Medicine › Physiology

Simulation-Based Education in Healthcare

Works Count: 29758

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Description

This cluster of papers focuses on the use of simulation-based techniques in medical education and training. It covers topics such as high-fidelity simulations, debriefing, clinical judgment, team training, mastery learning, patient safety, non-technical skills, and virtual patients.

Keywords

Simulation; Medical Education; Debriefing; Clinical Judgment; High-Fidelity Simulations; Team Training; Mastery Learning; Patient Safety; Non-Technical Skills; Virtual Patients

Simulation‐based learning in nurse education: systematic review

2009-12-09

Robyn Cant , Simon Cooper

cant r.p. & cooper s.j. (2010) Simulation‐based learning in nurse education: systematic review. Journal of Advanced Nursing 66 (1), 3–15. Abstract Title. Simulation‐based learning in nurse education: systematic review. Aim. … cant r.p. & cooper s.j. (2010) Simulation‐based learning in nurse education: systematic review. Journal of Advanced Nursing 66 (1), 3–15. Abstract Title. Simulation‐based learning in nurse education: systematic review. Aim. This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies. Background. Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown. Review methods. A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were ‘simulation’ and ‘human simulation’. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. Results. Twelve studies were included in the review. These used experimental or quasi‐experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7–11%). The validity and reliability of the studies varied due to differences in design and assessment methods. Conclusion. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.

The minimal relationship between simulation fidelity and transfer of learning

2012-05-23

Geoff Norman , Kelly Dore , Lawrence Grierson

High-fidelity simulators have enjoyed increasing popularity despite costs that may approach six figures. This is justified on the basis that simulators have been shown to result in large learning gains … High-fidelity simulators have enjoyed increasing popularity despite costs that may approach six figures. This is justified on the basis that simulators have been shown to result in large learning gains that may transfer to actual patient care situations. However, most commonly, learning from a simulator is compared with learning in a 'no-intervention' control group. This fails to clarify the relationship between simulator fidelity and learning, and whether comparable gains might be achieved at substantially lower cost.This analysis was conducted to review studies that compare learning from high-fidelity simulation (HFS) with learning from low-fidelity simulation (LFS) based on measures of clinical performance.Using a variety of search strategies, a total of 24 studies contrasting HFS and LFS and including some measure of performance were located. These studies referred to learning in three areas: auscultation skills; surgical techniques, and complex management skills such as cardiac resuscitation.Both HFS and LFS learning resulted in consistent improvements in performance in comparisons with no-intervention control groups. However, nearly all the studies showed no significant advantage of HFS over LFS, with average differences ranging from 1% to 2%.The factors influencing learning, and the reasons for this surprising finding, are discussed.

Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence

2011-04-21

William C. McGaghie , S. Barry Issenberg , Elaine Cohen +2 more

Purpose This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). Method This is a … Purpose This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). Method This is a quantitative meta-analysis that spans 20 years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes. Results Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared with traditional clinical medical education was 0.71 (95% confidence interval, 0.65–0.76; P < .001). Conclusions Although the number of reports analyzed in this meta-analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.

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The use of simulated patients in medical education: AMEE Guide No 42

2009-01-01

Jennifer Cleland , Keiko Abe , Jan‐Joost Rethans

Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations lead to the introduction of … Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations lead to the introduction of the 'simulated patient' (SP). SPs are now used widely for teaching and assessment purposes. SPs are usually, but not necessarily, lay people who are trained to portray a patient with a specific condition in a realistic way, sometimes in a standardized way (where they give a consistent presentation which does not vary from student to student). SPs can be used for teaching and assessment of consultation and clinical/physical examination skills, in simulated teaching environments or in situ. All SPs play roles but SPs have also been used successfully to give feedback and evaluate student performance. Clearly, given this potential level of involvement in medical training, it is critical to recruit, train and use SPs appropriately. We have provided a detailed overview on how to do so, for both teaching and assessment purposes. The contents include: how to monitor and assess SP performance, both in terms of validity and reliability, and in terms of the impact on the SP; and an overview of the methods, staff costs and routine expenses required for recruiting, administrating and training an SP bank, and finally, we provide some intercultural comparisons, a 'snapshot' of the use of SPs in medical education across Europe and Asia, and briefly discuss some of the areas of SP use which require further research.

Effectiveness of patient simulation in nursing education: Meta-analysis

2014-10-30

Sujin Shin , Jin Hwa Park , Jung Hee Kim

Simulation-Based Medical Education

2003-08-01

Amitai Ziv , Paul Root Wolpe , Stephen Small +1 more

Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' … Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to “first do no harm” in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.

Simulation-based learning: Just like the real thing

2010-01-01

Fatimah Lateef

Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real … Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often "immersive" in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals' knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors.

Computerized Virtual Patients in Health Professions Education: A Systematic Review and Meta-Analysis

2010-08-11

David A. Cook , Patricia J. Erwin , Marc M. Triola

Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and … Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design.The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model.Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes.Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.

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Technology-Enhanced Simulation for Health Professions Education

2011-09-06

David A. Cook , Rose Hatala , Ryan Brydges +5 more

Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education.To summarize the outcomes of technology-enhanced … Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education.To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention.Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011.Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals.Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors.From a pool of 10,903 articles, we identified 609 eligible studies enrolling 35,226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I(2)>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality.In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.

Low- to high-fidelity simulation - a continuum of medical education?

2003-10-27

Nicola Maran , Ronnie Glavin

Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational … Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational technique that allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks. The number and range of commercially available technologies used in simulation for education of health care professionals is growing exponentially. These range from simple part-task training models to highly sophisticated computer driven models.This paper will review the range of currently available simulators and the educational processes that underpin simulation training. The use of different levels of simulation in a continuum of training will be discussed. Although simulation is relatively new to medicine, simulators have been used extensively for training and assessment in many other domains, most notably the aviation industry. Some parallels and differences will be highlighted.

Simulation-based medical teaching and learning

2010-01-01

Abdulmohsen Al Elq

One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation … One of the most important steps in curriculum development is the introduction of simulation- based medical teaching and learning. Simulation is a generic term that refers to an artificial representation of a real world process to achieve educational goals through experiential learning. Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. Although medical simulation is relatively new, simulation has been used for a long time in other high risk professions such as aviation. Medical simulation allows the acquisition of clinical skills through deliberate practice rather than an apprentice style of learning. Simulation tools serve as an alternative to real patients. A trainee can make mistakes and learn from them without the fear of harming the patient. There are different types and classification of simulators and their cost vary according to the degree of their resemblance to the reality, or 'fidelity'. Simulation- based learning is expensive. However, it is cost-effective if utilized properly. Medical simulation has been found to enhance clinical competence at the undergraduate and postgraduate levels. It has also been found to have many advantages that can improve patient safety and reduce health care costs through the improvement of the medical provider's competencies. The objective of this narrative review article is to highlight the importance of simulation as a new teaching method in undergraduate and postgraduate education.

Simulation Technology for Skills Training and Competency Assessment in Medical Education

2007-12-18

Ross J. Scalese , Vivian Obeso , S. Barry Issenberg

Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and … Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and academic environments that limit patient availability as educational opportunities; worldwide attention focused on the problem of medical errors and the need to improve patient safety; and the paradigm shift to outcomes-based education with its requirements for assessment and demonstration of competence. The use of simulators addresses many of these issues: they can be readily available at any time and can reproduce a wide variety of clinical conditions on demand. In lieu of the customary (and arguably unethical) system, whereby novices carry out the practice required to master various techniques--including invasive procedures--on real patients, simulation-based education allows trainees to hone their skills in a risk-free environment. Evaluators can also use simulators for reliable assessments of competence in multiple domains. For those readers less familiar with medical simulators, this article aims to provide a brief overview of these educational innovations and their uses; for decision makers in medical education, we hope to broaden awareness of the significant potential of these new technologies for improving physician training and assessment, with a resultant positive impact on patient safety and health care outcomes.

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The history of simulation in medical education and possible future directions

2006-02-17

Paul A. Bradley

Clinical simulation is on the point of having a significant impact on health care education across professional boundaries and in both the undergraduate and postgraduate arenas.The use of simulation spans … Clinical simulation is on the point of having a significant impact on health care education across professional boundaries and in both the undergraduate and postgraduate arenas.The use of simulation spans a spectrum of sophistication, from the simple reproduction of isolated body parts through to complex human interactions portrayed by simulated patients or high-fidelity human patient simulators replicating whole body appearance and variable physiological parameters.After a prolonged gestation, recent advances have made available affordable technologies that permit the reproduction of clinical events with sufficient fidelity to permit the engagement of learners in a realistic and meaningful way. At the same time, reforms in undergraduate and postgraduate education, combined with political and societal pressures, have promoted a safety-conscious culture where simulation provides a means of risk-free learning in complex, critical or rare situations. Furthermore, the importance of team-based and interprofessional approaches to learning and health care can be promoted.However, at the present time the quantity and quality of research in this area of medical education is limited. Such research is needed to enable educators to justify the cost and effort involved in simulation and to confirm the benefit of this mode of learning in terms of the outcomes achieved through this process.

A systematic review evaluating the impact of online or blended learning vs. face‐to‐face learning of clinical skills in undergraduate nurse education

2014-08-19

Karen McCutcheon , Maria Lohan , Marian Traynor +1 more

Abstract Aim To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. Background The need … Abstract Aim To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. Background The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. Design Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. Data sources Computerized searches of five databases were undertaken for the period 1995–August 2013. Review methods Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. Results Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self‐efficacy/clinical confidence and user experience/satisfaction. The e‐learning interventions used varied throughout all the studies. Conclusion The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

Simulation-Based Education Improves Quality of Care During Cardiac Arrest Team Responses at an Academic Teaching Hospital

2007-06-16

Diane B. Wayne , Aashish Didwania , Joe Feinglass +3 more

The history of medical simulation

2008-06-01

Kathleen R. Rosen

Use of Simulation-Based Education to Reduce Catheter-Related Bloodstream Infections

2009-08-10

Jeffrey H. Barsuk , Elaine Cohen , Joe Feinglass +2 more

<h3>Background</h3> Simulation-based education improves procedural competence in central venous catheter (CVC) insertion. The effect of simulation-based education in CVC insertion on the incidence of catheter-related bloodstream infection (CRBSI) is unknown. … <h3>Background</h3> Simulation-based education improves procedural competence in central venous catheter (CVC) insertion. The effect of simulation-based education in CVC insertion on the incidence of catheter-related bloodstream infection (CRBSI) is unknown. The aim of this study was to determine if simulation-based training in CVC insertion reduces CRBSI. <h3>Methods</h3> This was an observational education cohort study set in an adult intensive care unit (ICU) in an urban teaching hospital. Ninety-two internal medicine and emergency medicine residents completed a simulation-based mastery learning program in CVC insertion skills. Rates of CRBSI from CVCs inserted by residents in the ICU before and after the simulation-based educational intervention were compared over a 32-month period. <h3>Results</h3> There were fewer CRBSIs after the simulator-trained residents entered the intervention ICU (0.50 infections per 1000 catheter-days) compared with both the same unit prior to the intervention (3.20 per 1000 catheter-days) (<i>P</i> = .001) and with another ICU in the same hospital throughout the study period (5.03 per 1000 catheter-days) (<i>P</i> = .001). <h3>Conclusions</h3> An educational intervention in CVC insertion significantly improved patient outcomes. Simulation-based education is a valuable adjunct in residency education.

Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education

2008-11-01

Jenny W. Rudolph , Robert Simon , Daniel B. Raemer +1 more

The authors present a four-step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 … The authors present a four-step model of debriefing as formative assessment that blends evidence and theory from education research, the social and cognitive sciences, experience drawn from conducting over 3,000 debriefings, and teaching debriefing to approximately 1,000 clinicians worldwide. The steps are to: 1) note salient performance gaps related to predetermined objectives, 2) provide feedback describing the gap, 3) investigate the basis for the gap by exploring the frames and emotions contributing to the current performance level, and 4) help close the performance gap through discussion or targeted instruction about principles and skills relevant to performance. The authors propose that the model, designed for postsimulation debriefings, can also be applied to bedside teaching in the emergency department (ED) and other clinical settings.

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Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum?

2004-12-01

Marc J. Shapiro

<b>Objective:</b> To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum. <b>Setting:</b> Level 1 trauma center and academic … <b>Objective:</b> To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum. <b>Setting:</b> Level 1 trauma center and academic emergency medicine training program. <b>Participants:</b> Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians. <b>Intervention:</b> : ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC®) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention. <b>Design:</b> Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams. <b>Results:</b> There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method. <b>Conclusion:</b> High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.

