Enhancing Simulation Literacy among Healthcare Professionals

Simulation in healthcare, empowered by big data analytics and artificial intelligence (AI), has the potential to drive transformative innovations towards enhanced interprofessional collaboration (IPC). This convergence of technologies revolutionizes medical education, offering healthcare professionals (HCPs) an immersive, iterative, and dynamic simulation platform for hands-on learning and deliberate practice. Big data analytics, integrated in modern simulators, creates realistic clinical scenarios which mimics real-world complexities. This optimization of skill acquisition and decision-making with personalized feedback leads to life-long learning. Beyond clinical training, simulation-based AI, virtual reality (VR), and augmented reality (AR) automated tools offer avenues for quality improvement, research and innovation, and team working. Additionally, the integration of VR and AR enhances simulation experience by providing realistic environments for practicing high-risk procedures and personalized learning. IPC, crucial for patient safety and quality care, finds a natural home in simulation-based education, fostering teamwork, communication, and shared decision-making among diverse HCP teams. A thoughtful integration of simulation-based medical education into curricula requires overcoming its barriers such as professional silos and stereo-typing. There is a need for a cautious implantation of technology in clinical training without overly ignoring the real patient-based medical education.

Over the past two decades, there has been a worldwide exponential growth in the use of simulation in healthcare. Anesthesiologists were among the pioneers to develop simulation-based education, training and research in medicine. Simulation for such purposes in this discipline includes the use of tasks trainers, which fidelity goes from simple low-tech to complex virtual reality simulators, computer-based simulations, full scale simulations using high-fidelity mannequins, and many other techniques. The present work reviews and summarizes the research conducted on the use of simulation for education, training and research in anesthesiology, with a special focus on the contribution of our research group in the understanding of this domain. It reviews the following areas: the definitions of simulation and simulators; the theories and educational principles underpinning simulation-based education; the evaluation of the use and the impact of simulation in anesthesiology to teach specific technical skills and generic non-technical skills; and finally the use of simulation as an evaluation tool for summative assessment and as a means for research in human factors. The evidence presented in this review supports the claim that simulation techniques are an essential tool both in anesthesiology and in many other healthcare professions. Some recent findings even suggest that the use of simulation may be cost-effective, since for some very specific skills such as central venous line placement and neonatal resuscitation, it has been shown to improve patient care and to reduce patient adverse events. Because the future adoption and dissemination of simulation will depend on our capacity as educators, clinicians and researchers to gather more convincing evidence, current and future research perspectives of particular interests for our study group are discussed.

As Accessible as a Book on a Library Shelf: The Imperative of Routine Simulation in Modern Health Care

IntroductionSuspension of disbelief (SoD) is a concept that relates to participants in healthcare simulation being willing to suspend their disbelief, being able to accept the unreal elements of a simulation, but still act as if the situation was real, so that they may become immersed in the simulation. However, the evidence to support this commonly used concept is not clear. This protocol sets out the methods to be used to undertake a scoping review of the literature relating to SoD in healthcare simulation.MethodsA scoping review methodology will be used to undertake a comprehensive database (l: MEDLINE, Psychology and Behavioural Sciences Collection, CINHAL Plus with Full text, APA PsycINFO APAPsycArticles, AMED – The Allied and Complementary Medicine Database and Scopus) literature search focussing on healthcare simulation following the Population, Concept and Context framework (healthcare professionals, SoD, and simulation). Included literature will be assessed using the Mixed Methods Appraisal Tool for primary research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature.AnalysisData analysis will be undertaken using thematic analysis and narrative reporting. This work will contribute to the wider understanding of the concept within healthcare simulation. It will help to provide guidance and a focus for future research into the concept.

