The importance of ‘workarounds’ in simulation training – A case study of a first responder mass casualty incident MR simulation

Phenomenon : The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach : An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings : The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed “always” in 16%, “most often” in 45%, “sometimes” in 29% and “rarely” or “not” in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights : Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps.

Beyond data visualization: A context-realistic construction equipment training simulators

IntroductionThis case study has examined the functioning and effects of simulation training within the bachelor’s level nursing program at Copenhagen University College (KP). The study involved a range of data...

Training for mass casualty incident (MCI) response is critical to ensure that resource allocation and treatment priorities limit preventable mortality. Previous research has investigated the use of immersive virtual environments as an alternative to high fidelity MCI training, which is expensive and logistically challenging to implement. While these have demonstrated positive early results, they still require complex technology deployment, dedicated training facilities, and significant time from instructors and facilitators. This study explores the feasibility of a smartphone-based application for trauma care training and MCI triage to fill the gap between classroom learning and high-fidelity simulation. The goals of this investigation were to evaluate clinician perceptions of a virtual MCI training simulator's usability, acceptability, fidelity, functionality, and pacing. This study used a smartphone-based training simulation called Extensible Field and Evacuation Care Training in a Virtual Environment (EFECTIVE), which presents virtual patient scenarios in a gamified, but visually high-fidelity environment. A total of 21 participants were recruited as a convenience sample of medical students, paramedics, nurses, and emergency medicine resident and attending physicians at University of Massachusetts Memorial Medical Center, an urban tertiary care medical center. Participants completed a brief tutorial and then performed a series of virtual patient scenarios and 1 MCI scenario on the simulator, each of which was 5 minutes in duration. Then, each participant completed a survey assessing the perceived usability, acceptability, fidelity, functionality, and pacing of the virtual training simulator. The research protocol was approved by the University of Massachusetts Chan Medical School Institutional Review Board. 48% of participants disagreed that a virtual simulator could completely replace live MCI training, though 71% agreed that app-based simulations could effectively supplement live MCI training and 67% felt that they could be used to learn how to order medical interventions in care under fire scenarios. 80% of participants agreed that the simulation could be used to practice MCI triage and to gain experience with coordinating movement of casualties to casualty collection points. 67% of participants believed that use of virtual simulators would increase their MCI preparedness. 76% agreed that the clinical cases depicted were medically realistic and that the clinical cases presented accurately represented the scenarios described. In addition, despite being presented on a smartphone as opposed to virtual reality, 62% of participants rated the experience immersive. This study provides encouraging evidence that easy to deploy smartphone-based simulations may be an effective way to supplement MCI and care under fire training. Although the study is limited by a small sample size, there was strong agreement among participants from a wide variety of emergency medicine roles that such a simulation could train core topics associated with MCI triage. Because app-based simulations are easily deployable and can be executed quickly and frequently, they could be used as a more flexible training model compared to large scale live or virtual reality-based simulations. The results of this investigation also indicate that a sufficient level of medical realism can be achieved without live simulation.

Implementation of a new bogie concept is an integrated part of the vehicle design which must follow a rigorous testing and validation procedure. Use of multibody simulation helps to reduce the amount of time and effort required in selecting a new concept design by analysing results of simulated dynamic behaviour of the proposed design. However, the multibody simulation software mainly looks at the dynamics of a single vehicle; hence, forces from the train configuration operational dynamics are often absent in such simulations. Effects of longitudinal-lateral and longitudinal-vertical interactions between rail vehicles have been found to affect the stability of long trains [1,2]. The effect of wedge design on the vertical dynamics of a bogie has also been discussed in [3,4]. It is important to apply the lateral and vertical forces from a train simulation into a single multibody model of a wagon to check its behaviour when operating in train configuration. In this paper, a novel methodology for the investigation of new bogie designs has been proposed based on integrating dynamic train simulation and the multibody vehicle modelling concept that will help to efficiently achieve the most suitable design of the bogie. The proposed methodology suggests that simulation of any configuration of bogie needs to be carried out in three stages. As the first stage, the bogie designs along with the wagon configurations need to be presented as a multibody model in multibody simulation software to test the suitability of the concept. The model checking needs to be carried out in accordance with the wagon model acceptance procedure established in [5]. As the second stage, the wagon designs need to be tested in train configurations using a longitudinal train dynamics simulation software such as ‘CRE-LTS’ [2], where a train set consisting of the locomotives and wagons will be simulated to give operational wagon parameters such as lateral and vertical coupler force components. As the third stage, the detailed dynamic analysis of bogies and wagons needs to be performed with a multibody software such as ‘Gensys’ where lateral and vertical coupler force components from the train simulation (second stage) will be applied on the multibody model to replicate the worst case scenario. The proposed methodology enhances the selection procedure of any alternate bogie concept by the application of simulated train and vehicle dynamics. The simulated case studies show that simulation of wagon dynamic behaviour in multibody software combined with data obtained from longitudinal train simulation is not only possible, but it can identify issues with a bogie design that can otherwise be overlooked.

