Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic

UK-based doctors in training have faced major disruption, loss of training opportunities and increased risk of burnout due to covid-19 [1,2]. Furthermore, the intensified post-covid strain on services continues to hamper efforts to restore training. A bottom-up review across departments at both of our sites revealed demand across specialties and grades for increased simulated training opportunities. Further highlighting the need for additional simulation programmes, simulated training has recently been demonstrated to reduce risk of burnout [3]. To restore lost learning opportunities, improve morale and promote team cohesion, we began a project to embed simulated training at a departmental level. A key aim of this project was to give departments ownership of their simulation programmes, to promote autonomy, tutor upskilling and sustainability. We systematically reviewed the curricula for all specialties with doctors-in-training across our two sites in order to establish how training needs could be met with simulation. Consultant ‘simulation lead’ positions were offered to consultants in each department. Following this, we met with each assigned simulation lead to perform a scoping exercise - thus establishing specific training needs and opportunities within each department. The medical education team used this information to support each department to develop its own simulated training programme and support its delivery. Crucially, unlike many simulated training opportunities, our programme is not tied to a particular training scheme nor does it incur any fees. This allows equal access to the programme for both locally employed doctors and Health Education England trainees. We worked with 13 departments in developing simulation-based training programmes. Eight departments had a single lead identified, three shared lead positions and in two departments no consultants assumed the position of lead. Experience and enthusiasm varied by department. In departments where a simulation lead was not identified, the education department has supported other team members such as Clinical Nurse Specialists and specialty registrars to devise and deliver sim-based training. Anonymized Microsoft Forms based post-course questionnaire responses completed by 42 participants to date have been overwhelmingly positive (outlined in Percentage of attendees rating the following areas as ‘agree’ or ‘strongly agree’ Our scheme has led to embedding of effective simulated training programmes across specialties at our sites, leading to sustainably improved training opportunities for post graduate doctors in the post covid era. 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.

Training Curriculum and Simulator Training for the Whole Surgical Team

This study aimed to investigate the factors associated with nurses' intent to use physical restraint. This cross-sectional study used a questionnaire to survey 403 nurses from a hospital in northern Taiwan. Nurses who participated in a simulation training program had better knowledge and behavioral intent toward physical restraint use. Seniority and workplace significantly influenced the knowledge of physical restraint use, whereas workplace and clinical ladder level significantly shaped nurses' attitude toward it. The results showed that the simulated physical restraint training program was effective. The impact of nurses' workplace, seniority, and clinical ladder level on an educational intervention should be considered before formulating a plan to reduce physical restraint use.

Negative experiences of undergraduate nursing students in simulation training: A meta-synthesis of qualitative studies.

This study developed a simulation program using standardized patients for the training of mental health practitioners in psychological first aid and evaluated its effect on learners' self-efficacy and psychological first aid performance competence and knowledge. The simulation used in this program was of a fire disaster. Thirty participants were randomly assigned to an experimental group, a comparison group, and a control group. The experimental group participated in simulation training after attending a two-hour psychological first aid lecture. The comparison group was given only the two-hour lecture and the control group was given a psychological first aid handout to study individually. The results of pre- and post-intervention questionnaires were then statistically analyzed. The participants' self-efficacy, performance competency, and knowledge improved in all groups, and there were some statistically significant differences between the three groups. The experimental group showed a greater improvement in self-efficacy and performance than the other groups. The psychological first aid simulation training program was effective in improving three qualities of mental health practitioners: self-efficacy, performance competency, and knowledge. Further research is required for the development of various learning scenarios for iterative psychological first aid education.

The physician associate (PAs) profession is a relatively new profession to the NHS. As such, there is no official national or regionally agreed further training to support PAs transitioning from PA school into clinical practice once they have graduated. Simulation training has proved to be an effective tool for developing clinical and non-clinical skills in other groups of clinicians We aimed to describe the development and implementation of a novel PA-specific simulation training programme and present the evaluation of our initial work.We designed and implemented a bespoke simulation training programme based on existing training for junior doctors. This model has three separate simulation sessions, spaced over 2 years, each session has three different clinical scenarios. Seventeen PAs have undergone the first two sessions. The first session contained three scenarios that highlighted important local protocols such as the major haemorrhage protocol and the sepsis At this point in time, we have feedback from 16 candidates from session 1 and 11 from session 2. The results are overwhelmingly positive showing improved confidence, better team-working skills and a perceived perception of improved patient safety following the simulation training, as shown in graphs 1 and 2. The majority of candidates partaking in the session found the simulation training beneficial to their practise. The main negative feedback given was the lack of ‘senior support’ (i.e. from a senior doctor) in the scenarios that were unrealistic to actual practice.The introduction of a novel PA simulation training programme has demonstrated improvements in clinical and non-clinical skills. This supports our aim of improving post-graduate PA training. Work continues to further develop our PA simulation programme and further evaluate its effectiveness with the aim of making this as a regional simulation programme that PAs can undertake when joining the healthcare workforce.

