Debunking educational myths: towards evidence-based simulation training

In recent times, there has been increased focus on the utilisation of virtual reality flight simulators in flight training, driven by their advantages compared to conventional methods. However, a paucity of empirical evidence has prevented their widespread introduction and regulatory approval. Existing research focuses on single-user simulators, leaving a gap in studies of collaborative training within virtual environments. Consequently, this paper investigates evidence-based simulator training within a collaborative virtual environment.A mixed methods approach was adopted, where behaviours related to industry-standard competencies were observed in a virtual reality complex aircraft and thematic analysis applied to a post-experiment participant debrief. The findings showcase the feasibility of utilising a collaborative virtual environment for evidence-based training purposes in scenarios aligned to typical initial First Officer airline training programmes, which is a precursor to supplementing traditional professional pilot training techniques. In addition, the study found that the visual barriers imposed by head-mounted displays were overcome through the adoption of refined communication strategies, thus laying the groundwork for physically separated multi-crew pilot training.

BackgroundPrevious self-harm is one of the strongest predictors of future self-harm and suicide. Increased risk of repeated self-harm and suicide exists amongst patients presenting to hospital with high-risk self-harm and major self-harm repeaters. However, so far evidence-based training in the management of self-harm for mental health professionals is limited. Within this context, we aim to develop, implement and evaluate a training programme, SAMAGH, Self-harm Assessment and Management Programme for General Hospitals in Ireland. SAMAGH aims to (a) reduce hospital-based self-harm repetition rates and (b) increase rates of mental health assessments being conducted with self-harm patients. We also aim to evaluate the training on self-harm knowledge, attitudes, and skills related outcomes of healthcare professionals involved in the training.Methods/designThe study will be conducted in three phases. First, the SAMAGH Training Programme has been developed, which comprises two parts: 1) E-learning Programme and 2) Simulation Training. Second, SAMAGH will be delivered to healthcare professionals from general hospitals in Ireland. Third, an outcome and process evaluation will be conducted using a pre-post design. The outcome evaluation will be conducted using aggregated data from the National Self-Harm Registry Ireland (NSHRI) on self-harm repetition rates from all 27 public hospitals in Ireland. Aggregated data based on the 3-year average (2016, 2017, 2018) self-harm repetition rates prior to the implementation of the SAMAGH will be used as baseline data, and NSHRI data from 6 and 12 months after the implementation of SAMAGH will be used as follow-up. For the process evaluation, questionnaires and focus groups will be administered and conducted with healthcare professionals who completed the training.DiscussionThis study will contribute to the evidence base regarding the effectiveness of an evidence informed training programme that aims to reduce repeated hospital self-harm presentations and to improve compliance with self-harm assessment and management. This study is also expected to contribute to self-harm and suicide training with the possibility of being translated to other settings. Its feasibility will be evaluated through a process evaluation.

Background Proper initial care for sexual assault victims within the healthcare system is critical, as mishandling may cause lasting trauma. Professionals must be trained through evidence-based simulations designed with instructional design principles. These include authenticity, supportive information, and just-in-time procedural guidance. Visual aids with appropriate language, actions, and questions can enhance this training. Objective This study aimed to assess the needs for developing an authentic visual aid to support healthcare professionals during simulation training on the initial approach to sexual assault victims. Methods A descriptive observational study was conducted using an online survey. Healthcare professionals evaluated the relevance of proposed items for the visual aid using a five-point Likert scale (1 = least, 5 = most relevant). Items were based on a literature review and reviewed by experts. Data was analyzed by rating frequency and further refined through a Delphi consensus round. Ethics approval was granted by the Faculdade Pernambucana de Saúde (CAAE: 75552723.8.0000.5569). Results A total of 186 professionals participated. The most highly rated items were: “show respect” (98.4%), “demonstrate empathy” (96.2%), “listen without interrupting” (83.9%), and “not blame the victim” (78.5%). These insights informed the development of the visual aid. Conclusion Evidence-based simulation training for healthcare professionals should incorporate instructional design elements, including authentic visual aids for just-in-time consultation, to enhance the initial response to sexual assault victims. Take-home message Authentic visual aids should be part of simulation training to better prepare healthcare professionals in the sensitive and critical initial care of sexual assault victims. Financing No conflict.

