Influence of simulation-based training on reflective practice

Introduction The role of hospital pharmacists has changed significantly over the past decade with a need for further educational interventions to support their professional development. Simulation based training (SBT) is widely used by other healthcare professionals to enhance skill acquisition and performance (1). However, the use of SBT does not appear to have evolved to the same level for hospital pharmacists (1), and there is no evidence exploring their experiences of participating in SBT and the barriers and enablers towards engaging with this training modality. Aim To explore the experiences and perceptions of hospital pharmacists of SBT, and to identify perceived barriers and enablers of participating in SBT. Methods This was a descriptive qualitative case study. A purposive sample of trainee and qualified pharmacists from a large acute teaching hospital were invited to participate in a focus group discussion. A topic guide was utilised to guide discussions, with topics such as previous SBT experience, barriers to participation within SBT and how they feel SBT would impact on their clinical practice. The focus groups were conducted within a private room, recorded, and transcribed verbatim, then analysed thematically using COM-B (capability, opportunity, motivation, behaviour) (2) as an analytical framework. Relevant approvals were obtained prior to commencing the research. Results Seventeen participants were recruited into one of four focus groups, with allocation based on Agenda for Change banding (band 5 to 8A). Focus groups lasted 45-60 minutes. Ten themes were identified and mapped across the COM-B domains with contrasting differences reported depending on participant experience and seniority. Psychological capability (knowledge and understanding of SBT, clinical knowledge and skills), physical opportunity (workload and time pressures, infrastructure to support SBT), social opportunity (social expectations of pharmacists, culture of learning within pharmacy), automatic motivation (emotional factors, desires for professional development), and reflective motivation (perceptions of SBT, belief in own role and abilities) were all factors reported as influencing their participation with SBT in hospital settings. All groups expressed that SBT is mainly focused on clinicians with limited pharmacist involvement as an ‘add on’. Pharmacists reported a lack of confidence in SBT, with limited opportunities for involvement within the hospital setting, and concerns on their ability to communicate with other healthcare professionals during any SBT. Conclusion This is the first known study exploring the experiences of SBT amongst hospital pharmacists. There is a desire to participate in SBT, however it is clear, that significant interventions and further training on SBT modalities are required to enable this, including opportunities to participate in contextualised SBT, reflecting the role, expectations, and professional developmental needs of pharmacists. Clear leadership and signposting are needed to operationalise this and reap the benefits of SBT. These results can be utilised as a framework to support the design and implementation of a successful SBT programme for hospital pharmacists as part of intra-professional and multi-professional SBT programmes. This study is limited as a single-site case study and further investigation is required to explore further views of the hospital pharmacist workforce.

Update on Simulation-Based Surgical Training and Assessment in Ophthalmology: A Systematic Review

Background: The provision and use of telecare services implies new ways of working for home healthcare staff. To gain the knowledge, skills and attitudes necessary for sound telecare practice, staff are in need of thorough training opportunities. Simulation has been suggested as a useful approach to prepare healthcare professionals for providing telecare services. The aim of this study was to test and evaluate a simulation-based telecare training program for qualified healthcare professionals and explore whether it met intended training objectives from the perspective of the trainees.Methods: A total of 14 healthcare professionals working in home healthcare services participated in up to two training sessions, each across two separate days. Data were collected by way of four tape-recorded focus group interviews and field notes from non-participant observations of eight simulation sessions, and were analysed by way of systematic text condensation.Results: The analysis resulted in seven categories addressing trainees’ experiences of partaking in simulated virtual visits; their perceptions of simulation-based telecare training; and their views on the main learning outcomes from the simulation-based training program in question.Conclusions: Simulation-based training provides trainees with realistic insight into the knowledge and skills required for new ways of working through telecare and can thus be a useful way of preparing healthcare professionals for the delivery of telecare services such as virtual home healthcare visits.

