Results of a Novel Long-Term Method for Laparoscopic Skills Online Training

Introduction: Ensuring patient safety in minimally invasive surgery (MIS) within the field of pediatric surgery requires systematic and extensive practice. Many groups have proposed mastery learning programs encompassing a range of training methods. However, short courses often have a narrow focus on specific objectives, limiting opportunities for sustained training. Our aim was to analyze our results with an online long-term competency-based and supervised training. Methods: This is a retrospective cohort study with prospective data collection of scores and performance of trainees during online courses from October 2020 to April 2023. Results: All participants (n = 76) were able to set up their personal training gym and complete the intensive stage of the course. The total score evolved from 2.60 ± 0.56 at the first meeting to 3.67 ± 0.61 at the fourth meeting, exhibiting a significant difference (P < .013). A considerable drop out was observed in the follow-up stage, with only 53.8% of the participants completing the course. When compared with the first meeting, they also showed a significant improvement with a mean general score of 3.85 ± 0.25 (P < .013) Conclusion: We have presented a novel online training program, based on continuous training that demonstrated that the unlimited access to a personal training gym allows surgeons to improve and maintain MIS skills.

Development and Evaluation of An In-House Lumbar Puncture Simulator for First-Year Resident Lumbar Puncture Procedure Learning

INTRODUCTION

Lumbar puncture (LP) is a common invasive technique considered an essential learning milestone for anesthesiologists due to its application in spinal anesthesia. We aimed to develop an in-house LP simulator, test its effectiveness in learning the steps to perform an LP and analyze its impact on the first-year residents' self-confidence at our hospital.

METHODS

 We used 3D printing and silicone casting to create an LP simulator based on a lumbar spine computed tomography (CT). We divided 12 first-year anesthesiology residents into control and experimental groups. The control group received traditional training, while the experimental group practiced with the simulator for three months. We used a procedure checklist and a Likert scale survey to evaluate their procedural knowledge and self-confidence at baseline, three, and six months. Eighteen months later, we evaluated their LP performance skills.

RESULTS

Both groups showed a significant improvement in their knowledge scores over time. After three months, the experimental group had a higher median knowledge score (10 (10 - 10) median (min-max)) than the control group (9 (8 - 9.5) median (min-max)) (p = 0.03). While there were no apparent differences in median self-confidence scores between the groups at any time point, the experimental group had a significant increase in their self-confidence for performing an unassisted LP, with a median score of 1/5 (1 - 2.3) at baseline and 5/5 (4.8 - 5) after six months (p = 0.006). In contrast, the control group's self-confidence scores decreased from 4/5 (3 - 4) after three months to 3/5 (2 - 5) after six months. The evaluation of performance skills did not yield statistically significant results.

CONCLUSION

Our study demonstrates that an in-house LP simulator is an effective and practical approach for first-year anesthesiology residents to learn the LP procedure. This approach could be particularly useful in settings with limited resources and a lack of sufficient patients to practice on, as it provides an opportunity for faster learning and increased self-confidence.

Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study

BACKGROUND

Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians.

METHODS

Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3-6 months later (retention post-test).

RESULTS

For the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=-0.30, P<0.05) and technical checklist scores (r=-0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3-6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=-0.30, P<0.05).

CONCLUSIONS

A reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3-6 months, regardless of age or years in practice.

Relationship Between Cognitive Load Theory, Intrinsic Motivation and Emotions in Healthcare Professions Education: A Perspective on the Missing Link

Cognitive Load Theory (CLT) is one of the key cognitive theories that have been used to assess learners' information and working memory load. CLT has been applied to Simulation Based Education (SBE) and optimizing instructional design. However, a challenge that occurs is that these high-fidelity simulations and mannequins of critically ill patients can elicit negative emotions in learners which can unfavorably impact the learning process. There is also a potential for cognitive overload if the simulation is more authentic and requires more dynamic interactions and lead to high levels of anxiety due to a novel learning environment, which can also have detrimental effects on learning process. Hence, it is critical for health professional educators (HPE) to know how to minimize cognitive load to improve learning as a professional in a workplace setting. The literature on the role of emotions, intrinsic motivation, cognitive load is scarce in HPE literature. Specifically when not being studied together at once since they move dynamically together and affect the learning for the learner. Therefore, the purpose of this perspective paper is to cover the gap in the literature and propose a framework and recommendation for future HPE research.

Empowering Non-healthcare Students as Simulation Assistants in the Digital Era of Simulation-Based Healthcare Education: Bridging the Gap

Simulation-based education plays a pivotal role in various high-stakes fields, notably in healthcare, where simulation technicians are crucial for the effective operation of simulation technology. Currently, these roles are often filled by healthcare professionals who transition from patient care, exacerbating shortages in the healthcare workforce. This editorial addresses the current gap by proposing an alternative solution, creating educational pathways for undergraduate students in science and health science programs to become "simulation assistants". Leveraging their foundational knowledge in biological and physical sciences, research skills, and attributes developed through health sciences programs, these students could support simulation activities while entering an ever-evolving field with copious growth opportunities. Paralleling the historical development of medical laboratory sciences, which saw the creation of distinct roles for technologists and assistants, the editorial suggests a collaborative model wherein simulation technicians and assistants work together to enhance simulation-based education in the healthcare sector. This paradigm shift has the potential to alleviate the growing healthcare personnel shortages. While acknowledging the challenges, the editorial envisions the transformative impact of integrating simulation assistants into the healthcare workforce, echoing the historical evolution of specialized roles in response to the changing demands of healthcare.

Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review

BACKGROUND

The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student's academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality-based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out.

OBJECTIVE

Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation.

METHODS

This scoping review will be structured using the Arskey and O'Malley's 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text.

RESULTS

This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development.

CONCLUSIONS

This review seeks to inform curriculum design by reporting on the gender equality-enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44584.

Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study

BACKGROUND

Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation.

OBJECTIVE

This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills.

METHODS

Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

RESULTS

We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21).

