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Brazil V, Reedy G. Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety. Adv Simul (Lond) 2024; 9:16. [PMID: 38720396 PMCID: PMC11080180 DOI: 10.1186/s41077-024-00291-6] [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: 11/16/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
The simulation community has effectively responded to calls for a more direct contribution by simulation to healthcare quality and safety, and clearer alignment with health service priorities, but the conceptual framing of this contribution has been vague. The term 'translational simulation' was proposed in 2017 as a "functional term for how simulation may be connected directly with health service priorities and patient outcomes, through interventional and diagnostic functions" (Brazil V. Adv Simul. 2:20, 2017). Six years later, this conceptual framing is clearer. Translational simulation has been applied in diverse contexts, affording insights into its strengths and limitations. Three core concepts are identifiable in recently published translational simulation studies: a clear identification of simulation purpose, an articulation of the simulation process, and an engagement with the conceptual foundations of translational simulation practice. In this article, we reflect on current translational simulation practice and scholarship, especially with respect to these three core concepts, and offer a further elaborated conceptual model based on its use to date.
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Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, Waterloo Bridge Wing G7, London, UK
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Guérard-Poirier N, Meloche-Dumas L, Beniey M, Torres A, Kapralos B, Dhane M, Mercier F, Younan R, Dubrowski A, Patocskai E. The exploration of remote simulation strategies for the acquisition of psychomotor skills in medicine: a pilot randomized controlled trial. DISCOVER EDUCATION 2023; 2:19. [PMID: 37469757 PMCID: PMC10352422 DOI: 10.1007/s44217-023-00041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023]
Abstract
Background Progress in remote educational strategies was fueled by the advent of the COVID-19 pandemic. This pilot RCT explored the efficacy of a decentralized model of simulation based on principles of observational and peer-to-peer learning for the acquisition of surgical skills. Methods Sixty medical students from the University of Montreal learned the running subcuticular suture in four different conditions: (1) Control group (2) Self-learning (3) Peer-learning (4) Peer-learning with expert feedback. The control group learned with error-free videos, while the others, through videos illustrating strategic sub-optimal performances to be identified and discussed by students. Performance on a simulator at the end of the learning period, was assessed by an expert using a global rating scale (GRS) and checklist (CL). Results Students engaging in peer-to-peer learning strategies outperformed students who learned alone. The presence of an expert, and passive vs active observational learning strategies did not impact performance. Conclusion This study supports the efficacy of a remote learning strategy and demonstrates how collaborative discourse optimizes the students' acquisition of surgical skills. These remote simulation strategies create the potential for implantation in future medical curriculum design.Trial Registration: NCT04425499 2020-05-06.
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Affiliation(s)
| | | | - Michèle Beniey
- Department of Surgery, Université de Montréal, Montreal, QC H2X3E4 Canada
| | - Andrei Torres
- Faculty of Business and IT, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Bill Kapralos
- Faculty of Health Sciences, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Malek Dhane
- Faculty of Medicine, Université de Montréal, Montreal, QC H2X3E4 Canada
| | - Frédéric Mercier
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
| | - Rami Younan
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
| | - Adam Dubrowski
- Faculty of Health Sciences, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Erica Patocskai
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
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3
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Pelletier F, Torres A, Meloche-Dumas L, Guérard-Poirier N, Kaviani A, Kapralos B, Mercier F, Dubrowski A, Patocskai E. The Role of Collaborative Observational Practice and Feedback-Discourse to Promote Remote Acquisition of Technical Surgical Skills. J Surg Res 2023; 288:372-382. [PMID: 37079953 DOI: 10.1016/j.jss.2023.02.006] [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: 03/08/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Acquisition of technical skills remotely in a decentralized model requires an efficacious way of providing feedback. The primary objective was to test the efficacy of various forms of feedback on the acquisition of surgical skills by medical students. METHODS Forty volunteers were randomized to four experimental groups, differing from the nature of feedback (free text versus structured) and who provided the feedback (expert versus peer learners). They had to perform sutures and upload attempts on a learning management system to receive interactive feedback. The pretest and retention test performances were assessed. RESULTS All groups significantly improved from pretests to retention tests; however, participants using checklist showed statistically lower improvements than the other groups, which did not differ from each other. CONCLUSIONS Remote learners can acquire surgical skills, and most importantly, peers who provide feedback, are as effective as experts if they use open-ended comments and not checklists.
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Affiliation(s)
- Florence Pelletier
- Faculty of Medicine, Université de Montréal, Montréal, Quebec City, Canada
| | - Andrei Torres
- Faculty of Business and IT, Ontario Tech University, Oshawa, Ontario, Canada
| | | | | | - Ahmad Kaviani
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec City, Canada
| | - Bill Kapralos
- Faculty of Business and IT, Ontario Tech University, Oshawa, Ontario, Canada
| | - Frédéric Mercier
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec City, Canada
| | - Adam Dubrowski
- Faculty of Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ontario, Canada
| | - Erica Patocskai
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec City, Canada.
