Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence

The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study

BACKGROUND

Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology.

OBJECTIVE

This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students' NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students' experience in using VR-Hosp.

METHODS

A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews.

RESULTS

In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS.

CONCLUSIONS

The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice.

Simulation-based education for teaching aggression management skills to healthcare providers in acute healthcare settings: A systematic review

BACKGROUND

Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills.

OBJECTIVE

The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings.

METHODS

The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses.

RESULTS

Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes.

CONCLUSIONS

Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes.

REGISTRATION

PROSPERO Registration Number CRD42020151002.

TWEETABLE ABSTRACT

Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression.

Designing and Evaluating an Emotionally Responsive Virtual Patient Simulation

INTRODUCTION

Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact).

METHODS

The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital.

RESULTS

A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP.

CONCLUSIONS

The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface.

Ward-based in situ simulation: lessons learnt from a UK District General Hospital

INTRODUCTION

In situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS impact on teamwork, technical skill performance, healthcare staff perception and latent error identification during simulated medical emergencies.

MATERIALS AND METHODS

Unannounced ISS sessions (n=14, n=75 staff members) using a high-fidelity mannequin were conducted in medical, paediatric and rehabilitation wards at Stepping Hill Hospital (Stockport National Health Service Foundation Trust, UK). Each session encompassed a 15 min simulation followed by a 15 min faculty-led debrief.

RESULTS

The clinical team score revealed low overall teamwork performances during simulated medical emergencies (mean±SEM: 4.3±0.5). Linear regression analysis revealed that overall communication (r=0.9, p<0.001), decision-making (r=0.77, p<0.001) and overall situational awareness (r=0.73, p=0.003) were the strongest statistically significant predictors of overall teamwork performance. Neither the number of attending healthcare professionals, their professional background, age, gender, degree of clinical experience, level of resuscitation training or previous simulation experience statistically significantly impacted on overall teamwork performance. ISS positively impacted on healthcare staff confidence and clinical training. Identified safety threats included unknown location of intraosseous kits, poor/absent airway management, incomplete A-E assessments, inability to activate the major haemorrhage protocol, unknown location/dose of epinephrine for anaphylaxis management, delayed administration of epinephrine and delayed/absence of attachment of pads to the defibrillator as well as absence of accessing ALS algorithms, poor chest compressions and passive behaviour during simulated cardiac arrests.

CONCLUSION

Poor demonstration of technical/non-technical skills mandate regular ISS interventions for healthcare professionals of all levels. ISS positively impacts on staff confidence and training and drives identification of latent errors enabling improvements in workplace systems and resources.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study

OBJECTIVE

To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.

METHODS

33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g.

RESULTS

Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).

CONCLUSION

HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

Efficacy of the Gulu University Reproductive Health Simulation Training for final year medical students and interns: a before-and-after study

Background

Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country.

Objectives

The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda.

Design

A before-and-after study.

Methods

A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value <0.05 considered significant.

Results

A total of 153 participants were enrolled, the majority being males (78.4%, n = 120) and medical students (73.9%, n = 113). Among the 40 interns, 55% (n = 22) were doctors, 30% (n = 12) were midwives, and 15% (n = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) versus 49% (42-54%), with a median difference of 14% (8-23%), p < 0.001].

Conclusion

The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.

Virtual Reality and Simulation Videos as Effective Training Tools for Creating Safe and Inclusive Environments for Transgender People

BACKGROUND

University education is undergoing a paradigm shift towards active methodologies, such as virtual reality and training videos, which have proven to be valuable resources, especially in the health sciences. The scarcity of existing research on the topic prompted us to conduct this study, which seeks to measure the knowledge gained from the aforementioned tools by users, their level of satisfaction with them, and their perceived utility.

METHODS

This is a quasi-experimental intervention study analysing the impact of virtual objects as learning resources for undergraduate nursing students.

RESULTS

Fifty-four participants completed the training, yielding highly significant differences between their mean scores, with a high statistical power and a large effect size. A total of 85.46% of participants confirmed that the virtual resources helped them considerably to empathise with the experiences of trans people in healthcare settings. Students were comfortable using the virtual resources, very satisfied with the methodology employed, and would recommend the training received.

CONCLUSIONS

University teaching must adapt to meet the current legislations and changing health needs of society, and teaching staff must be prepared to implement new active teaching methodologies that make learning a more dynamic process. Considering these results, our study serves as a guide for other nursing educators who seek to promote inclusive healthcare regarding gender diversity. This study is not registered.

Comparison of simulation and video-based training for acute asthma

BACKGROUND

Emergency medicine is particularly well suited to simulation training. However, evidence for the efficacy of simulation-based medical training remains limited especially to manage high-risk cases such as acute asthma.

OBJECTIVE

The objective of our study was to compare the performance of high-fidelity simulation (HFS) and interactive video-case challenge-based training (IVC) for final-year medical students in the management of acute asthma.

METHODS

This was a prospective randomized controlled study conducted at the emergency department (ED) of Monastir University hospital ( Tunisia). 69 final-year medical students were randomized to HFS (n = 34) and IVC (n = 35) training on acute asthma topic. The study was conducted over a 1-week period. Efficacy of each teaching method was compared through the use of multiple-choice questionnaires (MCQ) before (pre-test), after (post-test) training and a simulation scenario test conducted 1 week later. The scenario was based on acute asthma management graded on predefined critical actions using two scores: the checklist clinical score (range 0 to 30), and the team skills score (range 0 to 16). Student satisfaction was also evaluated with the Likert 5 points scale. Two years after the post-test, both groups underwent a third MCQ testing to assess sustainability of knowledge.

RESULTS

There were no differences in age between groups. There was no statistically significant difference between the HFS and IVC groups pre-test scores (p = 0.07). Both groups demonstrated improvement in MCQ post-test from baseline after training session; the HFS MCQ post-test score increased significantly more than the IVC score (p < 0.001). The HFS group performed better than the IVC group on the acute asthma simulation scenario (p < 0.001). Mean checklist clinical score and mean team skills score were significantly higher in HFS group compared to IVC group (respectively 22.9 ± 4.8 and 11.5 ± 2.5 in HFS group vs 19.1 ± 3 and 8.4 ± 3.1 in IVC group) (p < 0.001). After 2 years, MCQ post-test scores decreased in both groups but the decrease was lower in HFS group compared to the IVC group.