CONCLUSIONS

This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

Impact of Unexpected Death in a Simulation Scenario on Skill Retention, Stress, and Emotions: A Simulation-Based Randomized Controlled Trial

Introduction The simulation of patient death remains controversial in simulation-based education. We investigated the effect of simulated patient death on learners' skill retention, stress levels, and emotions. Methods After ethics approval, we recruited residents at two Canadian universities. Participants were randomized to manage a simulated cardiac arrest ending with either the unexpected death (intervention group) or survival (control group) of the simulated patient (i.e., manikin). Three months later, all participants performed the same scenario but with the opposite outcome. Blinded video raters assessed participants' non-technical and technical crisis resource management (CRM) skills at both time points. Stress levels (represented by anxiety level, salivary cortisol concentration, and cognitive appraisal) and emotional valence were measured. Outcomes were analyzed using analysis of covariance (ANCOVA) or generalized estimating equations as appropriate. Results The analysis included 46 participants (intervention: n=24; control: n=22). Simulated death neither affected retention of non-technical CRM skills (mean retention Ottawa Global Rating Scale score in the death group [29.4, 95% CI: 27.0, 31.8] versus control group [29.4, 95% CI: 26.8, 32.0; p=0.87]) nor technical CRM skills (mean retention task-specific checklist score in the manikin death group [11.8, 95% CI: 10.5, 13.0] versus the control group [12.5, 95% CI: 11.3, 13.7; p=0.69]). The simulated death had negative effects on participants' anxiety levels, cognitive appraisal, and emotions. Conclusion Simulated patient death did not affect the retention of non-technical or technical CRM skills but led to greater levels of short-term anxiety, stress, and negative emotions among learners.

Investigating the Effects of Intraprofessional Learning in Nursing Education: Protocol for a Longitudinal Study

Interprofessional learning (IPL), where nursing students learn how to work with multiple health professionals in their future practice to deliver the highest quality of care, has become an essential feature of undergraduate nursing programs. Intraprofessional learning (IaPL) is where individuals of two or more disciplines within the same profession collaborate; however, there is a dearth of literature investigating its effects in nursing education. The aim of this study is to investigate the impact of IaPL on the development of nursing students' knowledge, skills, and attitudes for collaborative practice. The study will utilize a mixed methods approach with surveys conducted at six time points across two years of two nursing programs and focus groups at the end of the program. Participants will be recruited from the Diploma and Bachelor of Nursing programs at an Australian Training and Further Education institute. Four specific IaPL educational experiences incorporating simulation will be developed on aged care, mental health, complex care and acute care. The study will provide nursing students with multiple opportunities to develop the necessary capabilities for collaborative practice. It will longitudinally evaluate nursing students' attitudes towards IaPL and examine whether IaPL motivates Diploma of Nursing students to pathway into a Bachelor of Nursing degree. The study will also investigate awareness amongst nursing students of the scope of practice, roles and responsibilities of the nursing team.

Development and validation of a performance assessment checklist for insertion of an intra-uterine device (IUD)

OBJECTIVES

The World Health Organization (WHO) supports increasing the availability and acceptability of long-acting reversible contraception including intra-uterine device (IUD), but its insertion includes certain risks (uterine perforation). The objective was to develop and validate an IUD insertion performance assessment checklist.

MATERIAL AND METHODS

This prospective study took place in hospitals and simulation center of the Poitou-Charentes region, France. The checklist content reached consensus among 10 experts solicited by a Delphi method. A modified gynecologic mannequin Zoe (Gaumard®) was used for simulations. Psychometric testing included 30 multi-professional participants for internal consistency and reliability between two independent observers, and 27 residents for assessment of score evolution over time and reliability. Cronbach alpha (CA) and intraclass coefficient (ICC) were used. Progression of performance was carried out using ANOVA for repeated measures. The data collected were used to plot receiver operating characteristic (ROC) curves for the score values and the area under the curve (AUC) was determined.

RESULTS

The checklist included 27 items (2 sections, total score = 27). Psychometric testing showed CA = 0.79, ICC = 0.99, and good clinical relevance. The checklist is discriminative, showing a significant increase in performance scores when the simulations were repeated (F = 77.6, p < 0.0001). ROC curve [AUC: 0.792 (95% CI: 0.71-0.89); p < 0.0001] revealed the best score cutoff predictive of 100% sensitivity, i.e., true positive rate or success rate. Performance score was highly correlated to success rate. The cut-off score guaranteeing successful IUD insertion was 22/27.

CONCLUSIONS

This coherent and reproducible checklist for IUD insertion provide an objective assessment of the procedure during SBT, with the aim of obtaining a score ≥ 22/27.

Exploring training needs of newly graduated medical doctors to inform the undergraduate simulation-based curriculum: a national Delphi consensus study

PURPOSE

Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors.

METHODS

We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures.

RESULTS

In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture.

CONCLUSION

Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education.

A Literature Review of Simulation-Based Nursing Education in Korea

This study reviewed the papers that studied the effect of simulation nursing education in the nursing field and examined the trend of simulation nursing education for nursing college students in Korea.

BACKGROUND

Simulation-based education started receiving attention as a pedagogical method in order to provide medical service of high quality in an ethical and safe environment. This has been of great importance during the coronavirus disease 2019 global pandemic. This literature review was conducted to suggest a direction for simulation-based nursing education in Korea.

METHODS

For literature searches, the authors used the following search terms in the Web of Science, CINAHL, Scopus, PubMed-'utilization', 'simulation,' 'nursing student', 'nursing education'. A final search was conducted on 6 January 2021. The materials for this study were collected through literature searches according to the PRISMA guidelines.

RESULTS

25 papers were selected as the final literature for analysis. The study was conducted for 48 percent of senior students in nursing college students in Korea (N = 12). High fidelity (HF) as the simulation type was 44 percent (N = 11). The simulation education subjects were composed of 52 percent adult health nursing (N = 13). According to educational goals described by Benzamine Bloom (1956), 90% in the psychomotor domain is considered a positive learning achievement.

CONCLUSIONS

Effectiveness in the psychomotor domain through simulation-based training is correlated with expert nursing. It is essential to develop a systematic debriefing model and methods to evaluate performance and learning in the short- and long-term to expand the effectiveness of simulation-based education in nursing.

The Hibiscus model: A feasible cadaveric model using continuous arterial circulation for intracranial bypass training and its validation

OBJECTIVE

The frequency of intracranial bypass procedures has declined. Thus, it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomical and physiological fidelity as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants.

METHODS

Fourteen participants attended a hands-on revascularization course with seven cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was re-examined and the participants completed a self-assessment questionnaire.

RESULTS

Initially, only three attendees were able to perform an end-to-end anastomosis within the time limit, and only two of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus, demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n=11 and n=9) CONCLUSIONS: Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons´ development irrespective of financial resources.

Implementation of a Multimodal Interdisciplinary Massive Transfusion Protocol Educational Bundle Improves Knowledge and Self-Efficacy

PURPOSE

Critical events in the operative setting require rapid management to prevent adverse outcomes. This article describes a multimodal educational bundle that was designed and implemented to improve readiness to respond to crises involving significant blood loss. Intended outcomes of this project were to increase knowledge and self-efficacy of anesthesia providers and perioperative staff members related to the use of the massive transfusion protocol (MTP).

DESIGN

This is a quality improvement (QI) project.