Does simulation really increase gynecologic surgical skill?

This study employed a randomized controlled trial to assess the efficacy of virtual-reality (VR) simulators and physical model simulators on colonoscopy training to explore the optimal and evidence-based simulation training. Forty participants were divided into 2 groups and randomized as dyads: the VR simulator group and the physical model simulator group. All the participants performed a baseline test through porcine colonoscopy. After a 6 h simulation training, each participant underwent a post-test on a pig after bowel preparation, and the procedures were video-recorded. Both the baseline test and the post-test were blindly assessed by 2 experienced assistant director physicians based on the GAGES-C scoring system. Simulation center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai. Forty surgical residents without colonoscopy experience. Both the VR simulator group and the physical model simulator group improved significantly over the baseline test. The VR simulator group performed significantly better than the physical model simulator group, p=0.042. The participants in both groups expressed a high level of simulator satisfaction. Novice residents can benefit from both VR simulators and physical model simulators. The VR simulator was shown to be more effective for colonoscopy training. VR simulators were more recommended for novices conducting basic colonoscopy training.

Evolution of an evidence-based supermicrosurgery simulation training curriculum: A systematic review

Despite the growing use of virtual patients (VPs) in medical education, few studies have explored the features and effectiveness of VP-based medical communication skills training. We undertook a systematic review to summarise the design and evaluation of VP-based medical communication skills training systems in order to identify features of successful cases. Following PRISMA guidelines, we searched four databases for studies published between 2006 and 2018. Using a refined classification scheme, we extracted data on instructional design (scenario and instructional intervention), technological design (modality and interaction), and evaluation (user experience, learning effectiveness and evaluator). We assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the QualSyst standard assessment criteria. A total of 14 studies were included for review. Of these, 85.7% (n=12) were quantitative and 71.4% (n=10) involved undergraduate students. The most common VP training scenario was history taking followed by the delivery of bad news. Diverse instructional interventions, including tutorials, learning activities, and feedback, were embedded in the VPs. The first-person perspective animated within-screen size VP was a popular technological feature. Most evaluations concerned the reality of simulation (for user experience) and skill in expressing empathy (as a learning outcome). Of the eight comparative studies, half reported significant attitude or skill improvements in the VP group. The distinct features of VPs shown to be effective were well-designed instructional interventions (eg, a pre-activity with a protocol-informed tutorial), and post-activity (eg, debrief or reflection), scaffolding and human feedback, but not system feedback. Evidence-based VP training can enable students to gain communication skills in a safe and affordable learning environment. Elaborate technology alone cannot guarantee effective learning, but evidence-based instructional interventions can facilitate its optimal use and bring about better learning outcomes.

Recently, three fundamental changes have been introduced in medical education, all of particular importance to critical care medicine: (1) clinical teaching and medical practice now emphasize evidence-based medicine, (2) patient safety aspects are increasingly stressed, and (3) use of simulation in medical training is spreading rapidly. In 1999, the disturbingly high frequency of life-threatening or even lethal medical complications was emphasized by the Institute of Medicine in the book To Err Is Human. The Institute of Medicine recommended establishing interdisciplinary team training programs incorporating efficient methods such as simulation. Although simulation has been used by the aviation industry and the military for several decades, only during the past decade has this become a teaching method in medicine. Currently, two full-scale computerized simulators are available: METI, provided by Medical Education Technologies, Sarasota, Florida, and SimMan, manufactured by Laerdal Medical, in Stavanger, Norway. The simulation center at the University of Pittsburgh Medical Center was established in 1994 and has grown quickly to its current large facility, where, in academic year 2003 to 2004, approximately 8000 healthcare professionals were trained on the SimMan. Courses taught include clinical procedures and decision making in perioperative medicine, acute medicine, pharmacology, anesthesiology, airway management, bronchoscopy, pediatric versus adult crisis management, critical events in obstetrics, and crisis team training. Advantages of simulation training over traditional medical education methods include (1) provision of a safe environment for both patient and student during training in risky procedures, (2) unlimited exposure to rare but complicated and important clinical events, (3) the ability to plan and shape training opportunities rather than waiting for a suitable situation to arise clinically, (4) the ability to provide immediate feedback, (5) the opportunity to repeat performance, (6) the opportunity for team training, and (7) lower costs, both direct and indirect. Within the next decade, use of computerized simulators for evidence-based education and training in medicine is expected to develop considerably and spread rapidly into a very important domain of medical schools throughout the entire world.

