COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought

Risk Perception and Preparedness of Undergraduate Dental Students to Treat Patients in View of COVID-19 Pandemic: A Questionnaire Survey

With the gradual resumption of dental services worldwide, it is crucial to focus on returning dental undergraduates to their clinical postings. The assessment of foreseeable concerns from a student's point of view will help the dental schools tailor a comprehensive plan of action that would be in the best interest of everyone. Aim. Hence, this survey was planned to assess dental undergraduates' risk perception and preparedness to provide patient care amidst the COVID-19 pandemic crisis. Material and Methods. It was an online survey carried out among students involved in clinical work at two dental colleges in Manipal and Mangalore, respectively, in Karnataka, India. The online questionnaire was sent to approximately 500 students, with responses from 301 students. The survey comprised 21 closed-ended questions about demographics, risk perception, and preparedness. The descriptive statistics were done on the data. Results. It was found that all the students (99.7%) perceived COVID-19 to be dangerous, and 73.4% chose to avoid treating those patients suspected to have an active COVID-19 infection. The fear of being infected was perceived by 55.1% of students, while 46.2% feared transmitting the infection to friends and family. A majority (87.7%) believed standard infection controls practiced prior to the pandemic were insufficient to work in the current scenario. Nearly 33.6% could not view the guidelines for dental procedures during the pandemic. A majority (87.7%) were not/little confident, and 61.7% were unsure/unprepared to manage suspected patients. Conclusion. It is the prime need of the hour for dental schools to instill self-reliance within students in managing patient care under these circumstances by strictly reinforcing the official protective care guidelines.

Simulated patient perceptions of telesimulation education

Perspectives of simulated participants (SPs) as stakeholders in simulation education are under-represented. With rapid increase in virtual education and anticipation of post-pandemic continuation it is important to establish best practices. This work aims to determine SP perceptions of telesimulation.

In-depth semi-structured interviews determined SP opinions of participation in telesimulation. Thematic analysis utilizing an inductive and semantic iterative coding process was performed. SPs completed a survey of their demographics, experience and prior SP training, both virtual and in-person.

Data sufficiency occurred after 16 interviews (10 females/6 males; 15 White/1 Black/African American). Median age was 56 years (range 37–72). Median number of in-person simulation experiences was 100 (range 6–300) and 27 telesimulations (range 3–100). Thematic analysis identified five themes: (1) students behave differently (distracted, less professional, less prepared for ‘real life’, less nervous), (2) my performance – some things are easier and some harder (increased cognitive load, coming out of role more, difficulties with non-verbal aspect, more standardized performance), (3) it’s harder to connect with learners (different cues, less of a personal connection), (4) safety for all in telesimulation (as psychologically safe as in-person, appreciate opportunity to continue to educate/work, personal safety), (5) future applications of telesimulation (telehealth training, better access to education for learners).

SP perceptions of telesimulation education revealed appreciation of the educational modality and identified potential benefit in telehealth education. SPs were concerned about learner participation, professionalism and resultant preparation for clinical practice. Incorporating SP feedback into telesimulation education may be important to ensure high quality.

Exploring Sustainable Fashion Consumption Behavior in the Post-Pandemic Era: Changes in the Antecedents of Second-Hand Clothing-Sharing in China

Second-hand consumption of clothing plays a vital role in promoting the overall global trend of low-carbon transition; however, the COVID-19 outbreak put this consumption model into a development dilemma. Cultivating consumers’ sustainable behavior will be an effective way to promote the sustainable development of the apparel industry. Based on the unified theory of acceptance and use of technology (UTAUT), this study starts with fashion-sharing behavior and investigates the antecedents that influence consumers’ use of second-hand clothing-sharing platforms in the post-pandemic era. The research background involves the Chinese clothing-sharing market in the growing period. The findings revealed that the pandemic raised people’s awareness of health and hygiene protection. In addition, the cleaning problem of platform clothing has become the primary reason for curbing consumers’ choice of sharing. High-cost performance, high efficiency, and convenience can stimulate consumers to use shared services. Considering that the pandemic has driven consumer economic fluctuations, perceived economic risks could widen the gap between willingness and behavior. In conclusion, platforms must fully realize the transparency of the clothing cleaning and maintenance process, improve their own construction level such as ease of use, convenience, and safety, and incorporate functional clothing-sharing to refine people’s sustainable consumption habits.

The Effect of Implementing COVID-19 Infection Control Precautions on Conducting Simulation-Based Training Activities

Introduction

Due to the coronavirus disease 2019 (COVID-19) pandemic, onsite simulation training required infection control precautions. This study aimed to investigate the effect of implementing the infection control protocol on the participants' evaluation of simulation activities.