CONCLUSION

High-fidelity simulation-based training was superior to interactive video-case challenge for teaching final year medical students,and led to more long-term knowledge retention in the management of simulated acute asthma patients.

TRIAL REGISTRATION

The study was registered at www.

CLINICALTRIALS

gov NCT02776358 on 18/05/2016.

Effect of video on satisfaction and self-confidence in simulation training: a randomized clinical trial

OBJECTIVES

to identify the effect on satisfaction and self-confidence of undergraduate nursing students after using a validated bed bath video during the simulation.

METHODS

blinded parallel randomized clinical trial. Participants were allocated to the control group (simulation with tutor) or intervention (simulation with video). After the interventions, the Student Satisfaction and Self Confidence with Learning Scale was used to assess satisfaction and self-confidence. The study was approved by the Ethics Committee and Brazilian Registry of Clinical Trials. Mann Whitney, Fisher Exact and Student t statistical tests were used. A significance level of 5% was adopted. Results: fifty eight students (30, control; and 28, intervention) were evaluated. There was no significant difference between the groups regarding satisfaction (p=0.832) and self-confidence (p>0.999).

CONCLUSIONS

satisfaction and self-confidence were similar between the groups, and the two strategies could be used in the simulated practice of bed bathing.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

Clinical dyspnea scenario: Using high-fidelity situation simulation teaching program to evaluate learning effectiveness for clinical junior and pre-clinical nurses

Background

Confronting a patient's breathing difficulties, clinical junior nurses often do not know how to respond, and fail to give proper evaluation and treatment. Sudden changes in the condition make the clinical nursing novices feel pressured, and even, frustrated.

Objectives

This study aims at exploring the effectiveness of the high-realistic situational simulation of dyspnea teaching program for pre-clinical and clinical 1^st year nurses after graduation.

Design

This study adopts a quasi-experimental repeated measure pre-post-test design study with nonequivalent control group pre- and post-test research design. A total of 135 subjects participated in the research: nurses, post graduate year (NPGY) (N = 69), have been employed in the adult ward of a medical center for less than 1 year; and pre-clinical nurses (N = 66), 3rd-year nursing students with nurse licenses from a university in the central part of Taiwan. Simulation-based education instructed and incorporated into the high-realistic situation simulation dyspnea teaching program. Questionnaires were used to measure the effectiveness of learning, data were analyzed with SPSS version 20.0, and the scores were repeatedly measured with the generalized estimating equation.

Results

For "cognition, skills, attitude, self-efficacy, teamwork," NPGY and pre-clinical nurses' post-tests are better than pre-tests, with statistically significant results. NPGY nurses' "skills," "attitude" and "teamwork" learning effectiveness are better than those of the pre-clinical nurses.

Conclusion

The high-realistic situational simulation of dyspnea teaching program can significantly improve the learning effectiveness of NPGY nurses and pre-clinical nurses in the clinical evaluation and treatment of dyspnea.

Visualization in Anatomy Education

In the post-pandemic era, one of the significant challenges for anatomy teachers is to reciprocate the experience of practical exposure while teaching the subject to undergraduates. These challenges span from conducting cadaveric dissections to handling real human bones, museum specimens, and tissue sections in the histology lab. Such exposures help the instructors to develop interactive communication with their fellow students and thus help to enhance communication skills among them. Recently, anatomy teachers all over the world started using cutting-edge educational technologies to make teaching-learning experiences for students more engaging, interesting, and interactive. Utilizing such cutting-edge educational technologies was an "option" prior to the pandemic, but the pandemic has significantly altered the situation. What was previously an "option" is now a "compulsion." Despite the fact that the majority of medical schools have resumed their regular on-campus classes, body donation and the availability of cadavers remain extremely limited, resulting in a deadlock. Anatomy teachers must incorporate cutting-edge educational technologies into their teaching and learning activities to make the subject more visual. In this chapter, we have attempted to discuss various new technologies which can provide a near-realistic perception of anatomical structures as a complementary tool for dissection/cadaver, various visualization techniques currently available and explore their importance as a pedagogic alternative in learning anatomy. We also discussed the recent advancement in visualization techniques and the pros and cons of technology-based visualization. This chapter identifies the limitations of technology-based visualization as a supplement and discusses effective utilization as an adjunct to the conventional pedagogical approaches to undergraduate anatomy education.

Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference?

Background

In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management.

Methods

To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training.

Results

The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment.

Conclusion

Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.

The role of artificial intelligence in surgical simulation

Artificial Intelligence (AI) plays an integral role in enhancing the quality of surgical simulation, which is increasingly becoming a popular tool for enriching the training experience of a surgeon. This spans the spectrum from facilitating preoperative planning, to intraoperative visualisation and guidance, ultimately with the aim of improving patient safety. Although arguably still in its early stages of widespread clinical application, AI technology enables personal evaluation and provides personalised feedback in surgical training simulations. Several forms of surgical visualisation technologies currently in use for anatomical education and presurgical assessment rely on different AI algorithms. However, while it is promising to see clinical examples and technological reports attesting to the efficacy of AI-supported surgical simulators, barriers to wide-spread commercialisation of such devices and software remain complex and multifactorial. High implementation and production costs, scarcity of reports evidencing the superiority of such technology, and intrinsic technological limitations remain at the forefront. As AI technology is key to driving the future of surgical simulation, this paper will review the literature delineating its current state, challenges, and prospects. In addition, a consolidated list of FDA/CE approved AI-powered medical devices for surgical simulation is presented, in order to shed light on the existing gap between academic achievements and the universal commercialisation of AI-enabled simulators. We call for further clinical assessment of AI-supported surgical simulators to support novel regulatory body approved devices and usher surgery into a new era of surgical education.