Simulation-based education (SBE) is increasingly used as an education tool to improve learning for healthcare providers. In newborn care practice, SBE is used in the Neonatal Resuscitation Program (NRP) and training in procedural skills. The NRP is a mandatory course in Malaysia for all house officers (interns) and medical officers (residents) during their pediatric rotation. Almost 30,000 of NRP providers have been trained over the last 5 years. The recent establishment of the Allied Healthcare Center of Excellence (AHCoE), an organization dedicated to promoting SBE, and Malaysian Society for Simulation in Healthcare (MaSSH) aims to enhance the integration of SBE into the healthcare training curriculum and set up a local healthcare simulation educator training program. Our experience in implementing SBE necessitated that we made several important choices. As there was no strong evidence to favor high-fidelity over low-fidelity simulation, and because simulation centers can be very costly to set up with limited resources, we chose SBE mainly in the form of low-fidelity and in situ simulation. We also identified an important developmental goal to train Malaysian instructors on structured debriefing, a critical activity for learning in SBE. Currently, debriefing is often carried out in our centers at an ad hoc basis because of time limitation and the lack of personnel trained. Finally, we aim to implement SBE further in Malaysia, with two axes: (1) the credentialing and recertification of physicians and nurses, and (2) the education of lay caregivers of high-risk infants before discharge from the neonatal intensive care unit.

Background context Training of simulation instructors is critical to developing high quality simulation programs.1 Yet, a structured strategy on developing and sustaining simulation faculty is a challenge.2 We describe a novel programme of developing faculty, which has helped increase our faculty base and sustain our simulation centre. Methodology We created honorary posts for doctors in training working at Hull and East Yorkshire Hospitals NHS Trust with an interest in education and gave them the opportunity to learn on one-to-one basis from educators in simulation. These Associate Simulation Fellow posts were “in programme” placements therefore the doctors did not have to undergo “out of programme” formalities to undertake the post. A structured training process was provided by HILS; group sessions and one-to-one teaching in simulation based education, time with the technicians in HILS to become independent with controlling high fidelity simulators. They underwent a process of observing debrief, and providing supervised debrief. Associate simulation director, a previous Simulation Fellow at our organisation, supervised and mentored them. Results 6 fellows were appointed in September 2015 following an interview process. All have completed a train the trainer course, delivered courses independently (with consultant supervision) and are contributing to research projects. All intend to continue their interests in simulation education. Each was able to contribute a minimum of 8 days to the scheme. Discussion We have demonstrated that it is possible to create a pool of skilled simulation educators from the junior doctor workforce. Time constraints due to clinical commitments proved a challenge. However, the Fellows were resourceful and received good support from their educational supervisors to pursue their educational interest. We believe that this model can be extended to the rest of the workforce. References Fanning R, Gaba D. The role of debriefing in Simulation-Based Learning. Simulation in Healthcare 2007;2(2)115–125. McGaghie WC, Issenberg B, Petrusa E, Scalese R. A critical review of simulation-based medical education research. Med Educ 2010;44(1)55–63.

