A47 The Missing Perspective: A Scoping Review on Autistic Learners in Simulation-Based Healthcare Education

Exploring the extent to which simulation-based education addresses contemporary patient safety priorities: A scoping review

India is waking up to the importance of simulation-based education (SBE). More and more institutions are setting up centralized simulation training facilities, while others have such facilities at the departmental level. The new National Medical Commission curriculum mandates communication and procedural skills training for undergraduate medical students and it is likely that SBE will soon be mandated for postgraduates as well. In my experience there are several difficulties with a universal adoption of SBE in healthcare in India. This article describes the current situation of SBE in healthcare in India before proposing strategies to enhance uptake and acceptance.

We have been developing 360° simulated practice videos for healthcare science students. The students who have taken part in the filming and watched the videos provided feedback on whether this would benefit their learning. We are doing this to continue to strive forward with innovations in virtual learning in line with Health Education England [1]. The simulation-based videos have been created to add to the healthcare sciences units to aid in ‘real-life’ teaching styles, to help build confidence and resilience in healthcare students, and to provide multidisciplinary, patient-focused scenarios that can be included in assessments [2]. First and third-year paramedic students took part in mass casualty scenarios filmed at our student’s union building. They worked with Critical Care Practitioners, Academics, Nurses in practice, and the National Ambulance Resilience Unit to create handover videos involving assessing casualties to create videos for other healthcare professionals. Follow-up videos were then filmed on the 360° cameras in the simulation suites to represent an accident and emergency environment as this is where mental health crisis assessments can take place. The adult psychosis presentation was filmed and shows ‘psychiatric liaison nurses’ played by second-year MSc and BSc mental health students assessing the person with suspected psychosis and making clinical decisions. The scenario mental state examination and the case study were scripted. Students could view the 360° videos using virtual reality headsets such as the Oculus Rift [3]. The student feedback evaluation data was collected via an online survey and focus group discussions (FGDs). A survey was completed with n=30 students across all fields of nursing students and paramedic students. The student FGD evaluations were very positive about alternative simulated learning styles with one student quoting ‘It will make an assessment of mental health patients a lot easier for students using appropriate tools and models’. Students found that simulation-based learning experience is an excellent addition to traditional learning approaches as it met the requirements for different learning styles. This research project brought together academics and practitioners from across practice and university. Future work should build on these resources based on feedback from students and service users. 1. National Health Service/Health Education England. 2020. A national vision for the role of simulation and immersive technologies in health and care. 2. ASPiH/HEE. 2016. Simulation-based Education in Healthcare Simulation-Based Education in Healthcare (aspih.org.uk) [Accessed on 17/06/2022] 3. Topal review: NHS. 2019. Preparing the healthcare workforce to deliver the digital future.

Simulation in healthcare education enables learners to practice in a realistic and controlled environment without putting real patients at risk. Deception can be incorporated to generate a realistic learning experience. We aim to perform a systematic review of the literature to study the effect of deception in SBE in healthcare. Online database search was performed from conception up to the date of search (December 2023). Qualitative descriptive analysis included all published and unpublished works as for the quantitative analysis, only randomized clinical trials with an objective measurement tool relating to learner’s performance were included. Forward citation tracking using SCOPUS to identify further eligible studies or reports was also applied. Twelve out of 9840 articles met the predefined inclusion criteria. Two randomized controlled trials were identified using deception for the intervention group and ten articles provided current knowledge about the use of deception in simulation-based education in healthcare. The aspects discussed in the latter articles related to the possible forms of deception, its benefits and risks, why and how to use deception appropriately, and the ethics related to deception. Although this meta-analysis shows that using deception in SBE in healthcare by challenging authority negatively affects the trainees’ performance on the mAIS scale, this approach and other forms of deception in SBE, when used appropriately and with good intent, are generally accepted as a valuable approach to challenge learners and increase the level realism of SBE situations. Further randomized trials are needed to examine and confirm the effect of other deceptive methods and the true psychological effect of those interventions on validated scales.

The benefits of observation in simulation-based education in healthcare are increasingly recognized. However, how it compares with active participation remains unclear. We aimed to compare effectiveness of observation versus active participation through a systematic review and meta-analysis. Effectiveness was defined using Kirkpatrick's 4-level model, namely, participants' reactions, learning outcomes, behavior changes, and patient outcomes. The peer-reviewed search strategy included 8 major databases and gray literature. Only randomized controlled trials were included. A total of 13 trials were included (426 active participants and 374 observers). There was no significant difference in reactions (Kirkpatrick level 1) to training between groups, but active participants learned (Kirkpatrick level 2) significantly better than observers (standardized mean difference = -0.2, 95% confidence interval = -0.37 to -0.02, P = 0.03). Only one study reported behavior change (Kirkpatrick level 3) and found no significant difference. No studies reported effects on patient outcomes (Kirkpatrick level 4). Further research is needed to understand how to effectively integrate and leverage the benefits of observation in simulation-based education in healthcare.