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Managing COVID-19 in an Australian designated isolation facility: Implications for current and future healthcare crises based on in-depth interviews. PLoS One 2022; 17:e0278479. [PMID: 36454875 PMCID: PMC9714878 DOI: 10.1371/journal.pone.0278479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Health care workers' (HCWs) lived experiences and perceptions of the pandemic can prove to be a valuable resource in the face of a seemingly persistent Novel coronavirus disease 2019 (COVID-19)-to inform ongoing efforts, as well as identify components essential to a crisis preparedness plan and the issues pertinent to supporting relevant, immediate change. We employed a phenomenological approach and, using purposive sampling, conducted 39 semi-structured interviews with senior healthcare professionals who were employed at a designated COVID-19 facility in New South Wales (NSW), Australia during the height of the pandemic in 2020. Participants comprised administrators, heads of department and senior clinicians. We obtained these HCWs' (i) perspectives of their lived experience on what was done well and what could have been done differently and (ii) recommendations on actions for current and future crisis response. Four themes emerged: minimise the spread of disease at all times; maintain a sense of collegiality and informed decision-making; plan for future crises; and promote corporate and clinical agility. These themes encapsulated respondents' insights that should inform our capacity to meet current needs, direct meaningful and in situ change, and prepare us for future crises. Respondents' observations and recommendations are informative for decision-makers tasked with mobilising an efficacious approach to the next health crisis and, in the interim, would aid the governance of a more robust workforce to effect high quality patient care in a safe environment.
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Szilagyi C, Tartaglia A, Palmer PK, Fleenor DW, Jackson-Jordan E, Knoll Sweeney S, Slaven JE. Delivering Clinical Pastoral Education (CPE) Remotely: Educators’ Views and Perspectives During the COVID-19 Pandemic and Beyond. JOURNAL OF PASTORAL CARE & COUNSELING: ADVANCING THEORY AND PROFESSIONAL PRACTICE THROUGH SCHOLARLY AND REFLECTIVE PUBLICATIONS 2022; 76:189-209. [PMID: 35499920 PMCID: PMC9066239 DOI: 10.1177/15423050221094492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many Clinical Pastoral Education programs pivoted to remote delivery during the
COVID-19 pandemic. Our survey explored educators’ preparedness, self-efficacy,
and views regarding remote Clinical Pastoral Education. Few respondents were
either very (14.2%) or not at all (16.5%) prepared. Most were confident
facilitating remote learning (69.8%–88.5%), believing remote Clinical Pastoral
Education can achieve outcomes equivalent to in-person (59.1%). Six qualitative
themes emerged: educator development, educator challenges, remote Clinical
Pastoral Education efficacy, remote group dynamics, clinical
practice/supervision implications, and benefits and opportunities.
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Affiliation(s)
| | | | | | | | | | | | - James E. Slaven
- Indiana University School of Medicine, Indianapolis, IN, USA
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Evans LV, Ray JM, Bonz JW, Joseph M, Gerwin JN, Dziura JD, Venkatesh AK, Wong AH. Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol. BMJ Open 2022; 12:e058980. [PMID: 35589358 PMCID: PMC9121107 DOI: 10.1136/bmjopen-2021-058980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION COVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors. METHODS AND ANALYSIS We will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory. ETHICS AND DISSEMINATION The protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators. TRIAL REGISTRATION NUMBER NCT04614844.
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Affiliation(s)
- Leigh V Evans
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jessica M Ray
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - James W Bonz
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey N Gerwin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James D Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Szilagyi C, Tartaglia A, Palmer PK, Fleenor DW, Jackson-Jordan E, Knoll Sweeney S, Slaven JE. COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic. JOURNAL OF PASTORAL CARE & COUNSELING: ADVANCING THEORY AND PROFESSIONAL PRACTICE THROUGH SCHOLARLY AND REFLECTIVE PUBLICATIONS 2022; 76:37-47. [PMID: 35060791 PMCID: PMC8926918 DOI: 10.1177/15423050211073572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical Pastoral Education (CPE) programs faced extraordinary challenges during the COVID-19 pandemic. We examined how ACPE-certified educators responded to maintain program delivery. Survey results (n = 210) suggested a substantial and abrupt increase in remote delivery for CPE instruction and supervised clinical practice, primarily driven by those previously fully in-person. Respondents reported abrupt changes impacted 1152 students. Participants rated their utilization and helpfulness of professional, organizational, and technology resources during the pivot and beyond.
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Affiliation(s)
| | | | | | - David W. Fleenor
- Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - James E. Slaven
- Indiana University School of Medicine, Indianapolis, IN, USA
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Brazil V, Scott C, Matulich J, Shanahan B. Developing a simulation safety policy for translational simulation programs in healthcare. Adv Simul (Lond) 2022; 7:4. [PMID: 35074018 PMCID: PMC8785148 DOI: 10.1186/s41077-022-00200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Healthcare simulation may present risks to safety, especially when delivered ‘in situ’—in real clinical environments—when lines between simulated and real practice may be blurred. We felt compelled to develop a simulation safety policy (SSP) after reading reports of adverse events in the healthcare simulation literature, editorials highlighting these safety risks, and reflecting on our own experience as a busy translational simulation service in a large healthcare institution. The process for development of a comprehensive SSP for translational simulation programs is unclear. Personal correspondence with leaders of simulation programs like our own revealed a piecemeal approach in most institutions. In this article, we describe the process we used to develop the simulation safety policy at our health service, and crystalize principles that may provide guidance to simulation programs with similar challenges.