METHODS

A two-part educational bundle consisted of pre-education and low-fidelity simulation (LFS) via computer-based training (CBT) modules followed by hands-on skills sessions. Anesthesia providers, registered nurses, and technicians in the operative suite completed the educational intervention. Knowledge and self-efficacy were measured pre-and-post intervention.

FINDINGS

After completing the educational bundle, the aggregated mean score on a knowledge test increased by 5.65%. Self-efficacy related to role-specific responsibilities and confidence regarding the team's ability to carry out the MTP significantly increased for all participants (n = 62).

CONCLUSIONS

This project serves as an example of how a multimodal educational bundle can improve knowledge, confidence, and readiness to respond to critical events. This model demonstrates how pre-education and LFS enable crisis management training to be readily accessible for an entire interdisciplinary team.

Simulation-based education in urology - an update

Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.

Effects of a mental health nursing simulation for general ward nurses: A pilot study

This study aimed to develop a mental health nursing simulation education programme for non-psychiatric nurses and verify its effects on mental health care competence, burden, and anxiety. To verify the effects of the simulation, we applied a non-equivalent control group pre-posttest research design. We developed a mental health nursing simulation using a standardized patient who presented moderate levels of anxiety and depressive mood during chemotherapy after mastectomy. The participants were nurses working at non-psychiatric wards of a general hospital in Seoul, Korea. Participants' mental health care competency scores increased by 80% in the experimental group and 15% in the control group from pre-test to posttest. Burden scores decreased by 42% in the experimental group and 4% in the control group from pre-test to posttest, and anxiety scores decreased by 77% in the experimental group and 24% in the control group. This study demonstrated the nursing simulation education programme's effectiveness as a complementary tool to improve mental health nursing care for non-psychiatric nurses.

Assessment of Core Surgical Skills Using a Mixed Reality Headset - The MoTOR Study

INTRODUCTION

Surgical skill assessment utilises direct observation and feedback by an expert which is potentially subjective, therefore obtaining objective data for hand and eye tracking is essential. Our aim was to evaluate a wearable mixed reality (MR) headset in these domains.

METHODS

Participants with differing levels of surgical expertise [novice (N), intermediate (I) & expert (E)] performed 4 simulated surgical tasks; 2 general dexterity (tasks 1&2) and 2 surgical skills (tasks 3&4) wearing the MR headset capturing their hand and eye movements (median & range). Metrics included hand path length and the speed of each index or thumb tip. Gaze data were also captured. Participant demographics, prior expertise and current experience were captured with an electronic survey. Data were analysed with a Shapiro-Wilk test or ANOVA as appropriate. A p-value of < 0.05 was significant.

RESULTS

Thirty-six participants were analysed (N = 18, I = 8, E = 8). Tasks 1&2 revealed 2 speed outcomes (left index and left-hand speed) which were significant. For tasks 3&4, various outcomes were significant: path length for left hand (N:45 cm vs. I:31 cm vs. E:27 cm, p = 0.03) and right hand (N:48 cm vs. I:29 cm vs. E:28 cm, p = 0.01) and total time (N:456s vs. I:292 vs. E: 245, p = 0.0002). With left-hand-tying, average path length (N:61 cm vs. I:39 vs. E:36, p = 0.04), average speed (N:11 cm/s vs. I:23 vs. E:24, p = 0.03), and total time (N:156s vs. I:43 vs. E:37, p = 0.003) were significant. The gaze-tracking was not statistically significant.

CONCLUSION

The MR headset can be utilised as a valid tool for surgical performance assessment. Outcomes including path length and speed can be valuable metrics captured by the MR Headset during the task completion for detecting surgical proficiency.

Hacking Intraosseous Infusion Skills Training With 3D Printing: maxSIMIO Drilling System

Intraosseous (IO) infusion is an alternative way to access the vascular system to administer drugs and fluids, which is particularly helpful when the commonly used peripheral intravenous route is inaccessible. The IO procedure can be done using a drill that involves disinfecting the area, landmarking the insertion point, seating the needle in a firm and stable position in the bone, and then delivering a smooth fluid flush. However, in the current medical training landscape, access to commercially available IO drills such as the Arrow® EZ-IO® Power Driver (EZ-IO; Teleflex, Morrisville, North Carolina, United States) is difficult, especially for rural and remote areas, due to the high costs. Furthermore, the EZ-IO is not rechargeable and does not clearly indicate the remaining battery life, which could potentially put patients at risk during the IO procedure. This technical report aims to address these concerns by describing the development of an alternative, affordable, and reliable IO drilling system for training use: the maxSIMIO Drilling System. This system consists of a cordless and rechargeable IKEA screwdriver which connects to a conventional, hexagon-shaped 3D-printed drill bit needle adapter. Two needle adapters were created: Version A was designed to use a friction-based mechanism to couple the screwdriver with the EZ-IO training needle, while Version B relies on a magnetic mechanism. The major differences between the EZ-IO and the screwdriver are that a) the EZ-IO has only one rotation to advance the cannula while the screwdriver features both directions, b) the EZ-IO is not rechargeable while the screwdriver is, and c) the EZ-IO has a custom needle holder that can fit any EZ-IO training needle size while the screwdriver needs to have a custom needle adapter made to connect to the EZ-IO training needle. Overall, through this exploration, the features of the maxSIMIO Drilling System in comparison to the EZ-IO appear more accessible for IO training. Future considerations for this development include gathering clinical expertise through rigorous testing of this novel system.

Evaluation of online interprofessional simulation workshops for obstetric and neonatal emergencies

OBJECTIVES

To explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops.

METHODS

This qualitative study was conducted at Monash University, Australia. Data were obtained from six separate online Obstetric Neonatal Emergency Simulation workshops held between May 2020 and August 2021. A total of 385 students attended and were invited to participate in the study by completing an online survey two-three weeks later. Of the attendees, 144 students completed the survey (95 medical, 45 midwifery), equating to a response rate of 37%. Survey responses were downloaded from online survey platform and separated into medical and midwifery responses. Thematic analysis of data was performed using a coding framework, resulting in development of themes and subthemes.

RESULTS

Main themes were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. Consistent with existing literature evaluating similar in-person programs, midwifery students were most interested in interprofessional interaction (predominant theme: dynamics of online interaction), whilst medical students were more concerned with developing clinical skills (predominant themes: learning through modelling, experiential learning).

CONCLUSIONS

Online learning may be a useful and convenient way of delivering interprofessional simulation-based education during the pandemic, in remote areas and as an adjunct to in-person teaching. Future studies should evaluate the impact of online learning with a mixed methods study and in comparison, to in-person programs.

