 responses. Barriers at the introduction and maintenance stages of simulated learning included irregular staff training resulting in inconsistent practice, and lack of onsite technical support. Educators lacked skills in some simulation and debriefing techniques, and basic education and research skills were limited, while technicians raised concerns regarding the maintenance of equipment and managing budgets. Discussion and conclusion Despite its effectiveness as an education tool, barriers remain at the introduction and maintenance stages of simulated learning environments. Efforts to improve the integrity and sustainability of simulation training should be informed by a comprehensive needs analysis. The resulting data should be used to address barriers in a way that maximises the limited resources and funding available for this important learning tool.
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Affiliation(s)
- Monica Peddle
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, 3086 Australia
| | - Karen Livesay
- School of Health and Biomedical Sciences, College of Science Engineering and Health, RMIT University, Melbourne, Australia
| | - Stuart Marshall
- Anaesthesia Teaching & Research, Monash University, Melbourne, Australia
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Shaw JR. Evaluation of communication skills training programs at North American veterinary medical training institutions. J Am Vet Med Assoc 2020; 255:722-733. [PMID: 31478810 DOI: 10.2460/javma.255.6.722] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe how North American veterinary medical teaching institutions (VMTIs) provide communication skills training to students. SAMPLE Faculty coordinators of communication skills training programs (CSTPs) at 30 North American VMTIs. PROCEDURES An online survey instrument was designed and administered to each respondent followed by a telephone (n = 28) or in-person (2) interview. The survey and interview process were designed to evaluate all aspects of CSTPs, such as communication framework used, program format, number of student-contact hours, staffing models, outcome assessment, faculty background, program priorities, and challenges. Descriptive results were generated, and guidelines for future development of CSTPs were recommended. RESULTS 27 US and 3 Canadian VMTIs were represented, and communication skills training was required at all. Twenty-five CSTPs used the Calgary-Cambridge Guide framework. Respondents provided a mean of 33 student-contact hours of training, primarily in the first 3 years of the veterinary curriculum in lecture (mean, 12 hours), communication laboratory (13 hours), and self-study (8 hours) formats with formative feedback. Communication skills training was integrated with other disciplines at 27 VMTIs. Most CSTPs were coordinated and taught by 1 faculty member with a < 0.50 full-time equivalent commitment and no administrative support. Stated priorities included acquisition of resources for CSTP faculty, administrative support, and video-equipped facilities; increasing integration of CSTPs into curricula; and assessment of educational outcomes. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that support for CSTPs and recognition of their value continue to grow, but a lack of resources, faculty expertise, validated methods for outcomes assessment, and leadership remain challenges.
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Ambardekar AP, Newell A, Blassius K, Waldrop WB, Young DA. Medical simulation utilization among pediatric anesthesiology fellowship programs. Paediatr Anaesth 2020; 30:823-832. [PMID: 32335993 DOI: 10.1111/pan.13895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Simulation-based education is a mainstay in education of pediatric anesthesiology trainees. Despite the known benefits, there is variability in its use and availability among various pediatric anesthesiology fellowship programs. AIM The primary aim was to understand the current state of simulation-based education among pediatric anesthesiology fellowship programs and define barriers that impede the development of an effective simulation program. METHODS This survey-based, observational study of simulation activities within United States-based pediatric anesthesiology fellowship programs was approved by the Institutional Review Boards (IRB) of the authors' institutions. A 35-question survey was developed in an iterative manner by simulation educators (AA, WW, DY) and a statistician familiar with survey-based research (AN) using research electronic data capture (REDCap) for tool development and data collation. Descriptive and thematic analyses were performed on the quantitative and qualitative responses in the survey, respectively, and were stratified with small, medium, and large fellowship programs. RESULTS Forty-five of 60 (75%) fellowship programs responded to the survey. The presence of a dedicated simulation program director and number of simulation instructors was positively associated with the size of program and years in operation. Dedicated simulation support was variable across programs and was usually present within the larger programs. A positive association also existed for educational activities among all programs mostly based on size of program and years in operation. Protected time was the most commonly cited barrier to having a comprehensive and sustainable simulation program. There was general agreement for establishing a standardized and shared curriculum among fellowship programs. Approximately 70% of simulation programs had no formal simulation instructor training requirement. CONCLUSIONS Simulation-based curricula are broadly offered by many fellowship programs. Improved collaboration locally, regionally, and nationally may improve educational opportunities for fellowship programs, particularly the small ones. These efforts may begin with the development of a standardized curriculum and formal instructor training programs.