Nephrologists are placing fewer non-tunneled temporary hemodialysis catheters. Requiring competence for nephrology fellow graduation is controversial. Anonymous, online survey of all graduates from a single, military nephrology training program (n = 81; 1985-2017) and all US Nephrology program directors (n = 150). Graduate response and completion rates were 59% and 100%, respectively; 93% agreed they had been adequately trained; 58% (26/45) place non-tunneled temporary hemodialysis catheters, independent of academic practice or time in practice, but 12/26 did ⩽5/year and 23/26 referred some or all. The most common reason for continuing non-tunneled temporary hemodialysis catheter placement was that it is an essential emergency procedure (92%). The single most significant barrier was time to do the procedure (49%). Program director response and completion rates were 50% and 79%, respectively. The single most important barrier to fellow competence was busyness of the service (36%), followed by disinterest (21%); 55% believed that non-tunneled temporary hemodialysis catheter insertion competence should be required, with 81% indicating it was an essential emergency procedure. The majority of graduates and program directors agreed that simulation training was valuable; 76% of programs employ simulation. Graduates who had simulation training and program directors with ⩽20 years of practice were significantly more likely to agree that simulation training was necessary. Of the graduate respondents from a single training program, 58% continue to place non-tunneled temporary hemodialysis catheters; 55% of program directors believe non-tunneled temporary hemodialysis catheter procedural competence should be required. Graduates who had non-tunneled temporary hemodialysis catheter simulation training and younger program directors consider simulation training necessary. These findings should be considered in the discussion of non-tunneled temporary hemodialysis catheter curriculum requirements.

Category: Bunion Introduction/Purpose: Minimally Invasive Surgery (MIS) for Hallux Valgus (HV) has become popular with similar results as open surgery with added benefits such as lower post-operative opioid use and improved cosmesis. However, adopting this technique faces challenges due to a pronounced learning curve. This study aims to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. Methods: A training program and a simulation model for HV MIS were designed based on recommendations from three experts. The phantoms were created using computed tomography scans of a patient with mild HV deformity, with iterative refinement through 3D printing and testing. Four experts performed a satisfaction survey of the phantoms. Participants, categorized into two groups based on MIS experience, underwent blind assessments. Evaluation parameters, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and X-ray usage. Four orthopedic surgeons without MIS experience took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery and a program evaluation survey. Four foot and ankle surgeons with vast experience performed the same procedure with one simulated model in order to compare the two groups' initial performance.The desired performance for novices was set at 80% of experts' performance for OSATS score. Results: Expert evaluation of the phantoms indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range 23-25) vs. 15.5 (range 12-17) (p=.01), median surgical times of 22.75 minutes (range 12-27) vs. 48.75 minutes (38-60) (p=.02), and median X-ray usage of 70 (range 53-102) vs. 232.5 (range 112-280) (p=.02). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (p = .01), reaching the desired performance of 20 points. Performance at the final training with the phantom did not differ from cadaveric surgery outcomes for all parameters. All trained novices expressed high satisfaction regarding the training program and reported that this program effectively enhanced their surgical skills and confidence. Conclusion: This study validated a simulation phantom model and training program, allowing non-experienced HV MIS orthopedic foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaveric model. [Figure: see text]

BackgroundInterprofessional simulation-based team training has been highlighted as a means to improve team performance,1 The Simulated interPRofessional Team training programme (SPRinT) has published data on the effectiveness of such programmes.2...

Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study

Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. III.

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Empowering a senior nurse in a shared leadership role has been proposed as a more efficient set up for the cardiac arrest team in ED. In this model, a senior nurse leads the cardiac arrest algorithm which allows cognitive off-loading of the lead emergency physician. The emergency physician is then more available to perform tasks such as echocardiography and exclude reversible causes. Simulation provides an opportunity for training and practice of this shared leadership model. We hypothesised that a structured simulation training programme that focused on implementing a nurse and doctor shared leadership model for cardiopulmonary resuscitation (CPR), would improve leadership and teamwork quality in the setting of cardiac arrest as measured by a Trauma Non-technical Skills (T-NOTECHS) teamwork scale. Fifteen senior ED nurses participated in this pre-interventional post-observational study. Training consisted of a didactic course on team leadership and crisis resource management (CRM) followed by 4 × 10-min resuscitation scenarios with a structured debrief focusing on team leadership skills and CRM. The primary outcome was measured on scenarios 1 and 4 using a modified T-NOTECHS teamwork scale. A statistically significant increase in the T-NOTECHS scale was detected for the measures of leadership (P = 0.0028), CRM (P = 0.0001), adherence to New Zealand Resuscitation Council ALS algorithm (P = 0.0088) and situational awareness (P = 0.0002). The present study shows that a short simulation training programme improved nurse leadership and teamwork performance in the setting of a shared leadership model for CPR in the ED which could easily be replicated in other departments.

BackgroundSimulation-based team-working training can improve patient safety and quality of care. We aim to demonstrate how a multi-disciplinary approach to theatre team training can result in improved team working skills.MethodsA...

The aim of the study was to review the performance of trainees in loop electrosurgical excision procedure (LEEP) procedures after the introduction of a simulation training program. A simulation training program was introduced in September 2016 for gynecology trainees at the study institution. Trainees were encouraged to perform at least 3 simulated LEEP procedures before operating. For a 12-month period after the introduction of training, data on operating time and specimen quality measures of clear margin status, adequate depth, and absence of fragmentation were reviewed. This was compared with a 12-month period before simulation training (from September 2014-September 2015). Trainees were surveyed for feedback on the training. In total, 135 LEEP procedures were reviewed: 68 before and 67 after simulator training. Trainee specimens after training were more likely to be nonfragmented (89.2% vs 55.9%, p = .003), have clear margins (72.2% vs 41.9%, p = .015), and meet "all criteria" (46% vs 20.6%, p = .043) than trainee specimens before training. There was no change in depth adequacy (70.3% vs 67.7%, p = .99). Median trainee procedure time reduced from 18 minutes (interquartile range = 11-24) before training to 8 minutes after training (interquartile range = 6-11) (p = <0.001). There was no significant change in operating time or specimen quality from LEEP procedures performed by attendings (who did not use the simulator). Trainee and attending procedural outcomes were similar after training. Trainees had mostly positive views on the training, though reported time constraints as a barrier to simulation. After the introduction of an LEEP simulation training program, operative time and specimen quality from trainee procedures seemed to improve.