High-fidelity medical simulation training improves medical students' knowledge and confidence levels in septic shock resuscitation

The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa - assessing knowledge, attitudes and practices

Introduction

Non-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.Emergency department doctors' knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors' use of NIV in the South African setting.

Methods

This was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description.

Results

The mean knowledge score of the participants was shown to increase with an increase in job designation (p < 0.001). The doctors' attitude towards NIV was more positive in those with higher knowledge scores (p < 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, p = 0.009) as was formal NIV training versus those without (77% vs. 69 %, p = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol.

Conclusion

Increased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.

Performance effects of simulation training for medical students - a systematic review

OBJECTIVE

Simulation based medical education (SBME) is fast becoming embedded into undergraduate medical curricula with many publications now describing its various modes and student self-reported impacts. This systematic review synthesizes the available literature for evidence of performance effects of SBME as an adjunct within traditional teaching programmes.

METHODS

A narrative systematic review was conducted according to PRISMA guidelines using Ovid MEDLINE, EMBASE, and PubMed databases for studies, published in English, reporting on general medical and surgical undergraduate SBME between 2010 to 2020. Two reviewers independently assessed potential studies for inclusion. Methods and topics of simulation with their assessments were evaluated. Descriptive statistics were used to describe pooled student cohorts.

RESULTS

3074 articles were initially identified using the search criteria with 92 full-text articles then screened for eligibility. Nineteen articles, including nine randomised trials, concerning 2459 students (median 79/study), were selected for review. Cardiac scenarios were commonest (n=6) with three studies including surgical topics. Nine studies used mannequin simulators (median time/session 17.5minutes) versus standardised patients in seven (median time/session=82 minutes). Educational impact was measured by written (n=10), checklist (n=5) and OSCEs (n=3) assessment either alone or in combination (n=1, OSCE/written assessment). All articles reported a positive effect of SBME on knowledge including improved retention in three.

CONCLUSION

SBME, as an adjunct to existing curricula, improves knowledge-based performance of medical students at least in the short-term. Future studies should broaden its topics, assess longer term impacts and cost-effectiveness while also considering whether and what areas of traditional undergraduate learning it can replace.

Impact of sepsis education for healthcare professionals and students on learner and patient outcomes: A systematic review

BACKGROUND

Sepsis is an important global healthcare problem that is a key challenge faced by healthcare professionals face worldwide. One key effort aimed at reducing the global burden of sepsis is educating healthcare professionals about early identification and management of sepsis.

AIM

To provide a comprehensive evaluation of sepsis education among healthcare professionals and students.

METHODS

Six databases (PubMed, CINAHL, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were searched. We included studies that described and evaluated any form of education or training on sepsis delivered to healthcare professionals and students. Study outcomes were summarised according to the adapted Kirkpatrick model of training evaluation.

RESULTS

Thirty-two studies were included in the review. The learning contents were reported to be in accordance with the Surviving Sepsis Campaign guidelines. Seven studies included the topic of interprofessional teamwork and communication in their sepsis education content. Most educational programs were effective and reported positive effects on immediate knowledge outcomes. Interventions that were delivered through an active learning approach such as simulation and game-based learning generally produced greater gains than didactic teaching. Improvements in patient care processes and patient outcomes were associated with the concomitant existence or implementation of a hospital sepsis care bundle.

CONCLUSION

Incorporating active learning strategies into sepsis education interventions has the potential to improve learners' long-term outcomes. In addition, sepsis education and protocol-based sepsis care bundle act in synergy to augment greater improvements in care processes and patient benefits.

Coronavirus-19 Multisystem Inflammatory Syndrome in Children (MIS-C): A Pediatric Simulation Case for Residents, Fellows, and Advanced Practice Providers

INTRODUCTION

A rare but serious condition often requiring intensive care, multisystem inflammatory syndrome in children (MIS-C) is characterized by hyperinflammatory shock related to the SARS-CoV-2 pandemic. This resource teaches residents, pediatric emergency medicine fellows, and advanced practice providers who care for children to recognize and manage MIS-C and associated sequelae while applying the basic principles of pediatric resuscitation.

METHODS

The simulation case was based on a real patient who presented to the emergency department with fever, rash, and cardiogenic shock. We designed the scenario to be used with a high-fidelity school-age mannequin in an emergency center resuscitation room or simulation lab. The case took 25 minutes to run, followed by a 15- to 20-minute debrief session. Personnel required for the case included a simulation technician, case instructor, emergency department nurse, parent, and consultant. Learners had to recognize the syndrome and treat the resultant shock and arrhythmia with a combination of vasopressors, antiarrhythmics, and defibrillation. Afterward, learners participated in a formal debriefing session and completed a written evaluation.