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A brief history of the development of mannequin simulators for clinical education and training

2004-12-16

Jeffrey B. Cooper , Viviany R. Taqueti

Simulation for medical and healthcare applications, although still in a relatively nascent stage of development, already has a history that can inform the process of further research and dissemination. The … Simulation for medical and healthcare applications, although still in a relatively nascent stage of development, already has a history that can inform the process of further research and dissemination. The development of mannequin simulators used for education, training, and research is reviewed, tracing the motivations, evolution to commercial availability, and efforts toward assessment of efficacy of those for teaching cardiopulmonary resuscitation, cardiology skills, anaesthesia clinical skills, and crisis management. A brief overview of procedural simulators and part-task trainers is also presented, contrasting the two domains and suggesting that a thorough history of the 20+ types of simulator technologies would provide a useful overview and perspective. There has been relatively little cross fertilisation of ideas and methods between the two simulator domains. Enhanced interaction between investigators and integration of simulation technologies would be beneficial for the dissemination of the concepts and their applications.

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The Utility of Simulation in Medical Education: What Is the Evidence?

2009-07-29

Yasuharu Okuda , Ethan O. Bryson , Samuel DeMaria +4 more

Abstract Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay … Abstract Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are “practicing” on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small‐group sessions, and increasing self‐directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education , and continuing medical education . Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation‐based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes. Mt Sinai J Med 76:330–343, 2009. © 2008 Mount Sinai School of Medicine

A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing.

2005-06-01

Pamela R. Jeffries

This article presents a framework that can be used to design, implement, and evaluate simulations used for teaching strategies in nursing education. Components of the framework include best practices in … This article presents a framework that can be used to design, implement, and evaluate simulations used for teaching strategies in nursing education. Components of the framework include best practices in education, student factors, teacher factors, simulation design characteristics, and outcomes. Variables are identified for each of the framework components.

The future vision of simulation in health care

2004-10-01

David M. Gaba

Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The … Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient's age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality.

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Training and simulation for patient safety

2010-08-01

Raj Aggarwal , Oliver Mytton , M. Derbrew +7 more

<h3>Background</h3> Simulation-based medical education enables knowledge, skills and attitudes to be acquired for all healthcare professionals in a safe, educationally orientated and efficient manner. Procedure-based skills, communication, leadership and team … <h3>Background</h3> Simulation-based medical education enables knowledge, skills and attitudes to be acquired for all healthcare professionals in a safe, educationally orientated and efficient manner. Procedure-based skills, communication, leadership and team working can be learnt, be measured and have the potential to be used as a mode of certification to become an independent practitioner. <h3>Results</h3> Simulation-based training initially began with life-like manikins and now encompasses an entire range of systems, from synthetic models through to high fidelity simulation suites. These models can also be used for training in new technologies, for the application of existing technologies to new environments and in prototype testing. The level of simulation must be appropriate to the learners9 needs and can range from focused tuition to mass trauma scenarios. The development of simulation centres is a global phenomenon which should be encouraged, although the facilities should be used within appropriate curricula that are methodologically sound and cost-effective. <h3>Discussion</h3> A review of current techniques reveals that simulation can successfully promote the competencies of medical expert, communicator and collaborator. Further work is required to develop the exact role of simulation as a training mechanism for scholarly skills, professionalism, management and health advocacy.

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A critical review of simulation-based mastery learning with translational outcomes

2014-03-09

William C. McGaghie , S. Barry Issenberg , Jeffrey H. Barsuk +1 more

Objectives This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes … Objectives This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. Methods This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006–2013). We use the ‘critical review’ approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. Results Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). Conclusions Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination.

Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82

2013-08-13

Ivette Motola , Luke Devine , Hyun Soo Chung +2 more

Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in … Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in simulation for training, such as aviation, the military and space exploration. Increased demands on training hours, limited patient encounters, and a focus on patient safety have led to a new paradigm of education in healthcare that increasingly involves technology and innovative ways to provide a standardized curriculum. A robust body of literature is growing, seeking to answer the question of how best to use simulation in healthcare education. Building on the groundwork of the Best Evidence in Medical Education (BEME) Guide on the features of simulators that lead to effective learning, this current Guide provides practical guidance to aid educators in effectively using simulation for training. It is a selective review to describe best practices and illustrative case studies. This Guide is the second part of a two-part AMEE Guide on simulation in healthcare education. The first Guide focuses on building a simulation program, and discusses more operational topics such as types of simulators, simulation center structure and set-up, fidelity management, and scenario engineering, as well as faculty preparation. This Guide will focus on the educational principles that lead to effective learning, and include topics such as feedback and debriefing, deliberate practice, and curriculum integration - all central to simulation efficacy. The important subjects of mastery learning, range of difficulty, capturing clinical variation, and individualized learning are also examined. Finally, we discuss approaches to team training and suggest future directions. Each section follows a framework of background and definition, its importance to effective use of simulation, practical points with examples, and challenges generally encountered. Simulation-based healthcare education has great potential for use throughout the healthcare education continuum, from undergraduate to continuing education. It can also be used to train a variety of healthcare providers in different disciplines from novices to experts. This Guide aims to equip healthcare educators with the tools to use this learning modality to its full capability.

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Effectiveness of intermediate‐fidelity simulation training technology in undergraduate nursing education

2006-04-21

Guillaume Alinier , Barry Hunt , Ray Gordon +1 more

Aim. The aim of this paper is to present the results of a study designed to determine the effect of scenario‐based simulation training on nursing students’ clinical skills and competence. … Aim. The aim of this paper is to present the results of a study designed to determine the effect of scenario‐based simulation training on nursing students’ clinical skills and competence. Background. Using full‐scale, realistic, medical simulation for training healthcare professionals is becoming more and more common. Access to this technology is easier than ever before with the opening of several simulation centres throughout the world and the availability on the market of more sophisticated and affordable patient simulators. However, there is little scientific evidence proving that such technology is better than more traditional techniques in the education of, for example, undergraduate nursing students. Methods. A pretest/post‐test design was employed with volunteer undergraduate students ( n = 99) from second year Diploma of Higher Education in Nursing programme in United Kingdom using a 15‐station Objective Structured Clinical Examination. Students were randomly allocated to either a control or an experimental group. The experimental group, as well as following their normal curriculum, were exposed to simulation training. Subsequently, all students were re‐tested and completed a questionnaire. The data were collected between 2001 and 2003. Results. The control and experimental groups improved their performance on the second Objective Structured Clinical Examination. Mean test scores, respectively, increased by 7·18 and 14·18 percentage points. The difference between the means was statistically significant ( P < 0·001). However, students’ perceptions of stress and confidence, measured on a 5‐point Likert scale, was very similar between groups at 2·9 (1, not stressful; 5, very stressful) and 3·5 (1, very confident; 5, not confident) for the control group, and 3·0 and 3·4 for the experimental group. Conclusions. Intermediate‐fidelity simulation is a useful training technique. It enables small groups of students to practise in a safe and controlled environment how to react adequately in a critical patient care situation. This type of training is very valuable to equip students with a minimum of technical and non‐technical skills before they use them in practice settings.

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Comparative effectiveness of instructional design features in simulation-based education: Systematic review and meta-analysis

2012-09-03

David A. Cook , Stanley J. Hamstra , Ryan Brydges +5 more

Background: Although technology-enhanced simulation is increasingly used in health professions education, features of effective simulation-based instructional design remain uncertain.Aims: Evaluate the effectiveness of instructional design features through a systematic review … Background: Although technology-enhanced simulation is increasingly used in health professions education, features of effective simulation-based instructional design remain uncertain.Aims: Evaluate the effectiveness of instructional design features through a systematic review of studies comparing different simulation-based interventions.Methods: We systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. We included original research studies that compared one simulation intervention with another and involved health professions learners. Working in duplicate, we evaluated study quality and abstracted information on learners, outcomes, and instructional design features. We pooled results using random effects meta-analysis.Results: From a pool of 10 903 articles we identified 289 eligible studies enrolling 18 971 trainees, including 208 randomized trials. Inconsistency was usually large (I 2 > 50%). For skills outcomes, pooled effect sizes (positive numbers favoring the instructional design feature) were 0.68 for range of difficulty (20 studies; p < 0.001), 0.68 for repetitive practice (7 studies; p = 0.06), 0.66 for distributed practice (6 studies; p = 0.03), 0.65 for interactivity (89 studies; p < 0.001), 0.62 for multiple learning strategies (70 studies; p < 0.001), 0.52 for individualized learning (59 studies; p < 0.001), 0.45 for mastery learning (3 studies; p = 0.57), 0.44 for feedback (80 studies; p < 0.001), 0.34 for longer time (23 studies; p = 0.005), 0.20 for clinical variation (16 studies; p = 0.24), and −0.22 for group training (8 studies; p = 0.09).Conclusions: These results confirm quantitatively the effectiveness of several instructional design features in simulation-based education.

