Development and Evaluation of the Advanced Joint Airway Management System for Educational Utility in Endotracheal Intubation, as Assessed by Expert Paramedic Instructors

INTRODUCTION

Between 2011 and 2014, The Combat Casualty Training Consortium research study sought to evaluate all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among U.S. combat fatalities. This study identified a major training gap in critical airway management. To address this gap, the Advanced Joint Airway Management System (AJAMS) was designed and assessed for physical fidelity and educational utility in a population of paramedic instructors.

MATERIALS AND METHODS

Paramedic instructors served as participants in this prospective observational pilot study (n = 12). Participants interacted with three airway management trainers: The AJAMS trainer, the Laerdal Airway Management Trainer, and the TruCorp AirSim Advance Bronchi X Trainer. Participants then completed an evaluation of the trainer using a purpose-built data collection instrument that queried the trainer's realism and educational utility. Within-group differences were analyzed via a 1-way repeated measures ANOVA, with a Bonferroni post hoc analysis. Rank data were analyzed via non-parametric Freidman's test, and Wilcoxon signed-rank test post hoc analysis, corrected using the Bonferroni correction.

RESULTS

The AJAMS trainer conveys significantly more physical fidelity (visual: P < .001, ηp2 = 0.977; tactile: P < .001, ηp2 = 0.983; and behavioral: P = .001, ηp2 = 0.971) and overall educational utility (χ2(2) = 15.273, P < .001) than the two commercially available skill trainers.

CONCLUSIONS

These data suggest that physical fidelity is an important attribute in the design of simulators for health care, as perceived by expert instructors. These data illustrate that the AJAMS-integrated simulator demonstrates unparalleled physical fidelity, relative to commercially available airway management skill trainers.

Distance Education in Anesthesia Using Screen-Based Simulation - A Brief Integrative Review

Screen-based simulation (SBS) using digital technology has been demonstrated to improve the cognitive and psychomotor skills of anesthesia trainees. As a method of education and evaluation, this form of simulation offers multiple advantages related to cost, availability, simplicity, repeatability, and scorability. Online use of SBS with software employing standard cloud-based peer-to-peer platforms allows for instruction at a distance of important anesthesia-related critical thinking skills including crisis management. Despite the fact that there are no studies concerning the application of SBS in anesthesia distance education, this form of instruction has increased as a result of quarantine measures associated with the coronavirus-2 pandemic that have disrupted traditional in-person mannequin-based simulation, and its usage likely will continue through the post-pandemic era for multiple reasons. Several options exist for asynchronous and synchronous teaching of anesthesia skills at a distance with SBS, and there are useful techniques that can assist in achieving these educational goals with this process.

Crew Resource Management Training Research, Practice, and Lessons Learned

Crew resource management (CRM) training was introduced to the aviation community in 1979. Since then it has evolved and matured and is now being applied in a number of domains, including health care and offshore oil production. There is abundant literature resulting from research in the area, but there is no recent comprehensive review of the origins, current state, and future direction of CRM. The purpose of this chapter is to perform that review and provide the reader with an understanding of the research, practice, and training associated with CRM. We also provide a number of lessons learned based on the literature and our observations, as well as future needs of the community.

A Critical Analysis of Computer Simulations for Conducting Team Research

This article discusses issues involved with the computer simulation of experimental tasks and settings used in team research with human participants. First, the purpose and components of simulation methodology are discussed along with the notion of simulation validity. Second, the common “external validity” criticism often leveled at experiments is considered, with particular attention given to the fidelity and realism questions researchers face when choosing or developing simulated team-performance environments. Third, the advantages and disadvantages of the current state of computerized team simulations are examined. The article concludes with considerations for future team research using computer simulation methodology.

Simulation Training in Health Care

In this chapter, we discuss the application of human factors and ergonomics to developing effective simulation training in health care. Simulation provides a safe, effective method for training and assessing human performance. In aviation, simulation-based training and assessment has been widely used, significantly improving safety. This progress would have been impossible without the involvement of human factors and ergonomics. Although aviation and health care have similarities, there also are differences that complicate the widespread implementation of simulation in health care.

Better retention of skill operating a simulated hydraulic excavator after part-task than after whole-task training

OBJECTIVE

We examined whether part-task training produces better learning and retention than whole-task training of a trench-and-load task performed on a hydraulic excavator simulator.

BACKGROUND

For complex perceptual-motor tasks that involve several components and require spatial awareness of the environment, part-task training will be effective if the benefit of being able to focus attention on each component outweighs the cost of integrating the components. We predicted that such would be the case for learning to operate an excavator.

METHOD

A part-task training group practiced separate Carrier Positioning, Trenching, and Truck Loading modules, whereas a whole-task training group practiced the Trench and Load module, which combines elements from the other modules. The latter module, involving different scenarios, was performed by both groups immediately after training and following a 2-week retention interval.

RESULTS

Production rate on the trench-and-load task was better overall on the retention test than on the immediate test. The part-task group showed improvement on the retention test compared with the immediate test, whereas the whole-task group did not. The part-task group showed higher productivity rates than did the whole-task group on the retention test.

CONCLUSION

Part-task training on the excavator simulator results in better skill retention than does whole-task training. The benefit of part-task training is likely to be found for other tasks requiring control of implements in various environments.

