Effects of high-fidelity simulation education on medical students' anxiety and confidence

A mixed methods study examining a socioemotional skills training program based on active learning methodologies in undergraduate nursing students

BACKGROUND

The development of socioemotional skills in the education of nursing students is crucial for improving the quality of care, patient safety, and job satisfaction. However, it is often observed that educational programs do not include sufficient training in these skills, which motivates the implementation of specific programs.

AIM

To evaluate the effectiveness of a socioemotional skills training program for nursing students.

DESIGN

A convergent mixed method design.

SETTINGS AND PARTICIPANTS

The study was conducted in a public nursing school the University of Cantabria. In total, 116 s-year students participated in the quantitative part of the study, of which 44 also participated in the qualitative study.

INTERVENTION

The students attended a 21-h training program in socio-emotional skills through active learning methodologies, such as flipped classroom, reflective dialogue, and simulation.

METHODS

The study consisted of two parts. First, a single-group quasi-experimental design with pretest and posttest was used. The students completed the Communication Skills Questionnaire (HABICOM). The second part consisted of a descriptive-exploratory qualitative study, in which the participants were distributed into six focus groups for in-depth analysis of their experiences and perceptions.

RESULTS

The quantitative analysis indicated significant improvements in socioemotional skills post-training, particularly in non-verbal communication and information transmission. Notable improvements were observed among younger female students and those with less prior experience in socioemotional training. The qualitative findings highlighted that students valued the realism and dynamic nature of the training, CONCLUSIONS: The training program effectively enhanced socioemotional skills, with significant gains noted in several key areas. The active learning strategies were particularly beneficial. Recommendations include extending program duration, incorporating more real-life cases, and increasing simulation opportunities. These insights are crucial for refining nursing education to better prepare students for the complexities of professional practice.

What can simulation educators learn from the reluctant participant? An exploration of the factors influencing engagement amongst adult learners participating in paediatric simulation training

BACKGROUND

Simulation educators are typically passionate advocates for simulation as a training modality; however, we frequently encounter participants who do not share our enthusiasm. The voice of the highly engaged participant is well publicised; however, the experience of those who do not readily engage in simulation has not been extensively studied and may offer valuable insights for educators. This qualitative study will explore factors which influence learner engagement in paediatric simulation training, informing the practice and approach of simulation educators to optimise learning experiences.

METHODS

We conducted a reflexive thematic analysis of 12 semi-structured interviews with medical and nursing professionals from a large paediatric teaching hospital in New Zealand who self-identified as reluctant participants in simulation-based education. Interviews explored factors which have influenced their engagement in simulation-based education over the course of their careers.

RESULTS

Three overarching themes were developed which describe the factors influencing adult-learner engagement in simulation-based education. The first, participant anxiety, explores the participants' narratives related to anxiety before, during and even following simulation which can impact on their ability to engage in current and subsequent simulation-based education. The second, protective behaviours, relates to the defensive mechanisms employed by participants in response to vulnerability experienced during simulation activities. The third theme, perception of the facilitator, examines the impact of simulation facilitator characteristics and behaviours on learner engagement.

CONCLUSIONS

These narratives highlighted that regular simulation activities with transparent learning objectives in which facilitators demonstrate vulnerability and adopt a co-learner attitude act to reduce participant anxiety. Emergent defensive behaviours, particularly "group shielding", interfere with collective learner engagement and should be both recognised and addressed by facilitators. Finally, there are potential discrepancies in the perceptions of facilitators and learners regarding what constitutes psychologically safe education environments. A collaborative and iterative approach to simulation-based education design may act to improve psychological safety for reluctant participants.

Evaluation of a simulation-based ophthalmology education workshop for medical students: a pilot project

BACKGROUND/AIMS

Ophthalmology is an under-represented specialty in many medical school curriculums resulting in reduced confidence in medical students and clinicians when dealing with eye conditions. Our study evaluates the impact of a simulation-based education (SBE) workshop to train medical students in ophthalmology.

METHODS

Second-year medical students were invited to participate in a two-day (eight-hour) simulation-based ophthalmology workshop. Standardised patients, free-to-use simulators, and low-cost eye models were used to teach eye anatomy, physiology, pathologies, skills (slit-lamp, ophthalmoscopy etc.), and eye procedures (cataract surgery, eye lasers etc.). Learners filled questionnaires to evaluate their ophthalmology interest, confidence, and knowledge before the workshop, immediately after the workshop, and three months later. They also answered a feedback survey on the workshop's quality and usefulness immediately after the workshop.

RESULTS

Nine students, including six females and three males, participated in the workshop. Pre-workshop, learners' mean self-reported confidence in dealing with ophthalmology patients was 1.8/5 and mean self-reported interest in pursuing an ophthalmology residency was 2.6/5 on a Likert-scale-based questionnaire (on a scale of 1-5). Learners scored a mean of 8.4/15 on an ophthalmology knowledge questionnaire with fifteen questions. Post-workshop (immediate), their mean self-reported confidence was 3.4/5 (p = 0.0001), interest in pursuing an ophthalmology residency was 3.2/5 (p = 0.022), and score on the ophthalmology questionnaire was 13/15 (p = 0.0001). Three months later, students' self-reported mean confidence was 3.2/5 (p = 0.0001), the likelihood of choosing ophthalmology residency was 2.8/5 (p = 0.59), and score on the ophthalmology knowledge questionnaire was 11/15 (p = 0.006). The feedback survey showed that all students found the workshop relevant, comprehensive, easy to understand, and that they gained knowledge/skills applicable to their future clinical practice.

CONCLUSIONS

A small group SBE ophthalmology workshop improves learners' knowledge, skills, and confidence using an approach they find interesting, with low cost and time investment.

TRIAL REGISTRATION

Not applicable.

"No pain, no gain": Simulation-based learning in teacher education: The mediating role of simulation hindrances

Research on educational simulations has attempted to decipher the simulation-based learning (SBL) process by examining factors that facilitate and impede this process. In the current study, we examined the role of SBL participants' hindrances, in particular their experience of anxiety or fear, which we view using the framework of leaving one's comfort zone. Departure from one's comfort zone has never been studied in the context of SBL in teacher education. A quantitative analysis of data collected via a questionnaire on Simulation Learning Outcomes in Teacher Education (SLOTE) revealed a model in which the hindrance variable potentially mediated all of the relationships between the background variables and the simulation learning outcomes (i.e., communication skills and collaborative learning insights). These results improve the theoretical understanding of the SBL process in this field and indicate ways to optimally utilize potential hindrances to plan and apply SBL for the purpose of learning.

Nursing Students' Experiences of Medical Simulation: A Mixed-Method Study

Introduction

Nursing students need to be prepared for the realities of acute situations or crises. Medical simulation training is a well-known pedagogical method for teaching acute care and teamwork. Despite that, there is a lack of knowledge about students' experiences with the training. Such knowledge could contribute to the development of the training program.

Objective

To describe nursing students' experiences of medical simulation.

Design

Mixed-method.