Critically ill patients with cardiac and/or respiratory failure may require extracorporeal membrane oxygenation (ECMO) to restore physiological function. The use of ECMO in intensive care units (ICUs) in the United States has increased over the past decade, most recently with the COVID-19 pandemic. In July 2020, an estimated 33 000 patients received ECMO support, with survival rates of 59% (pulmonary) and 43% (cardiac).1 Approaches for ECMO support are either venoarterial or venovenous cannulation aimed at restoring the patient’s cardiopulmonary or pulmonary function. Extracorporeal membrane oxygenation is indicated for severe cardiogenic shock, ventricular arrhythmias, cardiopulmonary resuscitation, and acute respiratory distress syndrome refractory to conventional therapies.2 Its management requires trained and experienced critical care providers (eg, nurses) as well as institutional infrastructure with robust leadership to ensure safety and quality patient care.2,3 The Extracorporeal Life Support Organization (ELSO) recommends that ECMO training should consist of didactic courses, hands-on experience, and continuing education.3 To that end, this column begins with the description of the role of the bedside registered nurse (RN) in ECMO management in the cardiothoracic ICU followed by the acute care nurse practitioner’s (ACNP) leadership in ECMO training tailored to the bedside RN’s educational needs.The management of patients receiving ECMO support is usually orchestrated by critical care multidisciplinary teams. In recent years, bedside RNs in ICUs have increasing responsibility in the technical aspects of ECMO care (ie, management of the ECMO system) (see Figure 1) traditionally performed by cardiovascular perfusionists. The increasing use of ECMO, technological refinements, and ELSO guidelines collectively influence the recent trends of ECMO management by bedside RNs. Unfortunately, there are no data about bedside RNs’ training and outcomes in ECMO care. However, there is consensus in the literature that adherence to ELSO guidelines is essential to quality patient care and outcomes. Notably, nurses at facilities with high or increasing ECMO cases can acquire a wide range of ECMO management skill sets including the associated nursing care.3Bedside RNs must be competent in managing patients receiving ECMO support and are expected to promptly intervene when problems arise, such as adjusting pump speed and flows to prevent complications and/or reduce mortality, as well as manage anticoagulation levels and trend hemodynamics. Thus, bedside RNs require training and continuing education tailored to their competency development, maintenance, and eventually, mastery.4 Nursing management competency for patients supported with ECMO is typically acquired through didactic and hands-on training. Didactic content includes ECMO physiology, procedures, emergencies, and anticoagulation management in patients receiving ECMO support. Although hands-on training varies among institutions, there is consensus that bedside RNs should and could manage ECMO including its circuit (see Figure 1) to meet the immediate needs of these highly acute and complex patient populations.Because of the emerging role of bedside RNs being directly responsible for managing ECMO circuits, there is a need for implementing education and training programs beyond the conventional didactic course (eg, simulation) for ICU RNs that is tailored for optimizing their knowledge, skill, and overall competence with ECMO patient management.As an example, a medical center in the western suburbs of Chicago identified a need to develop and implement an ECMO training program that facilitates the optimization of the ICU bedside RN knowledge and skills (competence) with ECMO. The medical center set this organizational priority because of insufficient ECMO training, needing 24-hour ECMO coverage at the bedside, and ensuring that bedside RNs deliver safe and quality patient care. On the basis of increasing evidence supporting high-fidelity simulation as an effective strategy for training health care providers in the management of ECMO, its circuit, and complications, the medical center selected simulation as the training methodology.4 Providing current evidence-based training to ECMO specialists can improve patient safety and the quality of care by improving communication and teamwork and optimizing confidence among ICU nurses.5 Simulation training provides bedside RNs the opportunity to apply theory into practice, make mistakes, and improve ECMO management skills in a risk-free learning environment. Simulation-based ECMO courses have demonstrated an improvement in cognitive, technical, and behavioral skills by providing active learning experiences.6 Extracorporeal membrane oxygenation simulation training can replicate the ICU room setting and emergent situations (eg, cardiac arrest), allows troubleshooting ECMO circuits in a controlled setting, and provides the ability to debrief. Debriefing allows the ICU team to process and evaluate how they respond in each scenario. In ECMO simulation, ACNPs can share their clinical expertise and experiences and lead the team as well as help the RN/team process, reflect, understand, and modify how they manage patients including responding to ECMO emergencies. It is worth mentioning that doctoral-prepared ACNPs (ie, doctor of nursing practice) are suited for taking on leadership roles in designing ECMO simulation training because of their advanced clinical practice and leadership education and training in critical care.In a rapidly changing health care system, ICU ACNPs can make significant contributions in improving patient care quality outcomes