APPLICATION

Part-task training can result in better retention of complex perceptual-motor skills involving several components, even when immediate transfer to the whole task does not show better performance than whole-task training.

Deepening the theoretical foundations of patient simulation as social practice

Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffman's concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.

Developing expert medical teams: toward an evidence-based approach

Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research.

Effects of Training Modality on Military Vehicle Identification in a Virtual Environment

Using the Deployable Virtual Training Environment (DVTE) simulation suite, we investigated the effects of two different training types (military issued cards and 1:35 scale models) on participant's abilities to correctly identify military vehicles. Using independent samples t-tests, it was found that neither the cards nor scale models of the same vehicles had an effect on identification scores when the participants were tested in the DVTE environment. We then compared this current study to a previous study that tested the two training modalities using the same media instead of a virtual environment. We found results for recognition demonstrating that either training was sufficient for predicting performance in the virtual environment. Performance for identifying the vehicles was significant only when the training and testing modality were the same.

Using Simulation-Based Training to Improve Patient Safety: What Does It Take?

BACKGROUND

Through simulations health care workers can learn by practicing skills taught and experiencing mistakes before interacting with an actual patient. A number of areas within the health care industry are currently using simulation-based training to help individuals and teams improve patient safety. WHAT IS SIMULATION-BASED TRAINING? The key components of simulation-based training are as follows: performance history/skill inventory, tasks/competencies, training objectives, events/exercises, measures/metrics, performance diagnosis, and feedback and debrief. WHAT DOES IT TAKE FOR SIMULATION-BASED TRAINING TO BE EFFECTIVE? To be effective, simulation-based training must be implemented appropriately. The guidelines are as follows: understand the training needs and requirements; instructional features, such as performance measurement and feedback, must be embedded within the simulation; craft scenarios based on guidance from the learning outcomes; create opportunities for assessing and diagnosing individual and/or team performance within the simulation; guide the learning; focus on cognitive/psychological simulation fidelity; form a mutual partnership between subject matter experts and learning experts; and ensure that the training program worked.

CONCLUSION

The health care community can gain significantly from using simulation-based training to reduce errors and improve patient safety when it is designed and delivered appropriately.

A comparison of the training value of two types of anesthesia simulators: computer screen-based and mannequin-based simulators

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study.

IMPLICATIONS

We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology.

It is not how much you have but how you use it: toward a rational use of simulation to support aviation training

One of the most remarkable changes in aviation training over the past few decades is the use of simulation. The capabilities now offered by simulation have created unlimited opportunities for aviation training. In fact, aviation training is now more realistic, safe, cost-effective, and flexible than ever before. However, we believe that a number of misconceptions--or invalid assumptions--exist in the simulation community that prevent us from fully exploiting and utilizing recent scientific advances in a number of related fields in order to further enhance aviation training. These assumptions relate to the overreliance on high-fidelity simulation and to the misuse of simulation to enhance learning of complex skills. The purpose of this article is to discuss these assumptions in the hope of initiating a dialogue between behavioral scientists and engineers.

The science of training: a decade of progress

This chapter reviews the training research literature reported over the past decade. We describe the progress in five areas of research including training theory, training needs analysis, antecedent training conditions, training methods and strategies, and posttraining conditions. Our review suggests that advancements have been made that help us understand better the design and delivery of training in organizations, with respect to theory development as well as the quality and quantity of empirical research. We have new tools for analyzing requisite knowledge and skills, and for evaluating training. We know more about factors that influence training effectiveness and transfer of training. Finally, we challenge researchers to find better ways to translate the results of training research into practice.

Team training in the skies: does crew resource management (CRM) training work?

The aviation community has invested great amounts of money and effort into crew resource management (CRM) training. Using D. L. Kirkpatrick's (1976) framework for evaluating training, we reviewed 58 published accounts of CRM training to determine its effectiveness within aviation. Results indicated that CRM training generally produced positive reactions, enhanced learning, and promoted desired behavioral changes. However, we cannot ascertain whether CRM has an effect on an organization's bottom line (i.e., safety). We discuss the state of the literature with regard to evaluation of CRM training programs and, as a result, call for the need to conduct systematic, multilevel evaluation efforts that will show the true effectiveness of CRM training. As many evaluations do not collect data across levels (as suggested by D. L. Kirkpatrick, 1976, and by G. M. Alliger, S. I. Tannenbaum, W. Bennett, Jr., & H. Traver, 1997), the impact of CRM cannot be truly determined; thus more and better evaluations are needed and should be demanded.

The design and delivery of crew resource management training: exploiting available resources

Despite widespread acceptance throughout commercial and military settings, crew resource management (CRM) training programs have not escaped doubts about their effectiveness. The current state of CRM training is an example of how an entire body of pertinent research and development has not had the impact on practice that it could. In this paper we outline additional resources (i.e., principles, information, findings, and guidelines) from the team training and training effectiveness research literatures that can be used to improve the design and delivery of CRM training. Some of the resources discussed include knowledge about training effectiveness, training teamwork-related skills, scenario design, and performance measurement. We conclude with a discussion of emerging resources as well as those that need to be developed. The purpose of this paper is to provide the CRM training developer with better access to resources that can be applied to the design and delivery of CRM training programs.