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Affiliation(s)
- Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Alana Newell
- Center for Educational Outreach, Baylor College of Medicine, Houston, TX, USA
| | - Kim Blassius
- Scope Anesthesia of North Carolina, Raleigh, NC, USA
| | - William B Waldrop
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - David A Young
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Peisachovich E, Da Silva C, Penhearow NJ, Sombilon EV, Koh M. Implementing Virtual Simulated Person Methodology to Support the Shift to Online Learning: Technical Report. Cureus 2020; 12:e8864. [PMID: 32754403 PMCID: PMC7386095 DOI: 10.7759/cureus.8864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has dramatically changed how education is delivered worldwide. The resultant rise of e-learning, whereby teaching is undertaken remotely and on digital platforms, has extensively impacted universities and other higher education organizations around the world. One approach to support this change in education delivery is the use of virtual simulation approaches. Our team at SimXSpace has piloted a virtual workshop using Zoom, an online video-conferencing platform, and virtual simulated persons (SPs) to support communication and interpersonal skills among learners. The main objective of the pilot virtual workshop was to develop and implement the SP methodology remotely via the Zoom platform (Zoom Video Communications, San Jose, California) and to evaluate its effectiveness as an immersive environment for simulation. The virtual workshop involved four instructors who intend to implement virtual SPs within their courses, two workshop facilitators, and two SPs. The workshop was conducted synchronously using Zoom features. The workshop followed a predefined structure and was completed as planned. Outcomes suggest that remote simulation delivery using virtual SPs and delivered online via Zoom is feasible and provides an effective environment in which to conduct SP methodology to teach communication and interpersonal skills. The findings suggest that remote simulation and virtual SPs can support experiential education and provide an effective and engaging learning environment. The virtual workshop was successful and laid a foundation for future online training programs for the use of SP methodology. Moreover, it formed an effective outline for subsequent iterations of this virtual training workshop and prompted discussion of plans for future workshops with various programs across a pan-university context.
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Affiliation(s)
| | - Celina Da Silva
- Medical Education and Simulation, York University, Toronto, CAN
| | | | | | - Marianne Koh
- Faculty of Health, York University, Toronto, CAN
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Green W, Shahzad MW, Wood S, Martinez Martinez M, Baines A, Navid A, Jay R, Whysall Z, Sandars J, Patel R. Improving junior doctor medicine prescribing and patient safety: An intervention using personalised, structured, video-enhanced feedback and deliberate practice. Br J Clin Pharmacol 2020; 86:2234-2246. [PMID: 32343422 PMCID: PMC7576627 DOI: 10.1111/bcp.14325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. METHODS Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated cost-effectiveness. RESULTS There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (P = .026, 95% confidence interval [CI] Wald 0.093 to 1.436; P = .026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (P = .007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (P = .04, 95% CI -0.068 to -0.001). The break-even analysis demonstrates cost-effectiveness for the intervention. CONCLUSION Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of Foundation Year doctors. The intervention is cost-effective with potential to reduce avoidable harm.