Effectiveness of high- and low-fidelity simulation-based medical education in teaching cardiac auscultation: a systematic review and meta-analysis

Simulation-based medical education (SBME) is an evolving method of teaching cardiac examination skills to healthcare learners. It has been deliberated how effective this teaching modality is and whether high-fidelity methods are more effective than low-fidelity methods. This systematic review aimed to assess the effectiveness of high-fidelity SBME in teaching cardiac auscultation compared with no intervention or another active teaching intervention (low-fidelity SBME) using evidence from randomized controlled trials (RCTs).

Literature searches were performed on Medline, Embase, PsychInfo and Cinahl. RCTs that compared the effectiveness of high-fidelity simulation against no intervention or high-fidelity simulation against low-fidelity simulation in teaching cardiac auscultation to healthcare learners were included. Outcomes were knowledge, skills and satisfaction relating to cardiac auscultation education. Data were analyzed using Review Manager 5.3 software.

Seventeen RCTs (n = 1055) were included. Twelve RCTs (n = 692) compared high-fidelity simulation with no intervention. The pooled effect sizes for knowledge and skills were 1.39 (95% confidence interval [CI], 0.39–2.38;

This review’s findings suggest that high-fidelity SBME is an effective teaching method for cardiac auscultation education. Interestingly, there was no significant difference in knowledge or skills among learners when comparing high-fidelity simulation with low-fidelity simulation. Further research is needed to establish the effectiveness of different forms of SBME as educational interventions.

Efficacy of a theoretical and practical programme to newly hired nursing personnel in a Paediatric Intensive Care Unit: A pilot study

AIMS

(1) to design a training programme for newly hired nursing personnel and (2) to determine self-perception and perceived stress before and after the theoretical and practical parts of the programme with high fidelity simulation activities.

METHODS

A pilot quasi-experimental pretest-posttest study without control group conducted in a Paediatric Intensive Care Unit from October 2018 to April 2019 was conducted. A newly hired nursing personnel training programme was first designed and delivered. Later, the participants' self-perception was assessed, as well as their perceived stress and grade of satisfaction using two different Likert scales.

RESULTS

A total of 20 newly hired nurses participated in the study, 90% (n = 18) were female with a median age of 25.5 ± 4.53 years. Higher scores were obtained in participants' self-perception before and after the theoretical training. Lower significant median scores of the participants' stress perception were found (6.9 ± 1.57 versus 5.6 ± 1.794). In the practical part of the programme, we obtained higher scores in all items, as well as lower median scores in stress perception (6.4 ± 1.73 versus 5.6 ± 1.93).

CONCLUSIONS

A theoretical and practical programme for newly hired nursing personnel in a Paediatric Intensive Care Unit improved participants' self-perception and reduced their perceived median scores in stress levels.

Assessing non-technical skills in undergraduate nursing students: a validation study

OBJECTIVES

Non-technical skills (NTS) are fundamental to the nursing profession to ensure safe, quality care. Purpose: The aim of this study was to develop a new instrument to assess NTS among nursing students: the Non-Technical Skills Student Evaluation (NTS-SE) tool.

METHODS

A cross-sectional study was conducted to test the psychometric properties of the tool. A number of 1,087 nursing students were enrolled from five Bachelor Schools of Nursing.

RESULTS

Exploratory and confirmatory factor analysis suggested the suitability of a two-factor model. The final version of the NTS-SE consisted of 23 items distributed in two domains: cognitive skills and interpersonal skills. For each domain, Cronbach's alpha coefficients were above 0.94. There were significant differences in scores between second- and third-year students (p<0.001) and among the different nursing schools (p<0.001).

CONCLUSIONS

The NTS-SE can be useful when assessing the effect of educational strategies and/or clinical traineeship experiences on the acquisition of NTS.

High-fidelity simulation in undergraduate nursing education: A meta-analysis

OBJECTIVES

To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021.

REVIEW METHODS

The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I².

RESULTS

Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown.

CONCLUSIONS

High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

Objective and Subjective Stress Parameters in Response to High and Low-Fidelity Simulation Activities

Nursing graduates are required to have both excellent theoretical and practical skills that should be used during stressful emergency interventions. Since the received knowledge should be practiced to gain skills and trained to achieve competences, simulation exercises can be beneficial to even reduce the stress that each individual may face during emergency management of patients. A total of 146 first-year nursing students participated in the study, including 124 women and 22 men aged between 19 and 50 years, with a mean age of 32 years. The objective method estimated psychophysiological parameters (serum cortisol). Objective and subjective methods were used. The subjective method assessed stress experienced by students based on the standardized Stress Appraisal Questionnaire Version B for dispositional assessment. The study was conducted in the Monoprofile Medical Simulation Centre at the University of Economics and Innovation in Lublin, Poland and was approved by the University Research Ethics Committee. Both participants under and over 25 years of age showed increased levels of stress after low and high-fidelity simulations, with statistically significantly higher stress levels found for the low fidelity method. Low-fidelity simulation methods generated a greater increase in cortisol levels, indicating a higher stress level than the high-fidelity methods. The analysis of the scores obtained in the Stress Appraisal Questionnaire (KOS-B) showed that higher cortisol levels after the low-fidelity simulation reduced the subjective perception of a threat, while higher cortisol levels before the high-fidelity simulation promoted higher intellectual activity among the students. Levels of stress in the education of nursing students using low and high-fidelity methods can limit the sense of threat and activate professional task performance. The use of low and high-fidelity simulation does not generate destructive stress levels.

What do I take home after the simulation? The importance of emergent learning outcomes in clinical simulation

BACKGROUND

Clinical simulation learning includes a debriefing after the simulated experience. Debriefing consists of several stages. In this work we focus on the last stage (summary or transfer phase), in which the participants present the most relevant of what they learned during the session.

OBJECTIVES

To analyze the perception of 4th year Nursing Degree students on the most significant aspects they learned during the simulation sessions.