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Juelsgaard J, Løfgren B, Toxvig N, Eriksen GV, Ebdrup L, Jensen RD. Healthcare professionals' experience of using in situ simulation training in preparation for the COVID-19 pandemic: a qualitative focus group study from a Danish hospital. BMJ Open 2022; 12:e056599. [PMID: 34996802 PMCID: PMC8743834 DOI: 10.1136/bmjopen-2021-056599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic forced hospital organisation and healthcare professionals to prepare for large quantities of patients in isolation rooms. In situ simulation may seem promising in order to manage the organisational changes that the pandemic require. This study aims to investigate in situ simulations influence on healthcare professional's self-perceived preparedness to face the pandemic. DESIGN A qualitative focus group study. SETTING We conducted full scale in situ simulations over a 3-week period in April 2020, including 277 healthcare professionals, at a Danish University Hospital. Subsequently, six semistructured focus group interviews, including 22 participants from the simulations, were conducted in May 2020. PARTICIPANTS 22 healthcare professionals participated in the focus group interviews. METHODS The simulations consisted of a briefing, two scenarios focusing on acute respiratory insufficiency and correct use of personal protective equipment (PPE), and a debriefing. We conducted six focus group interviews using comparable semistructured interview guides focusing on the organisational restructuring of the departments and outcomes of the needs-driven simulation-based programme. We used thematic analysis to identify main themes. RESULTS The informants perceived that the simulations resulted in positive experiences for the healthcare professionals and perceived the organisational changes as effective. They highlighted that simulation enhanced teamwork, demystified the COVID-19 disease, and improved skills, in correct use of PPE and acute treatment of COVID-19 patients. Data revealed that a predefined simulation task force including both experienced simulators and medical experts for facilitation of in situ simulation would be beneficial. CONCLUSION In situ simulation may be useful to enhance learning on organisation and individual level during a pandemic. This educational activity could serve an important role in facilitating hospital preparation and education of large numbers of healthcare professionals during a healthcare crisis. Introduction of a simulation task force is suggested to handle coordination and rapid enrolment across the hospital.
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Affiliation(s)
| | - Bo Løfgren
- Dept of Medicine, Randers Regional Hospital, Randers NE, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Neel Toxvig
- Region Midtjylland Koncern HR Udvikling, Aarhus, Denmark
| | | | - Lotte Ebdrup
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
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Blair C, Walsh C, Best P. Immersive 360° videos in health and social care education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:590. [PMID: 34819063 PMCID: PMC8611631 DOI: 10.1186/s12909-021-03013-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/03/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Research on the pedagogical use of immersive 360° videos is a rapidly expanding area within health and social care education. Despite this interest, there is a paucity of empirical data on its application. METHOD A scoping review methodology framework was used to search for relevant articles published between 1970 and July 2021. Six databases were used to identify studies using immersive 360° videos for training and education purposes within health and social care: PubMed, Ovid Medline, Psych Info, Psych Articles, Cochrane Database and Embase. Research questions included: Is there any evidence that immersive 360° videos increase learning outcomes and motivation to learn in health and social care education? What are the key pedagogical concepts and theories that inform this area of research? What are the limitations of using immersive 360° videos within health and social education? The four dimensions contained within Keller's ARCS model (attention, relevance, confidence and satisfaction) frame the results section. RESULTS Fourteen studies met our inclusion criteria. Learning outcomes confirm that immersive 360° videos as a pedagogical tool: increases attention, has relevance in skill enhancement, confidence in usability and user satisfaction. In particular, immersive 360° videos has a positive effect on the user's emotional response to the learning climate, which has a significant effect on users' motivation to learn. There was a notable lack of pedagogical theory within the studies retrieved and a general lack of clarity on learning outcomes. CONCLUSION Studies examining the effectiveness of such interventions remains weak due to smaller sample sizes, lack of randomised control trials, and a gap in reporting intervention qualities and outcomes. Nevertheless, 360° immersive video is a viable alternative to VR and regular video, it is cost-effective, and although more robust research is necessary, learning outcomes are promising. FUTURE DIRECTIONS Future research would do well to focus on interactivity and application of pedagogical theory within immersive 360° videos experiences. We argue that more and higher quality research studies, beyond the scope of medical education, are needed to explore the acceptability and effective implementation of this technology.
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Affiliation(s)
- Carolyn Blair
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland.
