Clinical Simulation Research Articles

Development and Content and Face Validation of Low-Cost Simulators Evaluation Instrument

BackgroundDeveloping low-cost simulators is an evolving area within clinical simulation. As such, there is a need for instruments to assess these simulators. The study aimed to develop and evaluate an instrument's face and content validity to assess if an own-made low-cost simulator meets the essential characteristics low-cost simulators should have. MethodMethodological study in two phases. Phase 1 developed the instrument's items, and phase 2 assessed the content and face validity of the instrument and items developed in the previous phase. Twenty-six experts evaluated the face and content validation of the instrument in terms of its representativeness, relevance, clarity and inter-rate reliability. ResultsTwenty-five items distributed in six factors were proposed to experts. All factors and items showed adequate content validity indexes and inter-rater reliability. Face validity was also endorsed for the instrument to represent the desirable key attributes of low-cost simulators. ConclusionThis study provides The Low-Cost Simulator Assessment Instrument, available in Spanish and Portuguese. The instrument, composed of twenty-five items distributed in six factors, has shown adequate content and face validity.

Integrated models of population pharmacokinetics and exposure response to optimize dosage regimen for anaprazole sodium in duodenal ulcer

Anaprazole sodium enteric-coated tablet is a novel proton pump inhibitor which has been approved for the treatment of duodenal ulcer. The aim of this study is to provide reliable information for the design of an optimal dosage regimen. Population pharmacokinetics and exposure-response models were integrated to evaluate the pharmacokinetic parameters and covariates of Anaprazole and its metabolite M21-1, and subsequently provided dosage suggestions based on clinical trials and simulation data. A pharmacokinetic model incorporating two-compartment for the parent drug and one-compartment for the metabolite, with both first-order and zero-order mixed absorption was used to describe the pharmacokinetics of Anaprazole and M21-1. Age emerged as a significant covariate affecting the elimination rate constant of M21-1, with clearance decreasing as age advances. No correlation was observed between the pharmacokinetics of Anaprazole or M21-1 and the adverse reactions under the current dosages. BMI might be the influence factor of the mild gastrointestinal adverse reactions. Meanwhile, Anaprazole had a good healing rate (94.0 %) in duodenal ulcer patients and the exposure-response analysis indicated that the cured results were not influenced by the exposure parameters of parent drug or metabolite. In conclusion, the drug is safe when dosing between 20 and 100 mg once a day.

The effectiveness of the Escape Room as an educational methodology in the Infarction Code

ObjectiveTo evaluate the efficacy of an educational intervention (escape room) in the acquisition and retention of knowledge in relation to the Infarction Code, and to compare the knowledge of other teaching methodologies related to the Infarction Code. MethodsA pre-post study was designed without a control group. After one month of the master class on the Infarction Code given to master’s degree (doctors and nurses), an educational intervention was carried out consisting of an Escape Room on the same content, with a questionnaire that collected various sociodemographic data, and a knowledge test on the Infarction Code, which was repeated immediately after the activity and at the end of 2 months after the activity, and a test of knowledge on the Infarction Code. immediately after the activity and 2 months after the master class. Likewise, after the activity, a gamified experience evaluation questionnaire (GAMEX) was completed. ResultsThirty-two students received the educational intervention (12 physicians and 20 nurses), and differences were observed between medical and nursing professionals in terms of initial knowledge of simulation and gamification. After the activity, and based on the initial knowledge test, the score increased by 3.49 points, an increase that was also reflected in the test taken two months after the master class, where an increase of 2.08 points was maintained. The participants rated the experience positively, with no significant overall differences between the two professional groups. ConclusionsThe nurses had greater knowledge and contact with clinical simulation, virtual reality and gamification. The escape room showed to be a valid method for the assimilation and retention of knowledge in master’s degree students. Medical professionals experienced a greater degree of immersion in the activity.

Validation of a self-perception instrument regarding the experience associated with simulated interprofessional hospital clinical practice

Introduction: clinical simulation is a training method that recreates safe and controlled clinical situations that help develop professional skills and promotes interprofessional collaborative practice through the development of specific competencies.Objective: determine the metric properties of a self-administered questionnaire that accounts for the level of satisfaction with simulated in-hospital clinical practice.Methods: based on expert opinion, an instrument was created that consisted of three dimensions. For statistical validation, it was applied to 291 students belonging to 6 careers distributed in three regions of Chile. Cronbach's Alpha was determined by dimension, in addition to performing a factor analysis to finally develop a standardized index for analysis.Results: a Cronbach's Alpha was obtained in the dimension of Satisfaction with the role of the tutor teacher of 0,928, in that of Satisfaction with the role of the actor/actress of 0,89 and in Satisfaction with the organization and equipment of the CISH of a 0,904. The Factor analysis confirmed the relevance of the questions within the three established dimensions.Conclusions: the developed instrument presented a high internal consistency, being a valid instrument to be applied to students in the area of health sciences in Chile

Developing a pediatric nursing simulation scenario template in South Korea: applying real-time Delphi methods.

