Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students

OBJECTIVE

This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students.

METHODS

This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model.

RESULTS

The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner.

CONCLUSION

Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.

3D-Printed silicone anatomic patient simulator to enhance training on cardiopulmonary bypass

BACKGROUND

Simulator training is important for teaching perfusion students fundamental skills associated with CBP before they start working in the clinic. Currently available high-fidelity simulators lack anatomic features that would help students visually understand the connection between hemodynamic parameters and anatomic structure. Therefore, a 3D-printed silicone cardiovascular system was developed at our institution. This study aimed to determine whether using this anatomic perfusion simulator instead of a traditional "bucket" simulator would better improve perfusion students' understanding of cannulation sites, blood flow, and anatomy.

METHODS

Sixteen students were tested to establish their baseline knowledge. They were randomly divided into two groups to witness a simulated bypass pump run on one of two simulators - anatomic or bucket - then retested. To better analyze the data, we defined "true learning" as characterized by an incorrect answer on the pre-simulation assessment being corrected on the post-simulation assessment.

RESULTS

The group that witnessed the simulated pump run on the anatomic simulator showed a larger increase in mean test score, more instances of true learning, and a larger gain in the acuity confidence interval.

CONCLUSIONS

Despite the small sample size, the results suggest that the anatomic simulator is a valuable instrument for teaching new perfusion students.

High-fidelity simulation training improves resident knowledge of contrast reaction management, especially for junior residents

Rationale and objectives

Contrast reactions are rare but serious events, frequently managed independently by Radiology Residents, who are likely underprepared to lead the acute event response. At our tertiary care center, Radiology Residents are the first responders to contrast reaction scenarios, and previously had didactic only training. We sought to create a High-Fidelity Simulation Training, and to assess whether this improved resident knowledge in managing contrast reactions.

Materials and methods

In September of 2020, we administered a didactic only contrast reaction training to 20 residents, with an anonymous 20 question multiple choice pre- and post-test. In January of 2022, we administered a 4-hour, 4-station contrast reaction High-Fidelity Simulation Training to 22 residents, with the same 20 question multiple choice pre- and post-test.

Results

The average number of residents answering each question correctly did not significantly improve following the didactic only training (p = 0.116). Following high-fidelity simulation training, however, there was a significant improvement by a mean of 2.45 (p = 0.028), as well as a mean improvement in individual scores of 10.45% (p = 0.0001). Comparing junior and senior residents, there was a significant difference in pre-test scores, with senior residents scoring on average 9.67% better (p = 0.0364); however on post-test scores, there was no significant difference.

Conclusion

High-fidelity simulation training improves resident knowledge of contrast reaction management, and allows inexperienced junior residents to attain senior resident level proficiency in these high-stress scenarios.

Nurse educator knowledge, attitude and skills towards using high-fidelity simulation: A study in the vocational education sector

High-fidelity simulation has become an essential educational approach in nurse education globally. Several studies have explored the experience of undergraduate nursing students and educators with high-fidelity simulation; however, none have explored the experience of students in the vocational educational sector. The aim of the study was to explore nurse educators' knowledge, attitude and skills toward using high-fidelity simulation in the setting of vocational education. An anonymous on-line survey design was conducted at three campuses of a major Australian Technical and Further Education vocational education setting. Forty-eight nurse educators teaching into Diploma of Nursing program for at least six months were invited to participate, 29 participated in the study, a response rate of 60%. Participants expressed lack of knowledge in managing technological issues, simulation facilitation procedures and conducting scenarios. Most participants had positive attitude towards high-fidelity simulation and rated their skills as 'novice'. An urgent need for nurse educator training was identified to enhance knowledge and skills in technical and scenario management of high-fidelity simulation. A program of supportive mentoring by nurse educator mentors experienced in high-fidelity simulation, engaging with existing simulation associations, will enhance and sustain nurse educator knowledge, attitude and skills in a protected environment further, so that they can optimise training they provide to students for safe quality care of patients in the future.

Using simulation and electronic health records to train nursing students in prevention and health promotion interventions

BACKGROUND

Prevention and health promotion activities are key to reducing prevalence and halting the progress of many chronic diseases. Standardised patient simulation is a useful option for training nursing students in this area.

OBJECTIVE

To evaluate skills related to prevention and health promotion activities acquired by third-year nursing students through standardised patient simulation and electronic health records.

DESIGN

A descriptive, cross-sectional study.

SETTINGS

A nursing faculty at a public university.

PARTICIPANTS

The study population consisted of all third-year nursing students in the academic year 2017-2018 (N = 142).

METHODS

The students attended three seminars on health promotion and prevention activities in adults, involving standardised patient simulation and electronic health record use. Skill acquisition was then evaluated through clinical case simulation in a fourth seminar.

RESULTS

A total of 137 (96.5%) students participated in the study. The mean score for all cases evaluated was 6.76 (standard deviation 1.85) out of 10. The most frequent activities were greeting and self-introduction, checking vaccination status, assessing physical exercise and eating habits, and calculating body mass index. The least frequent activities were questions about high-risk sexual behaviour, drug use, bowel cancer screening and sun protection recommendations. When writing the nursing report, students found it hardest to plan future patient interventions. Also, 108 students made notes to set reminders of case-related activities.

CONCLUSIONS

Third-year nursing students acquire good skills in health promotion and prevention activities. Some activities requiring a greater degree of confidence with the patient need to be reinforced, such as investigating high-risk sexual behaviour and drug use. Reinforcement is also needed in activities that are encountered less often in clinical practice, such as sun protection recommendations and bowel cancer screening. The use of electronic health records in conjunction with simulation enhances self-study.