METHOD

A qualitative, cross-sectional and descriptive study was conducted, with students in their last year of the Nursing Degree at the Catholic University of Murcia. The opinions of 67 students from 5 groups, on the debriefing phase, were analyzed, by comparing them with the objectives that were initially proposed during the design of the scenarios used in the simulations.

RESULTS

A total of 78 clinical scenarios were analyzed, with 292 pre-established learning objectives, on a total sample of 67 students. The participants provided a total of 464 learning outcomes that were significant for them, of which 101 coincided with those that were initially planned (21.8%), while the rest, 363 (78.2%), were considered emergent (not planned a priori). For the most part, the learning outcomes described by the students were technical knowledge and/or skills (70.5%), as compared to non-technical knowledge and/or skills (29.5%).

CONCLUSION

For the most part, the learning outcomes considered by the students to be significant did not correspond with the objectives set a priori in the design of the scenarios. Most were emergent elements, especially those that referred to the technical knowledge and skills. The emergent knowledge must be considered crucial by the educators for the teaching and training of students.

Dose-Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students' Learning Outcomes: An Italian Multimethod Study

Background: The best application modality of high-fidelity simulation in graduate critical care nursing courses is still rarely investigated in nursing research. This is an important issue since advanced nursing skills are necessary to effectively respond to critically ill patients' care needs. The aim of the study was to examine the influence of a modified teaching model based on multiple exposures to high-fidelity simulations on both the learning outcomes and the perceptions of graduate students enrolled in a critical care nursing course. Methods: A multimethod study involving a sample of graduate critical care nursing students was conducted. A theoretical teaching model focused on multiple exposures to high-fidelity simulations is currently applied as a teaching method in an Italian critical care nursing course. According to the Kirkpatrick model for evaluating training programs, the performance, self-efficacy, and self-confidence in managing critically ill patients were considered learning outcomes, while satisfaction with learning and students' lived experiences during the experimental phases were considered students' perceptions. Results: Multiple exposures to high-fidelity simulations significantly improved performance, self-efficacy, and self-confidence in managing virtual critically ill patients' care needs. The satisfaction level was high, while lived experiences of participants were positive and allowed for better explanation of quantitative results of this study. Conclusions: Multiple exposures to high-fidelity simulations can be considered a valuable teaching method that can improve the learning outcomes of graduate nurses enrolled in an intensive care course.

Low-Fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies

PURPOSE

To identify and appraise evidence assessing the effectiveness of low-fidelity arthroscopic simulation in the acquisition of arthroscopic surgical skills in a novice population.

METHODS

Four databases were electronically searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies, and review studies were excluded. Risk of bias assessment was conducted using the Cochrane Collaboration's Risk of Bias Tool or the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) checklist.

RESULTS

Sixteen studies were identified. Using the PRISMA algorithm, 6 studies were included with a total of 131 novice participants. Individual studies ranged from 8 to 40 novices and were of Level I to II evidence. Outcome measurements varied between studies (total 16 different outcomes used). Various outcome measures used for assessing arthroscopic surgical skills within all 6 studies demonstrated significant improvement. A cross-study subjective outcome synthesis revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (2 studies, P < .05), increased Arthroscopic Surgical Skill Evaluation Tool scores (2 studies, P < .01), and confirmed face validity (2 studies) and transfer of skills to cadavers (2 studies) or live patients (1 study). Cost data were under-reported in all studies apart from one.

CONCLUSIONS

Arthroscopic training using low-fidelity simulators likely improves the performance of novice participants in completing basic arthroscopic procedures. These simulators may also be more cost effective and thus more implementable than their high-fidelity counterparts.

LEVEL OF EVIDENCE

Level II, systematic review of Level I-II studies.

Simulation training and professional self-confidence: A large-scale study of third year nursing students

BACKGROUND

While hands-on training is a prerequisite for successful education of nursing students, constraints on clinical training availability and quality have increased focus on effects of in-school simulation training. However, existing research has produced inconsistent conclusions and the literature lacks high-powered evidence from controlled trials.

OBJECTIVES

To test effects of a simulation scheme on student professional self-confidence in technical and non-technical skills, as well as to investigate effects on knowledge acquisition and interaction with clinical training.

DESIGN

Field experiment, treatment is a three + two day simulation training scheme while control is a standard three hour simulation session. Self-confidence in a list of technical and non-technical skills is measured in three survey-rounds. Enriched with data on type of clinical training site and grade attainment.

SETTING

University College Copenhagen Department of Nursing, all third year students in 2019.

PARTICIPANTS

352 in cohort, out of which 316 participated and 311 answered first survey round (163 in treatment, 148 in control).

METHODS

Field experiment analyzed utilizing multivariate OLS regression analysis.

RESULTS

Students who receive increased simulation training report markedly higher levels of professional self-confidence immediately after training. This effect is double the size for confidence in technical skills, compared to non-technical skills. The effects on self-confidence in technical skills persist at the end of the following semester for those that receive low intensity clinical training. Students who receive the treatment see a small (and statistically uncertain) relative increase in grade attainment in the semester of treatment, but this difference dissipates over time.

CONCLUSIONS

Simulation training has substantial positive short-term effects for the professional self-confidence of nursing students and appears to have small positive effects on knowledge acquisition. Most of these effects are crowded out by other factors (notably intensive clinical training) over time but might have long-term positive effects for those that do not receive other intensive hands-on experiences. This is interpreted as an indication that simulation training can be used to compensate for uncertainties in providing sufficient training experiences outside of academic training.