Materials and methods

The study included undergraduate female students from healthcare colleges in Princess Nourah University (PNU) who have attended simulation training events in the simulation and skills development center (SSDC). The study design was a cohort retrospective where data were retrieved from the SSDC participant evaluation database. The data included information related to participants' characteristics, simulation activities type, and learners' evaluation. The simulation activities included in the study were procedural simulation (PS) and full simulation (FS).

Results

The study included 837 subjects that were randomly chosen from January 2019 to December 2021. All participant's evaluations of simulation events conducted in the SSDC during the specified period were reviewed and randomly selected to be included in the study. Due to the COVID-19 pandemic, the activities were conducted under infection control protocol measures. There was a significant difference in evaluation results of FS and PS activities before and after implementing the COVID-19 infection control protocol (p-value < 0.001).

Conclusion

The study showed that conducting simulation activities in a simulation center under the infection control protocol does not negatively affect participants' evaluation of simulation events.

Modeling Social Distancing and Quantifying Epidemic Disease Exposure in a Built Environment

As we transition away from pandemic-induced isolation and social distancing, there is a need to estimate the risk of exposure in built environments. We propose a novel metric to quantify social distancing and the potential risk of exposure to airborne diseases in an indoor setting, which scales with distance and the number of people present. The risk of exposure metric is designed to incorporate the dynamics of particle movement in an enclosed set of rooms for people at different immunity levels, susceptibility due to age, background infection rates, intrinsic individual risk factors (e.g., comorbidities), mask-wearing levels, the half-life of the virus and ventilation rate in the environment. The model parameters have been selected for COVID-19, although the modeling framework applies to other airborne diseases. The performance of the metric is tested using simulations of a real physical environment, combining models for walking, path length dynamics, and air-conditioning replacement action. We have also created a visualization tool to help identify high-risk areas in the built environment. The resulting software framework is being used to help with planning movement and scheduling in a clinical environment ahead of reopening of the facility, for deciding the maximum time within an environment that is safe for a given number of people, for air replacement settings on air-conditioning and heating systems, and for mask-wearing policies. The framework can also be used for identifying locations where foot traffic might create high-risk zones and for planning timetabled transitions of groups of people between activities in different spaces. Moreover, when coupled with individual-level location tracking (via radio-frequency tagging, for example), the exposure risk metric can be used in real-time to estimate the risk of exposure to the coronavirus or other airborne illnesses, and intervene through air-conditioning action modification, changes in timetabling of group activities, mask-wearing policies, or restricting the number of individuals entering a given room/space. All software are provided online under an open-source license.

158 The Introduction of Virtual Simulation into a Pre-Registration Nursing Course During the COVID-19 Pandemic

The COVID-19 Pandemic changed the way teaching and learning could be delivered at Sheffield Hallam University; the use of virtual simulation was explored to enhance the student experience and prepare students for placement.

The aim of the study was to evaluate the application of virtual simulation for pre-registration nursing students.

Oxford Medical Simulation (OMS) is an immersive, interactive, virtual healthcare simulation platform that allows participants to engage in a wide range of clinical scenarios. The environment, patient and other team members are fully interactive, with conversation and physiology adapting to students’ actions and treatment. The educational focus is on decision-making, clinical reasoning and critical thinking to improve patient care.

A programme was developed to allow students to take part in lecturer-led sessions where OMS was used to practise the assessment and management of an unwell patient. Virtual scenarios lasting 15–20 minutes were managed by the lecturer, with students offering their contributions to determine the steps they wanted to take to manage the patient. Screen sharing of the virtual simulation via Zoom allowed students to take part in the scenarios from home. Learning outcomes predominantly focussed on A to E assessment, encouraging students who had never encountered a ‘real’ patient before in a clinical setting to begin to develop a structured approach. Evaluation of introduction of OMS to Nursing Course. This evaluation describes the benefits realized between the launch of OMS in November 2020 and 1 January 2021. The data presented include qualitative and quantitative data collated and analysed from student online survey responses. Data from 188 purposively sampled student participants were collated and analysed. The qualitative data demonstrated improvements in the student experience, under the following themes: (a) preparing students for placement, helping to apply knowledge to practice and improve decision-making; (b) developing confidence, providing a safe learning space – able to make mistakes without patients coming to harm. Students were also asked to rate their level of satisfaction on a 5-point scale (where 5 was most satisfied). The median rating for the 55.9% (n = 105) student responses was 5.0 with no statistical difference between identifiable fields of nursing (

PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial

INTRODUCTION

Paediatric cardiac arrest (PCA), despite its low incidence, has a high mortality. Its management is complex and deviations from guideline recommendations occur frequently. We developed a new interactive tablet app, named PediAppRREST, to support the management of PCA. The app received a good usability evaluation in a previous pilot trial. The aim of the study is to evaluate the effectiveness of the PediAppRREST app in reducing deviations from guideline recommendations in PCA management.