The efficacy of simulation-based and peer-learning handover training for new graduate nurses

Introduction Simulation training is widely adopted in clinical medicine. Simulated environment provides a safe condition for participants to practice without any harm inflicted on patients. Within the spectrum of clinical anaesthesia, simulation mannequin was first developed in 1960. The first journal article with description about the use of simulator to teach intubation to anaesthesia residents occurred in 1969. The first report about simulated anaesthesia training was in 1988. Since then, there has been a flourishing trend of adopting this simulation training in clinical anaesthesia, across various subspecialties including obstetric anaesthesia, cardiac anaesthesia. For individual perspective, simulation training expanded beyond skill development into non technical skill training. This article is to review the impact of simulation training for individual development for anaesthesia residents or trainees. The aim is to evaluate the evidence of simulation training on individual anaesthesia resident performance and improvement on patient outcome. As a result, more vigorous use of simulation is adopted in modular subspecialty anaesthesia and also non-technical skill training for residents. Methods A search of literatures through search engines of Pubmed, Google Scholars, EMBASE, Cochrane library for ‘Simulation for training of clinical anaesthesia’ was done. After limit the search for English language and past 10 years, there are 223 articles. With appropriate exclusion criteria, 25 articles are selected for detail evaluation. Results Simulation has good effects in various aspects. For various anaesthesia subspecialties, simulation-based training can improve trainees’ confidence and capability in handling rare but life-threatening peri-operative crises. For assessments, simulation is an essential part of Israeli Board Examination in Anesthesia with good discriminating power. For technical skill development, simulation-based training can reduce residents’ time requirement to perform cricothyroidotomy and improve successful rate of central line insertion. The specific skill developed can retain for long period of time such as 12 months. For non-technical skills, there are conflicting results in behavioural scores. For patient safety and outcome perspective, there lacks the result from individual simulation-based training study. Conclusions Simulation in anaesthesia residents training is a worldwide practice. These simulation training allow residents to have exposure in various anesthesia subspecialty including cardiac, obstetrics, liver transplant. There are specific technical and non-technical skill development. Individual performance particularly time to complete cricothyroidotomy and confidence, understanding of procedures and anatomy by residents are also enhanced. Thus, simulation should be allocated more proportion of anaesthesia resident training in Hong Kong. Although there remains no study showing better patient outcome after simulation-based individual training, future studies should be done to confirm such presence and degree of association with simulation training.

Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking-derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6-8) vs. 25 (24-25), P = 0.01] performed in less time [563 (408-600) vs. 246 (214-267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.

BackgroundSimulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures.MethodsFifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator.ResultsSignificant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p < 0.05). A plateau for PS, PT, and PC in the learning curves occurred in trial 4. Retesting 6 months after training yielded similar scores to trial 5 (p > 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p < 0.05).ConclusionsThis study demonstrates that simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice.

Aim: This study aims to evaluate the effects of simulation-based obstetrics training on students' professional development and examine students' anxiety and technology readiness. Material and Methods: The study was quasi-experimental and performed with 3rd -year students in Midwifery Department (n=60) between September 2018 and January 2019. Students attended a 14-week simulation-based delivery training. In the pre-and post-training periods, the data were collected by the State-Trait Anxiety Inventory (STAI) and the Tendency Scale for the Use of Technology. Results: Students reported that simulation-based delivery training improved their "professional skills" (95%) and "professional internalization" (93.4%). They stated that there was a positive effect on "anxiety in the working environment" (93.3%) in post-training. Since no significant differences were observed in scores of the Tendency Scale for the Use of Technology and STAI in pre-and post-training periods (p&amp;gt;0.05), it was thought that they were not potential barrier factors in the training. Conclusion: The ensuring of professional development was achieved by using simulation-based training in the study. However, technology readiness and anxiety levels were stable in pre-and post-training periods.