Training with High Fidelity Simulation in the Care of Patients with Coronavirus-A Learning Experience in Native Health Care Multi-Professional Teams

The training of emergency and intensive care teams in technical and non-technical skills is fundamental. The general aim of this study was to evaluate the training of various professional teams with simulations based on the care of COVID-19 patients using Zone 3 simulations (native emergency medical services and intensive care units-ICU teams) in the Region of Murcia (Spain). A mixed pilot study was designed (qualitative/quantitative) comprised of three phases: Phase 1: detection of needs (focus groups), Phase 2: design of simulation scenarios, and Phase 3: training with high-fidelity simulation and evaluation of competences. The results were used to determine the real training needs of these health professionals, which were used to design four simulation scenarios in line with these needs. The team competences were evaluated before and after the training session, with increases observed after the training sessions, especially in non-technical skills such as communication. Training with zone 3 simulation, with multi-professional native emergency and intensive care teams who provided care to patients with coronavirus was shown to be an effective method, especially for training in non-technical skills. We should consider the training needs of the professionals before the start of any training program to stay one-step ahead of crisis situations.

Clinical Decision-Making in Nursing Scale (CDMNS-PT©) in nursing students: translation and validation

OBJECTIVES

to validate, for the Portuguese population, the Clinical Decision-Making Nursing Scale© (CDMNS©).

METHODS

this methodological study involved 496 nursing students who filled in a questionnaire created using sociodemographic and academic data, and the scale to evaluate the making of decisions in nursing.

RESULTS

the confirmatory factorial analysis showed that the adjustment of the factorial structure has good quality, being made up by three factors (X2/gl = 2.056; GFI = 0.927; CFI = 0.917; RMSEA = 0.046; RMR = 0.039; SRMR = 0.050). For the scale to be reliable, it had to include only the reliability of the scale required it to be constituted by 23 items, with correlation values that varied from 0.184 and 0.610, and a global Cronbach's Alpha of 0.851, which showed its good reliability.

CONCLUSIONS

the CDMNS-PT© is valid and reliable, showing a high potential to be used in clinical practice and investigation.

Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

The lived experiences of intensive care nursing students exposed to a new model of high-fidelity simulation training: a phenomenological study

BACKGROUND

In postgraduate intensive care nursing courses, high-fidelity simulation is useful to prepare students to guarantee safe and quality care of critically ill patients. Surprisingly, this issue has not attracted sufficient attention in the literature, and it is not clear whether the linear application of the traditional high-fidelity simulation method based on prebriefing, the simulation session and debriefing, can serve as empirical reference in postgraduate students' education. The aim of this study was to investigate the lived experiences of postgraduate students receiving multiple exposures to an innovative high-fidelity simulation design based on Kolb's Experiential Learning Theory.

METHODS

A phenomenological study was conducted at an Italian University involving a purposive sample of 15 nursing students attending the postgraduate intensive care course. Audio-recorded face-to-face in-depth interviews were held by a researcher in a dedicated room complemented with non-verbal communication outlined in the field notes. Thematic analysis was used to analyse the transcribed data.

RESULTS

Three themes and ten categories were derived from the data analysis. The themes included pragmatic learning experience, the emotional path, and confidence.

CONCLUSIONS

Multiple exposure to high-fidelity simulation was lived as a pragmatic learning experience enhancing the students' ability to apply theory into practice. This novel approach also contributed to the transition from negative to positive feelings and improved students' confidence about technical and non-technical skills when caring for a critically ill patient.

Mediating effects of stigma on the relationship between contact and willingness to care for people with mental illness among nursing students

BACKGROUND

Previous studies have demonstrated that contact positively impacts nursing students' willingness to care for people with mental illness. However, studies that have explored the mechanism of such a relationship between contact and willingness remain few.

OBJECTIVES

To examine the direct relationship between contact and nursing students' willingness to care for people with mental illness and to explore the potential mediating roles of stigma.

DESIGN

This was a cross-sectional study design.

SETTINGS

The study was conducted in a nursing school in Nanjing city, China.

PARTICIPANTS

A total of 839 nursing students were recruited in the study through convenience sampling.

METHODS

Nursing students' stigma, contact, and willingness to care for people with mental illness were measured online through the Stigma toward People with Mental Illness Scale (SPMI), the Level of Contact Report, and one item of "which degree indicates your willingness to provide care for people with mental illness," respectively. The structural equation model was applied to explore the potential mediating roles of stigma.

RESULTS

Contact with people suffering from mental illness directly affected nursing students' willingness to care for them (β = 0.076, p < 0.05). Meanwhile, stigma partly mediated the effect of students' contact on willingness to care for people with mental illness (β = 0.048, p < 0.05).

CONCLUSIONS

High level of contact can improve nursing students' willingness to care and the relationship is partly mediated by stigma. Measures to improve the level of contact and reduce stigmatizing attitudes of nursing students are accordingly essential in influencing them to have more willingness to care for people with mental illness.

High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences

Background

Simulation technology is widely used in medical education, providing an environment in which students can develop and practise a multitude of skills that are relevant to clinical practice, without the risk of harm to patients.

Methods

We conducted a mixed methods cross-over study with quantitative and qualitative outcomes. This analysed students’ perceptions of two simulation technologies: a high-fidelity patient simulator and virtual reality. Twenty final year medical students completed a questionnaire after having experienced both simulation modalities.

Results

Students scored the patient simulator higher in domains such as developing team working and ‘ABCDE assessment skills’, whereas the virtual reality simulation was more immersive and fun. Participants found the patient simulator more useful in preparing them for clinical practice.

Conclusion

Medical students in this study expressed that a high-fidelity patient simulator, in a simulated clinical environment, was of greater value to their preparation for clinical practice than virtual reality simulation of a similar environment. However, the virtual reality simulation offered a near comparable experience, and was found to be was enjoyable, immersive and easily portable.

Implementation of Innovative Educational Technologies in Teaching of Anatomy and Basic Medical Sciences During the COVID-19 Pandemic in a Developing Country: The COVID-19 Silver Lining?