through leading clinical nursing education initiatives.Such training took place in the western suburbs of Chicago at a quaternary care facility designated as a level 1 trauma center with over 500 beds. The CTICU was comprised of about 15 beds and over 50 nurses. Half of the nursing staff was certified in a variety of specialties (eg, CCRN, CSC, CMC). Years of nursing experience ranged from 35 years at the bedside to new graduate nurses.The unit lacked formalized ECMO training and skill competencies for its bedside nurses. The previous training was ever-changing. It consisted of direct observations of senior nursing care to ECMO patients lasting a total of 4 hours. The former training did not meet standards set by ELSO. For instance, ELSO recommends that ECMO centers, certified or not, should have a well-defined program for staff training.2 The program should include didactic lectures, laboratory training, bedside training, and a defined system for testing staff proficiency.2 Bedside RNs must be properly trained to think critically in emergent situations and to adequately and promptly troubleshoot complications.An ECMO training program developed with the support of the ACNP was designed to meet ELSO guidelines. As an initial strategy to systematize formal ECMO training, a survey was conducted to gain insight into the current ECMO training from bedside RNs. Ninety percent of the nurses that participated in the survey were not content with the current training. The survey results indicated that a more robust, innovative training tailored to the needs of the nursing staff caring for patients on ECMO would be beneficial. An ECMO simulation training for ECMO specialists was developed that took into account the lack of ECMO training and education on the unit, as well as the increasing acuity of patients in the CTICU; the training developers also compared the current training to ELSO guidelines. The purpose of this training was to improve the self-efficacy and knowledge of the nursing staff in the CTICU through the implementation of standardized ECMO education and simulation training that met ELSO standards.The proposed training was drafted in collaboration with the chief perfusionist. The CTICU followed an RN-perfusion model of ECMO management. The goal was to train CTICU RNs as ECMO specialists to be able to manage the ECMO circuit as well as the patient’s hemodynamics. The didactic consisted of ECMO physiology, patient care management, and troubleshooting venoarterial and venovenous mechanical components of the ECMO system (see Figure 2). The wet lab was a review of the ECMO circuit and priming. Each nurse was expected to correctly prime the circuit and was checked off individually as correctly completing the task. In the simulation training, nurses were divided into groups and participated in 6 scenarios including a mock code with ECMO cannulation (See Table 1).Following synthesis and evaluation of evidence-based literature, the ACNP presented the simulation training proposal to nursing administration but was met with resistance. The lack of leadership knowledge regarding the complexity of patients requiring ECMO was the main reason for resistance. The CTICU was the only unit capable of caring for patients receiving ECMO support, and the unit lacked a nurse educator; nursing management lacked an ICU background, so there was little understanding among leadership of what was required to care for these patients safely and effectively. Time and cost were also important factors in obtaining approval for implementing the training. Nursing leadership’s concern was with the cost of using the simulation laboratory, scheduling the nursing staff for the training, and compensating the chief perfusionist and ACNP. The chief perfusionist, ACNP, and the RNs who participated in the training volunteered their time without compensation for the training. The simulation laboratory was free of cost to the hospital as this was presented as a pilot study that was part of a DNP project. The costs of miscellaneous educational resources for the nursing staff were covered by the ACNP.The proposal was rejected by nursing administration for being infeasible. The proposal was then presented to members of the hospital executive team. Several meetings were organized with the unit medical director, a cardiac surgeon who served as director of the ECMO program, the president of the hospital, and the vice president of patient safety. The proposal was presented as an opportunity to improve the safety and quality of care provided to patients receiving ECMO therapy. After approval was obtained, the ACNP in collaboration with the chief perfusionist formed an ECMO specialist group and submitted approval to the institutional review board. The ACNP was responsible for developing assessment tools to evaluate knowledge and self-efficacy of the nursing staff.The second phase evaluated nurses’ perceived ability to troubleshoot ECMO before the didactic lectures and required nurses to take an anonymous exam consisting of 20 multiple-choice questions on ECMO physiology and a 10-item Likert scale self-efficacy survey. The goal of the simulation training was to empower nurses by giving them the tools necessary to increase their knowledge base on ECMO and improve their perceived ability to care for these patients.The 2-hour didactic lectures were developed based on ELSO recommendations. The didactic focused on introducing ECMO and advanced ECMO troubleshooting, focusing on ECMO physiology, procedures, emergencies, and anticoagulation management in patients receiving ECMO support.Twenty nurses completed a 1-hour wet lab reviewing the ECMO circuitry, alarm troubleshooting, and priming of