| | - Colm Walsh
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, 6 College Park, Belfast, Northern Ireland
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Getting everyone to the table: exploring everyday and everynight work to consider 'latent social threats' through interprofessional tabletop simulation. Adv Simul (Lond) 2021; 6:39. [PMID: 34732264 PMCID: PMC8564977 DOI: 10.1186/s41077-021-00191-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
In this methodological intersection article, we describe how we developed a new variation of the established tabletop simulation modality, inspired by institutional ethnography (IE)-informed principles. We aimed to design and conduct pilot implementations of this innovative tabletop simulation modality, which focused uniquely on everyday and everynight work, along with the factors that govern that work. In so doing, we aimed to develop a modality and preliminary findings that researchers and educators can use to simulate healthcare practices across longer episodes of care (i.e., time scales of hours or an entire day) and to detect the ‘latent social threats’ that can emerge during interprofessional clinical care. An interprofessional team designed tabletop simulation scenarios of interprofessional challenges during transfers of care on a labour and delivery (L&D) unit. Within each scenario, participants provided real-time explanations for their work and associated drivers, both independently and as a team. Thus, we combined ‘think-aloud’ and simulation principles to design tabletop simulation scenarios to elicit healthcare professionals’ descriptions of how they collaborate in their work on the L&D unit. We completed a total of five tabletop simulations with eight participants (obstetricians, N = 2; midwives, N = 2; nurses, N = 5). The conversations stimulated by the tabletop simulation scenarios and debriefs allowed us to generate a preliminary understanding of the texts that govern and organize clinicians’ everyday work processes. We generated data about longitudinal, multi-hour work processes in a condensed timeline, with opportunities to pause and probe, and with reduced focus on individual practitioner’s competence. We believe our innovative tabletop simulation approach allowed us to examine clinical work in ways no other simulation permits. Participants described how the scenarios opened a productive dialogue between professional groups and suggested this simulation-based approach might contribute to enhanced interprofessional understanding and cultural change. We suggest that others can adapt our low-resource approach to understand clinicians’ everyday work and to map how this work is governed by documents, like policies, with the end goal of facilitating system change and managing latent social threats.
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Blaak MJ, Fadaak R, Davies JM, Pinto N, Conly J, Leslie M. Virtual tabletop simulations for primary care pandemic preparedness and response. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:487-493. [PMID: 34422296 PMCID: PMC8327409 DOI: 10.1136/bmjstel-2020-000854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/13/2022]
Abstract
Introduction The COVID-19 pandemic prompted widescale use of clinical simulations to improve procedures and practices. We outline our deployment of a virtual tabletop simulation (TTS) method in primary care (PC) clinics across Alberta, Canada. We summarise the quality and safety improvements from this method and report end users’ perspectives on key elements. Methods Our virtual TTS used teleconferencing software alongside digital whiteboards to walk clinic stakeholders through patient scenarios. Participants reviewed and rehearsed their workflows and care practices. The goal was for staff to take ownership over gaps and codesigned solutions. After simulation sessions, follow-up interviews were conducted to collect feedback. Results These sessions helped PC staff identify and codesign solutions for clinical hazards and threats. These included the flow of patients through clinics, communications, redesignation of physical spaces, and adaptation of guidance for cleaning and personal protective equipment use. End users reported sessions provided neutral spaces to discuss practice changes and built confidence in delivering safe care during the pandemic. Discussion TTS has not been extensively deployed to improve clinical practice in outpatient environments. We show how virtual TTS can bridge gaps between knowledge and practice by offering a guided space to rehearse clinical changes. We show that virtual TTS can be used in multiple contexts to help identify hazards, improve safety and build confidence in professional teams adapting to rapid changes in both policies and practices. While our sessions were conducted in Alberta, our results suggest this method may be deployed in other contexts, including low-resource settings.
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Affiliation(s)
- Marlot Johanna Blaak
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Raad Fadaak
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Jan M Davies
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - John Conly
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada.,Departments of Medicine, Microbiology, Immunology and Infectious Diseases, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Brandão CFS, Bergamasco EC, Vaccarezza GF, Barba MLFD, Andrade EFMD, Cecilio-Fernandes D. Training in healthcare during and after COVID-19: proposal for simulation training. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67Suppl 1:12-17. [PMID: 34406292 DOI: 10.1590/1806-9282.67.suppl1.20200710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.
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Santos TM, Pedrosa RBDS, Carvalho DRDS, Franco MH, Silva JLG, Franci D, de Jorge B, Munhoz D, Calderan T, Grangeia TDAG, Cecilio-Fernandes D. Implementing healthcare professionals' training during COVID-19: a pre and post-test design for simulation training. SAO PAULO MED J 2021; 139:514-519. [PMID: 34378741 PMCID: PMC9632531 DOI: 10.1590/1516-3180.2021.0190.r1.27052021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) has imposed a new reality that presents several challenges for healthcare professionals. The main challenge has been the lack of proper training in relation to an unknown disease. OBJECTIVE To investigate healthcare professionals' acquisition of knowledge of a new airway management protocol for COVID-19 through their participation in simulation training. DESIGN AND SETTING Pre and post-test study with purpose sampling, carried out in a tertiary-level hospital in the city of Campinas, state of São Paulo, Brazil. METHODS This was a cross-sectional pre and post-test intervention among healthcare professionals working in the intensive care unit and emergency department of a large hospital. The training was carried out using an in situ simulation scenario and the participants answered pre and post-tests consisting of a 20-item questionnaire about the new protocol. RESULTS The paired-sample t test demonstrated that there was a significant increase in test score (t = -19.06; P < 0.001), from before the training (M = 8.62; standard deviation, SD = 3.53) to after the simulation training (M = 17.02; SD = 1.76). CONCLUSIONS The simulated training had a positive impact on the healthcare professionals' acquisition of the COVID-19 protocol. We also demonstrated that in situ simulation training was an efficient tool for implementing new protocols, thus bringing benefits to healthcare systems, professionals and patients.