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Affiliation(s)
- William Green
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | | | - Stephen Wood
- University of Leicester School of Business, University of Leicester, Leicester, UK
| | - Maria Martinez Martinez
- Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, UK
| | - Andrew Baines
- Pilgrim Hospital Boston, United Lincolnshire Hospitals (ULH) NHS Trust, Boston, Lincolnshire, UK
| | - Ahmad Navid
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Robert Jay
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Zara Whysall
- Department of Human Resource Management, Nottingham Business School, Nottingham Trent University, Nottingham, UK
| | - John Sandars
- Health Research Institute, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Rakesh Patel
- School of Medicine, University of Nottingham, Nottingham, UK
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Schick K, Reiser S, Mosene K, Schacht L, Janssen L, Thomm E, Dinkel A, Fleischmann A, Berberat PO, Bauer J, Gartmeier M. How can communicative competence instruction in medical studies be improved through digitalization? GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc57. [PMID: 33225049 PMCID: PMC7672381 DOI: 10.3205/zma001350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/29/2020] [Accepted: 05/29/2020] [Indexed: 05/10/2023]
Abstract
The teaching of communicative competence plays an increasingly important role in medical education. In addition to traditional teaching formats, such as role-plays with simulated patients, technology-based approaches become more important in medical education. Teaching materials are increasingly augmented by videos of simulated doctor-patient conversations. This combination allows the content of teaching materials to be demonstrated with video or for videos to create a basis for reflection activities. In addition, conversation videos can illustrate different qualities of clinical communication and serve as illustrative material for describing particular issues in more detail. In addition to teaching clinical communicative competence, the assessment of this competence also plays an important role in medical educational research. So far, this has mainly been conducted through direct observation using checklists or rating scales. Relatively little is known about the assessment of communicative competence using standardized online-based tests. Situational Judgement Tests (SJTs) offer a promising approach in this respect. The BMBF-funded (BMBF = Bundesministerium für Bildung und Forschung - Federal Ministry of Education and Research) joint project voLeA (Entwicklung videobasierter Lehr- und Assessmentmodule zur Gesprächskompetenz im Medizinstudium = Development of video-based teaching and assessment modules for communicative competence in medical studies) addresses these two issues. Specifically, the project is engaged in developing e-learning modules to promote communicative competence and an assessment of this competence using an SJT. The present paper focuses on the benefits of technology-based learning and assessment units for clinical communicative competence in medical studies, using the voLeA project as an example.
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Affiliation(s)
- Kristina Schick
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
- *To whom correspondence should be addressed: Kristina Schick, Technical University of Munich, TUM Medical Education Center, Ismaninger Str. 22, D-81675 Munich, Germany, Phone: +49 (0)89/4140-6311, E-mail:
| | - Sabine Reiser
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Katharina Mosene
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Laura Schacht
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Laura Janssen
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Eva Thomm
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Munich, Germany
| | - Andreas Fleischmann
- Technical University of Munich, Pro Lehre, Medien und Didaktik, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Johannes Bauer
- University Erfurt, Professur für Bildungsforschung und Methodenlehre, Erfurt, Germany
| | - Martin Gartmeier
- Technical University of Munich, TUM Medical Education Center, Munich, Germany
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Mills B, Dykstra P, Hansen S, Miles A, Rankin T, Hopper L, Brook L, Bartlett D. Virtual Reality Triage Training Can Provide Comparable Simulation Efficacy for Paramedicine Students Compared to Live Simulation-Based Scenarios. PREHOSP EMERG CARE 2019; 24:525-536. [PMID: 31580178 DOI: 10.1080/10903127.2019.1676345] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Mass-casualty incidents (MCIs) are catastrophic. Whether they arise from natural or man-made disasters, the nature of such incidents and the multiple casualties involved can rapidly overwhelm response personnel. Mass-casualty triage training is traditionally taught via either didactic lectures or table top exercises. This training fails to provide an opportunity for practical application or experiential learning in immersive conditions. Further, large-scale simulations are heavily resource-intensive, logistically challenging, require the coordination and time of multiple personnel, and are costly to replicate. This study compared the simulation efficacy of a bespoke virtual-reality (VR) MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Methods: Both simulations involved ten injured patients resulting from a police car chase and shooting. Twenty-nine second-year paramedicine students completed the live and VR simulation in a random order. The training efficacy of the VR and live simulation was evaluated with respect to student immersion and task-difficulty, clinical decision-making (i.e. triage card allocation accuracy and timeliness), learning satisfaction, and cost of delivery. Results: While perceived physical demand was higher in the live simulation compared to VR (p < 0.001), no differences were observed across mental demand, temporal demand, performance, effort or frustration domains. No differences were found for participant satisfaction across the two platforms. No differences were observed in the number of triage cards correctly allocated to patients in each platform. However, participants were able to allocate cards far quicker in VR (p < .001). Cost of running the VR came to AUD $712.04 (staff time), compared to the live simulations which came to AUD $9,413.71 (staff time, moulage, actors, director, prop vehicle), approximately 13 times more expensive. Conclusion: The VR simulation provided near identical simulation efficacy for paramedicine students compared to the live simulation. VR MCI training resources represent an exciting new direction for authentic and cost-effective education and training for medical professionals.