Method

A total of 175 nursing students in semesters three and five answered a questionnaire with quantitative questions and open-ended comments. The qualitative data from the open-ended questions were analyzed inductively using thematic analysis. Quantitative data from the closed-ended questions were analyzed using descriptive statistics. Finally, a mixed-method synthesis was conducted, in which the findings from the qualitative analysis guided the synthesis, while the quantitative data supported the themes and sub-themes that emerged from the qualitative analysis.

Result

An overall theme in the results emerged, which was: "Students need and want more simulation in their curriculum." This theme was then divided into five sub-themes: "Well-structured model," "Being prepared by practical training," "Enhanced knowledge," "Reflection gives self-awareness," and "Feelings of fun and positive nervousness."

Conclusions

The result highlights medical simulation as a reliable pedagogic method because it was a well-structured model which made them prepared, gave them enhanced knowledge, and helped their self-reflection. Students recognize the need for additional medical simulation training and express a desire for both longer sessions and more opportunities. They believe that simulation training is beneficial for their future roles as nurses because it enhances their competence in acute care and improves their teamwork skills. Bloom's taxonomy is a valuable framework for designing and developing curricula, particularly when medical simulation plays a key role in achieving all levels of high cognitive skills.

Insights into enhanced learning through virtual reality

INTRODUCTION

This study investigates the impact of Immersive Virtual Reality (VR) on learning outcomes in radiography training using Virtual Medical Coaching's X-Ray Pro VR software. VR offers immersive experiential learning that may enhance academic performance and professional preparedness.

METHODS

The study involved 130 students from two consecutive cohorts: one using traditional training methods and the other using VR software. We employed a mixed-methods approach, integrating quantitative measures of academic performance and clinical competency with qualitative insights into student engagement, enjoyment, and stress levels. The VR group used Virtual Medical Coaching simulation software, while the traditional group used physical simulation machines (Siemens Healthineers) to practice positioning anthropomorphic manikins, adjusting exposure settings, and handling X-ray equipment. Data were collected at four points: immediately post-training and at 1 month, 3 months, and 8 months follow-up.

RESULTS

The VR cohort showed significantly higher knowledge retention, work readiness, and lower stress levels compared to the traditional cohort. Among the participants trained in VR, a vast majority (59 out of 65) reported a high level of satisfaction with the immersive nature of the training, emphasizing its realism and direct applicability to clinical scenarios. Quantitative analysis revealed superior performance metrics for the VR group across all measured time points (p < 0.001). Qualitative feedback highlighted enhanced engagement and enjoyment among VR-trained students.

CONCLUSION

The results of this study clearly indicate that VR training significantly enhances learning outcomes in radiography education. The VR cohort exhibited higher knowledge retention, work readiness, student engagement, and enjoyment, along with lower stress levels and higher confidence compared to the traditional cohort. These findings support the integration of VR into professional training curricula to improve student performance and engagement.

Impact of COVID-19 on Confidence and Anxiety in Medical Students Related to Procedural Skills

BACKGROUND

During the COVID-19 pandemic, opportunities for hands-on surgical and procedural skills training and practice were significantly reduced, as many curricular activities were deferred or converted to a virtual format. This study focused on whether these changes contributed to increased anxiety and decreased confidence for medical students performing these skills.

METHODS

The Surgical Skills Technology Elective Program (SSTEP) is an annual five-day intensive procedural skills program after second-year medical school. Surveys assessing anxiety and confidence with respect to procedural skills were distributed and completed before and after SSTEP in 2016 and 2022.

RESULTS

Pre-SSTEP scores were higher for anxiety and lower for confidence in the 2022 cohort compared to the prepandemic group. Post-SSTEP scores for anxiety and confidence were comparable between cohorts.

CONCLUSIONS

Curricular changes and restrictions during the pandemic likely played a major role in the 2022 cohort having more anxiety and less confidence in their skills than prepandemic cohorts. However, these changes were effectively mitigated after participation in SSTEP. Medical schools should consider using and expanding on in-person bootcamps to support those with decreased exposure to surgical and procedural skills related to resource constraints and/or curricular changes.

Perception, confidence, and willingness to respond to in-flight medical emergencies among medical students: a cross sectional study

BACKGROUND

In-flight medical emergencies (IMEs) are expected to increase as air travel normalized in the post-COVID-19 era. However, few studies have examined health professions students' preparedness to respond to such emergencies. Therefore, this study aimed to investigate medical students' knowledge, confidence, and willingness to assist during an IME in their internship program.

METHODS

This cross-sectional survey utilized an online, self-administered questionnaire-based survey targeted at medical students at two medical colleges in Saudi Arabia. The questionnaire comprised three parts: sociodemographic characteristics, knowledge about aviation medicine (10 items), and confidence (7 items)/willingness (4 items) to assist during an IME. Odds Ratios (OR) and 95% Confidence Intervals (95%CI) were computed to detect potential associations between the knowledge levels and the other independent variables. Responses to confidence and willingness questions were scored on a 5-point Likert scale.

RESULTS

Overall, 61.4% of participants had inadequate knowledge scores for providing care during an IME, and the proportion of participants did not differ between those who had or had not attended life support courses (60.4% vs. 66.7%, p > 0.99). Only frequency of air travel ≥ two times per year was associated with higher odds of adequate knowledge score [OR = 1.89 (95%CI 1.14-3.17), p = 0.02]. In addition, 93.3% of the participants had low, 6.3% had moderate, and 0.8% had high willingness scores, while 86.3% had low, 12.2% had moderate, and 1.5% had high confidence scores. There were no differences in the proportion of participants with low, moderate, and high willingness or confidence scores by attendance in life support courses.

CONCLUSION

Even though over 8 in 10 students in our study had previously attended life support courses, the overwhelming majority lacked the knowledge, confidence, and willingness to assist. Our study underscores the importance of teaching medical students about IMEs and their unique challenges before entering their 7th-year mandatory general internship.

Impact of short-term patient education intervention on the teaching skills of physical therapy students: a randomized controlled trial

BACKGROUND

Patient education is an important aspect of physiotherapy. Effective education is based on quality communication and understanding of patients' needs. For a successful practice, it is necessary to recognize the factors that affect the ability to teach the patient and prepare new physiotherapists for this task. The research aims to determine the effect of training on the self-efficacy and skills of physiotherapy students in patient education.

METHODS

Final-year physiotherapy students were randomized into an intervention group (52 students) and a control group (51 students). The intervention group participated in 2.5 hours of lectures, discussions, simulated exercises with colleagues, and video examples of patient education. Students in the control group received standardized instruction without the additional intervention provided to the experimental group. All students performed a self-assessment of their teaching abilities. Patient education was assessed by a blinded evaluator using the Objective Structured Clinical Examination from an audio-recorded simulated clinical practice task.

RESULTS

The results show no differences in demographic variables, while a significant improvement was achieved for the intervention group after the training. The intervention group before the experiment did not perform differently than the control group on self-efficacy items (p>.05), but they did perform significantly better than the control group after the experiment (p<.001). The intervention group showed better results than the control group in almost all observed fields.