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Affiliation(s)
- Thiago Martins Santos
- MD, PhD. Assistant Professor, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | | | - Danielle Rachel dos Santos Carvalho
- PhD. Pharmacist and Researcher, Postdoctoral Researcher Program, Department of Medical Psychology and Psychiatry, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Mário Henrique Franco
- MD. Emergency Physician, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Juliany Lino Gomes Silva
- RN, PhD. Coordinator, Skills Laboratory, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Daniel Franci
- MD. Hospitalist, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Bruno de Jorge
- BSc. Coordinator, Department of Academic Support, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Daniel Munhoz
- MD, PhD. Cardiologist, Discipline of Cardiology, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Thiago Calderan
- MD, MSc. Trauma Surgeon, Discipline of Trauma Surgery, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Tiago de Araujo Guerra Grangeia
- MD, MSc. Pulmonologist, Discipline of Emergency Medicine, Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Dario Cecilio-Fernandes
- PhD. Researcher, Department of Medical Psychology and Psychiatry, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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15
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Nadir N, Kim J, Cassara M, Hrdy M, Zaveri P, Wong AH, Ray J, Strother C, Falk M. Simulation-based emergency medicine education in the era of physical distancing. AEM EDUCATION AND TRAINING 2021; 5:e10586. [PMID: 33786408 PMCID: PMC7995220 DOI: 10.1002/aet2.10586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 05/23/2023]
Abstract
Background The COVID-19 pandemic posed significant challenges to traditional simulation education. Because simulation is considered best practice for competency-based education, emergency medicine (EM) residencies adapted and innovated to accommodate to the new pandemic normal. Our objectives were to identify the impact of the pandemic on EM residency simulation training, to identify unique simulation adaptations and innovations implemented during the pandemic, and to analyze successes and failures through existing educational frameworks to offer guidance on the use of simulation in the COVID-19 era. Methods The Society for Academic Emergency Medicine (SAEM)'s Simulation Academy formed the SimCOVID task force to examine the impact of COVID-19 on simulation didactics. A mixed-methods approach was employed. A literature search was conducted on the subject and used to develop an exploratory survey that was distributed on the Simulation Academy Listserv. The results were subjected to thematic analysis and examined through existing educational frameworks to better understand successes and failures and then used to generate suggestions on the use of simulation in the COVID-19 era. Results Thirty programs responded to the survey. Strategies reported included adaptations to virtual teleconferencing and small-group in situ training with a focus on procedural training and COVID-19 preparedness. Successful continuation or relaunching of simulation programs was predicated on several factors including willingness for curricular pivots through rapid iterative prototyping, embracing teleconferencing software, technical know-how, and organizational and human capacity. In specific instances the use of in situ simulation for COVID-19 preparedness established the view of simulation as a "value add" to the organization. Conclusions Whereas simulation educator's responses to the COVID-19 pandemic can be better appreciated through the lens of iterative curricular prototyping, their successes and failures depended on existing expertise in technological, pedagogical, and content knowledge. That knowledge needed to exist and synergize within a system that had the human and organizational capacity to prioritize and invest in strategies to respond to the rapidly evolving crisis in a proactive manner. Going forward, administrators and educators will need to advocate for continued investment in human and organizational capacity to support simulation-based efforts for the evolving clinical and educational landscape.
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Affiliation(s)
- Nur‐Ain Nadir
- Department of Emergency MedicineKaiser Permanente Central ValleyModestoCaliforniaUSA
| | - Jane Kim
- Department of Emergency MedicineSUNY DownstateBrooklynNew YorkUSA
| | - Michael Cassara
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellManhassetNew YorkUSA
| | - Michael Hrdy
- Department of Clinical PediatricsPerelman School of Medicine at University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Pavan Zaveri
- Department of Pediatric Emergency MedicineChildren’s National Medical CenterWashingtonDCUSA
| | - Ambrose H. Wong
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Jessica Ray
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | | | - Michael Falk
- Department of Pediatric Emergency MedicineChildren’s National Medical CenterWashingtonDCUSA
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16
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Campbell S, Corbett S, Burlacu CL. Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:575-580. [PMID: 35520963 PMCID: PMC8245283 DOI: 10.1136/bmjstel-2021-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/03/2022]
Abstract
Background With the introduction of strict public health measures due to the coronavirus pandemic, we have had to change how we deliver simulation training. In order to reinstate the College of Anaesthesiologists Simulation Training (CAST) programme safely, we have had to make significant logistical changes. We discuss the process of reopening a national simulation anaesthesiology programme during a pandemic. Methods We approached how to reinstate the programme with three distinct but intertwined projects, as in the following: (1) a survey of effects of the pandemic on training opportunities for anaesthesiology trainees, (2) proposals for methods of reinstating simulation were developed under the headings avoidance, compromise, accommodation and collaboration. A small online video-assisted simulation pilot was carried out to test the compromise method, (3) having opted for combined accommodation (onsite with smaller participant numbers and safety measures) and collaboration (with other regional centres), a postreinstatement evaluation during a 4-month period was carried out. Results (1) Eighty-five per cent of 64 trainees surveyed felt that they had missed out not only just on simulation-based education (43%) but also on other training opportunities, (2) when five trainees were asked to state on a 1 to 5 Likert scale (strongly disagree, disagree, undecided, agree and strongly agree) whether online video-assisted simulation was similar to face-to-face simulation in four categories (realism, immersion, sense of crisis and stress), only 9 (45%) of the 20 answers agreed they were similar, (3) When onsite simulation was reinstated, the majority of trainees felt that training was similar to prepandemic and were happy to continue with this format. Conclusion In order to reinstate simulation, we have identified that accommodation and collaboration best suited the CAST while compromise failed to rank high among trainees' preferences. Onsite courses will continue to be delivered safely while meeting the high standards our trainees have come to expect.