Introduction Simulation is a powerful tool for learning, and has been shown to be effective for a wide range of skills. In situ simulation is delivered in the clinical setting with the objective of incorporating simulated learning into real working environments. This provides additional scope for learning, not only team working and clinical skills, but also in identifying latent errors. We established an in situ simulation programme within our gastroenterology department using the recent Association for Simulated Practice in Healthcare (ASPiH)¹ key standards: clearly defined learning objectives, authentic delivery and faculty proficient in simulation-based education. Methods We identified key learning objectives, highlighting both human factors (at an individual, team and organisational level) and clinical teaching pertinent to the gastroenterology team, to cover over the programme. We incorporated this into a series of clinically relevant scenarios including massive upper gastrointestinal haemorrhage, biliary sepsis and post-ERCP complications. We ran five sessions over a six month period with three faculty, involving twenty four participants across the spectrum of the multi-disciplinary team (MDT). Following each in situ simulation, we facilitated a short, structured debrief session highlighting key learning points, providing feedback and enabling reflection. Results Twenty three of twenty four participants enjoyed the sessions and felt better prepared for similar real life clinical scenarios. All team members involved felt well supported during the debrief process. Through our sessions we recognised both latent error (confusion over the new massive haemorrhage protocol contact number) and resource requirements (no Sengstaken–Blakemore tube on the ward). Following the sessions we highlighted specific teaching needs, and established a mandatory teaching day for our Junior and Senior Clinical Fellows, focusing on the management of the acutely unwell adult. Conclusions In conclusion, in situ simulation has proved a useful modality to deliver teaching in the clinical setting. The response from the multi-disciplinary team has been overwhelmingly positive, especially with feedback reporting it improved team dynamics. The team is currently expanding the in situ simulation programme across other wards to provide ongoing simulation teaching and consequently improve patient safety. Reference . SIMULATION-BASED EDUCATION IN HEALTHCARE– STANDARDS FRAMEWORK AND GUIDANCE. (2016). 1st ed. Health Education England. Available at: http://aspih.org.uk/wp-content/uploads/2017/07/standards-framework.pdf [Accessed 8 Feb. 2018].

This study aims to provide an updated overview of medical error taxonomies by building on a robust review conducted in 2011. It seeks to identify the key characteristics of the most suitable taxonomy for use in high-fidelity simulation-based postgraduate courses in Critical Care. While many taxonomies are available, none seem to be explicitly designed for the unique context of healthcare simulation-based education, in which errors are regarded as essential learning opportunities. Rather than creating a new classification system, this study proposes integrating existing taxonomies to enhance their applicability in simulation training. Through data from surveys of participants and tutors in postgraduate simulation-based courses, this study provides an exploratory analysis of whether a generic or domain-specific taxonomy is more suitable for healthcare education. While a generic classification may cover a broad spectrum of errors, a domain-specific approach could be more relatable and practical for healthcare professionals in a given domain, potentially improving error-reporting rates. Seven strong links were identified in the reviewed classification systems. These correlations allowed the authors to propose various simulation training strategies to address the errors identified in both the classification systems. This approach focuses on error management and fostering a safety culture, aiming to reduce communication-related errors by introducing the principles of Crisis Resource Management, effective communication methods, and overall teamwork improvement. The gathered data contributes to a better understanding and training of the most prevalent medical errors, with significant correlations found between different medical error taxonomies, suggesting that addressing one can positively impact others. The study highlights the importance of simulation-based education in healthcare for error management and analysis.

This study aims to provide an updated overview of medical error taxonomies by building on a robust review conducted in 2011. It seeks to identify the key characteristics of the most suitable taxonomy for use in high-fidelity simulation-based postgraduate courses in Critical Care. While many taxonomies are available, none seem to be explicitly designed for the unique context of healthcare simulation-based education, in which errors are regarded as essential learning opportunities. Rather than creating a new classification system, this study proposes integrating existing taxonomies to enhance their applicability in simulation training. Through data from surveys of participants and tutors in postgraduate simulation-based courses, this study provides an exploratory analysis of whether a generic or domain-specific taxonomy is more suitable for healthcare education. While a generic classification may cover a broad spectrum of errors, a domain-specific approach could be more relatable and practical for healthcare professionals in a given domain, potentially improving error-reporting rates. Seven strong links were identified in the reviewed classification systems. These correlations allowed the authors to propose various simulation training strategies to address the errors identified in both the classification systems. This approach focuses on error management and fostering a safety culture, aiming to reduce communication-related errors by introducing the principles of Crisis Resource Management, effective communication methods, and overall teamwork improvement. The gathered data contributes to a better understanding and training of the most prevalent medical errors, with significant correlations found between different medical error taxonomies, suggesting that addressing one can positively impact others. The study highlights the importance of simulation-based education in healthcare for error management and analysis.