CONCLUSION

Short-term educational intervention significantly enhances physiotherapy students' self-efficacy and patient education skills, emphasizing the value of structured educational interventions.

The impact of surgical simulation and training technologies on general surgery education

The landscape of general surgery education has undergone a significant transformation over the past few years, driven in large part by the advent of surgical simulation and training technologies. These innovative tools have revolutionized the way surgeons are trained, allowing for a more immersive, interactive, and effective learning experience. In this review, we will explore the impact of surgical simulation and training technologies on general surgery education, highlighting their benefits, challenges, and future directions. Enhancing the technical proficiency of surgical residents is one of the main benefits of surgical simulation and training technologies. By providing a realistic and controlled environment, With the use of simulations, residents may hone their surgical skills without compromising patient safety. Research has consistently demonstrated that training with simulations enhances surgical skills., reduces errors, and enhances overall performance. Furthermore, simulators can be programmed to mimic a wide range of surgical scenarios, enabling residents to cultivate the essential critical thinking and decision-making abilities required to manage intricate surgical cases. Another area of development is incorporating simulation-based training into the wider surgical curriculum. As simulation technologies become more widespread, they will need to be incorporated into the fabric of surgical education, rather than simply serving as an adjunct to traditional training methods. This will require a fundamental shift in the way surgical education is delivered, with a greater emphasis on simulation-based training and assessment.

Pedagogical strategies to improve emotional competencies in nursing students: A systematic review

OBJECTIVES

To reveal the effectiveness of didactic architectures and pedagogical strategies to be implemented in nursing curricula to develop and improve Emotional Competencies (EC) in undergraduate nursing students.

DESIGN

Systematic review of effectiveness conducted according to Joanna Briggs Institute (JBI) guidelines. We followed the PRISMA statement to guarantee the transparency of the review and the GRADE to report the strength of evidence.

DATA SOURCES

Seven databases were searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Grey literature was also searched through the OpenGrey database.

REVIEW METHODS

Studies focusing on educational programmes and/or activities to develop EC in nursing curricula, published in English or Italian were included. Quality assessment of the studies was evaluated using JBI critical evaluation tools and the Mixed Methods Appraisal Tool (MAAT). Following JBI guidelines, a narrative synthesis was performed.

RESULTS

A total of 19 studies from 8 countries were included. The population varied from first to fourth-year students in relation to the duration of the undergraduate nursing program across the various countries. Most of the students were females. The age of the participants ranged between18 and 56 years. The most common pedagogical strategies were simulation, role playing, and face-to-face lessons. In some cases, studies combined two or three pedagogical strategies in the same intervention. The most effective strategy was simulation, which improved EC, compassion, self-awareness, self-efficacy, empathy, critical thinking, clinical practice skills, and teamwork skills. Furthermore, the combination of lessons, simulation, and literature exploration effectively developed communication skills, and improved students' satisfaction.

CONCLUSIONS

Investing in simulation, role-playing activities, and lessons regarding the importance of EI, empathy and compassion, and the role of an emotionally competent nurse leads to improved nursing care and wellbeing.

Immersive Virtual Reality Simulation for Learning Fundamental Nursing Skills: A Mixed-Methods Study

BACKGROUND

Literature showed that learners' perceived usability and perspective toward a technology application affected their learning experience. Fewer studies have investigated immersive virtual reality (IVR) simulation learning of fundamental nursing skills learning (FNSL).

PURPOSE

The aim of the study was to explore the perceived usability of IVR simulations for FNSL among first-year nursing students and their perspectives toward this learning modality.

METHODS

This study used a mixed-methods design with an educational intervention. Sixty-five first-year nursing students participated in 2 IVR simulation procedures in complementary mode. Surveys and focus groups were conducted in the postintervention period.

RESULTS

The findings demonstrated students' positive inclinations toward IVR simulation learning. Two areas emerged: using IVR simulation as a complementary modality for FNSL and barriers affecting students' perceived usability toward this technology.

CONCLUSIONS

With addressing the concerns from students' perceived usability, immersive virtual reality simulation could be a potential complementary modality for FNSL.

Satisfaction of psychological needs, resilience, confidence and willingness to communicate in English of secondary school students

In recent years, educational policies have focused on promoting bilingualism in schools. This brings with it new challenges for the consolidation of communicative habits and English language proficiency among students. Thus, the aim of this study is to analyse the influence of psychological needs satisfaction on students' resilience and confidence in exhibiting communicative intention. The participants in the study were 786 secondary school students (406 were boys and 380 were girls). The analyses employed in the study were reliability analyses, descriptive statistics (mean, standard deviation and bivariate correlations) and structural equation modelling. The results revealed that satisfaction of psychological needs was positively associated with resilience and confidence. Furthermore, resilience was positively associated with willingness to communicate in English. These results can help to foster teaching strategies and design educational programmes that strengthen students' abilities, skills and confidence for everyday English language use in the classroom and in other contexts.

Effect of simulation-based emergency airway management education on the knowledge, skills and perceived confidence of medical interns

Background

An effective airway management education program is a crucial part of the undergraduate medical education curriculum. Theoretical instructions and practical demonstrations are the major modalities of medical education in Nepal. Simulation-based education (SBE) programs have not yet been implemented effectively. The authors aimed to determine the effects of an SBE program on the knowledge, skills, and perceived confidence of medical interns regarding emergency airway management.

Methods

This mixed methods study comprised both quantitative and qualitative components. The study participants were 47 medical interns who had participated in the SBE program.

Results

The mean age of the 47 participants was 24.74 years. There were 33 (70.21%) male and 14 (29.79%) female participants. The knowledge, skills, and perceived confidence scores of the participants for airway management preparation, basic airway management, endotracheal intubation, and laryngeal mask airway (LMA) insertion improved significantly following the SBE program (P<0.001). Analysis of the participants' feedback indicated that they largely approved of the SBE program. The majority of students and faculty expressed a willingness to include similar programs in the undergraduate medical education curriculum.

Conclusion

This study demonstrated through quantitative and qualitative metrics that SBE can enhance the knowledge, skills, and perceived confidence in performing emergency airway management among medical interns. The authors recommend measures to include and effectively implement SBE in the undergraduate medical education curriculum of Nepal.

Addressing Nursing Students' Anxiety During Simulation Sessions: A Pilot Intervention Study

BACKGROUND

Although simulation-based education plays a vital role in nursing education, it consistently induces high levels of anxiety among nursing students. This study aimed to implement a mindfulness intervention to alleviate anxiety in nursing students during simulation sessions.

METHOD

This randomized controlled trial study included 54 nursing students. Both survey and emotion track system data were collected and analyzed using multivariate analysis of covariance.

RESULTS

The intervention effectively reduced anxiety among students in the experimental group compared with students in the control group during simulation sessions. The frequency (F[1, 53] = 6.145, p = .016), intensity (F[1, 51] = 3.771, p = .050), and duration of anxiety felt by students (F[1, 50] = 4.223, p = .017) decreased after the intervention. However, no long-term effects of the intervention were identified.