This article is a descriptive and reflective piece on the strategic adaptations that facilitated and enabled the teaching of anatomy and related basic medical sciences to medical students in an African medical school that never shut down during the COVID-19 induced lockdown of the year 2020. The article considers the roles of educational technology, innovations, media and how these were used to achieve learning objectives with optimal outcomes during the lockdown. Specific technologies and innovations including the Anatomage Table, Complete 3D Anatomy software, and the use of High-Fidelity Mannequin were deployed to facilitate effective teaching of anatomy and related basic medical sciences. This was aided by the robust use of a learning management system - Canvas, as well as internet facility for connection, videoconferencing, online sessions and online-based assessment in a strategically organised manner. This system was dynamic enough to respond to changes in COVID-19 related government policies including the lockdown and social distancing-related adjustments in the physical settings. The outcome was that the teaching of medical students did not stop, and optimal results were achieved. The article considers the roles of educational technology and innovations as well as the media and how these were used to achieve learning objectives with optimal outcomes during the lockdown. It is believed that this experiential piece would inspire and inform other medical schools on the benefit of building robustly dynamic medical school systems as well as the use of innovations in times of challenges. The article also considers both the limitations and benefits of technology in teaching anatomy. Very importantly, specific tools, innovations, and technologies were considered as used, and the information provided might be a guide for other potential users. Ultimately, the lesson learned would be of use to us and we believe we could also benefit many others.

Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement Project

BACKGROUND

The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning.

OBJECTIVES

This quality improvement project was designed to implement a post-cardiac surgery resuscitation protocol in a nonacademic, community medical center to enhance nurse knowledge, confidence, and proficiency for optimal patient outcomes.

METHODS

The Cardiac Surgical Unit-Advanced Life Support is an evidence-based resuscitation protocol that was implemented using didactic, hands-on training, and SBL. It was evaluated using knowledge surveys, comparisons in nurse confidence and performance measures, and patient outcomes data.

RESULTS

Nurses' knowledge gains (ie, mean test scores) on our test were statistically significant between 3 time points (F2,60 = 81.204, P < .001). Knowledge significantly increased from pre-education to immediate post-education (P < .001), but declined from immediate post-education to 3-month post-education assessments (P < .001); however, the 3-month post knowledge mean was still higher than the pre-education knowledge mean (P < .001). Nurses were confident in their ability to apply the protocol, although results failed to show a correlation between confidence and performance ability. Statistical significance for delay in cardiopulmonary resuscitation was found between pre- and post-nursing education patient cardiac arrest events (P = .05).

CONCLUSIONS

Didactic and hands-on learning supported knowledge retention over time for cardiothoracic surgical intensive care unit nurses. Improving self-confidence and the application of an unfamiliar resuscitation protocol through SBL and any impact a training program has on patient outcomes will require ongoing practice and more evaluation.

Professional Nursing Communication Competence: Theoretical procedures for instrument development and pilot test

AIMS

To describe the theoretical procedures for the development of the Professional Nursing Communication Competence instrument, determine the content validity and describe the pilot test application.

BACKGROUND

Measuring instruments must be developed in accordance with the context and communication process by adopting theoretical procedures based on competence structures to support quality patient-centred care and nursing management.

METHODS

A methodological study was employed. The instrument was developed by using content-validated theoretical construct in accordance with 33 communication theories followed by semantic analysis and content validity by experts. The instrument was tested over three phases: before the lecture on professional nursing communication competence, after the simulation scenario experience and after debriefing.

RESULTS

The instrument showed an extremely high agreement (CVI = 0.99). Linear regression suggested three domains of the 46-item content-validated instrument comprising knowledge (18 items), skills (12 items) and attitudes (16 items).

CONCLUSION

The instrument was found to measure professional communication competence with a high theoretical reliability of the contexts and processes through a simulation strategy.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing educators, managers and staff can adopt the Professional Nursing Communication Competence (IMC-CPE) instrument to improve the effectiveness level of knowledge, skills and attitudes to reduce misunderstanding among team members and health care errors.

[Blended Learning in Critical Care to Improve Quality of Care the ERIC-Training]

Communication and teamwork skills are, besides clinical knowledge, key components of high quality care in modern intensive care units. In light of high staff fluctuations among intensive care unit teams and disparities in clinical experience, an ongoing training is essential to ensure optimal performance in stressfull situations. Further, when implementing new procedures, an adequate concept for staff education is of utmost importance. Blended learning is a novel approach, combining autonomous web-based education and on-site workshops in order to improve the training process. Enhanced Recovery after Intensive Care (ERIC) is a newly developed telemedical intervention targeted at improving evidence-based practice in critical care, guided by quality indicators defined by the German Interdisciplinary Society of Emergency and Critical Care Medicine (DIVI). This telemedical intervention is supplemented with a blended-learning concept combining an e-learning website, simulator-based workshops and on-site training in order to expand the knowledge and practical skills regarding adherence to the quality indicators.

Health Care Providers' Performance, Mindset, and Attitudes Toward a Neonatal Resuscitation Computer-Based Simulator: Empirical Study

BACKGROUND

Neonatal resuscitation involves a complex sequence of actions to establish an infant's cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leaves health care providers (HCPs) less prepared to respond appropriately and efficiently when they do occur. Computer-based simulators are increasingly used to complement traditional training in medical education, especially in the COVID-19 pandemic era of mass transition to digital education. However, it is not known how learners' attitudes toward computer-based learning and assessment environments influence their performance.

OBJECTIVE

This study explores the relation between HCPs' attitudes toward a computer-based simulator and their performance in the computer-based simulator, RETAIN (REsuscitation TrAINing), to uncover the predictors of performance in computer-based simulation environments for neonatal resuscitation.

METHODS

Participants were 50 neonatal HCPs (45 females, 4 males, 1 not reported; 16 respiratory therapists, 33 registered nurses and nurse practitioners, and 1 physician) affiliated with a large university hospital. Participants completed a demographic presurvey before playing the game and an attitudinal postsurvey after completing the RETAIN game. Participants' survey responses were collected to measure attitudes toward the computer-based simulator, among other factors. Knowledge on neonatal resuscitation was assessed in each round of the game through increasingly difficult neonatal resuscitation scenarios. This study investigated the moderating role of mindset on the association between the perceived benefits of understanding the terminology used in the computer-based simulator, RETAIN, and their performance on the neonatal resuscitation tasks covered by RETAIN.