This study aimed to describe the process of developing a validated pediatric nursing simulation scenario template using the real-time Delphi method. A panel of 13 pediatric nursing experts participated in a real-time Delphi survey conducted over two rounds. Initially, 83 items were included in the questionnaire focusing on the structure and content of the simulation scenario template. Data analysis involved calculating the content validity ratio (CVR) and the coefficient of variation to assess item validity and stability. Through iterative rounds of the Delphi survey, a consensus was reached among the experts, resulting in the development of a pediatric nursing simulation scenario template comprising 41 items across nine parts. The CVR values ranged from 0.85 to 1.0, indicating a high consensus among experts regarding the inclusion of all items in the template. This study presents a novel approach for developing a pediatric nursing simulation scenario template using real-time Delphi methods. The real-time Delphi method facilitated the development of a comprehensive and scientifically grounded pediatric nursing simulation scenario template. Our template aligns with the International Nursing Association for Clinical Simulation and Learning standards, and provides valuable guidance for educators in designing effective simulation scenarios, contributing to enhanced learning outcomes and better preparation for pediatric clinical practice. However, consideration of cultural and contextual adaptations is necessary, and further research should explore alternative consensus criteria.

Early Clinical Simulation Exposure May Enhances Academic Performance of Medical Students: A Quasi-Experimental Study in Saudi Arabia

Purpose: The traditional medical curriculum in Saudi Arabia needs to undergo major reforms to make it more student-centric, relevant, interesting and contemporary. This unmet need can be fulfilled by the use of “Early Clinical Exposure “(ECE) techniques, employed via simulation based medical education (SBME) courses, integrated into the medical curriculum. This study delivered ECE via SBME, to third year pre-clinical students, and assessed its impact on their fourth-year academic scores. Materials and Methods: SBME modules designed by expert faculty members were delivered through a peer-assisted learning model, spread over a three-week period, at a well-equipped medical simulation laboratory at our teaching hospital, in Jeddah, Saudi Arabia. Students who attended this SBME intervention were tracked for their performance in their fourth year, versus the control group. Result: Of the 401 third year students included in the study, only 30.2% consented to attend the SBME course, while 69.8% comprised the control group. The overall study population obtained a mean score of 40.27 in the fourth-year final examination. The male and female students who attended the SBME module obtained a statistically significantly higher mean score versus the non-attendees (p=0.0018). Among the SBME course attendees, no statistically significant difference was noted between the scores of males and females (p=0.187). Conclusion: SBME exposure during the pre-clinical years has a significantly positive impact on the performance of students, in the core clinical years at medical college. It holds promise in reducing redundancies in medical education, making medical studies more interesting, relevant, contemporary and practical. It facilitates seamless transition of students from pre-clinical to clinical years in medical college. Implementation of early SBME courses at the pre-clinical level, mandated and supported by government initiatives, would be a huge step forward in the medical education in Saudi Arabia.

Clinical needs and preferences for AI-based explanations in clinical simulation training

ABSTRACT Medical training is a key element in maintaining and improving today's healthcare standards. Given the nature of medical work, students must master not only theory but also develop their hands-on abilities and skills in clinical practice. Medical simulators play an increasing role in supporting the active learning of these students due to their ability to present a large variety of tasks allowing students to train and experiment indefinitely without causing any patient harm. While the criticality of explainable AI systems has been extensively discussed in the literature, the medical training context presents unique user needs for explanations. In this paper, we explore the potential gap of current limitations within simulation-based training, and the role Artificial Intelligence (AI) holds in supporting the needs of medical students in training. Through contextual inquiries and interviews with clinicians in training (N = 9) and subsequent validation with medical experts (N = 4), we obtain an understanding of the shortcomings in current simulation-based training and offer recommendations for future AI-driven training. Our results stress the need for continuous and actionable feedback that resembles the interaction between clinical supervisor and resident in real-world training scenarios while adjusting training material to the residents' skills and prior performance.

Adquisición de habilidades de comunicación mediante simulación clínica: Aspectos destacados por estudiantes de medicina

Learning communication skills is central in medical education. Clinical simulation provides conditions to foster comprehensive teaching and learning processes, although it is necessary to understand student acceptance as a way to evaluate and improve the strategy. The objective of this study was to analyze the perception of medical students after introducing clinical simulation sessions to optimize the teaching and learning processes of communication skills. The study design is observational, cross-sectional, mixed, and uses census sampling. A survey was conducted through a questionnaire, and a descriptive analysis of the results was performed. The results reveal a generally good perception, where the majority of students highlighted the debriefing space or final reflection (64.8%), while 27.8% valued clinical simulation as a space for applying knowledge and more than 20% referred to the simulation scenario or the experience with a simulated patient. In conclusion, the most notable space was debriefing as an area for reflection and learning, although other appreciated aspects such as the application of knowledge or the use of a simulated patient are also important in understanding clinical simulation as a tool for learning communication skills.