Simulation-based education model for under-resourced nursing education institutions in Lesotho

Background

The changing landscape of nursing education to competency-based education has strengthened the importance of simulation learning in the process of developing the required graduate competencies.

Aim

This study aimed to develop a model that guides the implementation of simulation-based education (SBE) in under-resourced nursing education institutions in Lesotho.

Setting

Four Nursing Education Institutions in Lesotho.

Methods

An explanatory sequential mixed methods design was adopted. Sampling methods included stratified systematic random, purposive and systematic sampling. The total sample was 390 comprising students, nurse educators and principals. Data were collected through questionnaires, focus group discussions and in-depth unstructured individual interviews. Statistical analysis was employed for quantitative data while a grounded theory approach guided the qualitative data analysis and model development.

Results

Implementation of simulation emerged as a multilevel, multi-actor and multistage process of adopting, introducing and implementing SBE. This education takes place in a simulated environment that serves as a connecting bridge between the learning of theory in the classroom and clinical learning in real-life settings. The model generated from this study has simulation implementation as the main concept that is supported by four major concepts: (1) simulation initiation at the strategic level, (2) simulation implementation at the tactical level, (3) simulation implementation at the operational level and (4) simulation outcomes.

Conclusion

Successful implementation of simulation requires buy-in from key stakeholders. Simulation-based education policy, competent facilitators and a well-resourced clinical skills laboratory may facilitate the development of the required competencies.

Contribution

The study provides guidance on how SBE can be implemented in resource-limited settings.

Online Faculty Development on Curriculum Design in Simulation-based Education by International Collaboration - An Example from the Democratic Republic of the Congo

PURPOSE

Faculty development for procedural specialists is intended to improve clinical education and surgical/procedural skills. Despite challenging in under-resourced settings, this may be enhanced by developing international collaboration agreements and supported by online learning experiences. The Congolese Society of Ophthalmology and the International Council of Ophthalmology agreed to collaborate on implementing an online educational program to form a community of practice (CoP) of ophthalmologists educators and enhance competence in curriculum design and simulation-based education (SBE) on cataract surgery.

METHODS

Ten Congolese ophthalmologists, faculty for the "Centre de Formation Ophthalmologique pour l'Afrique Centrale" (CFOACF), participated in a group-mentored 12-webinar modular program on curriculum design, in 2019. Considering the geo-social-cultural learning environment, we developed a curriculum framework incorporating social constructivism and experiential learning principles to facilitate the implementation of learning. Educational strategies included flipped, practice-based and social learning, group mentoring, and individual and collective reflection opportunities. A CoP was virtually nurtured using WhatsApp. Program evaluation relied on (a) feedback survey per module and 3 months upon conclusion, (b) individual declarative knowledge assessment, and (c) group assignment to test competence improvement.

RESULTS

The CFOACF formed a virtual CoP, commented on an enjoyable opportunity to develop scholar teaching competence, expressed intention in systematically building educational curricula design that includes active learning strategies and effective feedback and showed individual learning and team-competence improvement.

CONCLUSION

This first iteration of our online faculty development program nurtured the formation of a CoP of ophthalmologists' educators and enabled to practice a scholar teaching approach, especially applied to SBE.

Evaluation of teaching effect of first-aid comprehensive simulation-based education in clinical medical students

Background

Although students mastered the composition skills, they lack of the ability to effectively integrate these composition skills in real clinical situations. To address the problem, we set up different levels of situational simulation training for medical students in grades 2-4, and evaluate the teaching effect of first-aid situation comprehensive simulation-based education (SBE) on clinical medical students.

Methods

The medical students in Grade 2, 3, and 4 received different situational SBE, respectively. The 2nd-year medical students received a single skill module which included cardiopulmonary resuscitation, endotracheal intubation, and electric defibrillation training. The 3rd-year medical students received a single subject module which included cardiovascular and respiratory system training. The 4th-year medical students received the integrated multidisciplinary module which combined first-aid skills, clinical thinking, and teamwork training. The primary outcome was the expert evaluation and peer evaluation. The secondary outcome was students' satisfaction questionnaire response. In our training, we arranged an adequate teaching staff for intensive training and timely feedback (the student-teacher ratio of 5:1), adequate time for repetitive practice (Each SBE was carried out within 4 h), curriculum design, and integration from real cases by clinicians, realistic computer-driven mannequins to ensure simulation fidelity, providing a different difficult level of SBE to different grades of students, and pre- and post-tests for outcome measurement.

Results

In all of the single skill module, single subject module or comprehensive disciplines module, the scores in the expert evaluation and peer assessment after the training were significantly higher than before the training, and the differences were statistically significant (p < 0.05). The integrated subject training, although having the lowest pre-and post-test marks, had the largest increase in score.

Conclusion

The first aid comprehensive simulation-based education in grade 2-4 clinical medical students, basing on timely feedback, repetitive practice, curriculum integration, simulation fidelity, and outcome measurement are effective in improving the students' proficiency in managing the real emergencies.

Simulation-Based Education Implementation in Pharmacy Curriculum: A Review of the Current Status

Simulation-based education (SBE) is a fundamental teaching method that complements traditional teaching modalities. SBE has improved students' knowledge, understanding, and numerous essential skills within undergraduate pharmacy education, similar to traditional teaching methods. However, SBE has become crucial for developing students' teamwork, decision-making, and communication skills. Even though the Accreditation Council for Pharmacy Education (ACPE) has acknowledged the benefit of SBE in interprofessional education (IPE) and the introductory pharmacy practice experience (IPPE). This article provides evidence that SBE can be effective beyond that. This narrative review is focused on the literature related to SBE modalities and the assessment methods of student learning outcomes in the undergraduate pharmacy curriculum. The review illustrates that SBE is an effective teaching method that could be utilized within the pharmacy curriculum. The review also could help pharmacy educators decide on the best modality and placement of integrating patient simulation within the pharmacy curriculum. Combining multiple simulation techniques may be the best way to achieve the desired student learning outcomes.

The effect of simulation-based education before a cadaver dissection course

Although the methods for medical education continue to evolve due to the development of medicines, the cadaver dissection course still plays a fundamental role. The cadaver dissection course allows students to learn to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection comes with the risk of accidental injury. In recent years, the number of classes offered for the cadaver dissection course has decreased while the amount of knowledge required in clinical medicine has increased. Simulation-based education (SBE) has been proven to be an effective educational method that enhances the development of practical skills by integrating learners' knowledge and skills. This study aimed to investigate the effect of SBE as a preparatory education course when taken prior to a medical student's enrollment in the cadaver dissection course. In the present study, an SBE assuming practical cadaver dissection course was performed in the Clinical Simulation Center. The frequency of injury rates per 1000 h of cadaver dissection course was significantly less in 2017 and 2018 compared to that in 2016. Two years after the implementation of the SBE, average student self-efficacy scores and written examination scores significantly increased, whereas self-contentment scores were relatively unchanged. The results showed that the implementation of SBE decreased the incidence of injuries and improved students' overall self-efficacy scores and increased acquisition of knowledge evident on written examination score. Therefore, SBE as a preparatory education course may effectively promote the combined development of dissection skills and anatomical knowledge in the subsequent fundamental cadaver dissection course.