The Role of Debriefing in Simulation-Based Learning

2007-01-01

Ruth M. Fanning , David M. Gaba

The aim of this paper is to critically review what is felt to be important about the role of debriefing in the field of simulation-based learning, how it has come … The aim of this paper is to critically review what is felt to be important about the role of debriefing in the field of simulation-based learning, how it has come about and developed over time, and the different styles or approaches that are used and how effective the process is. A recent systematic review of high fidelity simulation literature identified feedback (including debriefing) as the most important feature of simulation-based medical education.1 Despite this, there are surprisingly few papers in the peer-reviewed literature to illustrate how to debrief, how to teach or learn to debrief, what methods of debriefing exist and how effective they are at achieving learning objectives and goals. This review is by no means a systematic review of all the literature available on debriefing, and contains information from both peer and nonpeer reviewed sources such as meeting abstracts and presentations from within the medical field and other disciplines versed in the practice of debriefing such as military, psychology, and business. It also contains many examples of what expert facilitators have learned over years of practice in the area. We feel this would be of interest to novices in the field as an introduction to debriefing, and to experts to illustrate the gaps that currently exist, which might be addressed in further research within the medical simulation community and in collaborative ventures between other disciplines experienced in the art of debriefing. THE BACKGROUND OF SIMULATION-BASED LEARNING Generally, in simulation-based learning, we are dealing with educating the adult professional. Adult learning provides many challenges not seen in the typical student population. Adults arrive complete with a set of previous life experiences and frames ("knowledge assumptions, feelings"), ingrained personality traits, and relationship patterns, which drive their actions.2 Adult learners become more self-directed as they mature. They like their learning to be problem centered and meaningful to their life situation, and learn best when they can immediately apply what they have learned.3 Their attitudes towards any specific learning opportunity will vary and depend on factors such as their motivation for attending training, on whether it is voluntary or mandatory, and whether participation is linked directly to recertification or job retention. Traditional teaching methods based on linear communication models (ie, a teacher imparts facts to the student in a unidirectional manner) are not particularly effective in adult learning, and may be even less so in team-oriented training exercises. The estimated half-life of professional knowledge gained through such formal education may be as little as 2 to 2.5 years.4 In the case of activities requiring both formal knowledge and a core set of skills, such as Advanced Cardiac Life Support, retention can be as little as 6 to 12 months.5,6 Much of the research in teaching adults indicates that active "participation" is an important factor in increasing the effectiveness of learning in this population.7 In fact, in any given curriculum, learning occurs not only by the formal curriculum per se but informally through personalized teaching methods (informal curricula), and even more so through embedded cultures and structures within the organization (hidden curricula).8 Adults learn best when they are actively engaged in the process, participate, play a role, and experience not only concrete events in a cognitive fashion, but also transactional events in an emotional fashion. The learner must make sense of the events experienced in terms of their own world. The combination of actively experiencing something, particularly if it is accompanied by intense emotions, may result in long-lasting learning. This type of learning is best described as experiential learning: learning by doing, thinking about, and assimilation of lessons learned into everyday behaviors. Kolb describes the experiential learning cycle as containing four related parts: concrete experience, reflective observation, abstract conceptualization, and active experimentation.9 Gibbs also describes four phases: planning for action, carrying out action, reflection on action, and relating what happens back to theory.10 Grant and Marsden similarly describe the experiential learning process as having an experience, thinking about the experience, identifying learning needs that would improve future practice in the area, planning what learning to undertake, and applying the new learning in practice.11 Simulation training sessions, which are structured with specific learning objectives in mind, offer the opportunity to go through the stages of the experiential cycle in a structured manner and often combine the active experiential component of the simulation exercise itself with a subsequent analysis of, and reflection on the experience, aiming to facilitate incorporation of changes in practice. Simulation offers the opportunity of practiced experience in a controlled fashion, which can be reflected on at leisure. Experiential learning is particularly suited to professional learning, where integration of theory and practice is pertinent and ongoing.11 In experiential learning, the experience is used as the major source of learning but it is not the only one. Both thinking and doing are required and must be related in the minds of the learner.10 The concept of reflection on an event or activity and subsequent analysis is the cornerstone of the experiential learning experience. Facilitators guide this reflective process. Indeed this ability to reflect, appraise, and reappraise is considered a cornerstone of lifelong learning. This is one of the core elements of training in healthcare articulated by the Accreditation Council on Graduate Medical Education in the United States.12 In practice however, not everyone is naturally capable of analyzing, making sense, and assimilating learning experiences on their own, particularly those included in highly dynamic team-based activities. The attempt to bridge this natural gap between experiencing an event and making sense of it led to the evolution of the concept of the "postexperience analysis"13 or debriefing. As such, debriefing represents facilitated or guided reflection in the cycle of experiential learning. ORIGINS OF DEBRIEFING IN SIMULATION-BASED LEARNING Historically, debriefing originated in the military, in which the term was used to describe the account individuals gave on returning from a mission.14 This account was subsequently analyzed and used to strategize for other missions or exercises. This military-style debriefing was both educational and operational in its objectives. Another connotation of debriefing developed out of the combat arena as a therapeutic or psychological association, as sort of "defusing," and aided the processing of a traumatic event with the aim of reducing psychologic damage and returning combatants to the frontline as quickly as possible. In this therapeutic approach, emphasis was placed on the importance of the narrative to reconstruct what happened. This cognitive reconstruction of events was performed in groups so that there was a shared meaning. The participants were brought together to describe what had occurred, to account for the actions that had taken place, and to develop new strategies with each other and the commanding officers. Another form of debriefing, critical incident debriefing, was pioneered by Mitchell15 and is used to mitigate stress among emergency first responders. He formulated a set of procedures termed the Critical Incident Stress Debriefing (CISD).15 CISD is a facilitator-led approach to enable participants to review the facts, thoughts, impressions, and reactions after a critical incident. Its main aim is to reduce stress and accelerate normal recovery after a traumatic event by stimulating group cohesion and empathy. Dyregrov modified this technique and called it psychological debriefing, designed to take place in the 48 to 72 hours after a traumatizing event in an attempt to assist participants in the cognitive and emotional processing of what they experienced.16 Currently, there is concern that an unrealistic expectation of CISD and its usefulness may be developing. A single session approach may be inadequate for certain individuals and situations, particularly as the technique is applied outside the realms for which it was originally designed.17 Another origin for the term "debriefing" comes from experimental psychology, and describes the means by which participants who have been deceived in some manner as part of a psychology study are informed of the true nature of the experiment.18 The purpose of this ethically required debrief is to allow dehoaxing to occur, and to reverse any negative effects the experience may have had.19 Each of the three fields have contributed to the development of debriefing in the educational arena, facilitator-led participant discussion of events, reflection, and assimilation of activities into their cognitions produce long-lasting learning. THE DEBRIEFING PROCESS Approach to Debriefing Just as in noneducational debriefing, where there exists an ethical duty of facilitators to set a safe, confidential scene for facilitation, there is the ethical obligation for the facilitator in simulation-based learning to determine the parameters within which behavior will be analyzed, thereby attempting to protect participants from experiences that might seriously damage their sense of self-worth.20 To ensure a successful debriefing process and learning experience, the facilitator must provide a "supportive climate"21 where students feel valued, respected, and free to learn in a dignified environment. Participants need to be able to "share their experiences in a frank, open and honest manner."14 An awareness of the vulnerability of the participant is needed, which must be respected at all times. This is highlighted by a recent study regarding the barriers to simulation-based learning, where approximately half the participants found it a stressful and intimidating environment and a similar proportion cited a fear of the educator and their peers' judgment.22 It is essential that the facilitator creates an environment of trust early on, typically in the prebrief session. This prebrief period is a time when the facilitator illustrates the purpose of the simulation, the learning objectives, the process of debriefing, and what it entails. It is the period where the participants learn what is expected of them and sets the ground rules for their simulation-based learning experience. It is also a time for the facilitator to reflect on the learning objectives, and to consider that every participant comes to the simulation with a preceding set of individual frames and life experiences.2 These previous experiences have an impact on how effective training will be, and need to be taken into consideration irrespective of the debriefing model employed. These frames or internal images of reality, how a person perceives something relative to someone else, affect the way people receive, process, and assimilate information.2 The simulation scenario and the debriefing techniques employed need to take individual learning styles into consideration. This factor is illustrated by Kolb with the incorporation of the experiential learning cycle with basic learning styles.23 Four prevalent learning styles are identified: diverging, assimilating, converging, and accommodating. Participants with diverging learning styles use concrete experience and reflective observation to learn. This style facilitates generation of ideas, such as brainstorming. Individuals with this learning style prefer to work in groups, listening and receiving feedback. Individuals with assimilating learning styles prefer abstract conceptualization and reflective observation. They like reading, lectures, and analysis. Converging-styled learners use abstract conceptualization and active experimentation. They like to find practical uses for ideas and theories. In a formal learning setting, they prefer to experiment with new ideas, simulations, laboratory experiments, and practical applications. Accommodating-styled learners use concrete experience and active experimentation. People with this style learn primarily from hands-on experience. In formal learning, they prefer to work in teams, to set goals, to do fieldwork, and to test different approaches to compiling a project. When learning in teams, individuals tend to orientate themselves and contribute to the team learning process by using their individual learning styles to help the team achieve its learning objectives. Highly effective teams tend to possess individuals with a number of different learning styles. In our experience, pairing appropriately learning-styled individuals may add to the team's performance. Individual learning styles and team composition are important factors for facilitators to consider when choosing which style of debriefing will be most successful for each simulation session. It is also important for facilitators to learn about the characteristics of the group: whether group members know each other, are novices or are experienced, or are new to simulation. The prebrief period can afford the experienced facilitator an opportunity to observe team behaviors and identify learner characteristics early on, and debrief accordingly. Structural Elements of the Debriefing Process Despite many approaches to debriefing,24,25 there are a number of structural elements common to most forms of facilitation. Lederman identified seven common structural elements involved in the debriefing process (Table 1).18 The first two elements are the debriefer(s) and those to be debriefed. It is possible for these two to be the same if participants act as their own debriefers.26 The third element is the experience itself (eg, the simulation), and the fourth is the impact this experience has on the participants. The concept of impact is important because adult learners typically need to be emotionally moved by the event, and the event needs to be relevant to their everyday lives to make an impact. The fifth and sixth elements involve recollection and report. Reporting of the event, although usually carried out in a verbal manner, may be written or involve the completion of a formal questionnaire.24 The seventh element is time: the experience will be seen differently depending on how much time has passed before the debriefing. Although most debriefing approaches are conducted very soon after the experience, some allow more time for formal reflection, with reporting long after the event via a written report of an individual event or through keeping a journal (a written review of educational experiences over a semester).24Table 1: Seven Common Structural Elements Involved in the Debriefing Process18Models of Debriefing A number of models exist incorporating these structural elements and describe various debriefing or facilitation styles.27–29 These models probably all evolve out of the natural order of human processing: to experience an event, to reflect on it, to discuss it with others, and learn and modify behaviors based on the experience. Although reflection after a learning experience might occur naturally, it is likely to be unsystematic. It may not occur at all especially if the pressure of events prevents focusing on what has just transpired. Conducting a formal debriefing focuses the reflective process, both for individual participants and for the group as a whole. Naturally, debriefings may move of their own power through three phases: description, analogy/analysis, and application. However, without a facilitator participants may have trouble moving out of this first descriptive phase, particularly the active "hot-seat" participant who is emotionally absorbed in the event and is blinkered in their view of what has occurred. The challenge for the facilitator is to allow enough time for defusing to occur, but direct the discussion in a more objective, broad-based capacity. The facilitator needs to move the discussion away from the very personalized account of what the participant thought occurred, to the more global perspective, away from the individual to the group, and the person to the event, but must be cognizant not to cut the participant off, or make him/her feel alienated. Although the core of the debrief centers on reflection of the active experience and making sense of the event, there are supporting phases that are necessary to allow this reflection and assimilation to occur. These phases of the debrief are described by many authors, and are categorized in different manners. The basic tenets of the various debriefing models have many overlapping elements (Table 2).Table 2: Models of the Debriefing ProcessAn initial phase of identifying the impact of the experience, considering the processes that developed and clarifying the facts, concepts, and principles which were used in simulation is described by Thatcher and Robinson.27 Lederman describes this phase as the introduction to systematic reflection and analysis that follows the active component of the simulation: "the recollection of what happened and description of what participants did in their own words."28 Paternek describes this introductory phase as the description of the events that occurred.29 The second phase is described as identifying the ways in which emotion was involved, either individually or for the group;27 the intensification and personalization of the analysis of the experience, where participants explore the feelings they experienced during the event;28 or the emotional and empathic content of the discussion.29 The third phase involves identifying the different views formed by each participant, and how they correlate with the picture as a whole;27 the generalization and application of the experience, during which participants attempt to make comparisons with real-life events;28 a phase of explanations and analysis, everyday applicability and evaluation of behaviors.2 Objectives of the Debriefing Session The design of the debriefing session should be tailored to the learning objectives and the participant and team characteristics. Objectives may be well defined, and specified beforehand, or may be emergent and evolve within the simulation. For well-defined objectives, such as a technical skill or a particular team behavior, the debriefing session affords the opportunity to examine how closely participants' performance has approached a known target, and what needs to be done to bridge any observed gaps between performance and target. It also affords an opportunity to share these objectives with participants. With emergent objectives, participants may be asked to reflect on the observed evolution of the scenario and to see how the behaviors, attitudes, and choices uncovered in the simulation relate to real life situations. When exploring objectives or goals, there are two main questions: 1) which pieces of knowledge, skills, or attitudes are to be learned? and 2) what specifically should be learned about each of them? In the case of emergent objectives, simulations may be viewed as experiments in which participants try alternative ways of behavior or test new strategies or courses of action. To debrief about such objectives is complicated because there are fewer predefined ideas about how the participants should have acted, so discussion must focus around issues that arise from the events themselves and their meaning to those involved. Role of the Facilitator in the Debriefing Process There is a tension between making participants active and responsible for their own learning versus ensuring they address important issues and extract maximum learning during debriefings. Data from surveys of participants indicates that the perceived skills of the debriefer have the highest independent correlation to the perceived overall quality of the simulation experience.30 As the skill of the debriefer is paramount in ensuring the best possible learning experience, training in facilitation is vital. A number of centers offer facilitation courses providing training in debriefing skills (Table 3).31 In addition to the formal education of facilitators, techniques such as the pairing of expert with novice facilitators early in their career to give guidance and direction are important. A recent study of facilitation in problem-based learning illustrated that while facilitators felt that a formal training course provided sufficient skills to commence debriefing, it was only with experience, and in the presence of an expert role model that they became more comfortable with the process.32 In the same study, students commented on the skill of facilitators as being an important factor in the learning process and the credibility of the course. Basic and advanced courses and refresher courses in facilitation are probably universally required.Table 3: List of Institutions and Organizations that Offer Formal Training for the Simulation-based Healthcare Educator31The exact level of facilitation and the degree to which the facilitator is involved in the debriefing process can depend on a variety of generic factors: The objective of the experiential exercise, The complexity of the scenarios, The experience level of the participants as individuals or a team, The familiarity of the participants with the simulation environment, Time available for session, The role of simulations in the overall curriculum, Individual personalities and relationships, if any, between the participants. Unlike the traditional classroom "teacher," facilitators tend to position themselves not as authorities or experts, but rather as colearners. This more fraternal approach may be most productive where the learning objective is behavioral change. Facilitators aim to guide and direct rather than to lecture. The role of the student or participant in debriefing is expanded from the traditional passive role to one where the skills demanded of them are the ability to critically analyze one's own performance retrospectively—not just what went well but what went wrong, and why it went that way, and to contribute actively to the learning process. Practical Points on Debriefing There are a number of methods of debriefing, and levels of facilitation that may be employed. Dismukes and Smith, while discussing debriefing in aviation, delineate three levels of facilitation.33 High Participants largely debrief themselves with the facilitator outlining the debriefing process and assisting by gently guiding the discussion only when necessary, and acting as a resource to ensure that objectives are met. Thus, paradoxically the high level facilitation actually implies a low level of involvement by the facilitator. This level of facilitation—initially described by Carl Rogers—describes the facilitator as a catalyst, allowing clients or students to draw their own conclusions, creating their own prescription for change.34 He described "core conditions" for the facilitative process, both counseling and educational. These are congruence (realness), acceptance, and empathy. Realness refers to genuine nature of the facilitator. The idea of acceptance is that the learner feels that their opinions are prized, as are their feelings and their person. For the third, empathy, the teacher aims to understand the learner's viewpoint and have sensitivity for it. Examples of techniques in high-level facilitation would be the use of pauses to allow thoughtful responses and comment, open-ended questions and phrases rather than statements of fact. The artful use of silence is another technique to draw further discussion from the group. Intermediate An increased level of instructor involvement may be useful when the individual or team requires help to analyze the experience at a deep level, but are capable of much independent discussion. Examples of techniques used in intermediate-level facilitation would include rewording or rephrasing rather than giving answers, asking questions in a number of ways to a number of participants and changing the tone of questions. Other techniques would be asking one member to comment on another, or moving around a group asking for input from all team members. Low An intensive level of instructor involvement may be necessary where teams show little initiative or respond only superficially. In such cases the facilitator guides the individual or the group through the debriefing stages, asks many questions and strongly directs the nature of the discussion. In low-level facilitation, participants show little initiative and tend to respond only superficially. Here the facilitator may need to be directive to operate a stepwise or pattern of analysis. Examples of techniques used in low-level facilitation would include answering for participants, confirming statements, agreeing, recapping, and reinforcing thoughts and ideas. Other techniques such as active listening, echoing, and expanding on statements and nonverbal encouragement such as nodding, leaning forward, and focused eye contact are useful. It is probably most beneficial to facilitate at the highest possible level, with the participants independently generating a rich discussion among themselves of all key issues. In our experience in healthcare, this ideal is rarely achieved, especially with relatively junior trainees or with first-time simulation participants of any age. Matching the level of instructor involvement to the nature of the material and the group is critical. Conversely, there may be a tendency for instructors to debrief at a lower level (with more instructor involvement) than the participant group might really need—that is, to "overinstruct." To ensure that participants become involved at the highest level, a good prebrief is essential. Individuals and teams unfamiliar with this kind of learning may start off a sequence of simulations and debriefings with a need for high instructor input but then become more participant-directed as the day progresses. Other Styles of Facilitation Just as different levels of facilitation may be employed to suit the needs of participants, different facilitator techniques may be used to engage participants in the debriefing process. Examples of other styles of facilitation include: funneling, where the facilitator guides or funnels the participants, but refrains from commenting; framing, introducing the experience in a manner that enhances its relevance and meaning; and frontloading, using punctuated questions before or during an experience to redirect reflection. Solution-focused facilitation changes the focus of questions away from problems, and directional-style debriefing is intended to change the way people feel or think.35 Techniques such as plus-delta may also be useful. This technique which involves creating two headings or columns entitled delta, the Greek symbol for change, and plus. Under the delta column, the participants or/and the facilitator place all the behaviors/actions they would change or improve on in future, where the plus column contains examples of good behaviors or actions. Different participants can contribute to the critique, which may single out individual or team behaviors. Variations on the technique include placing behaviors or actions that were found to be difficult on the delta column, and easier tasks or behaviors on the plus column, and subsequently discussing why this was the case. Facilitators at the Karolinska University Hospital in Sweden use a target-focused technique to aid facilitation.36 Target behaviors are identified prior to the simulation scenario in the prebrief period, and subsequently during the debrief these can be identified and evaluated by facilitators, participants, and by observers. This technique offers a structure for debriefing that may facilitate debriefing by participants. Facilitators may decide to use different communication styles while debriefing: using commands, cues, or questions. They may also decide to use acceptance and praise or be scolding and corrective.37 If there are a number of debriefers, they may decide to use opposing styles: "good cop-bad cop" to encourage discussion and cohesiveness within a participant team. A group of debriefers may offer advantages where specific educational or technical points need to be addressed. An expert (expert content debriefer) may debrief on specialized issues and offer credibility to the discussion, particularly where dealing with an experienced group of participants. When a number of facilitators are present, their roles need to clearly described before debriefing commences to avoid excessive facilitator input in discussions. This is particularly pertinent if the principal debriefer is attempting to use techniques such as active listening and silence to encourage group participation. The Debriefing Setting The physical environment in which debriefing is conducted is also an important factor. For complex debriefings lasting more than a few minutes, debriefings often take place in a room separate from the active portion of the simulation to allow diffusion of tension and to provide a setting conducive to reflection (this also frees up the simulation room to be set up for the next scenario). However, not all debriefings are held after the simulation, but in certain instances, for example, where the aim is to teach a technical skill or if the team behaviors are seriously flawed, debriefing may occur during the simulation, "in-scenario" debriefing. The debriefing room should be comfortable, private, and a relatively intimate environment (for example, a large auditorium would typically not be appropriate). The seating arrangement may vary with the style of the debriefing and the degree of facilitation i