Multidisciplinary Simulation-Based Team Training for Trauma Resuscitation: A Scoping Review

Introduction: Simulation-based training (SBT) has been adopted by various specialties and is often used to complement other aspects of education. Geriatric medicine is a diverse speciality, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBT the ideal vehicle to train geriatric medicine trainees. SBT is currently not a formal component of geriatric medicine training in Ireland. Trainees experience varying levels of exposure to SBT and the different uses, with many trainees reporting lack of knowledge of design and implementation of gerontological SBT. WICOPSIM is a dedicated gerontological simulation facility that promotes transdisciplinary SBT and encourages faculty to develop their own specialist interdisciplinary simulation scenarios. The WICOPSIM faculty were approached by the postgraduate medical training college to facilitate a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBT. Approach: A faculty consisting of the Royal College of Physicians Ireland (RCPI) Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians co-ordinated the event. All geriatric medicine trainees were invited to a one-day SBT event hosted at the WICOP simulation facility. The event commenced with a suite of didactic lectures focusing on simulation theory and application. Lectures included ‘Simulation in the Context of Medical Education’, ‘Preparing for a Simulation Scenario’, ‘The importance of Prebrief and Psychological Safety’, ‘How to Run a Simulation Scenario’ and ‘The Debrief-Where the Learning Happens’. All lectures were delivered by clinical educators with experience in geriatric medicine and/or SBT. This was followed by the demonstration of a simulation-scenario focusing on the interdisciplinary management of a patient whose capacity is in question. A two-part scenario consisting of a multidisciplinary team meeting with a social worker and memory clinical nurse specialist and subsequent patient clinic visit was delivered followed by a SBT participant workshop. Evaluation: Fifty-two trainees attended the event with all five training years represented. Forty-five trainees completed the post-event survey. Two trainee reported previous high experience with SBT as a learner and as teacher respectively. Thirty-nine reported a low level of SBT experience, while five trainees had no previous SBT experience. Of those who reported previous SBT experience, 52% (n=22) had experience in gerontological SBT. 98% (n=44) were satisfied with the variety of topics presented. The simulation demonstration, debrief, simulation design workshop and participant designed scenarios met 100% trainees’ expectations. All trainees indicated that they are highly likely to recommend to colleagues to attend this training event in the future. All trainees agreed SBT should be a routine element of training in geriatric medicine. 69% (n=31) intend to run SBT within their own department in the future. 98% (n=44) felt more prepared to design and run a scenario following the event. Conclusion: This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBT. The positive feedback generated amongst geriatric medicine trainees suggests this may be a useful tool to enhance the geriatric medicine training experience and warrants further exploration.

Simulation-Based Skill Training for Trainees in Cardiac Surgery: A Systematic Review

BackgroundDebriefing is a critical component to promote effective learning during simulation-based training. Traditionally, debriefing is provided only after the end of a scenario. A possible alternative is to debrief specific portions during an ongoing simulation session (stop-and-go debriefing). While this alternative has theoretical advantages, it is not commonly used due to concerns that interruptions disturb the fidelity and adversely affect learning. However, both approaches have not been rigorously compared, and effects on skill acquisition and learning experience are unknown.MethodsWe randomly assigned 50 medical students participating in a simulation-based cardiopulmonary resuscitation training to either a post-scenario debriefing or stop-and-go debriefing. After four weeks, participants performed a repeat scenario, and their performance was assessed using a generic performance score (primary outcome). A difference of 3 or more points was considered meaningful. A 5-item questionnaire was used to assess the subjective learning experience and the perceived stress level (secondary outcomes).ResultsThere was no significant difference between the groups for the performance score (mean difference: -0.35, 95%CI: -2.46 to 1.77, P = 0.748, n = 48). The confidence limits excluding the specified relevant 3-point difference suggest equivalence of both techniques with respect to the primary outcome. No significant differences were observed for secondary outcomes.ConclusionsStop-and-go debriefing does not adversely affect skill acquisition compared to the classic post-scenario debriefing strategy. This finding is reassuring when interruptions are deemed necessary and gives simulation instructors the latitude to tailor the timing of the debriefing individually, rather than adhering to the unsupported dogma that scenarios should not be interrupted.Trial registrationAs this study is not a clinical trial, it was not registered in a clinical trials register.