CONCLUSION

The implementation of a mindfulness intervention successfully alleviated anxiety among nursing students during simulation. [J Nurs Educ. 2024;63(9):577-583.].

Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial

INTRODUCTION

Simulation training is an important component of medical education. In former studies, diagnostic simulation training for direct and indirect funduscopy was already proven to be an effective training method. In this prospective controlled trial, we investigated the effect of simulator-based fundus biomicroscopy training.

METHODS

After completing a 1-week ophthalmology clerkship, medical students at Saarland University Medical Center (n = 30) were block-randomized into two groups: The traditional group received supervised training examining the fundus of classmates using a slit lamp; the simulator group was trained using the Slit Lamp Simulator. All participants had to pass an Objective Structured Clinical Examination (OSCE); two masked ophthalmological faculty trainers graded the students' skills when examining patient's fundus using a slit lamp. A subjective assessment form and post-assessment surveys were obtained. Data were described using median (interquartile range [IQR]).

RESULTS

Twenty-five students (n = 14 in the simulator group, n = 11 in the traditional group) (n = 11) were eligible for statistical analysis. Interrater reliability was verified as significant for the overall score as well as for all subtasks (≤ 0.002) except subtask 1 (p = 0.12). The overall performance of medical students in the fundus biomicroscopy OSCE was statistically ranked significantly higher in the simulator group (27.0 [5.25]/28.0 [3.0] vs. 20.0 [7.5]/16.0 [10.0]) by both observers with an interrater reliability of IRR < 0.001 and a significance level of p = 0.003 for observer 1 and p < 0.001 for observer 2. For all subtasks, the scores given to students trained using the simulator were consistently higher than those given to students trained traditionally. The students' post-assessment forms confirmed these results. Students could learn the practical backgrounds of fundus biomicroscopy (p = 0.04), the identification (p < 0.001), and localization (p < 0.001) of pathologies significantly better with the simulator.

CONCLUSIONS

Traditional supervised methods are well complemented by simulation training. Our data indicate that the simulator helps with first patient contacts and enhances students' capacity to examine the fundus biomicroscopically.

The use of Simulated Observations in Medical Simulation and its effect on perceived realism: A pilot project

Introduction

Simulation is an effective teaching method with increasing growth and recognition and refers to the artificial representation of a real-life scenario. The aim of this study was to compare simulation with and without the use of a simulated observations monitor and to investigate differences in students' impression of realism, engagement, learning, and enjoyment.

Methods

Simulation sessions were delivered to second and third-year Swansea University Medical Students, and a total of 15 students were included. Students carried out 2-3 scenarios each with and without the use of a simulated observations monitor. Data collection was conducted via student surveys and a joint interview.

Results

All students had an increased sense of realism with the use of the simulated observations monitor, feeling a closer resemblance to what would be experienced in clinical practice. They felt this improved their learning, making them more prepared for the real-life scenario. The monitor was more dynamic, responding to their interventions, helping them maintain focus and engagement throughout. A key theme was the reduction of interruptions or deviations from the scenario to communicate with the examiner or ask for observations. The visual and audible affects provided additional stimuli, adding to the realistic nature of the simulation.

Discussion

Simulation has been shown to be a useful education tool, but there is less evidence to support the use of higher fidelity over lower fidelity simulation. The terms are often used inconsistently, and many factors affect the students' perceived sense of realism. This study shows that the addition of a simple device such as the simulated observations monitor can produce a higher level of fidelity, particularly in terms of the stimuli provided and student perceptions of realism, which may be effective in improving engagement with the simulation, learning, and aid recall when presented with similar scenarios in a real-life situation.

Designing an evaluation tool for evaluating training programs of medical students in clinical skill training center from consumers' perspective

INTRODUCTION

The Clinical Skill Training Center (CSTC) is the first environment where third year medical students learn clinical skills after passing basic science. Consumer- based evaluation is one of the ways to improve this center with the consumer. This study was conducted with the aim of preparing a consumer-oriented evaluation tool for CSTC among medical students.

METHOD

The study was mixed method. The first phase was qualitative and for providing an evaluation tool. The second phase was for evaluating the tool. At the first phase, after literature review in the Divergent phase, a complete list of problems in the field of CSTC in medicine schools was prepared. In the convergent step, the prepared list was compared with the standards of clinical education and values of scriven. In the second phase it was evaluated by the scientific and authority committee. Validity has been measured by determining CVR and CVI: Index. The face and content validity of the tool was obtained through the approval of a group of specialists.

RESULTS

The findings of the research were in the form of 4 questionnaires: clinical instructors, pre-clinical medical students, and interns. All items were designed as a 5-point Likert. The main areas of evaluation included the objectives and content of training courses, implementation of operations, facilities and equipment, and the environment and indoor space. In order to examine the long-term effects, a special evaluation form was designed for intern.

CONCLUSION

The tool for consumer evaluation was designed with good reliability and trustworthiness and suitable for use in the CSTC, and its use can improve the effectiveness of clinical education activities.

Novel Performance Rating Instruments for Gynecological Procedures in Primary Care: A Pilot Study

BACKGROUND AND OBJECTIVES

 Improving training and confirming the acquisition of gynecological procedure skills for family physicians (FPs) is crucial for safe health care delivery. The objectives of this study were to (a) develop performance rating instruments for four gynecological procedures, and (b) pilot them to provide preliminary validity evidence using modern validity theory.

METHODS

 Sixteen academic FPs and gynecologists participated in a modified Delphi technique to develop procedure-specific checklists (PSCs) for four procedures: intrauterine device insertion, endometrial biopsy, punch biopsy of the vulva, and routine pessary care. We modified a previously validated global rating scale (GRS) for ambulatory settings. Using prerecorded videos, 19 academic FPs piloted instruments to rate one first-year and one second-year family medicine resident's performance. They were blinded to the level of training. We compared the mean scores for PSCs and GRS for each procedure using paired samples t tests and Cohen's d to estimate effect sizes.

RESULTS

 Consensus on items for the final PSCs was reached after two Delphi rounds. PSC and GRS scores were numerically higher for the second-year resident than the first-year resident for every procedure, with statistically significant differences for six of eight comparisons (P<.05). All comparisons demonstrated large effect sizes (Cohen's d>0.8). Both instruments received high scores for ease of use by raters.

CONCLUSIONS

 We developed novel performance rating instruments for four gynecological procedures and provided preliminary validity evidence for their use for formative feedback in a simulation setting. This pilot study suggests that these instruments may facilitate the training and documentation of family medicine trainees' skills in gynecological procedures.

Enhancing Surgical Nursing Student Performance: Comparative Study of Simulation-Based Learning and Problem-Based Learning

Background

Surgical nursing is a high-risk, high-pressure, and complex field. Nurses need extensive knowledge, skills, and abilities. Problem-Based Learning (PBL) and Simulation-Based Learning (SBL) are effective student-centered methods. Which method is better for surgical nurse training? More research is needed to determine the best approach for undergraduate surgical nurse education.

Purpose

To compare the impact of PBL and SBL on undergraduate nursing students' performance and improve learning outcomes in surgical nursing education.