A critical review of simulation-based medical education research: 2003â2009

2009-12-16

William C. McGaghie , S. Barry Issenberg , Emil Petrusa +1 more

Objectives This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers … Objectives This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. Methods This qualitative synthesis of SBME research and scholarship was carried out in two stages. Firstly, we summarised the results of three SBME research reviews covering the years 1969–2003. Secondly, we performed a selective, critical review of SBME research and scholarship published during 2003–2009. Results The historical and contemporary research synthesis is reported to inform the medical education community about 12 features and best practices of SBME: (i) feedback; (ii) deliberate practice; (iii) curriculum integration; (iv) outcome measurement; (v) simulation fidelity; (vi) skill acquisition and maintenance; (vii) mastery learning; (viii) transfer to practice; (ix) team training; (x) high-stakes testing; (xi) instructor training, and (xii) educational and professional context. Each of these is discussed in the light of available evidence. The scientific quality of contemporary SBME research is much improved compared with the historical record. Conclusions Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts. Medical Education 2010: 44: 50–63

High-Fidelity Simulation and the Development of Clinical Judgment: Students' Experiences

2007-06-01

Kathie Lasater

<h4>ABSTRACT</h4> <P>Nursing education programs across the country are making major capital investments in alternative learning strategies, such as human patient simulators; yet, little research exists to affirm this new innovation. … <h4>ABSTRACT</h4> <P>Nursing education programs across the country are making major capital investments in alternative learning strategies, such as human patient simulators; yet, little research exists to affirm this new innovation. At the same time, nursing programs must become even more effective in the development of students’ clinical judgment to better prepare graduates to take on increasingly complex care management. This qualitative study examined the experiences of students in one nursing program’s first term of using high-fidelity simulation as part of its regular curriculum. On the basis of these experiences, it seems that high-fidelity simulation has potential to support and affect the development of clinical judgment in nursing students and to serve as a value-added adjunct to their clinical practica.</P> <h4>AUTHOR</h4> <P>Received: May 5, 2005</P> <P>Accepted: October 14, 2005</P> <P>Dr. Lasater is Assistant Professor, Oregon Health & Science University, School of Nursing, Portland, Oregon. </P> <P>Address correspondence to Kathie Lasater, EdD, RN, Assistant Professor, Oregon Health & Science University, School of Nursing, 3455 SW Veterans Hospital Road, Mailcode SN-4S, Portland, OR 97239; e-mail: <a href="mailto:[email protected]">[email protected]</a>.</P>

Deepening the Theoretical Foundations of Patient Simulation as Social Practice

2007-01-01

Peter Dieckmann , David M. Gaba , Marcus Rall

Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on … Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffman's concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.

Promoting Excellence and Reflective Learning in Simulation (PEARLS)

2015-02-24

Walter Eppich , Adam Cheng

We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS [Promoting Excellence And Reflective Learning in Simulation]. We provide a rationale for scripted debriefing and introduce … We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS [Promoting Excellence And Reflective Learning in Simulation]. We provide a rationale for scripted debriefing and introduce a PEARLS debriefing tool designed to facilitate implementation of the new framework. The PEARLS framework integrates 3 common educational strategies used during debriefing, namely, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing information in the form of directive feedback and/or teaching. The PEARLS debriefing tool incorporates scripted language to guide the debriefing, depending on the strategy chosen. The PEARLS framework and debriefing script fill a need for many health care educators learning to facilitate debriefings in simulation-based education. The PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.

Reconsidering Fidelity in Simulation-Based Training

2014-01-21

Stanley J. Hamstra , Ryan Brydges , Rose Hatala +2 more

In simulation-based health professions education, the concept of simulator fidelity is usually understood as the degree to which a simulator looks, feels, and acts like a human patient. Although this … In simulation-based health professions education, the concept of simulator fidelity is usually understood as the degree to which a simulator looks, feels, and acts like a human patient. Although this can be a useful guide in designing simulators, this definition emphasizes technological advances and physical resemblance over principles of educational effectiveness. In fact, several empirical studies have shown that the degree of fidelity appears to be independent of educational effectiveness. The authors confronted these issues while conducting a recent systematic review of simulation-based health professions education, and in this Perspective they use their experience in conducting that review to examine key concepts and assumptions surrounding the topic of fidelity in simulation.Several concepts typically associated with fidelity are more useful in explaining educational effectiveness, such as transfer of learning, learner engagement, and suspension of disbelief. Given that these concepts more directly influence properties of the learning experience, the authors make the following recommendations: (1) abandon the term fidelity in simulation-based health professions education and replace it with terms reflecting the underlying primary concepts of physical resemblance and functional task alignment; (2) make a shift away from the current emphasis on physical resemblance to a focus on functional correspondence between the simulator and the applied context; and (3) focus on methods to enhance educational effectiveness using principles of transfer of learning, learner engagement, and suspension of disbelief. These recommendations clarify underlying concepts for researchers in simulation-based health professions education and will help advance this burgeoning field.

Establishing a Safe Container for Learning in Simulation

2014-09-05

Jenny W. Rudolph , Daniel B. Raemer , Robert Simon

Summary statement: In the absence of theoretical or empirical agreement on how to establish and maintain engagement in instructor-led health care simulation debriefings, we organize a set of promising practices … Summary statement: In the absence of theoretical or empirical agreement on how to establish and maintain engagement in instructor-led health care simulation debriefings, we organize a set of promising practices we have identified in closely related fields and our own work. We argue that certain practices create a psychologically safe context for learning, a so-called safe container. Establishing a safe container, in turn, allows learners to engage actively in simulation plus debriefings despite possible disruptions to that engagement such as unrealistic aspects of the simulation, potential threats to their professional identity, or frank discussion of mistakes. Establishing a psychologically safe context includes the practices of (1) clarifying expectations, (2) establishing a "fiction contract" with participants, (3) attending to logistic details, and (4) declaring and enacting a commitment to respecting learners and concern for their psychological safety. As instructors collaborate with learners to perform these practices, consistency between what instructors say and do may also impact learners' engagement.

Interprofessional communication in healthcare: An integrative review

2016-05-03

Cynthia Foronda , Brent MacWilliams , Erin McArthur

Effectiveness of simulation-based nursing education depending on fidelity: a meta-analysis

2016-05-23

Jung‐Hee Kim , Jin‐Hwa Park , Sujin Shin

Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. However, simulation approaches fall … Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. However, simulation approaches fall along a continuum ranging from low-fidelity to high-fidelity simulation. The purpose of this study was to determine the effect size of simulation-based educational interventions in nursing and compare effect sizes according to the fidelity level of the simulators through a meta-analysis. This study explores the quantitative evidence published in the electronic databases EBSCO, Medline, ScienceDirect, ERIC, RISS, and the National Assembly Library of Korea database. Using a search strategy including the search terms "nursing," "simulation," "human patient," and "simulator," we identified 2279 potentially relevant articles. Forty studies met the inclusion criteria and were retained in the analysis. This meta-analysis showed that simulation-based nursing education was effective in various learning domains, with a pooled random-effects standardized mean difference of 0.70. Subgroup analysis revealed that effect sizes were larger for high-fidelity simulation (0.86), medium-fidelity simulation (1.03), and standardized patients (0.86) than they were for low-fidelity and hybrid simulations. In terms of cognitive outcomes, the effect size was the largest for high-fidelity simulation (0.50). Regarding affective outcome, high-fidelity simulation (0.80) and standardized patients (0.73) had the largest effect sizes. These results suggest that simulation-based nursing educational interventions have strong educational effects, with particularly large effects in the psychomotor domain. Since the effect is not proportional to fidelity level, it is important to use a variety of educational interventions to meet all of the educational goals.

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More Than One Way to Debrief

2016-06-01

Taylor Sawyer , Walter Eppich , Marisa Brett-Fleegler +2 more

Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. … Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing conversation can be guided by either a facilitator (facilitator-guided) or the simulation participants themselves (self-guided). Postevent facilitator-guided debriefing may incorporate several conversational structures. These conversational structures break the debriefing discussion into a series of 3 or more phases to help organize the debriefing and ensure the conversation proceeds in an orderly manner. Debriefing process elements are an array of techniques to optimize reflective experience and maximize the impact of debriefing. These are divided here into the following 3 categories: essential elements, conversational techniques/educational strategies, and debriefing adjuncts. This review provides both novice and advanced simulation educators with an overview of various methods of conducting healthcare simulation debriefing. Future research will investigate which debriefing methods are best for which contexts and for whom, and also explore how lessons from simulation debriefing translate to debriefing in clinical practice.

Clinical Judgment Development: Using Simulation to Create an Assessment Rubric

2007-11-01

Kathie Lasater

Clinical judgment is a skill every nurse needs, but nurse educators sometimes struggle with how to present it to students and assess it. This article describes an exploratory study that … Clinical judgment is a skill every nurse needs, but nurse educators sometimes struggle with how to present it to students and assess it. This article describes an exploratory study that originated and pilot tested a rubric in the simulation laboratory to describe the development of clinical judgment, based on Tanner's Clinical Judgment Model.

Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review

2016-11-22

Robyn Cant , Simon Cooper

The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)

2017-06-27

Karen Lewis , Carrie Bohnert , Wendy L. Gammon +6 more

In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a … In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices.

Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

2018-12-20

Bhone Myint Kyaw , Nakul Saxena , Paul Posadzki +7 more

Background: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge … Background: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. Methods: We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. Results: A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals' cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

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Virtual reality and the transformation of medical education

2019-10-01

Jack Pottle

Medical education is changing. Simulation is increasingly becoming a cornerstone of clinical training and, though effective, is resource intensive. With increasing pressures on budgets and standardisation, virtual reality (VR) is … Medical education is changing. Simulation is increasingly becoming a cornerstone of clinical training and, though effective, is resource intensive. With increasing pressures on budgets and standardisation, virtual reality (VR) is emerging as a new method of delivering simulation. VR offers benefits for learners and educators, delivering cost-effective, repeatable, standardised clinical training on demand. A large body of evidence supports VR simulation in all industries, including healthcare. Though VR is not a panacea, it is a powerful educational tool for defined learning objectives and implementation is growing worldwide. The future of VR lies in its ongoing integration into curricula and with technological developments that allow shared simulated clinical experiences. This will facilitate quality interprofessional education at scale, independent of geography, and transform how we deliver education to the clinicians of the future.

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Virtual Learning During the COVID-19 Pandemic

2020-04-15

Zaid Almarzooq , Mathew S. Lopes , Ajar Kochar

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Simulation-Based Learning in Higher Education: A Meta-Analysis

2020-06-15

Olga Chernikova , Nicole Heitzmann , Matthias Stadler +3 more

Simulation-based learning offers a wide range of opportunities to practice complex skills in higher education and to implement different types of scaffolding to facilitate effective learning. This meta-analysis includes 145 … Simulation-based learning offers a wide range of opportunities to practice complex skills in higher education and to implement different types of scaffolding to facilitate effective learning. This meta-analysis includes 145 empirical studies and investigates the effectiveness of different scaffolding types and technology in simulation-based learning environments to facilitate complex skills. The simulations had a large positive overall effect: g = 0.85, SE = 0.08; CIs [0.69, 1.02]. Technology use and scaffolding had positive effects on learning. Learners with high prior knowledge benefited more from reflection phases; learners with low prior knowledge learned better when supported by examples. Findings were robust across different higher education domains (e.g., medical and teacher education, management). We conclude that (1) simulations are among the most effective means to facilitate learning of complex skills across domains and (2) different scaffolding types can facilitate simulation-based learning during different phases of the development of knowledge and skills.

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INACSL Standards of Best Practice: SimulationSM Simulation Design

2016-11-18

Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit *

2009-10-01

Jeffrey H. Barsuk , William C. McGaghie , Elaine Cohen +2 more

Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over … Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period. Design: Observational cohort study of an educational intervention. Setting: Tertiary-care urban teaching hospital. Subjects: One hundred three internal medicine and emergency medicine residents. Interventions: Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre- and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Measurements and Main Results: Simulator-trained residents reported fewer needle passes (p< .0005), arterial punctures (p< .0005), catheter adjustments (p= .002), and higher success rates (p= .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, sd = 23.4%; mean (subclavian) = 48.4%, sd = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at posttest: mean (internal jugular) = 93.9%, sd = 10.2; mean (subclavian) = 91.5%, sd = 17.1 (p< .0005). Written examination performance improved from mean = 70.3%, sd = 7.7%, to 84.8%, sd = 4.8% (p< .0005). Conclusions: A simulation-based mastery learning program increased residents’ skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.

The future vision of simulation in health care

2004-10-01

David M. Gaba

Simulation is a technique-not a technology-to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The … Simulation is a technique-not a technology-to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient's age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality.

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The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

2014-07-01

Jennifer Hayden , Richard Smiley , Maryann Alexander +2 more

Evaluasi diri mahasiswa keperawatan dalam praktik simulasi laboratorium gawat darurat dan kritis

2025-06-25

Hestia Magdalena , Maria Regina Olifiani Koehuan , Marry Angel Tuapetel +2 more | JURNAL KEPERAWATAN TROPIS PAPUA

Praktik simulasi laboratorium menjadi metode penting dalam pendidikan keperawatan gawat darurat, namun evaluasi diri mahasiswa setelah pelatihan masih perlu diteliti lebih lanjut. Penelitian ini bertujuan untuk mengetahui gambaran evaluasi diri … Praktik simulasi laboratorium menjadi metode penting dalam pendidikan keperawatan gawat darurat, namun evaluasi diri mahasiswa setelah pelatihan masih perlu diteliti lebih lanjut. Penelitian ini bertujuan untuk mengetahui gambaran evaluasi diri mahasiswa keperawatan setelah mengikuti praktik simulasi laboratorium gawat darurat dan kritis. Metode penelitian menggunakan desain kuantitatif deskriptif dengan sampel 176 mahasiswa (teknik convenience sampling). Data dikumpulkan melalui kuesioner Scale Evaluation Scale for Simulation Laboratory Practices (SES-SLP) yang telah divalidasi (Cronbach’s alpha 0,916) dan dianalisis secara univariat. Hasil penelitian menunjukkan skor evaluasi diri rata-rata 75,6±9,1 (rentang 35-92), dengan faktor pengembangan (62,7±8,6) lebih tinggi daripada faktor penyulit (12,9±3,9). Sebanyak 50,6% responden sangat setuju simulasi meningkatkan pengetahuan, sedangkan 75,0% tidak setuju bahwa simulasi menyulitkan pembelajaran. Simulasi laboratorium efektif meningkatkan kompetensi mahasiswa, tetapi perlu pengembangan skenario untuk meminimalkan faktor stres. Laboratory simulation practice has become a crucial method in emergency nursing education; however, students' self-evaluation after training remains an area requiring further investigation. This study aims to explore the self-evaluation of nursing students following emergency and critical care simulation laboratory practice. A descriptive quantitative design was employed, involving 176 students selected through convenience sampling. Data were collected using the validated Scale Evaluation Scale for Simulation Laboratory Practices (SES-SLP) (Cronbach's alpha 0.916) and analyzed using univariate analysis. The results showed an average self-evaluation score of 75.6±9.1 (range 35–92), with the development factor (62.7±8.6) scoring higher than the hindering factor (12.9±3.9). A total of 50.6% of respondents strongly agreed that simulation improved their knowledge, while 75.0% disagreed that simulation hindered their learning. Laboratory simulation was found to be effective in enhancing student competence; however, scenario development is necessary to mitigate stress-related factors.

Physician Assistant Student Simulation Training in Ultrasound-Guided Procedures Using Synthetic Cysts and Formalin-Embalmed Cadavers

2025-06-25

Betsy Piburn , Alden Harring , Kathryn M. Collins +3 more | The Journal of Physician Assistant Education

Introduction Traditionally, if ultrasound needle-guidance training is included in physician assistant (PA) education it occurs during the clinical year and uses live patients at the bedside. This practice requires learning … Introduction Traditionally, if ultrasound needle-guidance training is included in physician assistant (PA) education it occurs during the clinical year and uses live patients at the bedside. This practice requires learning a highly tactile skill in a high-stress learning environment where mistakes during the learning process will likely result directly in patient discomfort or complication-related injury. Simulation training with formalin-embalmed cadavers can provide realistic training opportunities with no risk to patients. This study examines the effectiveness of integrating simulation training in ultrasound-guided percutaneous cyst drainage into PA education. Methods Thirty-seven PA student participants engaged in training activities to learn to use ultrasound to access and drain synthetic cysts embedded within cadaver tissue. Participants were assessed using pre-training and post-training self-confidence questionnaires and objective skills examinations administered by an instructor. Results Participant self-confidence related to all assessed aspects of performing the procedure significantly increased after training ( P < 0.0001). Only 2 participants were unable to successfully pass the skills assessment. Participants required 1.9 needle sticks on average to complete the procedure successfully in an average time of 143 seconds. Discussion Simulation training using synthetic cysts and formalin-embalmed cadavers provides PA students with a realistic and low-stress learning environment in which to develop the complex tactile skills needed to successfully guide a needle with ultrasound while performing a clinical procedure. Training sessions like this should be integrated into PA education to allow students to safely develop the skills and confidence they need to perform ultrasound-guided procedures on live patients and minimize risk of adverse outcomes.

Simulated Clinical Stations in Quality and Patient Safety in a Primary Care Setting

2025-06-24

Yoseba Cánovas Zaldúa , Stephen Martin , J Bret +3 more | Healthcare

Background/Objectives: Clinical simulation-based training has become established as an effective strategy to improve healthcare quality and patient safety. This pre–post observational study presents an innovative experience implemented at the Catalan … Background/Objectives: Clinical simulation-based training has become established as an effective strategy to improve healthcare quality and patient safety. This pre–post observational study presents an innovative experience implemented at the Catalan Health Institute (ICS) through the evaluation of a training intervention based on Simulated Clinical Stations in Quality and Patient Safety. The main objective is to improve the competencies of Primary Care Teams (PCT) professionals in managing critical and urgent situations and to assess the impact of the intervention on knowledge and satisfaction using an immersive methodology based in active practice. Methods: More than 8.916 professionals participated in 285 training sessions at the Balmes Primary Care Center (CAP Balmes) simulation center (Barcelona). Knowledge data were collected before and after the training, along with satisfaction levels, showing significant improvement. Results: The analyses show a significant improvement in the knowledge acquired and a high level of participant satisfaction, reinforcing the value of clinical simulation as a key training tool. Conclusions: The study reinforces clinical simulation as an essential, scalable, and adaptable educational tool across different healthcare settings, establishing itself as a key resource for the continuous training of healthcare professionals.

Improving Acute Care Preparedness Amongst Medical Students: A Systematic Review

2025-06-24

Haider Merchant , Jen Tarr | Cureus

Evidence suggests that there is inadequate preparation for acute care within the undergraduate medical curriculum. Although previous attempts have been made to address this concern, a lack of formal evaluation … Evidence suggests that there is inadequate preparation for acute care within the undergraduate medical curriculum. Although previous attempts have been made to address this concern, a lack of formal evaluation of intervention effectiveness limits their utility. This review aimed to identify educational interventions seeking to prepare medical students for acute care and evaluate their effectiveness. MEDLINE, CENTRAL, Embase, Scopus and Web of Science were systematically searched. Primary research studies published between 2000 and 2020 and reporting changes in outcomes related to medical student preparation for acute care were included. Study outcomes were described as either highly effective, effective, ineffective, negative or variable. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). Studies with an MERSQI score of ≥14 were classed as high-quality. Overall, 72 studies were included in this review. The majority were single-group pre- and post-test studies (n=39, 54.2%) and none measured changes in student behaviour or patient/healthcare outcomes. Courses, clerkships, and simulation were found to be the most effective interventions. All Clerkship studies measuring improvements in acute care skills were effective or highly effective. Mean MERSQI score was 12.4 (range=7.8-15.5, SD=1.7) and 18 studies (25%) were classed as high-quality. This review favours the use of clerkships, as well as courses and simulation. However, considerable heterogeneity and numerous study limitations prevent firm conclusions from being drawn. Future high-quality studies, especially those measuring behavioural changes and patient/healthcare outcomes, are subsequently needed. Reviews with a more focused area of research, those assessing long-term outcomes and cost-effectiveness, would additionally prove beneficial.

Training in the ABCDE approach by simulation for medical students

2025-06-24

Francesco Pepe , Giuseppe Trainito , Valerio Mazzilli +5 more | Emergency Care Journal

One-hundred-forty-seven volunteer medical students in the 3rd (G1, 24 teams) and 202 in the 4th (G2, 30 teams) received a 15-minute lecture about the ABCDE approach. Then they managed two … One-hundred-forty-seven volunteer medical students in the 3rd (G1, 24 teams) and 202 in the 4th (G2, 30 teams) received a 15-minute lecture about the ABCDE approach. Then they managed two simulated patients (one with chest pain, and one with acute dyspnoea), with the task of implementing the strategy. In the second scenario, several items of the ABCDE sequence improved among G1 (SO2 measured in 96% in the second scenario versus 69 % in the first one, RR 92 vs. 67%, HR 92% vs. 67%, BP 100% vs. 832%, GCS 88% vs. 58%, Temperature 71% vs. 46%, p<0.05 for GCS and Temperature). The ability to identify “red flags” improved significantly between the first and the second simulation for both subgroups (G1 96% vs. 58%, G2 57% vs. 20%). A brief activity in simulation enabled medical students to assess comprehensively critical patients and to identify the “red flags” of each scenario.