Avatar and distance simulation as a learning tool - virtual simulation technology as a facilitator or barrier? A questionnaire-based study on behalf of Netzwerk Kindersimulation e.V

BACKGROUND

Virtual simulation modalities have been implemented widely since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic restrictions in March 2020, as educators face persistent restrictions to face-to-face education of medical students and healthcare professionals.There is paucity of published data regarding the benefits and barriers of distance and avatar simulation training modalities.

METHODS

Following a 2-day virtual pediatric simulation competition facilitated by Netzwerk Kindersimulation e.V., using remote human avatars and distance simulation, we conducted a multicenter survey to explore the advantages and challenges of avatar and distance simulation among participants. We used a modified Delphi approach to draft and develop the 32-item online questionnaire with 7-point Likert-like scales (7 being the highest rating).

RESULTS

Twenty participants answered our questionnaire. Respondents indicated both a high overall satisfaction (median of 5.0 [Q25-Q75: 4.0-6.0] ) for avatar and distance simulation 6.0 (5.0-6.0), respectively, as well as a high achieved psychological safety with both simulation types (5.0 [4.0-6.0] vs. 5.0 [4.0-6.0]). The most frequently reported profits of avatar and distance simulation included the elimination of travel distances, associated lower costs, less time spent attending the education activity, and effective communication and leadership training, especially with avatar simulation. Most often named challenges were technical problems, limited reception of non-verbal cues and a spatial distance from the team/educator.

DISCUSSION

Based on the results of this pilot study, avatar and distance simulation can be employed successfully and appear to be good supplements to face-to-face simulation. Other studies are warranted to further explore the effectiveness of various types of virtual simulation compared to conventional presential simulation. We suggest using avatar-based simulation for targeted communication and leadership skills training and the application of distance simulation to bring simulation experts virtually to remote places where educator resources are lacking.

Neonatal Simulation Program: A 5 Years Educational Journey From Qatar

We describe the process of implementation, adaptation, expansion and some related clinical intuitional impacts of the neonatal simulation program since its launch in 2016 in a non-simulation neonatal unit. The team has developed 6 types of curricula: 1 full-day course and 5 half-day workshops. A total of 35 free of charge simulation courses/workshops were conducted, 32 in Qatar and 3 abroad with a total of 799 diverse participants. There was a steady increase in the overall success rate of PICC insertion from 81.7% (309/378) to 97.6% (439/450) across 3 years (P < 0.0001). The first attempt PICC insertion success rate has been also increased from 57.7% (218/378) to 66.9% (301/450) across 3 years. The mean duration of PICC insertion has been improved from 39.7 ± 25 to 34.9 ± 12.4 min after implementing the program (P = 0.33). The mean duration of the LISA catheter insertion at the beginning of the workshop was 23.5 ± 15.9 compared to 12.1 ± 8.5 s at the end of the workshop (P = 0.001). When it came to clinical practise in real patients by the same participants, the overall LISA catheter insertion success rate was 100% and the first attempt success rate was 80.4%. The mean duration of LISA catheter insertion in real patients was 26.9 ± 13.9 s compared to the end of the workshop (P = 0.001). The mean duration of the endotracheal intubation at the beginning of the workshop was 12.5 ± 9.2 compared to 4.2 ± 3.8 s at the end of the workshop (P = 0.001). In real patients, the first-attempt intubation success rate has been improved from 37/139 (26.6%) in the first year to 141/187 (75.5%) in the second year after the program implementation (P = 0.001). The mean duration of successful endotracheal intubation attempts has been improved from 39.1 ± 52.4 to 20.1 ± 9.9 s (P = 0.78). As per the participants, the skills learned in the program sessions help in protecting neonates from potential harm and improve the overall neonatal outcome. Implementing a neonatal simulation program is a promising and feasible idea. Our experience can be generalised and replicated in other neonatal care institutions.

Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India

INTRODUCTION

Pediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings.

MATERIALS AND METHODS

We conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed of residents, fellows, and nurses. Data were collected on 332 pediatric patients in shock (72% of whom were in septic shock) before, during, and after the intervention. The data included the first hour time-critical intervention checklist, patient hemodynamic status at the end of the first hour, time for the resolution of shock, and team leadership skills in the emergency room.

RESULTS

There was a significant improvement in the percent completion of tasks by the pediatric emergency team in simulated scenarios (69% in scenario 1 vs. 93% in scenario 2; p < 0.001). In real patients, completion of tasks as per time-critical steps reached 100% during and after intervention compared to the pre-intervention phase (87.5%), p < 0.05. There was a significant improvement in the first hour hemodynamic parameters of shock patients: pre (71%), during (79%), and post (87%) intervention (p < 0.007 pre vs. post). Shock reversal time reduced from 24 h pre-intervention to 6 h intervention and to 4.5 h post intervention (p < 0.002). There was also a significant improvement in leadership performance assessed by modified Concise Assessment of Leader Management (CALM) instrument during the simulated (p < 0.001) and real patient care in post intervention (p < 0.05).

CONCLUSION

Telesimulation training is feasible and improved the process of care, time-critical interventions, leadership in both simulated and real patients and resolution of shock in real patients. To the best of our knowledge, this is one of the first studies where telesimulation has shown improvement in real patient outcomes.

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial

BACKGROUND

Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education.

OBJECTIVE

In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps.

METHODS

We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups.

RESULTS

We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion.

CONCLUSIONS

We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion.

Institutionalizing an interprofessional simulation education program: an organizational case study using a model of strategic change

Initiatives to implement interprofessional simulation education programs (ISEP) often fail due to lack of support, resources from management or proper integration into the organization system. This paper aims to identify factors that ensure the successful implementation of an ISEP. Further, the study explores the potential effects an ISEP can have on organizational processes and culture. The case study describes the implementation process of an ISEP in a non-academic community hospital using interviews, participative observations and archival data over six years. A thematic approach has been used to analyze the data guided by Kotter's 8-step model for organizational change. Strategies for a successful implementation of an ISEP include: 1) make a case for interprofessional simulation-based education (SBE), 2) search for healthcare champions, 3) define where the ISEP will lead the organization, 4) spread the word about interprofessional SBE, 5) ensure that structures, skills and supervisors align with the change effort, 6) win over smaller entities, 7) enable peer feedback and create more change, 8) institutionalize the ISEP. Indicators of how the ISEP impacted hospital culture are presented and discussed. ISEPs - if implemented effectively - provide powerful opportunities to span boundaries between professional groups, foster interprofessional collaboration, and eventually improve patient care.