the circuit (see Figure 1). The 2-hour simulation training was held at the simulation laboratory at the Midwest academic medical center. The simulated room was set up to resemble an ICU room. Six scenarios of issues commonly encountered in patients receiving ECMO therapy were developed as a part of the simulation training. Twenty nurses completed the 6 scenarios proctored by the ACNP and chief perfusionist. Nurses were able to debrief, allowing them to understand the actions taken and the implications of those actions. After completing the simulation training, each nurse retook the same deidentified ECMO knowledge exam and self-efficacy survey.Twenty nurses (100%) completed the training and surveys; knowledge and self-efficacy both showed significant improvement. Pretraining scores on the knowledge exam averaged 70%. Posttraining knowledge exam scores averaged 85%. Posttraining self-efficacy scores improved on each item of the survey. Refer to Table 2 for changes in confidence before and after training.After implementation of the training, a schedule was created with 2 ECMO specialists scheduled on each shift. Patients receiving ECMO support were preassigned to ECMO specialists for 5 months. During those 5 months, it was noted that there was a significant decrease in the number of pages to perfusionists. Nurses were better able to troubleshoot and prevent detrimental events. An ECMO committee was developed comprised of the ICU medical director, unit manager, chief perfusionist, ACNPs, pharmacist, and cardiac surgeons. The committee met monthly for 5 months. The ICU multidisciplinary team collaboratively developed an ECMO policy, created an order set for ECMO patients, revised an anticoagulation policy, and designated an ECMO cart fully equipped for emergent cannulation be stationed on the unit. Electronic health record documentation of ECMO was also updated to reflect the data provided by the Cardiohelp Console, which includes change in pressure, arterial and venous pressures, hemoglobin levels, hematocrit levels, mixed venous oxygen saturation, and activated clotting time results.Another important change in the unit was in how patients receiving ECMO support were signed out to the oncoming shift. An ECMO circuit check was now mandated at every change of shift. This check included the nurse review settings and cannulation sites, along with hemodynamic trends and the most recent postoxygenator gas levels. One of the most important changes because of this training was the approval for an ECMO coordinator position. This would assure nursing staff would receive formal ECMO training to maintain competencies.The level of stress endured during emergencies influences clinical performance. To ensure safe, high-quality ECMO management during emergencies, bedside RNs need technical, behavioral, and independent decision-making skills. This is essential for outstanding teamwork and improved patient outcomes.7 This simulation training enhanced nurses’ ability to identify and initiate an intervention promptly. There was an improvement in scores of the knowledge exam after training. Nurse self-efficacy was improved as evidenced by the improved percentages in the posttraining self-efficacy survey. These results indicate that nurses improved their self-efficacy and knowledge. Of note, in the simulation laboratory, regardless of years of experience, nurses had difficulty with more complex scenarios, further supporting the need for training and competencies.After training, nurses recognized acute events and intervened before these events could cause harm to patients. An example of the impact of this training was when nurses who participated in the training were able to promptly identify recirculation occurring in a patient receiving venovenous ECMO support. The nurses recalled this ECMO complication from a scenario practiced in the simulation laboratory. They were able to visualize this in a controlled setting and were able to apply what they learned to the bedside. A limitation of this education/training was that the nurses who participated in this training were highly specialized ICU nurses. The outcome of this training might be different in a group of less specialized nurses.This simulation training demonstrated the importance of using ACNPs to increase patient access to care in a critical care setting and to set the standards for care.8 Acute care nurse practitioners are instrumental resources because of their direct patient care skills.8 Both RNs and physicians consider education, research, collaboration, and leadership vital roles of the ACNP that are indispensable in any critical care unit.8 An ACNP with ECMO experience is vital to a CTICU because they can play a role in decreasing hospital lengths of stay and mortality, improving patient care, and promoting continuity of care. Acute care nurse practitioners are a strong liaison between bedside nurses and the ICU multidisciplinary team.This column outlines the essential role of the ACNP in ECMO in a CTICU. The goal of this training was to implement an ECMO simulation training led by an ACNP. Fundamental to this training was that it would improve the knowledge and self-efficacy of bedside RNs. Acute care nurse practitioner– led educational initiatives enhance structural empowerment through leadership and improved communication, which positively influences staff morale. Empowering bedside RNs through education increases staff retention and improves the quality and safety of patient care. The health care system in the United States is dynamic. As nursing leaders, ACNPs are essential resources that can empower bedside RNs to provide safe and quality nursing care to our most complex patients.