METHODS AND ANALYSIS

This is a multicentre, simulation-based, randomised controlled, three-parallel-arm study. Participants are residents in Paediatric, Emergency Medicine, and Anaesthesiology programmes in Italy. All 105 teams (315 participants) manage the same scenario of in-hospital PCA. Teams are randomised by the study statistician into one of three study arms for the management of the PCA scenario: (1) an intervention group using the PediAppRREST app or (2) a control group Paediatric Advanced Life Support (CtrlPALS+) using the PALS pocket reference card; or (3) a control group (CtrlPALS-) not allowed to use any PALS-related cognitive aid. The primary outcome of the study is the number of deviations (delays and errors) in PCA management from PALS guideline recommendations, according to a novel checklist, named c-DEV15plus. The c-DEV15plus scores will be compared between groups with a one-way analysis of variance model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance.

ETHICS AND DISSEMINATION

The Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the project to be a negligible risk study and approved it through an expedited review process. The results of the study will be disseminated in peer-reviewed journals, and at national and international scientific conferences. Based on the study results, the PediAppRREST app will be further refined and will be available for download by institutions/healthcare professionals.

TRIAL REGISTRATION NUMBER

NCT04619498; Pre-results.

Most significant barriers and proposed solutions for medical schools to facilitate simulation-based undergraduate curriculum in OBGYN

Despite having a good understanding of medicine, doctors lack clinical skills, problem-solving abilities, and the ability to apply knowledge to patient care, particularly in unanticipated circumstances. To overcome this, medical education has evolved into a system-oriented core curriculum with cognitive, psychomotor, and affective learning goals. With an emphasis on problem-based learning, the educator's aim is to establish a long-term, predetermined improvement in the learner's behavior, acquired skills, and attitudes (Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167-172. https://doi.org/10.1016/S0377-1237(12)60040-9 ). However, teaching these disciplines to real patients is almost impossible; this is where simulation comes in. This opinion paper will discuss the relevance and necessity of a simulation-based undergraduate curriculum in obstetrics and gynecology. What are the biggest obstacles that medical schools face in making the most of simulation-based learning, and how can they be overcome?

Simulation-based emergency medicine education in the era of physical distancing

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.

Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic

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.

Examining K-12 teachers' feelings, experiences, and perspectives regarding online teaching during the early stage of the COVID-19 pandemic

This mixed-methods study explored K-12 teachers' feelings, experiences, and perspectives regarding online teaching during the COVID-19 pandemic. The study also examined teachers' perspectives of the "new normal" after COVID-19 and of what should be done to better prepare teachers for future emergencies. Both quantitative and qualitative data were collected from an online survey and follow-up interviews. A total of 107 teachers from 25 different states in the United States completed the online survey, and 13 teachers from 10 different states participated in the follow-up interviews. The results revealed teachers' feelings about online teaching and various strategies and tools they used during the early stage of the COVID-19 pandemic. The major challenges faced by teachers during the pandemic included lack of student participation and engagement (or lack of parental support), students without access to technology, concerns about students' well-being, no face-to-face interactions with students, no work-life balance, and learning new technology. Four major themes emerged regarding how to better prepare teachers for future emergencies: (1) professional development for online learning, (2) technology access, (3) technology training for both teachers and students, and (4) action plans and communication. Regarding teachers' perspectives of the "new normal," five major themes emerged: (1) more online or blended learning, (2) rethinking normal, (3) hygiene and social distancing, (4) smaller classes and different school schedules, and (5) uncertainty and concerns about the "new normal."

Translational simulation: from description to action

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.

Role of health simulation centres in the COVID-19 pandemic response in Italy: a national study

Introduction

The COVID-19 pandemic has dramatically affected the Italian health systems and drastically impacted healthcare workers’ daily routine and training. Simulation is an efficient tool to provide medical education, especially in the case of incoming public health emergencies. This study investigated the role and activities of Italian simulation centres (SCs) during the acute phase of the COVID-19 pandemic.

Methods

The population was identified through a web search. The directors of Italian SCs were contacted via email and then enrolled. A structured interview was created, internally validated and administrated by phone to participants.

Results

Following the government’s ordinance, 37 (88.37%) SCs had to be closed to the public. Twenty (46.51%) SCs organised in situ simulation while 7 (16.28%) of them organised simulation inside the centre. Twenty-three (53.49%) SCs resorted to telematic modalities to provide training about COVID-19 and 21 (48.84%) of them for other training. Up to date, 13 SCs are still closed to the public.

Conclusions

Italy has been severely hit by COVID-19, with differences between the regions. Almost all the SCs were closed, with only a few delivering training. The SCs took advantage of emergent technologies to create new ways to train people safely. Unfortunately, nearly one-fourth of Italian SCs have not reopened yet. The evolution of the COVID-19 epidemic calls for reconsideration about training activities including adequate safety measures implemented for all individuals involved.

Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation

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.