Introduction: In simulation-based education in healthcare, while standardized patients will provide a summary for constructive verbal or written post-encounter feedback to the doctors or nurses from the patient’s viewpoint, peers are also valuable resources to provide accurate and rapid feedback in the view of other healthcare professionals. Objectives: To compare SPs’ and peers’ feedback in assessing communication skills. Methods: A cross-sectional study was conducted on trainees (doctors and nurses) and standardized patients who participated in the communication skills training in 2019. A convenience sampling method was applied to collect data using the self-designed questionnaire. Results: 889 pairs of SPs’ and peers’ feedback were included in this study. Peers and standardized patients did not agree on communication skills by scenarios, p >0.05. By subscales, there was also no agreement between peers’ and standardized patients evaluations of trainees’ communication skills. Conclusions: This finding supports the continued use of both training methods to help trainees have diverse perspectives in their self-reflection process as healthcare professionals.

Simulation-based education (SBE) is an important modality for training a competent and safe healthcare workforce. It is also an important component of core training and continuing professional development for healthcare workers in the National Health Service (NHS) of the United Kingdom. A comprehensive review of SBE provision, led by NHS Health Education England (HEE), discovered many areas of good practice, but also identified inequalities in the access to and delivery of simulation. A framework was developed to help improve the quality, provision, and access to SBE. Case studies are provided in this chapter showcasing the different types of simulation which contributed to the good practice, how they are used in healthcare education, and how they link to the SBE framework. The chapter sets out some of the current challenges with equitable and high-quality provision, detailing plans to further enhance the education and training of the healthcare workforce through SBE through the delivery of a framework, strategic overview, and vision to support these plans.

This policy insight outlines Latvia’s national strategy for integrating simulation-based education into all levels of medical and healthcare education by 2027. It is framed as a direct response to the 2024 Global Consensus Statement on Simulation-Based Practice in Healthcare, operationalizing its recomme ndations within a national policy context for Latvia. Grounded in international and national standards—including WHO guidance, EU directives, and principles of healthcare safety and education quality—the strategy promotes simulation as a transitional and indispensable phase between theoretical instruction and clinical practice. The strategy emphasises structured collaboration among universities, professional associations, healthcare providers, and government bodies. It sets out a governance and resource model for simulation-based learning environments, ensuring quality, sustainability, and alignment with ethical and professional standards. By embedding simulation-based education into undergraduate, postgraduate, and continuing medical education, Latvia aims to enhance healthcare professionals’ clinical competence, reduce preventable medical errors, and improve patient outcomes. The approach supports deliberate practice, facilitates safe and realistic training conditions, and strengthens the preparedness of healthcare workers for both routine and complex clinical scenarios. The strategy also calls for standardised quality-assurance mechanisms, accreditation procedures, and integration into national regulatory frameworks. This national roadmap aims to establish Latvia as a regional leader in simulation-based healthcare education, improving not only the safety and efficiency of healthcare services but also public trust and professional development. As such, the strategy serves both as a practical implementation plan and a model for countries pursuing similar goals.

This review will present developments in simulation-based education (SBE) over the past decade with a focus on activity in the UK’s National Health Service and the role of the national...

Over the past two decades, there has been an increase in the use of simulation-based education for training healthcare providers in technical and non-technical skills. Simulation education and research programs have mostly focused on the impact on clinical knowledge and improvement of technical skills rather than on cost. To study and characterize existing evidence to inform multi-stakeholder investment decisions, we performed a systematic review of the literature on costs in simulation-based education in medicine in general and in neonatal resuscitation as a particular focus. We conducted a systematic literature search of the PubMed database using two targeted queries. The first searched for cost analyses of healthcare simulation-based education more broadly, and the second was more narrowly focused on cost analyses of neonatal resuscitation training. The more general query identified 47 qualified articles. The most common specialties for education interventions were surgery (51%); obstetrics, gynecology, or pediatrics (11%); medicine, nursing, or medical school (11%); and urology (9%), accounting for over 80% of articles. The neonatal resuscitation query identified five qualified articles. The two queries identified seven large-scale training implementation studies, one in the United States and six in low-income countries. There were two articles each from Tanzania and India and one article each from Zambia and Ghana. Methods, definitions, and reported estimates varied across articles, implying interpretation, comparison, and generalization of program effects are challenging. More work is needed to understand the costs, processes, and outcomes likely to make simulation-based education programs cost-effective and scalable. To optimize return on investments in training, assessing resource requirements, associated costs, and subsequent outcomes can inform stakeholders about the potential sustainability of SBE programs. Healthcare stakeholders and decision makers will benefit from more transparent, consistent, rigorous, and explicit assessments of simulation-based education program development and implementation costs in low- and high-income countries.