Assessing emergency physicians’ motivation to conduct clinical teaching using the Q-methodology approach

2025-06-23

Sajida Agha , Maha Al Fayad , Sultan Alqahtani | Instructional Science

The Effect of Community Nurse Practice for Medical Students Who Rotate in Emergency Medicine

2025-06-23

Yoshiaki Iwashita , Haruka Saigusa , Moe Fusayama +6 more | International Medical Education

Background: Emergency medicine in Japan traditionally emphasizes critically ill patients, but recent trends show an increase in minor illness cases influenced by social factors. This study assessed integrating community nurse … Background: Emergency medicine in Japan traditionally emphasizes critically ill patients, but recent trends show an increase in minor illness cases influenced by social factors. This study assessed integrating community nurse (CN) training into an emergency medicine elective to evaluate its effect on students’ self-achievement and communication skills. Methods: Medical students rotating in the emergency department participated. Those choosing the CN training spent one week in the community, while others remained hospital-based. Surveys evaluated self-achievement of Shimane University emergency medicine objectives and communication skills per the Model Core Curriculum. Analyses used t-tests. Results: Of 35 students, 21 (60%) completed surveys. Satisfaction levels did not differ significantly between CN and non-CN groups (4.0 ± 0.70 vs. 4.5 ± 0.63, p = 0.15). Regression analysis indicated satisfaction correlated only with online practice availability. No significant differences emerged for goals or communication items (all p > 0.05), although CN participants tended to rate higher on patient proximity, communication, and social engagement. Discussion: CN training maintained overall satisfaction and slightly enhanced communication and social aspects, aligning with shifts toward psychosocial care in emergency medicine. Conclusions: Integrating CN practice did not significantly impact emergency medicine knowledge or skill satisfaction but showed a trend toward improved communication and social purpose satisfaction. Larger-scale studies are needed for validation.

Impact of the Away Rotation on Program Match Rates in Era of Virtual Residency Recruitment

2025-06-21

Jennifer Kaminsky , Leslie A. Bilello , Nicole M. Dubosh | Western Journal of Emergency Medicine

Resident Comfort, Retention, and Clinical Integration following Ultrasound-Guided Nerve Block Procedure Simulation Course

2025-06-21

Madison Williams Chen , Bryan Hudson , Andrew Bloom +4 more | Western Journal of Emergency Medicine

Impact of Simulation-Based Training on Procedural Competency

2025-06-21

Patrick Olivieri , Shaila Quazi , Holly Stankewicz +7 more | Western Journal of Emergency Medicine

The use of an escape room simulation in undergraduate community health nursing course: a single group pre-post evaluation

2025-06-20

Lufei Young , Xu Ning , Yinghao Pan +2 more | Research Square (Research Square)

<title>Abstract</title> Community health nursing (CHN) clinical practice is essential for pre-licensure nursing students to develop the competence and confidence needed to deliver safe and effective care in patients’ homes. However, … <title>Abstract</title> Community health nursing (CHN) clinical practice is essential for pre-licensure nursing students to develop the competence and confidence needed to deliver safe and effective care in patients’ homes. However, clinical placements are often hindered by limited site availability, preceptor shortages, and inconsistent quality. Escape room simulation (ERS) has emerged as an innovative strategy to address these challenges and provide meaningful learning experiences. Despite its growing use, there is limited evidence on the impact of ERS in enhancing nursing students’ readiness for home-based community settings. To address this gap, this study evaluated the effects of ERS on students’ competence and confidence in CHN. A quasi-experimental, single-group pre/post design was used with 56 full-time undergraduate nursing students. Data were collected at three time points: before ERS (T1), immediately after (T2), and ten weeks later (T3). Instruments included the CHN Competency Checklist, CHN Confidence Scale, and ERS Perception Scale. A linear mixed-effects model showed statistically significant increases in both competency (t = 6.413, <italic>p</italic> < .001) and confidence (t = 8.142, <italic>p</italic> < .001) from T1 to T2, with sustained or slightly improved scores at T3. Spaghetti plots revealed reduced variation in competence over time, suggesting consistent benefit across participants, while confidence growth showed greater variability, indicating individual differences in response. Students with lower baseline scores exhibited the most notable gains. Most had no prior ERS experience but reported high satisfaction. Findings support the integration of ERS into CHN curricula to enhance student preparedness, especially when clinical placements are limited.

Akademisyenlerin Metaverse Eğitim İnançlarının Değerlendirilmesi

2025-06-20

Serap Ejder Apay , Elif Erdoğan , Gamze Ceylan +1 more | Üniversite Araştırmaları Dergisi

Bu çalışma, Türkiye’nin doğusunda bulunan bir üniversitenin farklı enstitülerinde görev alan akademisyenlerin Metaverse eğitimine ilişkin inançlarını belirlemek ve karşılaştırmak amacıyla yapılmıştır. Tanımlayıcı ve karşılaştırmalı nitelikteki çalışma, 15 Ağustos 2023-30 Ocak … Bu çalışma, Türkiye’nin doğusunda bulunan bir üniversitenin farklı enstitülerinde görev alan akademisyenlerin Metaverse eğitimine ilişkin inançlarını belirlemek ve karşılaştırmak amacıyla yapılmıştır. Tanımlayıcı ve karşılaştırmalı nitelikteki çalışma, 15 Ağustos 2023-30 Ocak 2024 tarihleri arasında yapılmış olup araştırmayı kabul eden 304 akademisyen çalışmaya dâhil edilmiştir. Veri toplama aracı olarak “Tanımlayıcı Bilgi Formu” ve “Metaverse-Eğitim İnanç Ölçeği” kullanılmıştır. Veriler; ortalama, yüzde, standart sapma, bağımsız gruplarda t testi ve one way anova ile analiz edilmiştir. Akademisyenlerin Metaverse-Eğitim inançları ele alındığında, Sağlık Bilimleri alanındaki akademisyenlerin puan ortalaması en yüksek, Sosyal Bilimler alanındaki akademisyenlerin puan ortalaması ise en düşük bulunmuştur. Metaverse-Eğitim İnanç Ölçeği puanı, enstitüler bazında ele alındığında ölçek puanları arasında anlamlı farklılık bulunmuştur. Ölçek toplam puanları, cinsiyete göre incelendiğinde ise kadın akademisyenlerin Metaverse-Eğitim inançları, erkeklere göre anlamlı düzeyde yüksek ve orta düzeyde bulunmuştur. Metaverse hakkında bilgi sahibi olan, onunla ilgilendiğini belirten, derslerinde dijital materyal kullanan ve geliştiren akademisyenlerin, öğrencileriyle Metaverse ortamında birlikte çalışabilenlerin puan ortalaması anlamlı düzeyde daha yüksektir. Sonuç olarak tüm akademisyenlerin Metaverse eğitim inançları orta düzeydedir ve bazı değişkenlerden etkilenmektedir.

Learning technology for Ayurveda with pedagogically designed virtual patient case simulations

2025-06-20

Prema Nedungadi , Rammanohar Puthiyedath , Romita Jinachandran +6 more | Frontiers in Medicine

Introduction Ayurveda education in India has seen limited integration of learning technology, leading to significant gaps in clinical skill development. This study introduces AyurSIM, a virtual patient simulation platform designed … Introduction Ayurveda education in India has seen limited integration of learning technology, leading to significant gaps in clinical skill development. This study introduces AyurSIM, a virtual patient simulation platform designed with interactive virtual cases replicating real-world scenarios to address this gap, offering structured educational modules from patient examination through follow-up care, incorporating Ayurveda protocols and a comprehensive database of disease patterns. Methods AyurSIM was developed using pedagogical frameworks building on experiential learning, problem-solving tasks, and reflective practice. The platform enables the creation of regionally adapted virtual cases, aligning with diverse Ayurvedic practices while maintaining a structured protocol. Usability was evaluated using the validated System Usability Scale (SUS) among 210 diverse participants during training workshops. Results The platform achieved a “good” SUS score of 77.08. Participants commended the intuitive interface, immersive learning experience, and educational value. Suggested improvements included integrating AR/VR technologies, expanding clinical content across disciplines, and multilingual support. Discussion AyurSIM effectively bridges traditional Ayurveda education with modern methodologies, providing culturally responsive, practical learning experiences. The findings suggest that the blended pedagogical approach provides a robust framework for Ayurveda education. The ability to simulate realistic virtual patient clinical scenarios in a structured manner underscores the platform’s value in preparing students for real-world practice.

Reply to Hyder <i>et al.</i>: Emergency Intubation—A High-Stakes Procedure with Critical Gaps in Understanding Team Impact

2025-06-20

Stephanie C. DeMasi , Jonathan D. Casey , Matthew W. Semler | American Journal of Respiratory and Critical Care Medicine

Use of simulation-based education to improve wound care practice amongst registered and nursing students: An integrative review

2025-06-19

Sharon MacLean , Fiona Geddes , Keryln Carville | Clinical Simulation in Nursing

Improvisation Clinic – Building Relationship-Centered Communication Skills and Enhancing Learner Feedback in Emergency Medicine through Applied Improvisation

2025-06-19

Brendan Freeman , Abbas Husain , J. Valentin | Western Journal of Emergency Medicine

Understanding the Processes of Role Adoption in Pedagogical Role-Play Games (RPGs): A Narrative Dramaturgical Perspective on “Social RPGs” in Health Professions Education

2025-06-19

Sarah A. E. Aboushawareb , Gillian Bartlett , Amalia M. Issa +2 more | Simulation & Gaming

Background Health professional training interventions based on role-playing games (RPGs) have been shown to be an increasingly popular way to advance health professional students’ skills in communication and empathetic engagement … Background Health professional training interventions based on role-playing games (RPGs) have been shown to be an increasingly popular way to advance health professional students’ skills in communication and empathetic engagement with patients and colleagues. However, role adoption itself is largely assumed, with little research focusing on how students come to engage, or fail to engage, in role play. Objective This study aimed to identify the processes by which healthcare professionals and trainees (HCP/Ts) adopt roles in role-based serious games designed for health professions education (HPE). The theory of narrative dramaturgy informed this qualitative study, to illuminate the relationship between the participant and the role. Methods Four focus groups were conducted at the conclusion of four iterations of an RPG, in which different groups of healthcare professionals participated, focused on joint deliberation over a case in pediatric oncology. The data were analyzed thematically. Results & Conclusion Four themes were developed that characterize the process of role adoption: role commitment; simultaneous evocation of front and back stages; reflexivity; and visceral lingering. Our findings contribute to delineating the processes of role adoption that suggest specific conditions under which role play may or may not be beneficial, and how it can be taught and enhanced in health professional education. In doing so, the study draws attention to an under-researched form of RPG – a “social RPG” – grounded in interaction.

Utilizing Simulation to Integrate Social Determinants of Health into Emergency Medicine Medical Student Clerkships

2025-06-19

Andrew Bloom , J. Michael Waldeck , Erin F. Shufflebarger +3 more | Western Journal of Emergency Medicine

Enhancing Episiotomy Skills Through Interactive Online Simulation

2025-06-18

Hülya Tosun , Hava Özkan | Healthcare

Background/Objectives: The COVID-19 pandemic has significantly restricted clinical training for midwifery students, highlighting the need for alternative teaching methods. With the disruption of traditional face-to-face education, online simulation-based training has … Background/Objectives: The COVID-19 pandemic has significantly restricted clinical training for midwifery students, highlighting the need for alternative teaching methods. With the disruption of traditional face-to-face education, online simulation-based training has emerged as an effective alternative for developing essential clinical skills. The acquisition of hands-on skills has a direct impact on students' self-confidence and clinical performance. Interactive online simulations support the learning process by enhancing both theoretical knowledge and practical competencies. This study aims to evaluate the impact of online simple simulation-based episiotomy repair training on students whose clinical practice was limited due to the COVID-19 pandemic. Methods: A mixed-method approach was used, considering the outcomes from 61 midwifery students. Data were collected via observational questionnaires, which provide an online learning readiness scale and scales for student satisfaction and self-confidence. The analysis included descriptive statistics, McNemar's, binary logistic regression, and the Mann-Whitney U test. Results: Students who trusted themselves in both opening and repairing an episiotomy after training had more readiness for online learning (t(43) = 2.73, p = 0.009; t(43) = 2.40, p = 0.02). Students with better training performance are more likely to obtain higher scores on the final exam of the Clinical Practice module (rho = 0.33, p = 0.01). Additionally, their performance was a positive and significant predictor of achieving a full mark (b = 0.11, s.e. = 0.05, p = 0.01). Conclusions: Interactive online simulation training improved midwifery students' hand skills and self-confidence in clinical practice. Such methods should be promoted in circumstances like COVID-19.

Simulation-Based Curriculum in the Neonatal Intensive Care Unit (NICU): The New Era of Medical Education

2025-06-18

Aashika Janwadkar , Akanksha Sancheti , Tracy Raschke +2 more | Cureus

Senior Nursing Students in a Repeating Simulation Experience

2025-06-18

Laura Skoronski Chavez , Catherine P. Lovecchio | Nursing Education Perspectives

Abstract Many students wish for a simulation “do-over” to correct mistakes. When given the chance to repeat a scenario, students demonstrate great improvement and are more likely to sustain skills … Abstract Many students wish for a simulation “do-over” to correct mistakes. When given the chance to repeat a scenario, students demonstrate great improvement and are more likely to sustain skills and knowledge. A quasi-experimental study with a pretest/posttest data collection design was used to determine the impact a repeated simulation experience had on students’ knowledge, clinical judgment, and satisfaction. Participants demonstrated a significant increase in knowledge and clinical judgment ( p < .001) and high levels of satisfaction with the experience.