ContextDyad practice may be as effective as individual practice during clinical skills training, improve students’ confidence, and reduce costs of training. However, there is little evidence that dyad training is non‐inferior to single‐student practice in terms of skills transfer.ObjectivesThis study was conducted to compare the effectiveness of simulation‐based ultrasound training in pairs (dyad practice) with that of training alone (single‐student practice) on skills transfer.MethodsIn a non‐inferiority trial, 30 ultrasound novices were randomised to dyad (n = 16) or single‐student (n = 14) practice. All participants completed a 2‐hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre‐, post‐ and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills (OSAUS).ResultsThirty participants completed the simulation‐based training and 24 of these completed the transfer test. Dyad training was found to be non‐inferior to single‐student training: transfer test OSAUS scores were significantly higher than the pre‐specified non‐inferiority margin (delta score 7.8%, 95% confidence interval −3.8–19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre‐established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre‐ versus post‐test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single‐student group (p = 0.03).ConclusionDyad practice improves the efficiency of simulation‐based training and is non‐inferior to individual practice in terms of skills transfer.

BACKGROUND: More than 5 million central venous catheters (CVCs) are inserted in the USA each year, and although these catheters can be life saving, they are also associated with significant risks; 75% of complications arising from procedures like CVC occur in the first 30 cases of a physician’s career. A structured CVC training program9 and the use of ultrasound guidance for CVC placement, 7, 10, 11 increased patient safety by reducing complication rates. 8, 10–14 Simulation-based procedural trainers have demonstrated validity in transferring skills to applied clinical environments,1–6 and the use of simulators for CVC training is valuable because skills can be honed before attempting to perform the procedure on a live patient, thereby increasing patient safety. METHODS: Fifty-four Internal Medicine Interns received training and were assessed through didactic and one-on-one instruction in Ultrasound-guided CVC procedures using Blue Phantom? vascular access simulation models. After individual instruction, subjects independently practiced placement procedures using Ultrasound machines and standard catheter kits using one or more of 4 types of models: leg, arm, and head/neck anatomical models and a simple block model. Six-point Likert scales were used to assess pre- and post-test procedural self-efficacy, CVC performance on head/neck models, perceived value of simulation-based training, and an open response for subjects to write down what they learned. RESULTS: Mean subject score on the knowledge-based quiz was 91.68 / 100.00 (SD = 11.99). Subjects performed in the good to very good range for CVC performance (M=4.74, SD = .44). The small standard of deviation suggests that the training results were uniformly consistent. There were no significant differences between the type of practice model and CVC performance. There were no significant differences in CVC performance based on the number of previously placed CVCs, although prior placement ranged from zero to 35 (M = 4.33, SD = 4.97). This suggests that the instruction was effective independent of the experience level of the learner. Subjects indicated that after simulation-based training they were more confident in helping with CVC (t = -9.25, p =.000) and in performing CVC on their own (t = -13.52, p =.000). Subjects ranked the overall quality of instruction as very good (M = 5.25, SD = 0.17). More than half (57.4%) of the subjects made specific comments about what they learned during the training session, including specific mechanical techniques (83.87%), how to operate the equipment (67.74%), infection control techniques (38.71%), safety measures and contraindications (35.49%), associated complications (22.58%), specific anatomy (25.8%), and the advantages of practice (19.35%). CONCLUSION: The simulation-based training model that we employed using Ultrasound guidance and Blue Phantom? models for procedural training demonstrates that the integration of these components provides trainees with the tools they need to successfully demonstrate understanding and techniques associated with placing a CVC, and that the students perceived the training as effective. The logical next step is to assess the trainings effectiveness on the transfer of knowledge and skills to the clinical setting.

Intraocular surgery - assessment and transfer of skills using a virtual-reality simulator.