RESULTS

Twenty-five learners (six pediatric emergency medicine fellows, 12 residents, and seven advanced practice providers) participated in the scenario over a 3-month period. The written evaluation was completed by 20 of the 25 participants; all 20 felt their confidence, comfort, and knowledge regarding the topic had increased, with an average score of 5 (strongly agree) on a 5-point Likert scale.

DISCUSSION

This simulation case offers an effective experience for learners to become comfortable and confident in recognizing and managing MIS-C.

Prolonged, High-Fidelity Simulation for Study of Patient Care in Resource-Limited Medical Contexts and for Technology Comparative Effectiveness Testing

Most high-fidelity medical simulation is of limited duration, used for education and training, and rarely intended to study medical technology. U.S. caregivers working in prehospital, resource-limited settings may need to manage patients for extended periods (hours to days). This "prolonged casualty care" occurs during military, wilderness, humanitarian, disaster, and space medicine. We sought to develop a standardized simulation model that accurately reflects prolonged casualty care in order to study caregiver decision-making and performance, training requirements, and technology use in prolonged casualty care.

DESIGN

Model development.

SETTING

High-fidelity simulation laboratory.

SUBJECTS

None.

INTERVENTIONS

We interviewed subject matter experts to identify relevant prolonged casualty care medical challenges and selected two casualty types to further develop our model: a large thermal burn model and a severe hypoxia model. We met with a multidisciplinary group of experts in prolonged casualty care, nursing, and critical care to describe how these problems could evolve over time and how to contextualize the problems with a background story and clinical environment with expected resource availability. Following initial scenario drafting, we tested the models with expert clinicians. After multiple tests, we selected the hypoxia model for refinement and testing with inexperienced providers. We tested and refined this model until two research teams could proctor the scenario consistently despite subject performance variability.

MEASUREMENTS AND MAIN RESULTS

We developed a 6-8-hour simulation model that represented a 14-hour scenario. This model of pneumonia evolved from presentation to severe hypoxia necessitating advanced interventions including airway, breathing, and shock management. The model included: context description, caregiver orientation scripts, hourly progressive physiology tracks corresponding to caregiver interventions, intervention/procedure-specific physiology tracks, intervention checklists, equipment lists, prestudy checklists, photographs of setups, procedure, telementor, and role player scripts, business rules, and data collection methods.

CONCLUSIONS

This is the first standardized, high-fidelity simulation model of prolonged casualty care described in the literature. It may be used to assess caregiver performance and patient outcomes resulting from that performance during a complex, 14-hour prolonged casualty care scenario. Because it is standardized, the model may be used to compare differences in the impact of new technologies upon caregiver performance and simulated patient outcomes..

High-fidelity simulation versus video-based learning in the management of pediatric septic shock: a pilot study

High-fidelity simulation (HFS) and video-based learning (VBL) promote competence in acute care in a realistic and safe environment. These two modalities have not been compared in pediatric emergency situations. Interns rotating in the pediatric department were randomized for the two educational methods. The delivered learning subject was septic shock in children. The level of knowledge was measured before intervention, immediately after intervention (post-test 1) and 1 week later (post-test 2). Knowledge test scores improved significantly following intervention in both VBL study group and HFS study group (71.5 ± 13.2 [39.0-88.0], p < 0.001 and 80.1 ± 10.3 [57.4-94.5], p < 0.001, respectively). The improvement was significantly higher in HFS study group (p = 0.04). There was a non-significant drop in the retention score evaluated by the post-test 2 in the two groups compared to the post-test 1 score (66.9 ± 15.4 [31.5-86.1], p = 0.17 and 78.8 ± 12.4 [56.0-100.0], p = 0.72 in the VBL and HFS study groups, respectively). The retention score was significantly higher in the HFS group (p = 0.04).Conclusion: High-fidelity simulation and video-based training are both effective educational methods in teaching pediatric emergencies for interns. HFS appears to be superior in enhancing short-term retention. What is Known: • High-fidelity simulation is an effective educational tool to improve learners' knowledge and skills. • Video-based learning is an effective teaching tool in terms of short-term knowledge acquisition. What is New: • High-fidelity simulation is more effective in terms of short-term knowledge and generated more satisfaction than educational video learning.