Methods

We used a pretest/post-test design with 318 nursing undergraduates randomly assigned to two groups. Participants completed three progressive scenarios focused on surgical nursing cases. Experts blindly reviewed video recordings using the 70-item Korean Nurses' Core Competence Scale (KNCCS) to assess performance. The 13-item Satisfaction and Self-confidence in learning Scale (SSS) measured learning confidence and satisfaction. SBL participants also completed the 16-item Educational Practices in Simulation Scale (EPSS) and 20-item Simulation Design Scale (SDS).

Results

The study found significant positive effects on both groups, with noticeable improvements in post-test, retention, and follow-up test results (P < 0.001). The SBL group showed higher competency levels in nurses (P < 0.001). The Cohen's d and effect size (r) for various skills were as follows: clinical performance (0.84767 and 6.39023), critical thinking (0.31017 and 0.15325), professional attitude (0.85868 and 0.39452), and communication skills (1.55149 and 0.61294). The satisfaction and self-confidence of nurses were higher in the SBL group (4.53±0.596; 4.47±0.611) compared to the PBL group (4.32±0.689; 4.25±0.632) in all dimensions of SSS (all P < 0.05). The SBL group also scored high in simulation design and EPSS. However, improvements are needed in fidelity, objectives, information, and students' expectations.

Conclusion

SBL and PBL improve nurses' core competence, satisfaction, and self-confidence. SBL is superior. This study promotes student-centered education, enhancing surgical nursing professionals' quality and ensuring future patient safety.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Health-related behaviors and symptoms of anxiety and depression in Spanish nursing students: an observational study

Background

Symptoms of anxiety and depression are prevalent among young adults and are a significant public health issue. College students are at a higher risk of experiencing poor mental health than other young people due to several factors, including moving away from home, financial pressures, heavy workload, poor time management skills, competitivity, new processes of socialization and insufficient coping mechanisms, among others. In addition, nursing students' mental and physical health may also be affected by unhealthy lifestyle habits and health-related behaviors.

Aim

To determine the prevalence of symptoms of depression and anxiety, and the association between these symptoms and health-related behaviors, in a population of Spanish student nurses.

Methods

Cross-sectional study on a sample of 339 nursing students. We used the Hospital Anxiety and Depression Scale, the International Physical Activity Questionnaire-Short form, the Spanish Healthy Eating Index and an "ad hoc" questionnaire for sociodemographic variables. The association between psychological symptoms and health-related behaviors was analyzed through binary logistic regression models.

Results

The prevalence of symptoms of depression and anxiety was 3.8% and 24.5%, respectively. Negative health-related behaviors were frequent, namely tobacco and alcohol consumption, suboptimal physical activity and diet. Moderate physical activity was associated with a lower probability of experiencing depressive symptoms. Symptoms of anxiety were related to a low level of physical activity, an unhealthy diet and alcohol consumption ≥2 times a week.

Conclusion

Student nurses could benefit from the implementation of both physical and mental health promotion initiatives.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

OBJECTIVE

The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research.

INTRODUCTION

Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests.

INCLUSION CRITERIA

Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review.

METHODS

This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats.

RESULTS

Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values.

CONCLUSIONS

This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards.

REVIEW REGISTRATION

Open Science Framework https://osf.io/fgb34.

"It kinda helped us to be there": students' perspectives on the use of virtual patient software in psychiatry posting

BACKGROUND

At the Faculty of Medicine of the National University of Malaysia, a virtual patient software program, DxR Clinician, was utilised for the teaching of neurocognitive disorder topics during the psychiatry posting of undergraduate medical students in a modified team-based learning (TBL) module. This study aimed to explore medical students' learning experiences with virtual patient.

METHODS

Ten students who previously underwent the learning module were recruited through purposive sampling. The inclusion criteria were: (a) Fourth-year medical students; and (b) Completed psychiatry posting with the new module. Students who dropped out or were unable to participate in data collection were excluded. Two online focus group discussions (FGDs) with five participants each were conducted by an independent facilitator, guided by a questioning route. The data were transcribed verbatim and coded using the thematic analysis approach to identify themes.

RESULTS

Three main themes of their learning experience were identified: (1) fulfilment of the desired pedagogy (2), realism of the clinical case, and (3) ease of use related to technical settings. The pedagogy theme was further divided into the following subthemes: level of entry for students, flexibility of presentation of content, provision of learning guidance, collaboration with peers, provision of feedback, and assessment of performance. The realism theme had two subthemes: how much the virtual patient experience mimicked an actual patient and how much the case scenario reflected real conditions in the Malaysian context. The technical setting theme entailed two subthemes: access to the software and appearance of the user interface. The study findings are considered in the light of learning formats, pedagogical and learning theories, and technological frameworks.

CONCLUSIONS

The findings shed light on both positive and negative aspects of using virtual patients for medical students' psychiatry posting, which opens room for further improvement of their usage in undergraduate psychiatry education.

Bacterial Meningitis With Cerebral Edema in a Young Adult: A Simulation Case for Medical Students

Introduction

Simulation in the preclinical medical education setting is a beneficial tool for students to develop clinical skills, supplement preexisting knowledge, and prepare for clinical rotations and beyond. We detail the complete simulation scenario, including a participant postresponse questionnaire, of a 28-year-old male who developed bacterial meningitis after experiencing an upper respiratory infection in the days prior.

Methods

Simulation fellows and faculty at the Alabama College of Osteopathic Medicine created a simulation scenario pertaining to bacterial meningitis. The scenario utilized a high-fidelity patient simulator, one standardized participant for patient voiceover, one standardized participant as a patient family member, and one standardized participant as a physician consultant on an as-needed basis. Sixteen preclinical medical students from various specialty interest groups were recruited to participate in the scenario and complete the postscenario questionnaire.

Results

The simulation scenario was well received by the participants, and 15 of 16 completed the postscenario questionnaire. Ninety-three percent strongly agreed the simulation was a valuable clinical experience. Additionally, 73% of participants strongly agreed that the simulation experience was realistic, 80% strongly agreed that it tested their clinical reasoning ability, and 53% strongly agreed it was appropriate for their level of clinical knowledge.

Discussion

Medical simulation is a valuable educational tool tailored to maximize student learning and supplement the traditional didactic curriculum. The successful development and implementation of our meningitis simulation case further supports the continued use of medical simulation in the preclinical setting.

Tools measuring high haptic fidelity of procedural skills trainers in physician training and education: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify instruments that measure the physical haptic fidelity of procedural skills trainers.

INTRODUCTION

Procedural skills trainers have demonstrated beneficial outcomes for clinicians when used to practice and rehearse procedures. Despite this, several design flaws currently limit the widespread implementation of such trainers. One notable deficit in current trainer designs is haptic fidelity. Identifying measurements of haptic fidelity may maximize the benefit of using certain training devices as well as guiding future design.

INCLUSION CRITERIA

This review will consider studies that assess the high fidelity haptics of procedural skills training devices in adult physicians above the level of an intern physician. Studies that do not include physicians will be excluded.

