Medical Simulation: The Least Advertised and Most Versatile Weapon in Pandemic

Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual Battlefield Assisted Trauma Distributed Observation Kit (BATDOK)

INTRODUCTION

Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site handoffs. This is particularly important in the combat casualty care setting when a single casualty may be treated by four or more or five completely disparate teams across the roles of care. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the Air Force Research Laboratory to address this need. To support the deployment of this tool, we integrated BATDOK into a commercially available virtual reality (VR) medical simulation platform used by the U.S. Air Force and Defense Health Agency personnel in order to provide an immersive simulation training experience which included battlefield documentation.

METHODS

A multidisciplinary team consisting of medical educators, VR simulation engineers, emergency physicians and pararescuemen, and BATDOK developers first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives, critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available Virtual Advancement of Learning for Operational Readiness VR Medical Simulation System and underwent developmental testing and evaluation during pararescueman training exercises at the Air Force Special Operations Command Special Operations Center for Medical Integration and Development.

RESULTS AND CONCLUSIONS

The BATDOK capability was successfully implemented within the VR Medical Simulation System. The capability consisted of a virtual tablet with replicated interfaces and capabilities based on the developed specifications. These capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. The capability was found to be operational and in alignment with learning objectives and user acceptance goals.

Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study

BACKGROUND AND OBJECTIVE

Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission.

METHODS

A randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant-nurse teams and 12 resident-nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE.

RESULTS

There were significant differences in timing of PPV initiation (consultant-nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident-nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant-nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant-nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48).

CONCLUSIONS

In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.

TRIAL REGISTRATION NUMBER

NCT04666233.

Implementation of Interdisciplinary Province-Wide Webinar Series During the COVID-19 Pandemic by the Federation of Medical Specialists of Quebec (FMSQ): A Survey Study

Objectives: COVID-19 has forced a transformation in continuing professional development (CPD), shifting to virtual platforms. We report the results of a rapidly-implemented COVID-19 online interdisciplinary CPD webinar series. We aimed to determine if this virtual approach for large-scale CPD was relevant, appreciated, and effective for specialist physicians in Quebec.

Methods and Analysis: This was a retrospective descriptive online survey-based study. The weekly virtual educational webinars took place between March 3, 2020 to June 15, 2020, resulting in a total of 26 webinars over 16 weeks. The study included all individuals who attended any of the webinar sessions, namely specialist physicians and department chiefs. Number of participants and overall appreciation of webinar sessions were data points collected.

Results: Across all webinars, there were 8,500 unique specialist physicians which comprises 80.7% of the entire specialist practicing population in Quebec. Of note, every medical and surgical specialty was represented by attendance in at least one session. In total, 27,504 evaluation forms were completed out of all the sessions, meaning a 78.4% response rate. In post-webinar surveys, 97.6% of respondents agreed or strongly agreed that the webinars were pertinent to their practice and 94.6% agreed or strongly agreed that the presentation met their continuing professional needs.

Conclusions: This novel interdisciplinary COVID-19 webinar series is a successful and appreciated strategy to maintain CPD amidst a global pandemic. One year later, it has become a mainstay in our toolbox and we trust this unique model of large-scale interdisciplinary CPD via webinar sessions is useful in normal times as well as in times of crisis.

Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey

PURPOSE

The aim of this study was to investigate and compare the use of simulation-based technical skills training (SBTST) in the otolaryngology curriculum in different countries, and to explore the needs and opinions about the use of simulation among young otolaryngologists.

METHODS

An e-survey conducted among Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) members.

RESULTS

139 Yo-IFOS members from 51 countries completed the survey. During residency training, 82.7% of respondents have used SBTST on cadavers, 51.8% on physical simulators, and 43.8% on virtual reality simulators. High costs (65.5%), lack of availability (49.2%) and lack of time (25.5%) were the main barriers limiting the practice of SBTST. These barriers also limited teaching using simulation. Sinonasal surgery (72.7%), temporal bone surgery (67.6%), and head/neck surgery (44.6%) were significantly more frequently taught using SBTST than suspension microlaryngoscopy (25.9%) and pediatric surgery (22.3%) (p < 0.001). The procedures rated as the most important to learn through SBTST were tracheotomy (50.4%), emergency cricothyroidotomy (48.9%), and rigid bronchoscopy (47.5%). On an analogic visual scale (0-100) for the question "how important will simulation be for future ENTs in surgical training?", the mean score was 79.5/100 (± 23.3), highlighting the positive attitude toward the use of SBTST in otorhinolaryngology training.

CONCLUSION

SBTST is an attractive learning and teaching method in otorhinolaryngology, but associated costs, lack of access, and lack of time are the main barriers limiting its use. Emergency procedures are key technical skills to be learned using simulation but in some cases, lack relevant simulators for training.