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Rowe M, Osadnik CR, Pritchard S, Maloney S. These may not be the courses you are seeking: a systematic review of open online courses in health professions education. BMC MEDICAL EDUCATION 2019; 19:356. [PMID: 31521150 PMCID: PMC6744630 DOI: 10.1186/s12909-019-1774-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/29/2019] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Open Online Courses (OOCs) are increasingly presented as a possible solution to the many challenges of higher education. However, there is currently little evidence available to support decisions around the use of OOCs in health professions education. The aim of this systematic review was to summarise the available evidence describing the features of OOCs in health professions education and to analyse their utility for decision-making using a self-developed framework consisting of point scores around effectiveness, learner experiences, feasibility, pedagogy and economics. METHODS Electronic searches of PubMed, Medline, Embase, PsychInfo and CINAHL were made up to April 2019 using keywords related to OOC variants and health professions. We accepted any type of full text English publication with no exclusions made on the basis of study quality. Data were extracted using a custom-developed, a priori critical analysis framework comprising themes relating to effectiveness, economics, pedagogy, acceptability and learner experience. RESULTS 54 articles were included in the review and 46 were of the lowest levels of evidence, and most were offered by institutions based in the United States (n = 11) and United Kingdom (n = 6). Most studies provided insufficient course detail to make any confident claims about participant learning, although studies published from 2016 were more likely to include information around course aims and participant evaluation. In terms of the five categories identified for analysis, few studies provided sufficiently robust evidence to be used in formal decision making in undergraduate or postgraduate curricula. CONCLUSION This review highlights a poor state of evidence to support or refute claims regarding the effectiveness of OOCs in health professions education. Health professions educators interested in developing courses of this nature should adopt a critical and cautious position regarding their adoption.
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Affiliation(s)
- Michael Rowe
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Christian R. Osadnik
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Shane Pritchard
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Stephen Maloney
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
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Shrestha R, Shrestha AP, Shrestha SK, Basnet S, Pradhan A. Interdisciplinary in situ simulation-based medical education in the emergency department of a teaching hospital in Nepal. Int J Emerg Med 2019; 12:19. [PMID: 31455223 PMCID: PMC6712774 DOI: 10.1186/s12245-019-0235-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulation is well established as an effective strategy to train health care professionals in both technical and nontechnical skills and to prevent errors. Despite its known efficacy, adequate implementation is restricted due to the financial burden in resource-limited settings like ours. We therefore pursued to introduce cost-effective in situ simulation (ISS) in the emergency department (ED) to explore its impact on perception and learning experience among multidisciplinary health care professionals and to identify and remediate the latent safety threats (LST). METHODS This is a prospective cross-sectional study with a mixed method research design, which was conducted in the ED of Dhulikhel Hospital-Kathmandu University Hospital. The pretest questionnaire was used to determine baseline knowledge, attitude, and confidence of the staff. The ISS with minimal added cost was conducted involving multidisciplinary healthcare workers. The LSTs were recorded and appropriate remediation was performed. Voluntary post simulation feedback was collected after the sessions. RESULTS Overall 56 staff participated in at least one of the 35 simulation sessions, among which 45 (80%) responded to the questionnaires`. Twenty participants (45.5%) were reluctant to use the defibrillator. The self-reported confidence level of using defibrillator was low 29 (64.6%). The knowledge score ranged from 0 to 8 with the median score of 3 and a mean of 3.29 ± 1.8. There was no statistically significant difference in knowledge scores among participants of different occupational backgrounds, previous training, duration of work experience, and previous use of a defibrillator. A total of 366 LSTs {individual (43%), medication (17%), equipment (4%), and system/team (36%)} were identified (10.45 LST per ISS). The overall feedback from the participants was positive. Eighty percent of participants reported increased skills to use a defibrillator, and 82% reported increased confidence for managing such cases. They also agreed upon the need and continuity of such type of simulation in their workplace. CONCLUSIONS The baseline knowledge score and the confidence level of the staff were low. Self-reported feedback suggested increased confidence level and teamwork skills after ISS. It promoted identification and remediation of latent safety threats. ISS serves as a cost-effective powerful educational model that can be implemented even in settings where finances and space are limited.
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Affiliation(s)
- Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal.
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Sanu Krishna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Samjhana Basnet
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Alok Pradhan
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
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