Effective communication is a vital skill in healthcare, whether discussing sensitive or challenging topics, explaining decisions, supporting colleagues, welcoming staff, de-escalating situations, reviewing accolades and complaints or building rapport. Many people find it difficult to initiate, hold, conclude and follow-up conversations. Simulation-based education (SBE) has been identified as an effective way to improve communication skills, however, a structured communication skills framework is necessary. A plethora of established communication skills frameworks [1-3] exist, each excellent within their own sphere. Our purpose was to develop a generalizable, transferable framework to suit the broad range of communications covered in SBE; a framework which can be repeated, practised, and easily memorized. Experts in communication skills, healthcare education, and SBE reviewed existing communication skills frameworks. The new framework’s foundations were key skills, within every conversation, between healthcare professionals and colleagues, patients or relatives/carers, or between non-healthcare professionals and colleagues/clients. Thematic analysis of data from participants of sessions from the previous five years identified these themes: Why, when, where and how to start a conversation The best time to have a conversation Showing empathy and listening (verbal and nonverbal skills) Providing support, without being solution orientated How to sense-check ourselves and others, after the conversation The STEPS framework was developed two years ago and has been used by our facilitators in SBE, to assist participants to be confident in structuring and having conversations. The five-step framework has a memorable mnemonic STEPS; Start, Time, Empathy, Provide-support, and Sense-check. STEPS has been well received by over 500 participants. They have reported that it is easy to remember and highly applicable to situations in and out of work. Post-intervention surveys showed significant improvement in learners’ confidence and perceived competence in holding conversations. Focus group discussions revealed that learners found the STEPS approach helpful in managing their own emotions and in creating an open dialogue with others. The STEPS approach is a generalizable communication skills framework that can be implemented in SBE activities to improve people’s understanding of structuring conversations. It has had a positive impact on participants particularly regarding their perceptions of having ‘challenging’ conversations. The STEPS approach can be used to guide healthcare and non-healthcare professionals in various settings and is a valuable tool in improving person-centred communication. STEPS helps people initiate, structure and navigate a conversation with kindness and in a way that makes constructive outcomes possible. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Introduction/Background Recently, there has been a shift in attitudes to recognize the need for formalized faculty development courses and innovative teaching methodologies to improve medical education worldwide.1 In response to such a demand, the use of simulation-based medical education (SBME) has increased dramatically. Research on SBME has shown that there is a core set of best practices required to produce optimal results, requiring detailed curriculum design and trained instructors.2 General practitioners in Ecuador have expressed the need for a simulation-based training program to improve current knowledge, skills and attitudes related to advancements in educational technologies, novel educational methods and improved healthcare practices. To date, there is not an active dedicated simulation center or simulation-based educational curriculum in Ecuador. We propose a novel simulation-based, blended learning curriculum geared towards General Practitioners and healthcare educators in Ecuador. The goal of our project is to introduce low-cost, high-quality teaching principles and strategies that are both 1) tailored to a specific cultural and contextual setting and 2) sustainable for continued curricular implementation. Methods Effectively deploying a simulations-based curriculum to a new institution and nation requires a multi-tiered approach regarding institutional design, faculty development and simulation-based educational curricula. In partnership with the Andean Health and Development organization, we initiated the first phase of our project by traveling to Ecuador to perform a targeted needs assessment 3, where we anonymously surveyed a random cohort of physicians, nurses and paramedics (n=18). The survey asked questions regarding current educational practices in medical education, as well as current perceived needs and challenges for medical education in Ecuador. Qualitative data was analyzed for descriptive purposes. In addition, we piloted a two-day "Introduction to Simulation" course in one of the largest rural hospitals in Santo Domingo, Ecuador. The introductory course offered a blend of didactics and simulations-based hands-on application in the areas of educational theory, the basics of simulation, case design, instructor debriefing, as well as the technological and logistical aspects of designing a simulation center. We held the course in Ecuador’s soon to be first dedicated simulation center, in Santo Domingo and had healthcare professionals and academic leaders from various parts of the country attend. Our preliminary data illustrate that currently, in Ecuador, the majority of teaching in medical schools is still mostly classroom based (50%), followed by clinical teaching (44%). However, 80% of our population surveyed state they learn best through hands-on practice, not an ideal method for either classroom settings or actual patient care. The majority of the participants stated that the biggest need in medical education in Ecuador was the following, (in descending order); the need for technological advancement and utilization, a simulation center, new methods of learning including hands-on practice methodologies, environments for application of skill, improved quality of trained academic educators and improved relationships between students and professors. The feedback from our two day pilot course yielded positive reviews and invitations for future partnerships and collaborations for similar simulations-based courses and curricula in other parts of the country. Conclusion In Ecuador, a gap exists between methods of educational delivery and knowledge/skill acquisition, which can improve through the implementation of a SBME curriculum. This project will result in improved systems based healthcare education, through the engagement of faculty development opportunities and implementation of a resource sensitive, culturally aware simulation-based program for both urban and rural Ecuador. Additional factors to consider in the future include financial and resource barriers, as well as other requirements to support the sustainability of the proposed curricula. After implementation of the simulation-based curriculum, our next steps are to validate our approach and ultimately demonstrate improvement in healthcare practices and systems-based approaches to healthcare delivery in Ecuador.