The impact of simulated participant simulation on enhancing mental health knowledge, skills and attributes in Diploma of Nursing students

2025-06-17

Karen Hall , Debra Kiegaldie , Jason Skues | Clinical Simulation in Nursing

Comparing virtual reality-based simulation, booklet-based and standard preparation methods for pediatric magnetic resonance imaging (MR-VR): study protocol for a randomized clinical trial

2025-06-17

Sándor Erdős , F. Papik , Nyáry Dorottya +7 more | Virtual Reality

Theatre etiquette Delphi: the development of a guide on professional conduct and best practices in operating environments

2025-06-17

Michael El Boghdady , J. Hardie , PA Brennan | Annals of The Royal College of Surgeons of England

The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, … The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, non-standard and 'ad hoc' training in theatre behaviour and etiquette. We conducted a Delphi consensus study among senior surgeons to develop standardised guidance on theatre etiquette for those unfamiliar with the theatre environment, including resident surgical trainees and medical students. An international Delphi process of two rounds was conducted. An electronic survey was distributed among senior surgeons, anaesthetists and senior scrub nurses/practitioners, with participants recruited via surgical societies. Participants were asked to rank each statement on a Likert scale of 1 to 5. Consensus was considered if achieved for any statement for which 75% or more indicated agreement. The study was registered with the Open Science Framework. A total of 261 participants completed the Delphi process; 239 valid responses were included in round 1, with a 23% dropout in round 2. Participants were from 23 countries, 66% were from the UK, 58.2% were male, 51% were from the 30 to 40-year age group, 39% were consultant surgeons and 49% were senior trainees. General surgeons made up 68.6% of respondents, trauma and orthopaedic surgeons 13.4%, healthcare practitioners 2.1% and anaesthetists 1.3%. Thirteen statements were excluded, and 29 reached agreement and were included in the final guidance. There was agreement among a large international group of surgeons to develop a standardised guidance for theatre etiquette, addressing most of the key aspects of professional conduct and team dynamics. We anticipate that this guidance will serve as a valuable resource for orienting new members of the surgical team, providing a clear framework for maintaining professionalism and fostering effective communication within the theatre environment.

Preparing Medical Students for Sideline Sports Care in Underserved Communities: A Comparison of Simulation and Lecture-Based Training

2025-06-17

Adel El-Naggar , David Abdelnour , Ammar Chauhdri +7 more | Cureus

A Comparative Analysis of OSH Training: Evaluating Traditional Methods Versus Interactive and Virtual Reality Approaches in the Context of Sustainability

2025-06-17

Tomáš Pětvaldský , Samuel Kočkár , Petr Lepík +2 more | Sustainability

Occupational safety and health (OSH) training plays a crucial role in preventing workplace accidents, ensuring compliance with legislation, and fostering a safety-oriented culture across all sectors. This article compares traditional … Occupational safety and health (OSH) training plays a crucial role in preventing workplace accidents, ensuring compliance with legislation, and fostering a safety-oriented culture across all sectors. This article compares traditional OSH training methods with innovative approaches that incorporate interactive elements and virtual reality (VR) technologies, with a particular emphasis on their contributions to sustainability. The study analyzes feedback from training participants across various occupational roles and age groups, focusing on the effectiveness, engagement, and perception of each method. The results demonstrate that interactive training and VR-based training not only enhance participant engagement and improve comprehension of safety procedures but also promote sustainable training practices by reducing the need for physical materials, minimizing travel, and decreasing reliance on extensive on-site infrastructure. These advancements contribute to environmental sustainability within safety training programs. The paper further explores the benefits, challenges, and economic considerations associated with implementing sustainable, technologically enhanced training approaches. The findings suggest that integrating modern, sustainable educational technologies into OSH training leads to more effective knowledge transfer, better preparedness of employees for emergency situations, and a reduction in environmental impact, aligning safety training practices with broader sustainability goals.

Improving pediatric trauma care at a level 1 pediatric trauma center through the multi-year implementation of a Pediatric Trauma Boot Camp curriculum

2025-06-17

Elizabeth Brigham , Erica Hodgman , Nicole Shilkofski +5 more | Advances in Simulation

Abstract Background Traumatic injuries are a significant contributor to pediatric morbidity and mortality, and trauma care necessitates that providers from different specialties and backgrounds be prepared to work together in … Abstract Background Traumatic injuries are a significant contributor to pediatric morbidity and mortality, and trauma care necessitates that providers from different specialties and backgrounds be prepared to work together in high acuity settings to provide optimal care. Simulation-based trauma education consistently demonstrates improved knowledge, skill acquisition, teamwork, and task performance among providers, but relatively few studies assess provider performance during real resuscitations. The objective of this study is to develop an interdisciplinary pediatric trauma curriculum to improve trauma bay teamwork and adherence to ATLS ideals in the clinical environment. Methods We developed a simulation-based pediatric trauma curriculum (Pediatric Trauma Boot Camp) incorporating learners from multiple departments and divisions all of whom care for pediatric trauma patients at our institution. To determine the impact of the curriculum on trauma team clinical performance, videos of trauma activations throughout the multi-year implementation period were reviewed and data abstracted. Teamwork was assessed using the Trauma NOTECHS scale and ATLS compliance by the presence or omission of eight items of the primary and secondary survey. Eighty-six total trainees participated during 2 years of curriculum implementation with faculty from General Pediatric Surgery, Pediatric Emergency Medicine, and Pediatric Critical Care serving as facilitators. Results Out of a maximum of 25, the mean total Trauma NOTECHS score for the pre-pilot videos ( n = 29) was 14.0. Post-pilot ( n = 26), the mean total score improved to 16.8 ( p = 0.001). Mean secondary survey completion improved from 4.1/8 pre-pilot to 5.4/8 post-pilot ( p = 0.039). No significant difference was observed in primary survey completion between the first two cohorts. Following the second year of curriculum implementation, primary survey completion improved to 6.1/8 in the third cohort ( n = 27) from 5.5/8 ( p = 0.079). Continued improvement in total Trauma NOTECHS scores was observed (mean = 17.7), and improvements demonstrated in secondary survey completion were preserved. Conclusion An interdisciplinary simulation-based pediatric trauma curriculum incorporating learners across specialties has the ability to positively impact provider behavior and direct patient care at a level 1 pediatric trauma center as evidenced by improved teamwork scores and secondary survey completion on video review of live trauma activations.

Escape Room Education in Anesthesiology and Intensive Care- an original article

2025-06-17

Dana Yahav‐Shafir , I G EPSTEIN , Sabine Nabecker +4 more | Research Square (Research Square)

<title>Abstract</title> Background Escape Room is a team game in which players cooperatively discover clues and solve puzzles to progress and complete a specific goal in a limited amount of time. … <title>Abstract</title> Background Escape Room is a team game in which players cooperatively discover clues and solve puzzles to progress and complete a specific goal in a limited amount of time. Escape rooms have gained popularity as an educational tool in different fields of medicine. Aim This manuscript reports our experience using escape rooms as part of the clinical training of medical students in anesthesia and intensive care. Methods Twenty medical students (4 groups) completed two different escape room scenarios. The content was based on the knowledge and skills taught during the rotation, patient safety and teamwork. Participants answered feedback questionnaires after each escape room. Results Questions assessed by the feedback questionnaire targeted the general satisfaction of course participants, the learning and self-assessment of participants, and teamwork and communication. Overall, all participants gave high to very high scores on all assessed questions, mean scores ranging from 4.3-5. All three questions in the general satisfaction category achieved a slightly lower mean score after the second escape room (p > 0.05). Questions targeting whether participants had equal opportunities to practice (p > 0.05)., express their opinions (p > 0.05), or practice their practical skills (p < 0.01) were also scored lower after the second escape room. Conclusion We describe the design, execution, and participants' feedback of an escape room training practice for medical students during clinical rotations in anesthesia and intensive care. It was perceived as a positive and novel experience. Students agreed it is an appropriate format to practice and assess taught knowledge, however, concerns were raised that it is not suitable for assessing an individual participant rather than a team. In the supplementary material to this article, we provide a guide as to how such an escape room can be realized for educators to use and adapt to their local requirements free of charge.

Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study

2025-06-17

Shirong Wu , Linqi Gan , Chuanren Ling +7 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background: </bold>Basic Life Support (BLS) is an essential emergency skill for healthcare professionals. Newly Graduated Registered Nurses (NGRNs) often encounter challenges in clinical practice due to their lack of … <title>Abstract</title> <bold>Background: </bold>Basic Life Support (BLS) is an essential emergency skill for healthcare professionals. Newly Graduated Registered Nurses (NGRNs) often encounter challenges in clinical practice due to their lack of clinical experience. Standardized operational training can enhance the emergency response capability and clinical emergency response of NGRNs. <bold>Objectives: </bold>This study explores the application of BOPPPS-RCDP to the training of NGRNs-BLS, aiming to (1) compare the effect of BOPPPS-RCDP with that of BOPPPS training, and (2) explore the experiences and views of NGRNs and instructors on the integrated model and (3) provide evidence-based recommendations for improvements to BLS training in nursing education. <bold>Study design: </bold>This study employed an explanatory sequential mixed-methods design, involving conducting semi-structured interviews with both students and instructors. <bold>Methods:</bold> The 80 participants were randomly divided into the control group and the intervention group in a 1:1 ratio. The control group adopted the traditional teaching method, while the intervention group added the RCDP teaching method to the traditional teaching method. The researchers conduct a semi-structured interview among students and instructors according to the semi-structured interview guidelines to gain an in-depth understanding of the subjective feelings of NGRNs and training instructors. <bold>Results: </bold>The results of quantitative analysis showed that the BOPPPS-RCDP group had significantly improved theoretical knowledge and practical skills compared with the BOPPPS model alone (<italic>P</italic> < 0.05). Except for compression depth, chest recoil rate, and theoretical test scores, all measured indicators demonstrated statistical significance (<italic>P</italic> < 0.05), indicating that the BOPPPS-RCDP model is more effective in enhancing training outcomes. Qualitative findings show that most of the NGRNs and instructors believe that BOPPPS-RCDP can effectively promote the acquisition of BLS skills. <bold>Conclusion: </bold>The BOPPPS-RCDP model has been shown to effectively facilitate the rapid acquisition of BLS skills among NGRNs, thereby enhancing both the training outcomes and participant satisfaction. This model represents an innovative educational approach with significant potential for advancing BLS education within nursing practice.

The Rural Rumble: Gamification and Simulation to Improve Resident Skills for Low-Resource Emergency Medicine Practice

2025-06-16

Ross Sinicrope , Mitchell Voter , Taylor Cesarz +3 more | Western Journal of Emergency Medicine

Effectiveness of in situ simulation for knowledge of mental health emergencies, aggression minimization skills, and perceived self-confidence among undergraduate nursing students in Oman: A quantitative study

2025-06-16

Khalood Al‐abri , Judie Arulappan , K Y Divya +3 more | Clinical Simulation in Nursing

Using high fidelity simulation to mitigate workplace violence and incivility

2025-06-16

Caroline Ferzoco , Kathleen Ryan Avery , Barbara E. Lakatos +5 more | Clinical Simulation in Nursing

Creation and Implementation of an Ob-Gyn Escape Room for Emergency Medicine Residents

2025-06-16

Hayley Blend , J. Justice , Carmen Wolfe | Western Journal of Emergency Medicine

Addition of a Screen-Based Human-Like Avatar to Traditional Mannequin-Based Simulation for Emergency Medicine Resident Training

2025-06-16

SV Phadnis , Lisa M. Clayton , Patrick G. Hughes +2 more | Western Journal of Emergency Medicine

Simulación clínica in situ en servicios de emergencia: implicancias para la seguridad del paciente

2025-06-16

José Francisco Villanueva-Valverde , Javier Chavarría Campos , Santiago Sebastián Alvarado +2 more | Revista Hispanoamericana de Ciencias de la Salud

La simulación clínica in situ es una estrategia de capacitación que se desarrolla directamente en entornos clínicos reales, utilizando el equipamiento habitual del servicio. Esta modalidad busca fortalecer las competencias … La simulación clínica in situ es una estrategia de capacitación que se desarrolla directamente en entornos clínicos reales, utilizando el equipamiento habitual del servicio. Esta modalidad busca fortalecer las competencias del personal de salud, mejorar la respuesta ante situaciones críticas y optimizar la seguridad del paciente. Al replicar escenarios realistas en el lugar de trabajo, se facilita la transferencia de habilidades a la práctica clínica y se promueve la comunicación efectiva y el trabajo en equipo, factores clave para una atención segura. No obstante, su implementación enfrenta barreras como la falta de estandarización, la sobrecarga laboral, la escasa disponibilidad de tiempo y recursos. La incorporación de tecnologías innovadoras, como la realidad virtual y aumentada, representa una oportunidad para potenciar la efectividad de estas intervenciones formativas. Para superar estos desafíos, se recomienda fortalecer el liderazgo institucional, capacitar a instructores en metodologías andragógicas, optimizar los recursos disponibles y monitorear el impacto de la simulación en la seguridad del paciente.