Editorial Commentary: Simulation-Based Training in Orthopaedic Surgery: Current Evidence and Limitations

This is a national survey of UK obstetric trainees and consultant labour ward leads designed to investigate the current practice and training for an impacted foetal head (IFH) at Caesarean Section (CS). An anonymous, on-line survey was disseminated to trainees via Postgraduate Schools and RCOG trainee representatives, and to labour ward leads via their national network. Three hundred and forty-five obstetric trainees and consultants responded. The results show that IFH is variably defined and encountered by most UK obstetricians (98% had encountered IFH and 76% had experienced it before full cervical dilatation). There is significant variation in management strategies, although most respondents would use a vaginal push up to assist delivery prior to reverse breech extraction. Responses revealed a paucity of training and lack of confidence in disimpaction techniques: over one in ten respondents had not received any training for IFH and less than half had received instruction in reverse breech extraction. Impact statement What is already known on the subject? IFH is an increasingly recognised, technically challenging complication of intrapartum CS. A recent report suggested that birth injuries associated with IFH are now as common as with shoulder dystocia. However, there is no consensus nor guidelines regarding the best practice for management or training. What do the results of this study add? This study demonstrates that IFH is poorly defined and commonly encountered by UK obstetricians. It highlights that IFH is not restricted to CS at full dilatation and reveals the ubiquity of the vaginal push method in UK practice. We found evidence that UK obstetricians are using techniques which have not been investigated and are not recommended for managing an IFH. Moreover, this survey is an eye-opener as to the paucity of training, highlighting that UK obstetric trainees are not adequately prepared to manage this emergency. What are the implications of these findings for clinical practice and/or further research? There is a pressing need to standardise the definition, guidance and training for IFH at CS. Further research should clarify the appropriate techniques for IFH and establish consensus for the best practice. An evidence-based simulation training package, which allows clinicians to learn and practice recognised disimpaction techniques is urgently required.