For many years, simulation-based education (SBE) at Walsall Manor Hospital (WMH) was carried by a one-man simulation technician, with intermittent input from department facilitators. Inadvertently creating SBE dis-equality across departments. Studies have demonstrated that formalized SBE plans improve training [1] and clinical outcomes [2]. We aimed to create standardisation and equity in SBE across departments by formulating a SBE training and delivery plan and governance structure at WMH. In the Autumn 2021, WMH started standardising SBE across the Trust in order to improve both the undergraduate and postgraduate standard of education [3]. The team grew to incorporate five multidisciplinary members; SIM technician, SIM lead (consultant), SIM nurse, SIM project support, and SIM technician support. With further expansion to now include speciality simulation leads in emergency medicine (EM) and paediatrics. Currently there is active recruitment for speciality leads in other departments. The SIM staff were appointed already holding simulation education related qualifications and/or experience. In addition, staff attended the University of Stafford foundations in simulation and debriefing courses. The governance process has been developed and implemented around the appointment of simulation speciality staff, formation of simulation courses, and simulation delivery. Furthermore, collection of attendance, feedback forms, certificates of participation and attendance have been made mandatory element of simulation delivery. In addition, there has been internal and external investment in increasing simulation equipment, including paediatric manikins and immersive technology. In seven months, achievements have included: a range of simulation-based training events, the implementation of in-situ simulation in acute medicine, simulated sessions for final year medical students, the development of a simulation Foundation Year 1 and 2 curriculum, successful construction and running of mock royal college of physicians viva examination, multiple medical procedure courses, the re-introduction of Ill Medical Patients’ Acute Care Treatment (IMPACT) course, and simulation sessions for student nurses. SBE activities were delivered by and to a multidisciplinary team. Putting together a simulation team and formalizing the governance process around SBE delivery has increased the number of educational activities for both undergraduate medical/nursing students and postgraduate doctors and allied health care professionals. Feedback scores have been good to excellent and multidisciplinary work in EM has improved. The SIM team will continue to promote, implement, embed, and sustain SBE within the Trust to bigger and bolder activities. We would like to thank and acknowledge the Dinwoodie charitable company for their support. 1. Weaver SJ, Salas E, Lyons R, Lazzara EH, Rosen MA, DiazGranados D, Grim JG, Augenstein JS, Birnbach DJ, King H. Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare. Journal of Emergencies, Trauma and Shock. 2010;3(4):369–377. 2. Houzé-Cerfon CH, Boet S, Marhar F, Saint-Jean M, Geeraerts T. Simulation-based interprofessional education for critical care teams: Concept, implementation and assessment. Presse Medicale (Paris, France: 1983). 2019;48(7–8 Pt 1):780–787. 3. Irwin PM, Brown RA, Butler S. The undergraduate simulation framework: standardising design and delivery’. Higher Education, Skills and Work-Based Learning. 2020;11(2):576–586.

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.