BINGO: A Novel Observation Tool to Optimize the Observer Role in Simulation Based Setting

2025-06-16

Deborah Jaenicke , Erich Heine , Sara Baker | Western Journal of Emergency Medicine

National Survey of Emergency Medicine Residency Program Simulation Resources

2025-06-16

Max Berger , Arlene Chung , Daniel J. Ackil +3 more | Western Journal of Emergency Medicine

Corrigendum to “Stimulating simulation: Managing stress through effective time management”

2025-06-15

| Management Teaching Review

Immersive virtual reality training: Addressing challenges and unlocking potentials

2025-06-15

Amalie Middelboe Andersen , Jesper Kjærgaard , Ilse Hoffman +7 more | Medical Education

Abstract Background Simulation‐based training has significantly improved healthcare professionals' skills and patient outcomes. Immersive virtual reality is gaining attention in this field and offers potential educational benefits. However, little is … Abstract Background Simulation‐based training has significantly improved healthcare professionals' skills and patient outcomes. Immersive virtual reality is gaining attention in this field and offers potential educational benefits. However, little is known about how key stakeholders in simulation‐based training and debriefing receive a complex intervention like immersive virtual reality. This study explores the enablers, barriers and applied debriefing strategies involved in using immersive virtual reality in simulation‐based training. Methods We purposefully sampled simulation centre directors, course leaders and researchers within debriefing, simulation‐based emergency training and immersive virtual reality. First, they observed and debriefed an online immersive virtual reality‐based emergency training. Then, they participated in an individual semi‐structured interview that was audio recorded and transcribed. We coded and analysed the data based on a reflexive thematic analysis method with a constructionist framing, guided by normalisation process theory as a theoretical lens. All co‐authors informed and validated the identified themes. Results We conducted 10 individual semi‐structured interviews and generated five main themes on factors that supported or impeded the normalisation of immersive virtual reality for simulation‐based training: understanding, engagement, strategies in action, appraisal and psychological safety. Discussion Immersive virtual reality contains unique challenges and potential for simulation‐based training. Its strengths and limitations should be carefully considered in relation to learning goals, the target group and context. This study explored the advantages and disadvantages of various immersive virtual reality features in relation to different learning objectives and proposed practical strategies for enhancing learning in immersive virtual reality simulation‐based training.

The effect of intensive care nursing education on the competence in intensive and critical care nursing of nursing students

2025-06-15

So-eun Choi | Korean Association For Learner-Centered Curriculum And Instruction

Objectives This study was conducted to verify the effect of an intensive care nursing educational program on the competence of nursing students in intensive and critical care nursing. Methods The … Objectives This study was conducted to verify the effect of an intensive care nursing educational program on the competence of nursing students in intensive and critical care nursing. Methods The study had a nonequivalent control group pre-post design. A total of 119 fourth-year nursing students were recruited and assigned to either the experimental group (n=78) or the control group (n=41). The intensive care nursing educational program was conducted for 1 hour per week for a total of 15 weeks. The Intensive and Critical Care Nursing Competence Scale Version 1 (ICCN-CS-1) questionnaire was used for data collection. The ICCN-CS-1 is divided into clinical competencies and professional competencies and consists of four dimensions (knowledge, skills, attitudes/values, and experience). Results Significant differences were found between the experimental and control groups in clinical competence (t=2.51, p=.014). In the experimental group, professional competence, knowledge, skill, attitudes/values, and experience were statistically significantly different after treatment. Conclusions The results indicate that this intensive care nursing educational program was effective in improving the competence of nursing students in intensive and critical care nursing. The findings are significant in that this analysis of intensive and critical care nursing competence in four dimensions, as well as clinical competencies and professional competencies, presents the future direction of intensive care nursing education.

Simulation-Based Curriculum for Medical Undergraduates in Non-technical Skills

2025-06-14

Manpreet Kaur , Rashmi Ramachandran , Abhishek Nagarajappa +4 more | Cureus

Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Armed Penetrating Trauma

2025-06-14

Ashley Wong , Anita Thomas , Jean Pearce +7 more | Cureus

Development and evaluation of a dynamic nomogram model for intraoperative blood transfusion decision-making

2025-06-13

Min Li , Wei Jiang , Jialing Lin +3 more | Frontiers in Medicine

Objective By gathering data on patients with intraoperative blood transfusion and investigating the factors influencing intraoperative blood transfusion in patients, we aimed to construct a dynamic nomogram decision-making model capable … Objective By gathering data on patients with intraoperative blood transfusion and investigating the factors influencing intraoperative blood transfusion in patients, we aimed to construct a dynamic nomogram decision-making model capable of continuously predicting the probability of intraoperative blood transfusion in patients. This was done to explore a new mode of individualized and precise blood transfusion and to guide doctors to make timely and reasonable blood transfusion decisions and save blood resources. Methods Data of surgical patients in our hospital from 2019 to 2023 were collected. Among them, 705 patients who had blood transfusions were the experimental group, and 705 patients without intraoperative blood transfusions were randomly selected as the control group. Preoperative and intraoperative indicators of 1,410 patients were collected. 80% of the data set was used as the training set and 20% as the test set. In the training set, independent risk factors affecting intraoperative blood transfusion in patients were obtained through Lasso regression and binary logistic regression analysis, and the regression model was established and validated. Results Through Lasso regression with cross-validation and binary logistic regression analysis, the independent risk factors affecting patients’ intraoperative blood transfusion decision-making were determined as ASAs (III) (OR = 3.009, 95% CI = 1.311–6.909), surgical grading (IV) (OR = 3.772, 95% CI = 1.112–12.789), EBL (OR = 1.003, 95% CI = 1.002–1.004), preHGB (OR = 0.932, 95% CI = 0.919–0.946), LVEF (OR = 1.063, 95% CI = 1.028–1.098), Temp (OR = 57.14, 95% CI = 9.740–35.204), preAPTT (OR = 1.147, 95% CI = 1.079–1.220), and preDD (OR = 1.127, 95% CI = 1.048–1.212). The area under the curve (AUC) of the receiver operating characteristic curve (ROC) of the training set was 0.983, p &lt; 0.05. By calculating the Jordon index, when the Jordon index reached its maximum value, the corresponding diagnostic probability threshold was 0.515. When the model predicted that the probability threshold was 0.515, the sensitivity was 0.939 and the specificity was 0.964. These independent risk factors were introduced into R statistical software to fit the intraoperative blood transfusion decision-making dynamic nomogram model. The goodness of fit test of the model for the training set was χ 2 = 111.85, p &lt; 0.01, and the AUCs of the training set and the testing set were 0.983 and 0.995, respectively, p &lt; 0.05. The calibration curve showed that the predicted probability of the model was in good agreement with the observed probability. Clinical decision curves (CDA) and clinical impact curves were plotted to evaluate the clinical utility of the model and the net benefit of the model. Conclusion Variables were screened by Lasso regression, the model was developed by binary logistic regression, and a dynamic nomogram model for intraoperative transfusion decision-making was successfully fitted using R software. This model had good goodness of fit, discrimination, and calibration. The model can dynamically and instantaneously predict the probability of blood transfusion and its 95% confidence interval under the current patient indicators by selecting the patient’s independent risk factors in the drop-down mode during the operation. It can assist doctors in making a reasonable blood transfusion decision quickly and save blood resources.

Clinical Decision-Making in Nursing in the Emergency Department: Systematic Literature Review Synthesis

2025-06-13

Saharuddin Saharuddin , Nur Elly , Masfuri Masfuri +2 more | Salud Ciencia y Tecnología

Introduction: Clinical decision-making is vital in nursing and impacts care quality and patient safety. The increasing complexity of healthcare demands nurses to integrate theoretical knowledge, clinical experience, and professional judgment. … Introduction: Clinical decision-making is vital in nursing and impacts care quality and patient safety. The increasing complexity of healthcare demands nurses to integrate theoretical knowledge, clinical experience, and professional judgment. This review synthesizes literature on clinical decision-making in nursing, focusing on theoretical models and strategies for enhancing nurses' competencies globally.Methods: A systematic literature review was conducted using Scopus, PubMed, ScienceDirect, and CINAHL. English-language articles published from 2015 to 2024 were included. Data were thematically analyzed to identify consistent models, themes, and influencing factors.Results: Analysis of 18 articles revealed six core themes in clinical decision-making: recognizing cues, analyzing cues, prioritizing hypotheses, formulating solutions, taking action, and evaluating outcomes. Clinical experience, critical thinking, intuition, team collaboration, technology, cultural context, and professional ethics were key influencing factors. Effective decision-making often combines analytical and intuitive approaches, particularly in complex or emergencies.Conclusions: Clinical decision-making is a multifaceted process shaped by individual factors, workplace dynamics, and systemic support. These findings highlight the need for tailored, evidence-based education and training programs to strengthen decision-making skills among nurses across diverse healthcare settings.

Assessing Long‐Term Skill Retention in Pre‐Clerkship Medical Students Using Simulation Intravenous Catheter Placement: A Prospective Cohort Study

2025-06-13

Miles G. Gibson , Zachary T. Terrell , J Burns +3 more | The Clinical Teacher

ABSTRACT Introduction Hands‐on learning is described as one of the most important aspects of medical education, but most preclinical medical students are not exposed to skills such as intravenous cannulation … ABSTRACT Introduction Hands‐on learning is described as one of the most important aspects of medical education, but most preclinical medical students are not exposed to skills such as intravenous cannulation (IVC) until the transition to clerkship period. An earlier introduction to a skill through simulation may improve performance as a student moves into the clinical setting. This study seeks to describe the impact of a single preclinical IVC session on skill retention in students entering the transition to clerkship. Methods The study is a prospective cohort analysis consisting of a trained group (TG) who attended an optional IVC skill session ( n = 42) and a control group (CG) of randomly selected medical students who did not attend the session ( n = 50). Six months after the session, the groups were video recorded performing IVC and graded by six blinded anaesthesiologists using a validated checklist. The primary outcome was the composite checklist score. Time to completion, successful cannulation, and number of attempts were secondary outcomes. Results The median composite checklist score, number of attempts, and successful cannulation were not significantly different between groups ( p = 0.60, p = 0.13, p = 0.52). In a subgroup analysis of students who successfully cannulated, the time to complete was significantly shorter in the TG compared to the CG ( p = 0.006). Conclusion Time to complete IVC was significantly reduced in the TG, demonstrating the long‐term impact of a single preclinical skill session on student retention. Future studies should test students in the clinical setting utilising identical outcomes to provide further insight into the utility of preclinical skill simulation.

Interprofessional collaboration in surgical setting during the implementation of a multimodal analgesia protocol: A qualitive study

2025-06-12

Emilie Bourdeau , Émilie Paul-Savoie , Johanne Lapré +3 more | International Journal of Orthopaedic and Trauma Nursing

The Enhanced Recovery after Surgery (ERAS) program has been a turning point for healthcare professionals and patient's surgical units. To optimize patient relief, a new multimodal analgesia (MMA) protocol was … The Enhanced Recovery after Surgery (ERAS) program has been a turning point for healthcare professionals and patient's surgical units. To optimize patient relief, a new multimodal analgesia (MMA) protocol was deployed. Implementing this protocol required several professionals, with their roles and interactions emerging as key factors to explore. The aim of this qualitative study is to describe the interprofessional collaboration (IC) process during the MMA protocol implementation with surgical healthcare professionals. A secondary analysis of data from a descriptive qualitative study was conducted. A total of 71 participants, including registered nurses, assistant nurses, managers/educators, residents, surgeons, and pharmacists, took part in semi-structured interviews. Emerging ideas were synthesized using thematic analysis (Braun and Clark, 2006) and then categorized based on constructs defined by the Sunnybrook framework (McLaney et al., 2022). Several subthemes emerged from secondary analysis: professional roles, interprofessional communication, beliefs, interprofessional trust, interprofessional influence, and nurse autonomy. The protocol implementation fostered role clarification, more efficient and relevant communication, highlighted interprofessional values and ethics, and shared decision-making. Three emerging findings from this analysis: the importance for professionals of having a shared vision, the need for effective and relevant communication, and the importance of fully occupying professional roles. Successful MMA protocol implementation relying on IC could optimize pain management for surgical patients in ERAS trajectories. The ERAS program optimized post-surgical pain management, with successful MMA implementation relying on IC. This analysis highlights the importance of involving all relevant professionals in complex interventions like post-op pain relief to maximize outcomes.