METHODS

The review will follow the JBI methodology for scoping reviews and will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Both published and unpublished studies will be searched for in MEDLINE (PubMed), Scopus, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), Embase (Ovid), CINAHL (EBSCOhost), ProQuest Dissertations and Theses (ProQuest), and Google Scholar. There will be no date, setting, or geographical limits, but only studies in English will be included.

REVIEW REGISTRATION

Open Science Framework osf.io/pvazu/.

"Sawbones": A pilot study assessing simulation-based orthopedic training for medical students

Intro

Simulation-based training has become a valuable new tool in medical education across the country. The Orthopedic Surgery Interest Group (OSIG) at the University of Miami Miller School of Medicine organized a benchtop training workshop known as "Sawbones" to give medical students essential exposure to basic techniques and instruments commonly used in orthopedic surgery. This pilot study seeks to investigate the participating students' perceptions of this workshop as part of a potential longitudinal intervention.

Methods

A total of 30 medical students (MS1-MS4) with a documented interest in orthopedic surgery were randomly selected via email invitation to participate in this workshop. Students first had a lecture-based training session with faculty on an overview of screw fixation. Participants then formed groups that were headed by an orthopedic resident or attending and took turns fixing fractures on model bones made of synthetic material. Following the session, students were sent an anonymous Qualtrics survey to assess their satisfaction with the workshop.

Results

A total of 22 students (73%), responded to the survey. On a ten-point scale, the average reported interest in orthopedics was 9.2 (SD 0.4). All students (n = 22, 100%) reported that they would like more hands-on orthopedic experiences as a component of their medical education. Nineteen students (86.4%) reported that this training increased their interest in pursuing a career in orthopedic surgery and twenty-one (95.5%) further stated that they would recommend this training to other students.

Discussion

Based on the results of this pilot study, Sawbones was promising at engaging students in orthopedics, providing a team environment, and introducing students to orthopedic skills and instrumentation. Providing these sessions in a longitudinal manner could provide opportunities for mentorship and better prepare students for a residency in orthopedics. We recommend a program like Sawbones to better address the lack of Orthopedic exposure in medical school.

The Use of Simulation in Audiology Education: A Systematic Review

PURPOSE

This study aimed to assess the level and quality of evidence supporting the use of simulation in audiology education regarding enhanced knowledge, skills, self-confidence, and satisfaction.

METHOD

A systematic review of qualitative and quantitative peer-reviewed literature published between 2000 and 2023 was conducted. The PICO mnemonic (where P = population, I = intervention, C = comparison, and O = outcomes) was used to frame the clinical question and generate search terms. Search strategies were executed in seven databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to track the peer-reviewed literature identification and selection process. The Joanna Briggs Institute Critical Appraisal Checklists and Levels of Evidence were used to characterize the research studies.

RESULTS

A total of 668 records were identified. Nineteen peer-reviewed publications met the inclusion criteria. Diverse study designs, interventions, assessment techniques, and simulation types were identified. Characteristics of included studies (e.g., author, year, study purpose) were reported by evidence tables. Primary and secondary outcomes were identified and described. Results indicate statistical and/or clinically significant improvements in knowledge, skills, and/or self-confidence following simulation training. Each study was critically appraised, and the level, quality, and strength were assigned.

CONCLUSIONS

The use of simulation as an educational method among audiology students has been shown to dramatically increase knowledge, skills, and self-confidence. However, the use of simulation in audiology education is still behind compared to other health professions. As a result, there are a limited number of simulation-based studies in audiology. Most health academic institutions have well-designed simulation centers; therefore, audiology programs are urged to collaborate with colleagues in other professions and benefit from the services offered by these facilities.

Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation

INTRODUCTION

This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical-practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations.

MATERIALS AND METHODS

This was a quasi-experimental pre-post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Marañón Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020-2021 and 2021-2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives.

RESULTS

Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020-2021 academic year and 80.6% of students in the 2021-2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical-practical knowledge (improvement mean = 1.38 and 1.21 in 2020-2021 and 2021-2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points.

CONCLUSIONS

Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.

Efficacy of Simulator-Based Slit Lamp Training for Medical Students: A Prospective, Randomized Trial

INTRODUCTION

Simulation training has an important role in medical education. In ophthalmology, simulation-based training has been shown to be significantly effective for surgical and diagnostic training in direct and indirect ophthalmoscopy. In this study, we analysed the effects of simulator-based slit lamp training.

METHODS

In this prospective controlled trial, medical students in their eighth semester at Saarland University Medical Center (n = 24) who had attended a 1-week ophthalmological internship were randomized into two groups: The traditional group (n = 12) was examined directly after the 1-week internship; the simulator group (n = 12) was trained with the slit lamp simulator before passing an objective structured clinical examination (OSCE). A masked ophthalmological faculty trainer assessed the students' slit lamp skills (maximum total score 42 points [pts]): preparation (5 pts), clinical examination (9.5 pts), assessment of findings (9.5 pts), diagnosis (3 pts), commentary on the examination approach (8 pts), measurement of structures (2 pts) and recognition of five diagnoses (5 pts). All students completed post-assessment surveys. Examination grades and survey responses were compared between the groups.

RESULTS

The overall performance of the slit lamp OSCE was significantly better (p < 0.001) in the simulator group than in the traditional group (29.75 [7.88] vs. 17.00 [4.75]) with significantly higher scores for the preparation and assessment of slit lamp controls (5.0 [0.0] vs. 3.0 [3.5]; p = 0.008) and localization of relevant structures (6.75 [3.13] vs. 4.0 [1.5]; p = 0.008). Consistently higher scores, but not significant, were assigned for the description of structures found (4.5 [3.38] vs. 3.25 [2.13]; p = 0.09) and the correct diagnosis (3.0 [0.0] vs. 3.0 [0.0]; p = 0.48). Surveys reflected the students' subjectively perceived knowledge gain during the simulator training for slit lamp illumination techniques (p = 0.002), recognition (p < 0.001), and assessment of the correct localization of pathologies (p < 0.001).

CONCLUSION

Slit lamp examination is an important diagnostic method in ophthalmology. Simulator-based training improved students' examination techniques for localizing anatomical structures and pathological lesions. The transfer of theoretical knowledge into practice can be achieved in a stress-free atmosphere.

Virtual versus paper-based PBL in a pulmonology course for medical undergraduates

BACKGROUND

Problem-based learning (PBL) remains a valid and effective tool for small-group medical education. Using Virtual patients (VP) case simulation in PBL is a recognizable educational method that has successfully prepared students to focus learning on core information that uses realistic patient-based cases relating to everyday clinical scenarios. Using other modalities as the virtual patient in PBL instead of the paper-based methods remains debatable. This study aimed to evaluate the effectiveness of using VP case simulation mannequin in PBL versus the PBL in paper-based cases in improving the cognitive skills by comparing the grades of a multiple-choice question test and assess its ability to reach students' satisfaction using questionnaire with Likert survey instrument.