Due to the effect of the global pandemic and rising student cohort numbers, simulated practice placements are being implemented into nursing curricula. To deliver simulation-based education (SBE) within the Higher Education Institutions (HEI) staff must be adequately prepared. For SBE to be effective, thoughtful consideration to appropriate staff training is important [1]. A structured unified approach is more beneficial as it sets the same aspirations and contributes to a shared philosophy [2]. This unified approach meant both Health Board and HEI staff were being trained to delivery simulation in the same way, which was new for this HEI. Creating a faculty for simulation emulates a community of practice and also comprises essential networking with other simulationists [2]. It helps support Benner’s novice to expert theory as staff start of as novices and subsequently develop emulating that robust educational training for SBE faculty development is essential [3]. Importantly, it addresses quality assurance and governance frameworks in meeting the requirement of the International Nursing Association for Clinical Simulation Learning (INACSL) [3], Association for Simulated Practice in Healthcare (ASPiH), and Nursing and Midwifery Council (NMC) standards. The overall aim of this innovation was to implement a unified approach to faculty development training for academic staff within an HEI. Three training sessions were delivered in January and February 2022. HEI staff attended a one-day session. Health Board Simulation Educators facilitated the sessions for the HEI Academic Staff. Using a unified approach to this faculty development had a positive outcome in supporting HEI staff to be upskilled in the delivery of SBE. It has also resulted in the subsequent development and implementation of a 2-day training course comprising the following sessions: Session 1 – Introduction to clinical skills and simulation and writing learning outcomes and scenarios; Session 2: Technology supporting simulation; Session 3: Preparation, briefing, and debriefing; Session 4: Running an immersive simulation session. This in-house training programme will continue to be delivered to HEI staff undertaking SBE and evaluated. Using a unified approach enhances the quality and parity of the delivery of SBE within the HEI. A unified approach to faculty development within the HEI will continue to be delivered to upskill staff in SBE. Collaboration with clinical partners in faculty development is crucial in the delivery of SBE to ensure a unified evidence-based approach. 1. Bryant K, Aebersold ML, Jeffries PR, Kardong-Edgren S. Innovations in simulation: Nursing leaders’ exchange of best practices. Clinical Simulation in Nursing. 2020;41:33–40. 2. Peterson DT, Watts PI, Epps CA, White ML. Simulation faculty development: a tiered approach. Simulation in Healthcare. 2017;12(4):254–259. 3. Hallmark BF. Faculty development in simulation education. Nursing Clinics. 2015;50(2):389–397.

Simulation is an interactive educational tool that is increasingly used in medical education, and there is mounting evidence to support its role in improving knowledge, behaviours, as well as skill outcomes. Simulation is not a technology but a technique, which aims at mimicking or magnifying a real experience that is performed under supervision and guidance from a professional educator in a fully interactive manner. Equipment and facilities often dominate the discussion when taking about simulation-based education; however, effective learning using simulation as a methodology usually involves facilitators as well as simulated patients. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of healthcare. Various leading forces and enactment mechanisms are required to drive simulation forward. By itself, simulation does not guarantee learning, but within the proper environment, it is a tool of paramount importance for modern curricula oriented by the adult learning theory. The future of simulation in healthcare depends on the commitment and creativity of the healthcare simulation community to see that improved patient safety using this tool becomes a reality. This chapter will discuss the art and science of simulated learning, the simulation fidelity continuum (low to high, multimode) and how it can be tailored to the learner’s needs. It will also discuss using simulation for assessment, how to design an effective simulation-based medical education activity as well as approach to evaluation of a simulation learning activity. It will expand to include curriculum integration and simulated learning in rheumatology and then will conclude with future directions of simulation-based education.

IntroductionIn 2019 the NMC published the standards for student supervision and assessment (NMC, 2019), stating that the role of practice supervisor (PS) and practice assessor (PA), previously combined in the...

Background Simulation-based education (SBE) has been adopted by various specialties and is used to complement other aspects of education. Geriatric medicine is a diverse specialty, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBE the ideal vehicle to train geriatric medicine trainees. SBE is currently not a formal component of geriatric medicine training in Ireland and trainees experience varying levels of exposure to SBE. To address this, WICOPSIM in collaboration with the Royal College of Physicians (RCPI) facilitated a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBE. Methods A faculty consisting of RCPI Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians coordinated the event. All geriatric medicine trainees were invited to a one-day SBE event hosted by WICOPSIM. Lectures on simulation theory and application preceded a simulation scenario demonstration focusing on the interdisciplinary management of a patient whose capacity was in question; followed by a SBE participant workshop. Results Fifty-two trainees attended the event. Forty-five trainees completed the post-event survey. 98% (n=44) were satisfied with the variety of topics presented and felt more prepared to design and run a scenario. The simulation demonstration, debrief and design workshop met 100% trainees’ expectations. All trainees indicated that SBE should be a routine element of geriatric medicine training. 69% (n=31) intend to run SBE within their own department in the future. Conclusion This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBE. SBE offers trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging scenarios, in a protected environment. The positive feedback generated suggests SBE is a useful tool to enhance the specialist geriatric medicine training experience and warrants further exploration.

Coming of Age: Online Continuing Education for the Journal and the Society for Simulation in Healthcare