Nursing students' experiences with simulation-based education as a pedagogic method in low-resource settings: A mixed-method study

AIMS AND OBJECTIVES

This study introduced simulation-based education in nurse education programs in Tanzania and Madagascar and explored nursing students' experiences with this pedagogic method as a mode of learning.

BACKGROUND

Simulation-based education has barely been introduced to education programs in resource-constrained settings. The study was conducted in two nurse education programs: one in rural Tanzania and the other in the mid-land of Madagascar. Both institutions offer diploma programs in nursing. Simulation-based education has not been included in the teaching methods used in these nursing programs.

DESIGN

A descriptive and convergent mixed method design was employed.

METHODS

Ninety-nine nursing students were included in the study. Simulation sessions followed by data collection took place once in 2017 and twice in 2018. Data were collected by means of several questionnaires and six focus groups. The data were analyzed using descriptive statistics and qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) was used to report the results.

RESULTS

The quantitative data revealed that the students rated all the questions related to the simulation design elements, educational practices, and students' satisfaction and self-confidence in learning with scores of above four on a 5-point Likert scale. The qualitative data from the first theme, building competence and confidence, further emphasized and outlined the quantitative results. Additionally, the qualitative data revealed a second theme, improving through encouragement and corrections. The students clearly expressed that they wanted to be aware of their weaknesses to be able to improve; however, the provision of feedback should be carried out in an encouraging way.

CONCLUSION

The findings indicated that the nursing students were satisfied with simulation as a pedagogic method, as it improved their competence and prepared them for professional practice. Further research is necessary to explore whether the students are able to transfer their knowledge into clinical practice.

RELEVANCE TO CLINICAL PRACTICE

Simulation as a pedagogic method is valuable for the learning of clinical skills and preparation for clinical practice.

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

Background

The Alberta Health Services' Provincial Simulation Program (eSIM) is Canada's largest simulation program. The eSIM mobile simulation program specializes in delivering simulation-based education (SBE) to rural and remote communities (RRC). During the COVID-19 pandemic, a quality improvement project involving rapid cycle in situ virtually facilitated simulation (VFS) for COVID-19 airway management and health systems preparedness in RRC was successfully implemented.

Methods

Between April 24 and July 31, 2020, a team of six rural simulationists (four nurses and two physicians) provided 24 VFS sessions with virtual debriefing to 200 health care providers distributed across 11 RRC in Alberta and the Northwest Territories, covering a geographic area of approximately 169,028 km².

Results

Video analysis of sequential VFS rapid cycle sessions using a standardized observational tool indicated decreased personal protective equipment (PPE) breaches by 36.6% between the first and third cycles. Teams demonstrated increased competency with airway management such as correct use of bag-valve-mask ventilation, and implementation of health system process improvements, such as incorporation of an intubation checklist. Improvements occurred on average over 2.2 rapid cycles completed within 1.3 weeks per RRC. Postsession self-reported participant electronic surveys indicated self-reported improvement in clinical management, teamwork behavior, and health systems issues outcome measures which were categorized based on the Crisis Resource Management and Systems Engineering Initiative for Patient Safety (SEIPS) frameworks. Of the 48 survey respondents, 86.1% reported that VFS was equivalent or superior to in-person simulation. The cost of VFS was 62.9% lower than comparable in-person SBE.

Conclusion

VFS provides a rapidly mobilizable and cost-effective way of delivering high-quality SBE to geographically isolated communities.

Effects of using a cognitive aid on content and feasibility of debriefings of simulated emergencies

Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated. Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool - a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) - or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM). Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions. Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.

Nursing Students' Experiences with Computer Simulation-Based Communication Education

Simulation-based communication education has improved nursing students’ communication knowledge and skills. However, communication patterns that students commonly exhibit in simulated situations and students’ responses to specific clinical situations have not been systematically examined. The specific aims of the present study were (1) to identify non-therapeutic communication patterns that nursing students exhibit in simulated situations in the computer simulation-based education (ComEd) program, and (2) explore students’ responses to challenging clinical situations. This study used a mixed-method research design and a convenience sampling method to recruit participants. Frequency analysis and a conventional content analysis method were used to analyze answers provided by participants. A total of 66 students from four Korean nursing schools participated in the study. “False reassurance” was found to be the most common non-therapeutic communication pattern used by nursing students. Nursing students had difficulty in clinical situations such as reporting a patient’s condition to a doctor, communicating with a patient and perform basic nursing skills at the same time, and managing conflicts between patients. Technology-based communication simulation programs, which reflect various clinical situations, are considered a new alternative that can supplement the limitations of clinical practicum and improve the quality of nursing education.

NEOGAMES: A Serious Computer Game That Improves Long-Term Knowledge Retention of Neonatal Resuscitation in Undergraduate Medical Students

Background: Serious games are potential alternatives for supplementing traditional simulation-based education for neonatal resuscitation training. However, evidence regarding the benefits of using serious games to improve long-term knowledge retention of neonatal resuscitation in undergraduate medical students is lacking. Objective: We designed a serious computer game "NEOGAMES" to train undergraduate medical students in neonatal resuscitation in a cost-friendly and accessible way and to examine whether serious game-based training improves long-term knowledge retention in medical students. Methods: "NEOGAMES" consists of a screen with images of an incubator, a baby, visual objects, anatomy, action cards, monitors, real-time feedback, and emotional components. Undergraduate medical students from Shanghai Medical College of Fudan University were invited to participate and were allocated to a game group or a control group. Participants in the game group played the game before the training. All the participants completed three written tests, pre- and post-training knowledge tests and a follow-up test after 6 months. Results: Eighty-one medical students participated in the study. The student demographic characteristics of the groups were comparable, including sex, age, and grade point average (GPA). Significant short-term knowledge improvement was noticed only for male students in the game group based on their 5.2-point higher test scores than those of the controls (p = 0.006). However, long-term knowledge improvement at 6 months was identified for both male and female students in the game group, with test scores 21.8 and 20 points higher, respectively, than those of the controls (P < 0.001). The long-term knowledge retention in the game group was almost 3 times higher than that in the control group. Conclusions: Long-term knowledge retention was nearly 3 times higher for the game group than for the control group. The improvement in knowledge supports the use of serious games for undergraduate medical education.

Design and evaluation protocol for 'DEALTS 2': a simulation-based dementia education intervention for acute care settings

BACKGROUND

There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate 'DEALTS 2', a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England.