METHODS

The study was conducted on 459 fourth-year medical students studying in the pulmonology module of the internal medicine course, Faculty of Medicine, October 6 University. All students were divided into 16 PBL classes and randomly divided into groups A and B by simple manual randomization. The groups were parallel with a controlled cross-over study between paper-based and virtual patient PBL.

RESULTS

The pre-test showed no significant difference between both, while post-test scores were significantly higher in both VP PBL cases 1 discussing COPD (6.25 ± 0.875) and case 2 discussing pneumonia (6.56 ± 1.396) compared to paper-based PBL (5.29 ± 1.166, 5.57 ± SD1.388, respectively) at p < 0.1 When students in Group A experienced PBL using VP in case 2 after paper-based PBL in case 1, their post-test score improved significantly. (from 5.26 to 6.56, p < .01). Meanwhile, there was a significant regression in the post-test score of the students in Group B when they experienced the paper-based PBL session in case 2 after using PBL using VP in case 1, (from 6.26 to 5.57, p < .01). Most of the students recommended using VP in PBL as they found VP was more engaging and inducing concentration in gathering the information needed to characterize the patient's problem than in a classroom- paper-based cases session. They also enjoyed the teaching of the instructor and found it a suitable learning style for them.

CONCLUSION

Implementing virtual patients in PBL increased knowledge acquisition and understanding in medical students and was more motivating for students than paper based PBL to gather the needed information.

The double-edged sword of emotions in medical education: A scoping review

Emotions are universal in academic and clinical settings. A student is likely to hope for success, maybe be worried about failure, or may feel comfortable after an exam. These feelings undoubtedly affect his/her motivation, effort, academic performance, and progress. This study aimed to investigate the role of emotion in the learning and performance of medical students and its mechanism. This study was a scoping review conducted in 2022 to examine the role of emotions in medical education. The three databases PubMed, ERIC, and Science Direct and the search engine Google Scholar were searched using the following keywords: "emotion," "medical student," "teaching," "learning," and "medical education." English articles published from 2010 to 2022 were reviewed, and finally, 34 articles that met the inclusion criteria were reviewed. Review of the selected articles showed that there was a significant relationship between the cognitive system and emotions in the brain. The conceptual framework of the relationship between cognition and emotion can be explained in the form of dimensional and discrete views of emotions and based on cognitive load theory. Emotions affect cognition with the four mechanisms of memory, cognitive resources, cognitive strategies, and motivation and can be effective in learning self-regulation, clinical reasoning, and academic achievement of medical students. Emotions in medical education is a double-edged sword. In other words, it is highly recommended to divide emotions into activating and inactivating, instead of dividing them into positive and negative ones. In this context, medical educators can use the positive aspects of nearly all emotions to improve the quality of their teaching.

Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications

Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.

Impact of the COVID-19 Pandemic on Neonatal Nursing Practicum and Extended Reality Simulation Training Needs: A Descriptive and Cross-Sectional Study

This study investigated the neonatal intensive care unit (NICU) clinical practicum status during the COVID-19 pandemic and the need for extended reality (XR)-based training for neonatal care. A structured questionnaire was distributed to 132 prelicensing nursing students. Data were analyzed using importance-performance analysis and Borich needs analysis. Students wanted to use XR to learn about treating high-risk preterm infants. COVID-19 limited clinical training in NICUs, and most students preferred training in XR programs to improve their nursing competency for neonates. There is a large demand for nursing skills concerning high-risk newborns and hands-off training.

Effects of simulation-based education for neonatal resuscitation on medical students' technical and non-technical skills

Simulation is a learner-centered practice that helps develop and maintain knowledge, skills, and competencies. This study evaluated the effect of neonatal resuscitation simulation-based education for medical students in the fifth year (part of the regular clinical clerkship program) on the perceived performance of their technical and non-technical skills. In addition, we analyzed the difference between instructor's and learners' evaluations of technical skills after the simulation. A one-group pretest-posttest design was adopted. The simulation-based education of the neonatal resuscitation program (NRP) was conducted for 40 medical students from July to November 2020 at a medical school in South Korea. The simulation-based education comprised 5 minutes of pre-briefing, 10 minutes of running the simulation, and 30 minutes of debriefing (using a recorded video). The perceived performance of students' technical and non-technical skills before and after the simulation was compared by collecting and analyzing the pre- and post-questionnaires. The perceived performance of technical (p = .001) and non-technical skills (p < .001) was found to have significantly increased after the simulation. Particularly, the performance of technical skills, such as diagnostic (p = .007) and therapeutic actions (p < .001) and non-technical skills, such as leadership (p < .001), teamwork (p = .001), and task management (p = .020) improved significantly. There was no significant difference in the evaluations of the technical performance of the instructor and learners after the simulation (p = .953). Simulation-based education can improve technical skills, such as diagnostic and therapeutic actions for neonatal resuscitation. It is also effective in enhancing non-technical skills, such as leadership, teamwork, and task management. Further, after the simulation-based education, students can fully self-evaluate through objective reflection and improve their clinical competency.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available.

INTRODUCTION

Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers.

INCLUSION CRITERIA

This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings.

METHODS

This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results.

SCOPING REVIEW PROTOCOL REGISTRATION

Open Science Framework https://osf.io/fgb34.

Simulation Training Needs of Nurses for Nursing High-Risk Premature Infants: A Cross-Sectional Study

Opportunities fomr clinical training in the newborn nursery and neonatal intensive care units (NICU) are becoming insufficient and limited to observation-oriented training. Premature infants admitted to the NICU require specialized and highly sophisticated care. Therefore, this descriptive cross-sectional study aimed to understand nurses’ educational needs for establishing a high-risk premature infant nursing simulation training program. It used a descriptive cross-sectional design. We conducted a survey involving 99 newborn nursery and NICU nurses; data were analyzed using descriptive statistics, a paired t-test, an Importance-Performance Analysis (IPA), a Borich needs analysis, and the locus for focus to confirm educational priorities. The scores indicating the importance of nursing high-risk premature infants were higher than those of performance. Results indicated that the highest educational need was in the “treatment and procedure” domain. After deriving the priority of educational needs using the Borich needs analysis and the locus for focus, “maintenance of various tubes” showed the highest priority. By identifying the training priorities for high-risk premature infants nursing using various analytical frameworks, an extended reality simulation program met nurses’ high-risk premature infant nursing educational needs. Training for high-risk premature infants treatment and procedures—maintaining various tubes—is highly demanded by nurses and should be prioritized.