Background: Bacterial pharyngitis is a commonly over-diagnosed ambulatory condition that can contribute to antibiotic overuse. Rapid antigen detection tests (RADT) are valuable in determining whether pharyngitis is caused by Group A streptococcus (GAS) and requires antibiotic therapy, or is viral in etiology. In 2021, Henry Ford Health partnered with QURE Healthcare to implement incentivized, evidence-based patient simulation training platforms for ambulatory primary care providers (PCP). This study aimed to describe outcomes of a simulated educational approach for ambulatory PCPs related to optimal pharyngitis testing and management. Methods: This was an IRB-exempt cross-sectional study of PCPs at an urban health system in Michigan. In 2024, four online simulated pharyngitis patients (two with characteristic GAS symptoms, two with hallmark viral symptoms) were incorporated into the program to assess antimicrobial stewardship among PCPs. PCPs provided care for simulated patients in random order over two seasons (spring and fall 2024), including the accuracy of medical decision-making about diagnostic testing and antibiotic treatment. At each decision point, PCPs received direct feedback on how decisions aligned with internal evidence-based guidelines. The primary outcome was to measure ordering decisions for RADTs and antibiotics by PCPs over the two simulation seasons. Results: 368 PCPs performed all four pharyngitis simulations. In cases where symptoms were congruent with GAS etiology, PCPs ordered RADT in 84.0%. Of those who ordered RADT, 98.7% ordered any antibiotic and 85.6% ordered an evidence-based antibiotic (i.e., penicillin or amoxicillin). For those who did not order RADT but received feedback within the case, 95.8% ordered any antibiotic and 76.3% ordered an evidence-based antibiotic. In cases with viral symptoms, 57.7% ordered RADT unnecessarily despite the low likelihood of GAS etiology. Antibiotics were ordered in 6.4% of cases with a negative RADT and without ordering RADT altogether. There was little difference in correct/incorrect RADT ordering patterns for the spring and fall seasons (P>0.05); there was an increase in ordering the preferred penicillin from the start of the first season to the end of the second season (25.0% to 33.7%, P = 0.062) and a 45.7% relative reduction in ordering non-recommended antibiotics (23.0% to 12.5%, P = 0.066). Conclusion: This study shows two-fold RADT challenges: overutilization for viral symptoms and underutilization for bacterial symptoms. Significant opportunities remain to increase guideline-recommended penicillin and reduce antibiotic use in viral pharyngitis cases. These results suggest that simulation-based measurement offers valuable insights into group-wide practice patterns and case-based feedback can improve evidence-based decision-making.

간호대학생의 근거기반 실무교육을 연계한 시뮬레이션 실습의 효과

간호대학생의 근거기반 시뮬레이션 실습 교육 경험

Employment offers many important benefits yet the majority of adults with disabilities are not represented in the workforce suggesting more research is needed on evidence-based vocational training for adults with disabilities (U.S.Bureau of Labor Statistics, 2024). The evidence base for improving current vocational training practices can be expanded through more research on fluency-based instruction and precision teaching. Precision teaching has been demonstrated to improve skill repertoires in a number of academic settings but its application for vocational skill acquisition is still emerging. The present study evaluated precision teaching as a tool to teach employment skills and extended Cohen (2005). Thus, the purpose of this study was to determine the effects of precision teaching with frequency building on the acquisition of job skills for adults with disabilities and examine the effects of training component skills using frequency building at a simulated training site on composite skill performance at the job site requiring the vocational skill. The results suggest frequency building was successful at improving vocational component repertoires. Evaluations of fluency outcomes after aims were met found degradations in participants' component performances. Finally, maximizing the effects component skill fluency has on related composite repertoires may require composite skills to be explicitly trained.