METHODS

Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process.

EVALUATION DESIGN

Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train.

CONCLUSIONS

Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.

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.

Maximizing Learning and Creativity: Understanding Psychological Safety in Simulation-Based Learning

Psychological safety refers to the belief that one can express oneself without fear of the negative consequences or feedback that their speech, comment, or action might generate. It is about the willingness of learners or workers in an organization, in expressing themselves physically, cognitively, and emotionally. Psychological safety is very dynamic and will continue to evolve and change, with the interplay of a variety of external and internal factors affecting the individual, the organization, or the community. It is also closely linked to the culture in the organization, the institution, or the department. It has become a new norm, especially in high-frequency, high-intensity, and high-performance institutions and workplaces, that psychological safety must be mainstreamed and should not be just an incidental element. It also serves as a foundation for effective learning. When people feel safe and comfortable, they are more open to development, growth, and negotiating change. This is a current opinion piece by the author, who is the Director of The SingHealth Duke NUS Institute of Medical Simulation in Singapore. This is the largest and most comprehensive facility in Singapore, which is also the largest in South-East Asia. It has accreditation by the Society for Simulation in Healthcare. The paper is unique in sharing the perspectives of psychological safety in simulation-based education as well as many of the issues related to culture, which can trump strategy. Characteristics and attributes for facilitators, team training and dynamics, as well as the issue of power and hierarchy are also addressed.

The RETAIN Simulation-Based Serious Game-A Review of the Literature

Background: Each year, over 13 million babies worldwide need help to breathe at birth. While guidelines recommend the Neonatal Resuscitation Program course, medical errors remain common. Frequent simulation training and assessment is needed to address this competence gap; however, alternative approaches are needed to overcome barriers to access. The RETAIN (REsuscitation TrAINing) simulation-based serious game (Retain Labs Medical Inc., Edmonton, AB, Canada) may provide a solution to supplement traditional training. This paper aims to review the available evidence about RETAIN for improving neonatal resuscitation education. Method: Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and EMBASE databases were performed to identify studies examining the RETAIN serious game for neonatal resuscitation training. All of the studies describing the RETAIN board game and computer game were included. Results: Three papers and one conference proceeding were identified. Two studies described the RETAIN board game, and two studies described the RETAIN computer game. RETAIN was reported as usable and clinically relevant. RETAIN also improved knowledge of neonatal resuscitation by 12% and functioned as a summative assessment. Further, performance on RETAIN was moderated by players' self-reported mindset. Conclusion: RETAIN can be used for the training and assessment of experienced neonatal resuscitation providers. Further studies are needed to understand the effectiveness of RETAIN to (i) improve other cognitive and non-cognitive skills, (ii) in diverse populations of neonatal resuscitation providers, (iii) in comparison to current standard training approaches, and (iv) in improving clinical outcomes in the delivery room.

The physical demands and risks of working in healthcare simulation center

BACKGROUND

The purpose of this study was to describe the physical demands and risks associated with working in a simulation center.

METHODS

The 26-item online survey included questions about the physical nature of a simulationist's role and about what engineering and administrative controls they most commonly used. The sample consisted of 119 simulation operators and educators recruited from simulation interest groups based in the United States.

RESULTS

Fifty-five percent of participants reported that their job description did not match their work, and 59% of participants believed that they experienced a musculoskeletal disorder resulting from their work in a simulation center.

CONCLUSION

This study highlights the need to address workplace safety in simulation centers. Future research is needed to inform best practices for safe handling policies and procedures in simulation programs.

Surgical leadership in changing times: the American College of Surgeons perspective

Surgeons around the globe are challenged by the rapid evolution of the environment in which they practice their profession. Changes in surgical technologies, the complexity of surgical patient care, and the regulatory and financial environment of surgical care delivery demand that surgeons be supported in their work with access to superb educational offerings and engagement to foster satisfaction and efficacy in their professional activities. The American College of Surgeons (ACS), the largest international surgical professional organization, is committed to supporting surgeons as leaders in the healthcare system to build programs to create the optimal environment for delivery of quality surgical care to our patients. A selected portfolio of the programs of the ACS is presented.

Integrating Diverse Disciplines to Enhance Interprofessional Competency in Healthcare Delivery

Interprofessional education (IPE) typically involves clinical simulation exercises with students from medical and nursing schools. Yet, healthcare requires patient-centered teams that include diverse disciplines. Students from public health and informatics are rarely incorporated into IPE, signaling a gap in current educational practices. In this study, we integrated students from administrative and non-clinical disciplines into traditional clinical simulations and measured the effect on communication and teamwork. From July 2017-July 2018, 408 students from five schools (medicine, nursing, dentistry, public health, and informatics) participated in one of eight three-hour IPE clinical simulations with Standardized Patients and electronic health record technologies. Data were gathered using a pre-test-post-test interventional Interprofessional Collaborative Competency Attainment Survey (ICCAS) and through qualitative evaluations from Standardized Patients. Of the total 408 students, 386 (94.6%) had matched pre- and post-test results from the surveys. There was a 15.9% improvement in collaboration overall between the pre- and post-tests. ICCAS competencies showed improvements in teamwork, communication, collaboration, and conflict management, with an average change from 5.26 to 6.10 (t = 35.16; p < 0.001). We found by creating new clinical simulations with additional roles for non-clinical professionals, student learners were able to observe and learn interprofessional teamwork from each other and from faculty role models.

Does the virtual refractor patient-simulator improve student competency when refracting in the consulting room?

BACKGROUND

The use of patient simulators in ophthalmic education appears limited. This study examines the effects of the addition of the 'Virtual Refractor' patient simulator learning activity into a short unit preparing students to determine the power of the spectacle lenses required by patients in a clinic.

METHODS

Twenty-four year one optometry students were randomly assigned to either the simulator-intervention group (n = 12) or the non-intervention group. All students attended tutorials on refraction and the use of a refractor-head. Simulator-intervention students additionally attended a tutorial on the Virtual Refractor. All answered a questionnaire concerning time spent studying, perceived knowledge and confidence. Twenty-four short-sighted patients were recruited. Two refractions per student were timed and the accuracy compared with that of an experienced optometrist.

RESULTS

Ten students from each group completed the study. Students who used the simulator were significantly (p < 0.05) more accurate at a clinical level (within 0.22 ± 0.22 DS, 95 per cent CI 0.12-0.32) than those who did not (within 0.60 ± 0.67 DS, 95 per cent CI 0.29-0.92) and 13 per cent quicker (4.7 minutes, p < 0.05). Students who used the simulator felt more knowledgeable (p < 0.05) and confident (p < 0.05), but had spent more time reading about refraction and practised on the Virtual Refractor at home for 5.7 ± 1.3 hours.