There is a growing recognition of the need for disaster management training for medical students in Saudi Arabia, but there is limited research on its effectiveness. Thus, this study evaluated the effectiveness of a disaster simulation training program for undergraduate medical students in Saudi Arabia. A disaster management simulation activity was conducted for 32 medical students. The students attended a 30-minute lecture about mass casualty incidents (MCIs) and completed a pre-simulation survey. They were then randomly assigned to one of three groups (performer, actor, observer) and asked to apply their skills to triage patients after a Level C MCI. A debriefing session was conducted using the plus/delta debriefing method. Then, the students completed a post-simulation survey. The results showed that after the simulation training the students' self-confidence in their ability to respond to a disaster increased from 40.7% to 59.4% (p value < 0.01), to utilize incident command structure increased from 37.9% to 62.5% (p value < 0.01), to demonstrate START triage for victims of a disaster increased from 28.2% to 65.7% (p value < 0.01), and to apply safe search and rescue techniques increased from 40.7% to 59.4% (p value < 0.01). The students' self-confidence in their ability to perform basic first aid skills also increased after the simulation. The study findings suggest that disaster management simulation training can be an effective way to increase medical students' self-confidence and preparedness for disaster response.

企業シミュレーショントレーニング

BackgroundPersonalised medicine is rapidly changing the clinical environment, especially in regard to the management of cancer. However, for the large part, methods used to educate undergraduate students as future biomedical scientists and medical doctors have not reflected these changes. In order to make effective use of advances in cancer genomic knowledge, there is a need to expose students to the challenges of genomic medicine and to do so in a manner that makes this complex information accessible.MethodsThe teaching method developed, OncoSim, is a scaffolded ‘Personal Research’ module option for final year biomedical undergraduate students. It uses an authentic learning approach to teach cancer genomics via simulated cancer patient case studies that have identifiable potential therapeutic targets with associated drug therapies (so-called targeted therapy/precision oncology). In addition, these simulated case studies can be uploaded to a dedicated learning website (OncoWiki) where they can be freely downloaded and used to teach medical students the principles of targeted therapy. A preliminary evaluation of OncoSim was carried out using 3 research tools: (1) online questionnaires; (2) semi-structured interviews; and (3) analysis of whole cohort mark ranges. Thematic analysis was used to code and categorise interview data.ResultsThe teaching materials for OncoSim and the OncoWiki site are freely accessible at https://www.oncowiki.co.uk. Questionnaire data and comparison of whole cohort marks showed OncoSim was at least as effective as alternative choices, and suggested OncoSim provided a valued alternative to traditional laboratory-based projects. No barriers to receptiveness were found. Interview analysis provided 5 broad themes (authentic learning experience; individual challenges; interest in cancer; positive learning experience; supportive structure) supporting the authentic learning aspect of the project, the strong scaffolding provided and the overall effectiveness of the approach.ConclusionsOur preliminary, proof-of-concept, evaluation suggests that OncoSim will be effective in supporting the teaching of genomic medicine to undergraduate students. We plan and hope our study will encourage further formal evaluation in a larger cohort of students, including a control group. The OncoWiki site has the capacity to grow independently as future students create and upload simulated case studies for other students to then download and analyse.

Life cycle assessment of combined bioheat and biopower production: An eco-design approach

Simulator fidelity has been defined as the conformance of a flight simulator to the characteristics of the real aircraft. Objective fidelity evaluation is an engineering approach that attacks the fidelity problem with comparison of simulator and the actual system behavior over some quantitative measures. Testing can be pronounced as the fundamental mean for this comparison. From the utilization perspective, flight simulators are classified as research, engineering and training simulators. Research simulators are both test beds for flight simulator research and computational tools for flight systems and human factors research. Engineering simulators are used for systems development and training simulators are utilized for flight training. While training simulators are subject to rare or few upgrades or modifications in their lifespan, engineering simulators are under occasional and research simulators are under frequent change. The test cases to evaluate the fidelity of training simulators are guided by standards whereas for engineering and research simulators, test cases may present a great variation depending on the scope of change and the use case. These two characteristics of engineering and research simulators, combined with the complexity of today’s aircrafts necessitate new methodologies for efficient and effective testing. Model-Based Testing (MBT) targets flexibility and adaptability via utilization of models for specification of test cases and proposes workflows for automatic test case generation. The paper presents an MBT approach for objective fidelity evaluation of engineering and research simulators. The proposed approach is exercised with an infrastructure implementation and an example case study. Thus, evidences are collected that indicate increased efficiency and an effective test process.