RESULTS

The results revealed that mindset moderated the relation between participants' perceived terminology used in RETAIN and their actual performance in the game (F3,44=4.56, R2=0.24, adjusted R2=0.19; P=.007; estimate=-1.19, SE=0.38, t44=-3.12, 95% CI -1.96 to -0.42; P=.003). Specifically, participants who perceived the terminology useful also performed better but only when endorsing more of a growth mindset; they also performed worse when endorsing more of a fixed mindset. Most participants reported that they enjoyed playing the game. The more the HCPs agreed that the terminology in the tutorial and in the game was accessible, the better they performed in the game, but only when they reported endorsing a growth mindset exceeding the average mindset of all the participants (F3,44=6.31, R2=0.30, adjusted R2=0.25; P=.001; estimate=-1.21, SE=0.38, t44=-3.16, 95% CI -1.99 to -0.44; P=.003).

CONCLUSIONS

Mindset moderates the strength of the relationship between HCPs' perception of the role that the terminology employed in a game simulator has on their performance and their actual performance in a computer-based simulator designed for neonatal resuscitation training. Implications of this research include the design and development of interactive learning environments that can support HCPs in performing better on neonatal resuscitation tasks.

Use of high-fidelity simulation technology in disasters: an integrative literature review

New innovative high‐fidelity simulation (HFS) technologies, including augmented reality and virtual reality, have begun being used for disaster response and preparedness. However, few studies have assessed the merit of these technologies in disaster simulation. This integrative literature review of 21 studies assesses the role of HFS technology in disaster. Most studies used a quantitative methodology (71.4%), followed by mixed (19%) or qualitative methods (9.6%). Nearly 60% covered only disaster preparedness phase, whereas 10% addressed disasters in middle‐income countries without including low‐income nations. The four most frequently mentioned technologies were immersive virtual reality simulation, computerized virtual reality simulation, full‐scale simulation, and augmented reality wearable smart glasses simulation. Nearly 50% of the studies used technology for purposes other than disaster simulation education, including telemedicine (14.3%), risk planning (14.3%), high‐risk map generation for preparedness purposes (9.5%), or rehabilitation medicine (4.8%). HFS technologies must be further evaluated outside of high‐income countries and in different disaster phases to better understand their full potential in disaster simulation. Future research should consider different health professions and more robust protocols to assist disaster response professionals and agencies in the adoption of HFS technologies.

The Use of in situ Simulation in Healthcare Education: Current Perspectives

In situ simulation is the practice of using simulated scenarios in a clinical environment itself rather than in training facilities to promote learning and improved clinical care. The use of in situ simulation has been increasingly used to train healthcare staff in dealing with emergencies, resuscitation and clinical skills. The aim of this study is to provide an overview of the themes, perspectives and approaches to in situ simulation for educational purposes with healthcare staff. The literature search included studies describing and evaluating in situ simulations with an educational component. We carried out a narrative synthesis and extracted data on the clinical setting, the simulation purpose, design, evaluation method and impact. In situ simulation has proved useful in a range of different specialties for skills improvement and team development. Simulation design ranges in terms of fidelity, duration and topic. No specific design has shown to be the most efficient. However, adopting a design that fits into the specific centers resources, educational needs and clinical demands is the most important consideration.

Communication skills training using virtual reality: A descriptive qualitative study

BACKGROUND

Modern medical pedagogical strategies are shifting toward the use of virtual patient simulations.

OBJECTIVE

This study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training.

DESIGN

A descriptive qualitative study design was used.

SETTING

Nursing faculty at a local university in Singapore.

PARTICIPANTS

24 nursing undergraduates and six clinical facilitators.

METHODS

This study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Two overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled 'value of technology in teaching communication' comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills.

CONCLUSION

The mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula.

A guide to curriculum inquiry for brachytherapy simulation-based medical education

PURPOSE

Brachytherapy is a required clinical competency within radiation oncology training but decreased utilization and volume have limited trainee exposure. Simulation-based medical education is an established educational tool that allows learners to engage in higher-order learning in a safe space and has unique application in brachytherapy instruction.

METHODS AND MATERIALS

We reviewed best practices in curriculum development for simulation-based medical education in brachytherapy, current works in brachytherapy simulation, and identify areas for future development.

RESULTS

The systematic curriculum inquiry method as it relates to brachytherapy was described using the "six-step approach" of problem identification and general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation and feedback. Best practices in simulation identified several features of effective learning, including feedback, repetitive practice, and curriculum integration. A review of current simulation-based medical education brachytherapy publications revealed five manuscripts to date with a focus on feasibility across a variety of disease sites, including the prostate, cervical, breast, and head and neck. Potential areas of future development include curricular quality improvement, long-term outcomes, objectives that scale to the learner's competencies, and expansion beyond psychomotor skills.

CONCLUSIONS

Brachytherapy is an essential modality in radiation oncology. Simulation-based medical education provides a powerful opportunity to improve brachytherapy training effectively.

Successful Implementation of a Novel Collaborative Interprofessional Educational Curriculum for Nurses and Residents in a Pediatric Acute Care Setting

Interprofessional collaboration is vital to maintain a successful healthcare team. We describe the development, implementation, and evaluation of an interprofessional educational curriculum on a large inpatient, acute care pediatric unit. Our objective was to improve attitudes towards collaborative care and collegial relations between staff nurses and pediatric medical residents. Nurses and residents participated in several interventions including a video for the nurses, a video for the residents, a team-building exercise, and three interprofessional clinical simulations. Participants' attitudes toward collaborative care were evaluated by a self-reported questionnaire, adapted from several validated survey instruments, before and after the intervention. Each question was mapped to one of the four domains of interprofessional practice: Teams and Teamwork, Interprofessional Communication, Values and Ethics for Interprofessional Practice, and Roles and Responsibilities. The National Database of Nursing Quality Indicators - Practice Environment Scale (NDNQI-PES) question on collegial nurse and physician relations was also queried to corroborate these findings. There was a statistically significant improvement in the nurses' response to 7/24 (29%) survey questions, of which 4 were within the domain of Teams and Teamwork. There was a statistically significant improvement in the residents' response to 5/24 (21%) questions, of which 3 fell within the domain of Interprofessional Communication. None of the survey questions demonstrated a statistically significant decrease. There was also an improvement on NDNQI-PES scores for the target unit, both during and immediately following the intervention. In conclusion, this educational curriculum involving nurses and residents led to improved participants' attitudes toward interprofessional collaboration.