CONCLUSION

The Virtual Refractor has many features of high-fidelity medical simulation known to lead to effective learning and it also offers flexible independent learning without a concomitant increase in the student time-burden. The improved accuracy and speed on first patient encounters found in this study validates the use of this patient simulator as a useful bridge for students early in training to successfully transfer theoretical knowledge prior to entering the consulting room. The translational benefits resulting from compulsory learning activities on a patient simulator can lead to reduced demands on infrastructure and clinical supervision.

Management of Cold Water-induced Hypothermia: A Simulation Scenario for Layperson Training Delivered via a Mobile Tele-simulation Unit

Newfoundland and Labrador (NL) has one of the highest provincial drowning rates in Canada, largely due to the many rural communities located near bodies of water. Factor in the province's cold climate (average NL's freshwater temperature is below 5.4°C)and the prevalence of winter recreational activities among the population, there exists an inherent risk of ice-related injuries and subsequent hypothermia. Oftentimes, these injuries occur in remote/rural settings where immediate support from Emergency Medical Services (EMS) may not be available. During this critical period, it frequently falls on individuals without formal healthcare training to provide lifesaving measures until help arrives. Training individuals in rural communities plays an important role in ensuring public safety. In recent years, simulation-based education has become an essential tool in medical, marine and first aid training. It provides learners with a safe environment to hone their skills and has been shown to be superior to traditional clinical teaching methods. The following case aims to train laypeople from rural settings in the immediate management of an individual who becomes hypothermic following immersion into cold water. However, reaching these individuals to provide training can be a challenge in a province with such a vast geography. To assist with overcoming this, the development of a simulation center that is portable between communities (or Mobile Tele-Simulation Unit) has occurred. By utilizing modern technology, this paper also proposes an innovative method of connecting with learners in more difficult to reach regions.

The Simulation-Based Assessment of Pediatric Rapid Response Teams

OBJECTIVE

To create scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners.

STUDY DESIGN

A set of 10 simulated scenarios was designed for the training and assessment of pediatric RRTs. Pediatric RRTs, comprising a pediatric intensive care unit (PICU) registered nurse and respiratory therapist, led by a PICU intensivist-in-training or a pediatric nurse practitioner, managed 7 simulated acutely decompensating patients. Two raters evaluated the scenario performances and psychometric analyses of the scenarios were performed.

RESULTS

The teams readily managed scenarios such as supraventricular tachycardia and opioid overdose but had difficulty with more complicated scenarios such as aortic coarctation or head injury. The management of any particular scenario was reasonably predictive of overall team performance. The teams led by the PICU intensivists-in-training outperformed the teams led by the pediatric nurse practitioners.

CONCLUSIONS

Simulation provides a method for RRTs to develop decision-making skills in managing decompensating pediatric patients. The multiple scenario assessment provided a moderately reliable team score. The greater scores achieved by PICU intensivist-in-training-led teams provides some evidence to support the validity of the assessment.

Survey of factors influencing learner engagement with simulation debriefing among nursing students

Simulation-based education has escalated worldwide, yet few studies have rigorously explored predictors of learner engagement with simulation debriefing. The purpose of this cross-sectional, descriptive survey was to identify factors that determine learner engagement with simulation debriefing among nursing students. A convenience sample of 296 Korean nursing students enrolled in the simulation-based course completed the survey. A total of five instruments were used: (i) Characteristics of Debriefing; (ii) Debriefing Assessment for Simulation in Healthcare - Student Version; (iii) The Korean version of the Simulation Design Scale; (iv) Communication Skills Scale; and (v) Clinical-Based Stress Scale. Multiple regression analysis was performed using the variables to investigate the influencing factors. The results indicated that influencing factors of learning engagement with simulation debriefing were simulation design, confidentiality, stress, and number of students. Simulation design was the most important factor. Video-assisted debriefing was not a significant factor affecting learner engagement. Educators should organize and conduct debriefing activities while considering these factors to effectively induce learner engagement. Further study is needed to identify the effects of debriefing sessions targeting learners' needs and considering situational factors on learning outcomes.

Using local clinical educators and shared resources to deliver simulation training activities across rural and remote South Australia and south-west Victoria: A distributed collaborative model

PROBLEM

There is a lack of access to simulation-based education (SBE) for professional entry students (PES) and health professionals at rural and remote locations.

DESIGN

A descriptive study.

SETTING

Health and education facilities in regional South Australia and south-west Victoria.

KEY MEASURES FOR IMPROVEMENT

Number of training recipients who participated in SBE; geographical distribution and locations where SBE was delivered; number of rural clinical educators providing SBE.

STRATEGIES FOR CHANGE

A distributed model to deliver SBE in rural and remote locations in collaboration with local health and community services, education providers and the general public. Face-to-face meetings with health services and education providers identified gaps in locally delivered clinical skills training and availability of simulation resources. Clinical leadership, professional development and community of practice strategies were implemented to enhance capacity of rural clinical educators to deliver SBE.

EFFECTS OF CHANGE

The number of SBE participants and training hours delivered exceeded targets. The distributed model enabled access to regular, localised training for PES and health professionals, minimising travel and staff backfill costs incurred when attending regional centres. The skills acquired by local educators remain in rural areas to support future training.

LESSONS LEARNT

The distributed collaborative model substantially increased access to clinical skills training for PES and health professionals in rural and remote locations. Developing the teaching skills of rural clinicians optimised the use of simulation resources. Consequently, health services were able to provide students with flexible and realistic learning opportunities in clinical procedures, communication techniques and teamwork skills.

[Actor as a simulated patient in medical education at the University of Pécs]

INTRODUCTION

Medical training in the 21st century faces simulation-based education as one of the challenges that efficiently contributes to clinical skills development while moderating the burden on the clinicians and patients alike.

AIM

The University of Pécs, Medical School has launched a simulation program in the MediSkillsLab based on history taking with actors to improve patient interviewing communication skills.

METHOD

This new program was inspired by experiences gathered in previous medical language teaching and integrates the method of the "Standardized Patient Program". The method has been applied in America since the 1960s.

RESULTS

This is the first time the program has been introduced in Hungary and implemented in an interdisciplinary design, where medical specialists, linguists, actor-patients and medical students collaborate to improve professional, language and communicative competence of the students.

CONCLUSION

A course like this has its pivotal role in the medical training, and as a result more efficient and patient-oriented communication may take place at the clinical setting. Orv Hetil. 2017; 158(26): 1022-1027.

Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance

OBJECTIVE

To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis.

DESIGN

A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external).

RESULTS

Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time.

CONCLUSION

Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.