Asphalt operations are equipment-intensive, highly-coordinated, and context-sensitive. To ensure high-quality asphalt, operators need to be mindful of, among others, the degree of compaction required/achieved, temperature of the asphalt mixture, its cooling rate, other equipment, and the supply logistics. However, the current training program for the operators of asphalt equipment is inadequate because (1) the training heavily depends on the use of actual equipment for the training and because of the cost/safety risks involved in using actual equipment, novice trainees do not get enough opportunity to develop the required skills; and (2) given the sensitivity of the asphalt operations to the environment, the type of the asphalt mixture, logistics, etc., it is very difficult to allow trainees become sensitized to all the influential parameters in a limited time provided for the practical training. In recent years, Virtual Reality (VR) based training simulators are employed to help train operators in a safe environment. However, scenarios used in the construction simulators are mostly hypothetical. The context of operation in these scenarios is static and devoid of dynamism common in a construction site. This is a major oversight, particularly in highly-collaborative asphalt operations. Therefore, it seems crucial to better represent the actual work context in the training simulators. Given the myriad of parameters involved in the asphalt operations, designing a training scenario based on pure modeling is very challenging. This research proposes an approach for developing a training simulator based on the data collected from actual asphalt operations. The collected data will be analyzed and translated into a training simulator that can better capture the interaction between various operators of asphalt operations. A prototype is developed and a case study is conducted to demonstrate the feasibility of the proposed approach. It is shown that actual data can be used to effectively generate realistic training scenarios.

The use of graphical‐display training simulators is presented as a means of enhancing efficiency in operating multi‐reservoir water delivery systems. Water delivery systems of this type include municipal water supply systems and irrigation water delivery systems (ditch companies). As a stand‐alone tool, the training simulator can improve human operational performance. However, a coupling of human operational capabilities and mathematical programming techniques may also be beneficial. The mathematical programming technique called aggregate state dynamic programming (ASDP) explicitly draws upon the knowledge base of the system operator. Augmentation of that knowledge base is possible through the use of graphical‐display training simulators to obtain improved operating rules for spatial allocation of water. The dynamic programming component of ASDP handles the temporal allocation. A case study is presented to display the application of the procedure and to provide direct comparisons against human operational performance.

Training simulations, which involve the collaboration of multiple users (represented as avatars), sharing a common virtual environment, are difficult to build, control and manage. This paper describes an architecture to support non-programmer emergency management trainers to rapidly create different instances of powerful and complex training simulations. The novel aspects of this architecture, that makes it different from other related systems, are the innovative techniques and concepts that are used. Events collected from sensor networks deployed on physical environments subject to emergency situations can be added to the simulation scenarios being created. A set of ontologies was devised to create powerful training simulation instances, such as different fire classes, different fire fighting techniques, specific rescue tactics, etc. A case study was implemented to validate the architecture. The results show that this system can be a powerful tool for the creation of complex training simulations.

The authors started to use high-fidelity simulators at Semmelweis University, Faculty of Health Sciences in September, 2007. The aim of this study was to evaluate the students' performance in order to determine their knowledge after each simulation course. The Creighton Simulation Evaluation Instrument (C-SEI) was used to evaluate midwifery students' performance during examinations. 67 midwifery students were evaluated after the "Clinical simulation" course and 58 midwifery students after the "Case studies in simulation" course. The average total scores were significantly higher than the desired level of 75 (p<0.01); after the "Clinical simulation" 88.8±9,14, and after the "Case studies in simulation" courses 86.6±14.87. Among subscales the lowest average total score was found in critical thinking in each of the course. Statistically significant correlation was found between the results of "General nursing care" and the results of "Case studies in simulation" courses (r = 0.34; p<0.01). The use of high-fidelity simulators with valid tools simultaneously might be a suitable method for students' evaluation.

Maritime transportation is currently in a transitional period to an impending autonomous future. To that end, novel technologies are increasingly being introduced on-board ships and their engine rooms. At the same time, advancements in digitalization and automation are progressively replacing and reducing the number of marine engineers on-board. Consequently, with increasing automation in machinery spaces and unmanned engine rooms, the role of the marine engineers has been altered to that of monitoring and oversight. The substantial changes in the nature of tools and job description of the marine engineers necessitate the re-assessment and revision of their training and pedagogy. Currently, the simulator is a powerful tool in the training and development of marine operators. Although the literature review reveals some interest in marine engineering simulation training, however, there is a lack of attention to remote and cloud-based simulation training as part of blended learning. This study reveals that imparting marine engineering simulation training online is not free from challenges. This study reports the findings from a qualitative study of marine engineering simulation training, conducted as part of a larger ethnographic study on developing maritime competence. The study utilizes the socio-historical, context-dependent framework of the Activity System (AS) to analyze marine engineering simulation training. The study reveals issues with cloud-based marine engineering simulation training. Firstly, cloud-based training is not seamless to access. Secondly, not all features present in the desktop simulation are present in the cloud version. Thirdly the cloud-based platform affords limited feedback in comparison to the desktop version. Fourthly, cloud-based simulation training does not support peer learning. An understanding of the challenges of cloud-based marine engineering simulation training will help address these concerns. Furthermore, it will facilitate the competence development of marine engineers as they work in increasingly automated workspaces in the transition to autonomous ship operations.