Low-Cost Stereotactic Brain Biopsy Simulation Model

OBJECTIVE

Simulation training improves technical skills in a safe environment. Stereotactic techniques are widely used in neurosurgery for different kinds of procedures. The objective of the study was to describe a combined cadaveric and synthetic low-cost stereotactic simulation model and its validation by neurosurgeons.

METHODS

The brain was made using self-supporting gel with solid and cystic lesions. We used imaging scans to calculate x, y, and z target coordinates. A standard frame needle biopsy was performed. We calculated the number of mistakes and time needed to accomplish the task, and we evaluated the frame assembly and biopsy performance. Wilcoxon signed rank was used to analyzed the data; we considered a P value <0.05 as statistically significant.

RESULTS

The median initial number of mistakes was 32 (interquartile range [IQR]: 27.5-37) and after repeated training and feedback the final median number was 3.5 (IQR: 2-6) (P < 0.001). The median time needed to finish the exercises before training was 1020.5 seconds (IQR: 908-1125.5) and after using the model the final median time was 479 seconds (IQR: 423-503) (P < 0.0001).

CONCLUSIONS

We presented a stereotactic simulation model with immediate haptic feedback. The model can be easily handmade in any neurosurgical laboratory. This model allows neurosurgeons in training to acquire and improve stereotactic techniques, reducing the number of surgical mistakes and time needed to finish the task.

Standardized language systems for the design of high-fidelity simulation scenarios: A Delphi study

PURPOSE

This study aimed to identify which of the standardised Nursing Interventions Classification (NIC) activities should be used in the design of clinical cases with high fidelity simulation for educational preparation of undergraduate nursing students in non-technical skills.

DESIGN AND METHODS

A three-round Delphi study was carried out: the first round with taxonomy experts, the second round with academic and clinical lecturers with limited experience in the simulation-based learning methodology, and the third round with academic and clinical lecturers having at least two years of simulation experience. The NIC interventions were grouped into two levels of competence in accordance with the undergraduate nursing degree curriculum (1st- and 2nd-year students, the "novice" level; 3rd- and 4th-year students, the "advanced" level). The NIC allows the description of nurse student competencies in multiple clinical scenarios and throughout various contexts: theory, clinical practice and simulation.

FINDINGS

The experts identified 163 interventions in 8 areas as relevant and feasible, selecting 42 for the "novice" students, in Nursing Fundamentals (13) and Adult Nursing Care 1 (29), and 97 for the "advanced" students: Maternity Care and Child Health Nursing (18), Mental Health (13), Nursing Care of Older People (12), Community Health Nursing (20) and Adult Nursing Care 2 (34). In addition, 24 interventions were identified as cross-cutting, with training to be provided across all four years of the degree.

CONCLUSION

A total of 163 interventions of the NIC list were selected by experts as being both relevant and feasible to nursing undergraduate education. This creates the favourable framework to design high-fidelity scenarios for the training of non-technical skills according to the competences required and in line with the health care reality. Therefore, enabling an optimal combination of theoretical education by academic lecturers with practical training by clinical lecturers and staff nurses.

Nursing students' transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study

BACKGROUND

Simulation-based training is used to develop nursing students' clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students' experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice.

METHODS

Eight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis.

RESULTS

Three major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration.

CONCLUSIONS

This study revealed students' transfer of learning outcomes from simulation-based training to clinical practice. The students' experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students' experiences of the transfer of knowledge to clinical practice.

A new tool for assessing short debriefings after immersive simulation: validity of the SHORT scale

BACKGROUND

Simulation is being increasingly used worldwide in healthcare education. However, it is costly both in terms of finances and human resources. As a consequence, several institutions have designed programs offering several short immersive simulation sessions, each followed by short debriefings. Although debriefing is recommended, no tool exists to assess appropriateness of short debriefings after such simulation sessions. We have developed the Simulation in Healthcare retrOaction Rating Tool (SHORT) to assess short debriefings, and provide some validity evidence for its use.

METHODS

We designed this scale based on our experience and previously published instruments, and tested it by assessing short debriefings of simulation sessions offered to emergency medicine residents at Laval University (Canada) from 2015 to 2016. Analysis of its reliability and validity was done using Standards for educational and psychological testing. Generalizability theory was used for testing internal structure evidence for validity.

RESULTS

Two raters independently assessed 22 filmed short debriefings. Mean debriefing length was 10:35 (min 7:21; max 14:32). Calculated generalizability (reliability) coefficients are φ = 0.80 and φ-λ3 = 0.82. The generalizability coefficient for a single rater assessing three debriefings is φ = 0.84.

CONCLUSIONS

The G study shows a high generalizability coefficient (φ ≥ 0.80), which demonstrates a high reliability. The response process evidence for validity provides evidence that no errors were associated with using the instrument. Further studies should be done to demonstrate validity of the English version of the instrument and to validate its use by novice raters trained in the use of the SHORT.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

Implementation of a novel synchronous multi-site all day high-fidelity simulation

Integration of simulation in educational curricula for anesthesia and intensive care residents is a hot topic. There is a great interest for simulation centers to share their experiences through multi-site synchronous simulation sessions. The present study results from an experience conducted at three sites in France (Paris, Lyon, and Caen), which involved 16 instructors and 25 residents facing the same scenario across 1 day. Synchronous simulations were performed at each site with local and shared debriefing via teleconference. This innovative approach to simulation was found to be feasible, although certain difficulties were encountered with connectivity.