Dear SirThe dissemination of innovation in medical education including simulation-based healthcare education (SBHE) has been influenced by a Western bias. Countries less experienced with SBHE often...

Aim: To help prepare community nurses to manage complex scenarios in practice. Objectives: To design and deliver two full days of simulated scenarios within a community setting, split across the academic year To obtain feedback from participants, both learners and faculty, with regards to realism and application of learning to practice To provide faculty development with regards to debriefing and scenario delivery To provide an opportunity for peer review of debriefing Summary of work undertaken: Initially, the simulation team at the University were approached by the Specialist Community Public Health Nursing (SCPHN) course lead to design and co-deliver a day of simulated scenarios designed to challenge experienced nurses starting on the SCPHN course. It is reported that there remains a lack of community-based simulation in current nursing education.1 Four scenarios were designed in collaboration with the SCPHN course team which were intended to address common issues that may be encountered in the role, e.g. gaining access to review a disengaged service user, safeguarding, recognising a deteriorating child and safety in the home. The first simulation day was delivered within the students’ first week at university, for them to gain a feel for the role, and encourage team building and peer support. It was also intended to add something different to the induction week, with a practical aspect, in order to stimulate future learning and help students consider new learning needs from an early point. All the scenarios were delivered in a community setting, using a small house on the university premises. Due to this setting (with limited space) and the fact that the students were at an early stage within their course, video recording was not carried out, however, using a community setting added to the realism of the scenarios, as evidenced through learner feedback. In response to positive feedback and a drive for further challenge, a second day was developed and delivered approximately six months later with additional scenarios designed to incorporate a higher level of complexity. At the start of both days, learners had a period of preparation timetabled and were given a brief overview of the themes the scenarios might cover. This allowed time to review policies, protocols and procedures as needed. Post-simulation debrief was led jointly by a member of the simulation team and SCPHN lecturer. Both learners and faculty were asked to provide feedback through a questionnaire for evaluation and future development. Debriefing peer review was also undertaken amongst faculty using the Harvard Debriefing Assessment for Simulation in Healthcare tool.2 Impact on practice: Faculty: Prior to the first day, a faculty development session was delivered to those staff unfamiliar with simulation-based education (SBE) to support and develop the staff team. An online learning package was developed for those who were unable to attend the face to face session. This supported the effective delivery of both simulation days from a faculty perspective (particularly regarding debriefing skills), and in turn the quality of teaching and learning opportunities. This will hopefully also benefit future practice, instilling knowledge and confidence in lecturers previously less familiar with simulation. The simulation days supported interprofessional learning and faculty cohesion, allowing the simulation team to learn more about the SCPHN role and the SCPHN team to develop knowledge, skills and attributes within SBE. Peer review of debriefing was also extremely valuable with regard to personal/professional development, thus supporting The Association for Simulated Practice in Healthcare (ASPiH) SBE Standards 2 and 3.3 Learners: Students developed increased confidence in patient management and safe practice, demonstrated by learner feedback. The simulations and debriefs encouraged learners to reflect on practice, helping to identify strengths, learn from others, and generate an awareness of gaps in practice and priorities for future personal development. Whilst it is acknowledged that this is only level 2 evaluation,4 further evaluation will take place at the end of the course to determine how learning from the two simulation days has been put into practice. References Hartman SA. An innovative strategy for community nursing student simulation experiences. Journal of Nursing Education 2018;57(10):630. doi:http://dx.doi.org.hallam.idm.oclc.org/10.3928/01484834-20180921-13. Accessed 16 May 2019. Simon, R., Raemer, D.B., Rudolph, J.W. (2018). Debriefing Assessment for Simulation in Healthcare (DASH)© – Rater Version, Long Form. Centre for Medical Simulation, Boston, Massachusetts. Retrieved from https://harvardmedsim.org/dash-rv-long-scoresheet-en-2018/. Accessed 20 May 2019. The Association for Simulated Practice in Healthcare (ASPiH). (2016). Simulation-based education in healthcare. Standards framework and guidance. Retrieved from http://aspih.org.uk/wp-content/uploads/2017/07/standards-framework.pdf. Accessed 20 May 2019. Kirkpatrick Partners. (2019). The New World Kirkpatrick Model. Retrieved from https://www.kirkpatrickpartners.com/Our-Philosophy/The-New-World-Kirkpatrick-Model. Accessed 1 June 2019.