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BACKGROUND

Critical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.

OBJECTIVES

The purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).

DESIGN

A quantitative causal-comparative methodology with a pretest/posttest design.

SETTING

A private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.

PARTICIPANTS

Baccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).

METHODS

This research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.

RESULTS

A repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).

CONCLUSIONS

The use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

BACKGROUND

An increasing number of incidents involving aggressive behaviour in acute care hospitals are being witnessed worldwide. Acute care hospital staff are often not trained or confident in managing aggression. Competent management of clinical aggression is important to maintain staff and patient safety. Training programmes for acute care staff are infrequently described in the literature and rarely reported for paediatric staff. Simulation training allows practice of skills without patient risk and may be more effective than traditional teaching formats for aggression management.

AIM AND DESIGN

The aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants' perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3-6 months following the simulation training.

FINDINGS

Nine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following the simulation training, 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2- or 3-point increase. At 3-6 months post-training, 66% of respondents (N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues.

CONCLUSIONS

Simulation training is an acceptable method of training and shows promise to improve staff-perceived confidence for managing behavioural emergencies in acute paediatric health care settings. In addition, there were potential enduring positive impacts at 3 months after the study. Whilst resource and time intensive, further research assessing the benefits of utilising simulation training in this setting is warranted in order to minimise staff burn-out and improve outcomes for these very vulnerable patients.

Creation and Implementation of a Large-Scale Geriatric Interprofessional Education Experience

The care of the older adult requires an interprofessional approach to solve complex medical and social problems, but this approach is difficult to teach in our educational silos. We developed an interprofessional educational session in response to national requests for innovative practice models that use collaborative interprofessional teams. We chose geriatric fall prevention as our area of focus as our development of the educational session coincided with the development of an interprofessional Fall Risk Reduction Clinic. Our aim of this study was to evaluate the number and type of students who attended a pilot and 10 subsequent educational sessions. We also documented the changes that occurred due to a Plan-Do-Study-Act (PDSA) rapid-cycle improvement model to modify our educational session. The educational session evolved into an online presession self-study didactic and in-person educational session with a poster/skill section, an interprofessional team simulation, and simulated patient experience. The simulated patient experience included an interprofessional fall evaluation, team meeting, and presentation to an expert panel. The pilot session had 83 students from the three sponsoring institutions (hospital system, university, and medical university). Students were from undergraduate nursing, nurse practitioner graduate program, pharmacy, medicine, social work, physical therapy, nutrition, and pastoral care. Since the pilot, 719 students have participated in various manifestations of the online didactic plus in-person training sessions. Ten separate educational sessions have been given at three different institutions. Survey data with demographic information were available on 524 participants. Students came from ten different schools and represented thirteen different health care disciplines. A large-scale interprofessional educational session is possible with rapid-cycle improvement, inclusion of educators from a variety of learning institutions, and flexibility with curriculum to accommodate learners in various stages of training.

Comparison of Flexible 3D Printed Stenotic Airway Model Versus Standard Model for Therapeutic Bronchoscopy Training a Proof of Concept

AIM

This study aimed to determine operator impressions of an airway obstruction procedure using a custom silicone model of low cost and high accuracy.

BACKGROUND

Current procedural education for therapeutic bronchoscopy relies on animal models, supervised in-patient training, and inanimate artificial models. Model manufacturing via lost-wax casting allows for the flexibility of the material selection and reproduction of complex airway shapes.

METHODS

A patient computed tomography scan was anonymized and segmented into a stereolithographic (STL) file. The water dissolvable interior airway mold was 3-dimensional (D) printed using polyvinyl alcohol and the exterior mold was printed with polylactic acid. Flexible silicone was injected into the mold. During advanced bronchoscopy courses (2017-2018) at Beth Israel Deaconess Medical Center, participants were asked to evaluate both standard bronchoscopy manikin and the manikin with 3D customization.

RESULTS

We evaluated 17 participants with different levels in training in the pulmonary field. All of them reported that they previously have performed >100 bronchoscopies, 88% having treated patients with airway stenosis. In total, 77% of participants thought the 3D model was better or much better for airway inspection when compared with Broncho-Boy. Overall, 94% of participants reported the 3D model was accurate or very accurate for realism. In total, 69% of trainees reported the overall experience as excellent. All of them reported 3D model would improve their skills on stent placement.

CONCLUSION

3D printing with silicone lost wax casting can be used to reproduce airway abnormalities for tactile simulation bronchoscopy. Reproducible custom airway models can be created for a relatively low cost.

Low-fidelity simulation of medical emergency and cardiac arrest responses in a suspected COVID-19 patient - an interim report

BACKGROUND

COVID-19 poses many challenges to healthcare systems and workers. Responding to medical emergencies in patients with suspected COVID-19 will require new guidelines and protocols. Simulation can support their development.

METHODS

We organised seven simulations involving patients with suspected COVID-19 for staff at Brighton and Sussex University Hospitals. Participants completed pre- and post-simulation questionnaires.

RESULTS

Fifty-six staff participated and they reported being significantly less prepared to respond to an emergency in a patient with suspected COVID-19 than in one in whom it is not suspected. The simulations significantly improved the participants' confidence in responding to emergencies in patients with suspected COVID-19. Numerous challenges were identified along the themes of equipment, personnel, communication and procedures.

CONCLUSIONS

Low-fidelity simulation can provide relevant and timely information on how prepared health systems and their workforce are to respond to emergencies. We urge NHS trusts nationally to implement simulations to identify problems and develop effective solutions.

Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis

STATEMENT

We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.