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Affiliation(s)
- Sinead Campbell
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Sarah Corbett
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesiology, Critical Care and Pain Medicine, St James's Hospital, Dublin, Ireland
| | - Crina L Burlacu
- CAST, College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
- Division Of Surgery and Surgical Specialties, Dublin, Ireland, University College Dublin—National University of Ireland, Dublin, Ireland
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17
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Brewster DJ, Nickson CP, McGloughlin S, Pilcher D, Sarode VV, Gatward JJ. Preparation for airway management in Australia and New Zealand ICUs during the COVID -19 pandemic. PLoS One 2021; 16:e0251523. [PMID: 33961677 PMCID: PMC8104394 DOI: 10.1371/journal.pone.0251523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/28/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This paper aimed to describe the airway practices of intensive care units (ICUs) in Australia and New Zealand specific to patients presenting with COVID-19 and to inform whether consistent clinical practice was achieved. Specific clinical airway guidelines were endorsed in March 2020 by the Australian and New Zealand Intensive Care Society (ANZICS) and College of Intensive Care Medicine (CICM). METHODS AND FINDINGS Prospective, structured questionnaire for all ICU directors in Australia and New Zealand was completed by 69 ICU directors after email invitation from ANZICS. The online questionnaire was accessible for three weeks during September 2020 and analysed by cloud-based software. Basic ICU demographics (private or public, metropolitan or rural) and location, purchasing, airway management practices, guideline uptake, checklist and cognitive aid use and staff training relevant to airway management during the COVID-19 pandemic were the main outcome measures. The 69 ICU directors reported significant simulation-based inter-professional airway training of staff (97%), and use of video laryngoscopy (94%), intubation checklists (94%), cognitive aids (83%) and PPE "spotters" (89%) during the airway management of patients with COVID-19. Tracheal intubation was almost always performed by a Specialist (97% of ICUs), who was more likely to be an intensivist than an anaesthetist (61% vs 36%). There was a more frequent adoption of specific airway guidelines for the management of COVID-19 patients in public ICUs (94% vs 71%) and reliance on specialist intensivists to perform intubations in private ICUs (92% vs 53%). CONCLUSION There was a high uptake of a standardised approach to airway management in COVID-19 patients in ICUs in Australia and New Zealand, likely due to endorsement of national guidelines.
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Affiliation(s)
- David J. Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher P. Nickson
- Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- Centre for Health Innovation, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Steve McGloughlin
- Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The Australian and New Zealand Intensive Care—Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Centre for Health Innovation, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Vineet V. Sarode
- Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan J. Gatward
- Intensive Care Unit, Royal North Shore, Sydney, NSW, Australia
- The University of Sydney Northern Clinical School, Sydney, NSW, Australia
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18
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Shelton C, Huda T, Lee A. The role of clinical simulation in preparing for a pandemic. BJA Educ 2021; 21:172-179. [PMID: 33520288 PMCID: PMC7836946 DOI: 10.1016/j.bjae.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- C. Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - T. Huda
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A. Lee
- Columbia University Irving Medical Center, New York, NY, USA
- Margaret Wood Center for Simulation and Education, New York, NY, USA
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19
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Nickson CP, Petrosoniak A, Barwick S, Brazil V. Translational simulation: from description to action. Adv Simul (Lond) 2021; 6:6. [PMID: 33663603 PMCID: PMC7930894 DOI: 10.1186/s41077-021-00160-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
This article describes an operational framework for implementing translational simulation in everyday practice. The framework, based on an input-process-output model, is developed from a critical review of the existing translational simulation literature and the collective experience of the authors' affiliated translational simulation services. The article describes how translational simulation may be used to explore work environments and/or people in them, improve quality through targeted interventions focused on clinical performance/patient outcomes, and be used to design and test planned infrastructure or interventions. Representative case vignettes are used to show how the framework can be applied to real world healthcare problems, including clinical space testing, process development, and culture. Finally, future directions for translational simulation are discussed. As such, the article provides a road map for practitioners who seek to address health service outcomes using translational simulation.
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Affiliation(s)
- Christopher Peter Nickson
- Intensive Care Unit and Centre for Health Innovation, Alfred Health, Melbourne, Australia.
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Andrew Petrosoniak
- St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Barwick
- Mater Education, South Brisbane, Queensland, Australia
- Bond University, Gold Coast, Australia
| | - Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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20
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Lateef F, Suppiah M, Chandra S, Yi TX, Darmawan W, Peckler B, Tucci V, Tirado A, Mendez L, Moreno L, Galwankar S. Simulation Centers and Simulation-Based Education during the Time of COVID 19: A Multi-Center Best Practice Position Paper by the World Academic Council of Emergency Medicine. J Emerg Trauma Shock 2021; 14:3-13. [PMID: 33911429 PMCID: PMC8054807 DOI: 10.4103/jets.jets_185_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022] Open
Abstract
COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their "new norm." These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.