Learning Outcomes of High-fidelity versus Table-Top Simulation in Undergraduate Emergency Medicine Education: Prospective, Randomized, Crossover-Controlled Study

INTRODUCTION

Over the last several decades simulation, in both graduate and undergraduate emergency medicine education, has continued to develop as a leading and highly effective teaching modality. Limited research exists to evaluate the efficacy of low-fidelity (table-top) simulation, as compared to high-fidelity standards, as it relates to medical knowledge learning outcomes. We sought to assess the efficacy of a low-fidelity simulation modality in undergraduate emergency medicine education, based on quantitative medical knowledge learning outcomes.

METHODS

A prospective, randomized, crossover-control study comparing objective medical knowledge learning outcomes between simulation modalities. Analysis was designed to evaluate for the statistical equivalence of learning outcomes between the two cohorts. This was done by comparing a calculated 95% confidence interval (CI) around the mean difference in post-test scores, between experimental and control modalities, to a pre-established equivalence margin.

RESULTS

Primary outcomes evaluating student performance on post-test examinations demonstrated a total cohort CI (95% CI, -0.22 and 0.68). Additional course-subject subgroup analysis demonstrated non-inferior CIs with: Shortness of Breath (95% CI, -0.35 and 1.27); Chest Pain (95% CI, -0.53 and.94); Abdominal Pain (95% CI, -0.88 and 1.17); Cardiovascular Shock (95% CI, -0.04 and 1.29). Secondary outcome analysis was done to evaluate medical knowledge acquisition by comparing the difference in pre and post-test examination between the cohorts. CI of the full cohort ranged from (95% CI, -0.14 and 0.96).

CONCLUSION

The student's performance on quantitative medical-knowledge assessment was equivalent between the high-fidelity control and low-fidelity experimental simulation groups. Analysis of knowledge acquisition between the two groups also demonstrated statistical equivalence.

Outcome of Undergraduate Medical Education using Medical Simulation according to Students' Feedback

Objectives

This study aimed to determine students’ overall satisfaction with clinical simulation sessions and compare the satisfaction levels of obstetrics/gynaecology (OBGYN) students (group one) and internal medicine students (group two).

Methods

This study was conducted from January to June 2019 at the Arabian Gulf University, Manama, Bahrain. Students from year five were included and offered sessions that used simulations to support clinical skill development. Data were collected using a five-point Likert scale (i.e. strongly agree, agree, neutral, disagree, strongly disagree) via feedback forms.

Results

A total of 150 students were included in this study (response rate: 99.07%). In groups of seven, the students attended five cycles of simulations with two sessions per cycle in each specialty over six months. The mean percentage of responses of “strongly agree” and “agree” was 97.8 ± 2.3% in group one and 95.7 ± 2.7% in group two. The satisfaction scores of group one were higher than those from group two for all statements. Significant differences were found between groups one and two in their responses to the statement of whether the simulation session was relevant to clinical practice (100% versus 92.9%; P <0.001) and whether the debriefing session was useful (98.1% versus 94.8%; P = 0.015).

Conclusion

Students indicated high satisfaction after attending the simulation sessions; however, OBGYN students were more satisfied compared to those studying internal medicine.

Comparison of knowledge and confidence between medical students as leaders and followers in simulated resuscitation

OBJECTIVES

To compare both the knowledge and self-reported confidence levels between medical students as the team leaders and followers in shock resuscitation simulation training.

METHODS

A cross-sectional study was conducted with all fifth-year medical students participating in a shock resuscitation simulation-based training between May 2017 and March 2018. The simulation class was a 3-hour session that consisted of 4 shock type scenarios as well as a post-training debriefing. Medical students were assigned into groups of 4-5 members, in which they freely selected a leader, and the rest filled the roles of followers. Of 139 medical students, 32 students were leaders. A 10-question pre-test and post-test determined knowledge assessment. At the end of the class, the students completed a 5-point Likert scale confidence level evaluation questionnaire. A t-test was applied to compare knowledge scores and confidence levels between the leaders and followers.

RESULTS

At the end of the class, the knowledge scores between the leaders (M=6.72, SD=1.51) and followers (M=6.93, SD=1.26) were not different (t₍₁₃₇₎= -0.81, p=0.42). In addition, the student confidence levels were also similar between the leaders (M=3.63, SD=0.55) and followers (M=3.41, SD=0.64) after training (t₍₁₃₇₎=1.70, p=0.09).

CONCLUSIONS

The knowledge and confidence levels were not different between either the leaders or followers in simulated resuscitation. With time-limit simulation training, we suggested every student may not need to fulfil the leadership role, but a well-designed course and constructive debriefing are recommended. Future studies should evaluate skills and longitudinal effects of the leader role.