The Confidence and Accuracy of Medical Students Trained in Ultrasound or Landmarks for Performing Knee Aspiration

Introduction Medical students are trained using anatomical landmarks in order to perform many procedures, such as knee aspirations. With the growing popularity and use of ultrasound, the question arises whether training students with ultrasound instead of landmarks increases their skill. Previous research has shown increased accuracy and confidence in residents who trained with ultrasound compared to landmarks only. No studies to date have analyzed the effect of ultrasound learning versus landmark learning in medical students. Objective The purpose of this study is to analyze the confidence and accuracy of medical students when taught knee aspiration using ultrasound training compared to students taught with landmarks only. Methods The project was deemed exempt by the Edward Via College of Osteopathic Medicine (VCOM) Institutional Review Board (IRB) because it falls under the quality improvement category (IRB number 1806802-1). Subjects were randomized into two groups: one trained in ultrasound and one trained in landmarks for performing knee aspirations. Both groups were tested for accuracy by the ability to aspirate fluid from the model and the number of attempts; each student was given a maximum of three attempts. Documentation included the number of attempts for each student or "no fluid" for those exceeding three attempts. They were then surveyed for confidence. The study took place in an educational setting at VCOM-Carolinas. A total of 42 first-year medical students participated in this study. Results Fisher's exact test showed statistically significant results for confidence (p<0.001) between the ultrasound group (N=22) and non-ultrasound group (N=20) with a power of 0.285. The accuracy of aspirating fluid was not found to be statistically significant (p=0.4805). Conclusions Although no significant differences in the accuracy of knee aspirations at short term were seen, there was a clear improvement in student confidence and perceived capability of the skill. Those students who learned using ultrasound-guided techniques were more confident in their ability to accurately perform the technique when compared to their peers.

The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study

Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N = 128) was expected to significantly increase during scenarios of increasing fidelity (M_roleplay  = 2.08 ± 0.92; SPEs: M_{simulatedpatient}  = 2.68 ± 1.08; RPEs: M_realpatient  = 3.35 ± 1.08; p < 0.001). Whereas physiological stress was significantly higher with real patients (N = 106), psychological stress was not affected by the fidelity of the scenarios (N = 85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.

‘A much kinder introduction’: exploring the benefits and challenges of paediatric simulation as a transitioning tool prior to clinical practice

Simulated practice is an opportunity to transition nursing students from on-campus learning to clinical practice. There is limited evidence on simulated practice’s role in assisting this transition at the beginning of a nursing student’s education in terms of benefits, challenges, differences and affordances. This study aimed to research the impact of a simulated practice programme as a transitioning tool for first-year paediatric nursing students.

A participatory action research approach was used to address challenges in student’s transitioning to clinical practice and a lack of clinical placement capacity. A low-technological (physical), high-authenticity (emotional and environmental)-simulated practice programme for first-year paediatric nursing students was implemented. Forty students across two cohorts were recruited, and a qualitative survey was completed post-simulation/pre-clinical practice and post-clinical practice. Reflexive thematic analysis was used to develop the resulting themes.

There was an initial 93% response rate after the simulated practice and 88% after clinical placement. Eight themes (‘bridging’ from simulation to practice and to enhance practice; ‘preparedness’ once on clinical placement; ‘applied learning’ reliably transferred to practice; ‘skill decay’ between simulation and practice; ‘same but different experiences’ between simulation and practice; simulation and clinical ‘practice pace’; ‘safety’ of simulation; and ‘unique affordances’ of simulated practice) were constructed from the data, and an additional nine sub-themes were identified (transference to practice; practice enhancement; slow-motion care; hectic; it is safe; it was safe; feedback and reassurance; practice and practice; and unpressured). Collectively, the themes indicated that simulated practice in this context is conveyed as a well-being tool in addition to having experiential learning and bridging benefits.

This study revealed that simulated practice can assist in transitioning paediatric student nurses to clinical practice. It identified its value in terms of fostering holistic learning, well-being and bridging theory to practice. To ensure long-term effectiveness, simulation maintenance training, booster training and refresher strategies should be included as part of the programme to prevent skill decay. Future studies should consider isolating these key findings for a more in-depth look at their meaning.

A Simulation-Based Clinical Nursing Education Framework for a Low-Resource Setting: A Multimethod Study

Simulation-based clinical education is a useful strategy for teaching, learning, and assessing clinical competence in health professions education. However, the use of simulation-based clinical nursing education (SBCNE) in low-resource settings such as Ghana has been hampered by the lack of a context-specific framework to guide its design, implementation, and evaluation. This study sought to develop a context-specific framework to guide the design, implementation, and evaluation of SBCNE in a low-resource setting. The study employed a sequential multimethod design, comprising a scoping review; qualitative descriptive design (situational analysis) made up of two parts–focus group discussions (FGDs) with post-registration nurses and nursing students, and semi-structured interviews with nurse educators; and narrative synthesis of the scoping review and situational analysis data, used to develop a draft SBCNE framework for a low-resource setting. The draft SBCNE framework was evaluated by stakeholders of nursing education and practice using nominal group discussions. The framework is comprised of five constructs (context, planning, design, community of learning, and outcomes). The user-centric, comprehensive, context-specific SBCNE framework has the potential to enhance the implementation of simulation in nursing education and the development of clinical competence in a low-resource setting. As a result, we urge nursing leaders and nurse educator unions to take the lead in lobbying regulatory bodies, the central government, and their development partners to provide the necessary financial support and resources for the implementation of the framework and adoption of SBCNE in low-resource settings.

Evaluation of a Novel Simulation Curriculum With the Segmented Model in Pediatric Cardiovascular Education

Objective

The need to develop the full range of knowledge, skills, and professionalism poses new challenges for pediatric cardiovascular education. This study aimed to investigate the effectiveness of a novel simulation curriculum with the segmented model for pediatric cardiovascular residents.

Materials and Methods

First, the simulation course was designed according to a prior survey and based on a human patient simulator setting. Then, another 55 residents were randomly selected and assigned to participate in a simulation course (about acute fulminant myocarditis in children), either in the experimental group or the control group. Taking full advantage of the simulation education, the simulation case in the experimental group was divided into three segments and included a micro-debriefing at the end of each segment. The three segments were independent but together formed the whole case. It was designed through three cycles of running and debriefing, and more challenging tasks were gradually proposed to residents. The case in the control group was not split and included only one case running and debriefing. The assessments of the residents' knowledge, skills, professionalism performance, and satisfaction feedback from residents were analyzed to evaluate the effectiveness of the course.

Results

In total, 44 residents completed the whole experimental period, including 23 participants in the experimental group and 21 participants in the control group. The pre-course knowledge assessment scores of the two groups were comparable, while the mean post-course score in the experimental group was 82.61 ± 17.38, which was significantly higher than that in the control group (50.48 ± 18.57, p < 0.01). The mean skills assessment score of residents in the experimental group was 84.17 ± 6.01, which was significantly higher than the control group (54.50 ± 5.72, p < 0.01). In terms of the professionalism assessment, the residents in the experimental group achieved better performance than those in the control group in all aspects (respect, privacy, communication, responsibility, and cooperation) (p < 0.05). Satisfaction feedback from residents showed that self-confidence regarding knowledge mastery in the experimental group was significantly higher than that in the control group (p < 0.05), while there were no significant differences in the evaluations of the teacher's performance (p > 0.05).

Conclusions

The novel simulation curriculum with the segmented model helps residents achieve better performance in terms of knowledge, skills, and professionalism while improving self-confidence. It has some value in pediatric cardiovascular education and is worthy of further promotion.

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study

BACKGROUND

Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.

OBJECTIVE

To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19-safe environment using SimMan 3G.

METHODS

Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.

RESULTS

In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.

CONCLUSIONS

Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.