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Affiliation(s)
- Fatimah Lateef
- Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Professor, Duke NUS Graduate Medical School, Yong Loo Lin School of Medicine, National, University of Singapore and Lee Kong Chian Medical School, Nanyang Technological University, Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Philadelphia, USA
| | - Madhavi Suppiah
- Assistant Director, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Philadelphia, USA
| | - Shruti Chandra
- Assistant Professor, Sidney Kimmel Medical College, Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Too Xin Yi
- Assistant Manager, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Wellington, New Zealand
| | - Willy Darmawan
- Senior Executive, SingHealth Duke NUS Institute of Medical Simulation (SIMS), Wellington, New Zealand
| | - Brad Peckler
- Emergency Medicine Specialist and Director of The Wellington Regional Simulation and Skills Center, Capital and Coast District Health Board, Wellington, New Zealand
| | - Veronica Tucci
- Research and Scholarly Activity Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA, Professor of Research and Emergency Medicine, Hattiesburg, MS USA
| | - Alfredo Tirado
- Program Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA
| | - Lorraine Mendez
- Simulation Director, Oak Hill Emergency Medicine Residency Program, Brooksville, FL USA
| | - Lisa Moreno
- President of AAEM, Florida State University Emergency Medicine Residency Program, Associate Professor Florida State University, Sarasota, FL USA
| | - Sagar Galwankar
- Research Director, Florida State University Emergency Medicine Residency Program, Associate Professor Florida State University, Sarasota, FL USA
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21
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Abstract
Simulation-based medical education is an experiential modality that has evolved over the last 60 years, amassing evidence as an efficacious tool for skill acquisition and care improvement. We review the underlying theory, core defining principles, and applications of medical simulation broadly and in pediatrics in hopes that it can be accessible to every pediatric clinician regardless of practice environment and resources. Any situation where there is risk of harm to a patient or clinician can be simulated for practice, reflection, and re-practice. Whether preparing for clinic-based emergencies, new hospital units, or new daily workflows, simulation is valuable to novice and master clinicians for individual and team care enhancement. [Pediatr Ann. 2021;50(1):e13-e18.].
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22
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Kong JY, Bharadwaj SS, Chinnadurai A, Ho SKY. Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation. Front Pediatr 2021; 9:785524. [PMID: 34926355 PMCID: PMC8674782 DOI: 10.3389/fped.2021.785524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Rapid spread of the COVID-19 pandemic raised an urgent need for preparedness in the healthcare sector, including training of healthcare workers to cope with the burden of infected cases while ensuring proper protection of themselves. Improper infection prevention and control measures were key reasons for infection in healthcare workers during the early phase of the outbreak. Objectives/Methods: This paper describes the combined approach of 3 restructured hospitals in Singapore in preparing and training neonatal healthcare workers' during the COVID-19 pandemic crisis, as well as lessons learnt during this process. Results: Information sharing was conducted in the form of e-learning, emphasizing on topics like disease knowledge and infection prevention and control procedures. Skills and competency training were carried out in the form of simulation, with sessions scaled into 4 levels progressing from individual task training to larger group simulations involving multiple disciplines and departments. Challenges encountered included information fatigue by large amount of constantly changing information and multiple amendments to workflows as more information arose. Difficulties conducting training and simulation sessions included restriction of group size to mitigate infection risk amongst participants and the limited supply of personal protective equipment prioritized for direct patient care. Conclusion: Healthcare institutions should ensure adequate dissemination of conceptual knowledge as well as skills competency training of staff in infection control measures for the protection of healthcare workers and patient safety. Ongoing training for sustainability of knowledge and skills, while adapting to the rapidly evolving situation is important in the preparation for future outbreaks.
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Affiliation(s)
- Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Srabani Samanta Bharadwaj
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Amutha Chinnadurai
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Selina Kah Ying Ho
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
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23
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Gormley GJ, Kajamaa A, Conn RL, O’Hare S. Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development? Adv Simul (Lond) 2020; 5:29. [PMID: 33106760 PMCID: PMC7582418 DOI: 10.1186/s41077-020-00148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The healthcare needs of our societies are continual changing and evolving. In order to meet these needs, healthcare provision has to be dynamic and reactive to provide the highest standards of safe care. Therefore, there is a continual need to generate new evidence and implement it within healthcare contexts. In recent times, in situ simulation has proven to have been an important educational modality to accelerate individuals' and teams' skills and adaptability to deliver care in local contexts. However, due to the increasing complexity of healthcare, including in community settings, an expanded theoretical informed view of in situ simulation is needed as a form of education that can drive organizational as well as individual learning. MAIN BODY Cultural-historical activity theory (CHAT) provides us with analytical tools to recognize and analyse complex health care systems. Making visible the key elements of an in situ simulation process and their interconnections, CHAT facilitates development of a system-level view of needs of change. CONCLUSION In this paper, we theorize how CHAT could help guide in situ simulation processes-to generate greater insights beyond the specific simulation context and bring about meaningful transformation of an organizational activity.
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Affiliation(s)
- Gerard J. Gormley
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Anu Kajamaa
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Richard L. Conn
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Sarah O’Hare
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
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24
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Jensen RD, Bie M, Gundsø AP, Schmid JM, Juelsgaard J, Gamborg ML, Mainz H, Rölfing JD. Preparing an orthopedic department for COVID-19. Acta Orthop 2020; 91:644-649. [PMID: 32907437 PMCID: PMC8023962 DOI: 10.1080/17453674.2020.1817305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The COVID-19 pandemic has disrupted healthcare services around the world. We (1) describe the organizational changes at a level 1 trauma center, (2) investigate how orthopedic healthcare professionals perceived the immense amount of information and educational activities, and (3) make recommendations on how an organization can prepare for disruptive situations such as the COVID-19 pandemic in the future. Methods - We conducted a retrospective survey on the organizational restructuring of the orthopedic department and the learning outcomes of a needs-driven educational program. The educational activities were evaluated by a non-validated, 7-item questionnaire. Results - The hospital established 5 COVID-19 clusters, which were planned to be activated in sequential order. The orthopedic ward comprised cluster 4, where orthopedic nursing staff were teamed up with internal medicine physicians, while the orthopedic team were redistributed to manage minor and major injuries in the emergency department (ED). The mean learning outcome of the educational activities was high-very high, i.e., 5.4 (SD 0.7; 7-point Likert scale). Consequently, the staff felt more confident to protect themselves and to treat COVID-19 patients. Interpretation - Using core clinical competencies of the staff, i.e., redistribution of the orthopedic team to the ED, while ED physicians could use their competencies treating COVID-19 patients, may be applicable in other centers. In-situ simulation is an efficient tool to enhance non-technical and technical skills and to facilitate organizational learning in regard to complying with unforeseen changes.
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Affiliation(s)
- Rune Dall Jensen
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Magnus Bie
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
| | | | | | - Joachim Juelsgaard
- Department of Respiratory Disease and Allergy, Aarhus University Hospital
| | - Maria Louise Gamborg
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Centre for Health Sciences Education, Aarhus University, Denmark
| | - Hanne Mainz
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | - Jan Duedal Rölfing
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
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25
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Dubé M, Kaba A, Cronin T, Barnes S, Fuselli T, Grant V. COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada. Adv Simul (Lond) 2020; 5:22. [PMID: 32821441 PMCID: PMC7432586 DOI: 10.1186/s41077-020-00138-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.
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Affiliation(s)
- Mirette Dubé
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Alyshah Kaba
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Theresa Cronin
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Sue Barnes
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Tara Fuselli
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
| | - Vincent Grant
- eSIM Provincial Simulation Program, Alberta Health Services, Alberta Health Services, 1403 29th Street NW, Calgary, Alberta T2N 2 T9 Canada
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- KidSIM Pediatric Simulation Program, Alberta Children’s Hospital, 28 Oki Dr NW, Calgary, Alberta T3B 6A8 Canada
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Lakissian Z, Sabouneh R, Zeineddine R, Fayad J, Banat R, Sharara-Chami R. In-situ simulations for COVID-19: a safety II approach towards resilient performance. Adv Simul (Lond) 2020; 5:15. [PMID: 32754345 PMCID: PMC7388429 DOI: 10.1186/s41077-020-00137-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND COVID-19 has taken the world by surprise; even the most sophisticated healthcare systems have been unable to cope with the volume of patients and lack of resources. Yet the gradual spread of the virus in Lebanon has allowed healthcare facilities critical time to prepare. Simulation is the most practical avenue not only for preparing the staff but also for troubleshooting system's latent safety threats (LSTs) and for understanding these challenges via Hollnagel's safety I-II approaches. METHODS This is a quality improvement initiative: daily in situ simulations were conducted across various departments at the American University of Beirut Medical Center (AUBMC), a tertiary medical care center in Beirut, Lebanon. These simulations took place in the hospital with native multidisciplinary teams of 3-5 members followed by debriefing with good judgment using the modified PEARLS (Promoting Excellence and Reflective Learning in Simulation) for systems integration. All participants completed the simulation effectiveness tool (SET-M) to assess the simulation. Debriefings were analyzed qualitatively for content based on the Safety Model and LST identification, and the SET-Ms were analyzed quantitatively. RESULTS Twenty-two simulations have been conducted with 131 participants. SET-M results showed that the majority (78-87%) strongly agreed to the effectiveness of the intervention. We were able to glean several clinical and human factor safety I-II components and LSTs such as overall lack of preparedness and awareness of donning/doffing of personal protective equipment (PPE), delayed response time, lack of experience in rapid sequence intubation, inability to timely and effectively assign roles, and lack of situational awareness. On the other hand, teams quickly recognized the patient's clinical status and often communicated effectively. CONCLUSION This intervention allowed us to detect previously unrecognized LSTs, prepare our personnel, and offer crucial practical hands-on experience for an unprecedented healthcare crisis.
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Affiliation(s)
- Zavi Lakissian
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Sabouneh
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut, 110 72020 Lebanon
| | - Rida Zeineddine
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Joe Fayad
- Department of Fine Arts, American University of Beirut, Beirut, Lebanon
| | - Rim Banat
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236 Riad El Solh, Beirut, 110 72020 Lebanon
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