Analysis of Knowledge and Satisfaction in Virtual Clinical Simulation among Nursing Students: A Mixed Study.

Virtual simulation offers a powerful educational tool with considerable, albeit underexplored potential. This technology immerses students in lifelike digital scenarios, fostering the acquisition of knowledge and skills necessary for their future careers. This study aimed to assess knowledge acquisition and satisfaction outcomes among students using a virtual simulation teaching approach. The specific objectives were (1) to compare pre-and posttest knowledge acquisition, (2) to investigate the influence of prior professional experience on knowledge, and (3) to explore satisfaction levels with virtual simulation. One hundred and fifty-nine nursing students participated in a virtual simulation-based clinical intervention, entailing the resolution of a virtual adult patient hospitalized with respiratory pathology. Sociodemographic data and prior professional experience were collected, and knowledge was evaluated through pre-to-post tests. Satisfaction levels were assessed using open-ended questions. Quantitative data were analyzed using descriptive statistics, Wilcoxon, Mann-Whitney U, and Cohen's tests, while qualitative data underwent keyword-in-context analysis. Significant differences were noted between pre- and posttest knowledge levels, with prior experience showing no significant impact on knowledge acquisition. Participants reported high levels of satisfaction. Lexicometric analysis identified four clusters of words related to the key terms "simulation", "learn", "activity", and "knowledge". Virtual clinical simulation effectively enhances knowledge acquisition and fosters satisfaction, with students recognizing the positive impact of this approach on their learning. Consequently, virtual simulation contributes to the training of competent health professionals.

Evaluating Satisfaction and Self-Confidence among Nursing Students in Clinical Simulation Learning.

Clinical simulation is effective in nursing student education, fostering autonomous learning and critical skill development in safe environments. This method is adaptable to dynamic educational approaches and integrates technology. Satisfaction and self-confidence are key elements in its evaluation. The general objective of this research was to describe the levels of satisfaction and self-confidence among undergraduate nursing students regarding the use of clinical simulation in the field of family and community nursing. A cross-sectional descriptive study was conducted at the University of Jaén, Spain, during the 2023/2024 academic year. Data on sociodemographic aspects, satisfaction, and self-confidence were collected using a validated instrument. The statistical analysis included central measures, dispersion, and frequencies, with confidence intervals. The study involved 96 students in scenario 1 (family assessment) and 97 in scenario 2 (family intervention), with the majority being women. In scenario 1, the mean satisfaction score was 4.38 out of 5, and self-confidence was scored 4.44 out of 5. Prior preparation time correlated significantly with higher levels of satisfaction and self-confidence. In scenario 2, the mean scores were slightly higher but not statistically significant. Our study demonstrated high levels of satisfaction and self-confidence among nursing students following clinical simulations. Prior preparation was associated with better outcomes, and the quality of the simulation positively impacted the results.

Perspectives on the use of Virtual Reality within a public hospital setting: surveying knowledge, attitudes, and perceived utility among health care professionals

BackgroundVirtual reality (VR) is a burgeoning technology within healthcare, though routine implementation of VR within hospital settings remains limited. Health professionals are key stakeholders in knowledge translation, though limited research has explored their knowledge and attitudes towards using VR for different purposes within healthcare. This study aimed to scope health professionals’ knowledge of, and attitudes towards, the use of VR applications in a public hospital setting.MethodsA cross-sectional survey of multidisciplinary health professionals (medical, nursing, allied health professionals) was conducted in a major metropolitan public hospital in Australia. The custom survey was comprised of 28 mixed categorical and free-text fields designed to scope levels of knowledge, prior experience, and interest in VR; the perceived utility of VR within a hospital context; and perceived barriers and enablers of VR use within the hospital setting. Data were analyzed via descriptive and non-parametric statistics.ResultsOne hundred and thirty-seven health professionals participated (38% allied health, 37% nursing, 24% medical). The majority had no prior exposure to VR in clinical (95%) or recreational (67%) settings; and only 16% were aware of any clinical research evidence for VR. Despite limited awareness, participants expressed support for VR use in hospitals. 99% reported VR had potential utility in healthcare, most commonly for clinical simulations (81%), clinical education (80%) and as a physical therapy tool (68%). Participants identified multiple barriers to VR implementation most commonly relating to perceived cost, lack of required infrastructure, time, knowledge and technical skill. Prominent enablers related to increasing capability at provider and system levels. Participants’ familiarity with VR was associated with stronger support for its’ use (Rho = 0.4, p < 0.001).ConclusionsHealth professionals in the hospital workforce reported limited knowledge and familiarity with VR; yet they perceived VR had broad utility and expressed overall support for different VR applications within hospitals. Health professionals appear interested in VR though face multiple barriers to its use in a hospital context. Increasing capability among multidisciplinary health providers and the wider hospital system appear to be important considerations for the success of future VR implementation in public hospitals.

Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial.

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

The impact of incorporating a simulation program into the undergraduate nursing curricula: A cross-sectional descriptive study

AimTo determine the degree of satisfaction for each academic year and according to the type of simulation performed (simulated patient actor/advanced simulator) among nursing students after the use of clinical simulation. IntroductionClinical simulation is currently being incorporated in a cross-cutting manner throughout undergraduate nursing education. Its implementation requires a novel curricular design and educational changes throughout the academic subjects. DesignA cross-sectional descriptive study was performed. MethodsDuring the academic years 2018–2019 and 2019–2020, 425 students completed the High-Fidelity Simulation Satisfaction Reduced Scale for Students based on 25 questions and six factors, with a total score between 0 and 125. In total, 91 simulation sessions were performed among students who had different degrees of clinical and previous experience with simulation as well as standardized patient versus advanced simulator. A bivariate analysis was performed, comparing the total scores and the different subscales by sex, previous experience, academic year, and simulation methodology. Linear regression was used for both bivariate and multivariate analysis. ResultsThe mean scale score was 116.8 (SD=7.44). The factor with the highest score was "F2: feedback or subsequent reflection", with a mean score of 14.71 (SD=0.73) out of 15. Fourth year students scored the highest (mean=119.17; SD=5.28). Students who underwent simulation training with a simulated patient actor presented a higher level of overall satisfaction (p<0.05) (Mean=120.31; SD=4.91), compared to students who used an advanced simulator (Mean=118.11; SD=5.75). ConclusionsSatisfaction with the simulation program was higher in fourth-year students compared to first-year students and was also higher when a simulated patient actor was used compared to an advanced simulator. The most highly valued aspect was the subsequent debriefing or reflective process.

Effect of acidic environment on color and translucency of different indirect restorative materials

PurposeThe aim of the current study was to evaluate the effect of simulated gastric acid on the color and translucency of different indirect restorative materials.Materials and methodsA total of 36 disc-shaped samples were cut by using an isomet saw and divided into four equal groups (n = 9) according to the material type: Group Z: translucent zirconia (Ceramill® Zolid ht.+ preshade, Amann Girrbach, Koblach, Austria); Group E: lithium disilicate (IPS e.max CAD, Ivoclar Vivadent AG, Schaan, Liechtenstein); Group C: resin nanoceramic (Cerasmart, GC, Tokyo, Japan); Group P: polyether ether ketone (PEEK) (Bettin Zirconia Dentale Italy) veneered with indirect high impact polymer composite (HIPC) (breCAM HIPC, Bredent GmbH & Co. KG, Germany). The samples were immersed in simulated gastric acid (HCl, pH 1.2) for 96 hours at 37 °C in an incubator. The color change (ΔE00) and translucency (RTP00) were measured every 9.6 hours (one-year clinical simulation) of immersion in simulated gastric acid.ResultsFor color change (∆E00) and translucency (RTP00) among the tested materials, there was a highly statistically significant difference (P < 0.001) after every year of follow-up. The color change in both Z and G groups was the lowest after 1 year of acid immersion, followed by that in group H, and the highest change in color was recorded in group P.ConclusionHigh translucent zirconia is recommended in patients who are concerned about esthetic, especially with acidic oral environment.

Effectiveness of gamification in nursing degree education.

Previous research in nursing has found favorable results from the use of teaching methodologies alternative to lectures. One of the complementary methodologies used for university teaching is gamification, or the inclusion of game elements, creating a dynamic learning environment that allows the acquisition of knowledge and the development of other skills necessary for nursing students. The purpose of this study was to evaluate the effect of a gamification session on student satisfaction and knowledge scores in nursing students in simulated laboratory practice. A pre-post quasi-experimental study was conducted with 122 students from the nursing degree program who participated in the research. The evaluation consisted of four sessions of three hours each. In two sessions, participants were trained through a vertical methodology, by means of theoretical training provided by teaching staff, and two hours of clinical simulation, where the students were able to practice the techniques on professional simulators. At the other two sessions, participants received an explanation of the theoretical aspects of the session, one hour of clinical simulation, and one hour of gamification, in which they had to pass tests based on the performance of practical activities on the subject of the session. At the end of the gamification session, all the participants received a certificate as winners of the "nursing game". There was an improvement in the satisfaction and the knowledge level in the gamification sessions. Both were statistically significant (P < 0.001). There was an improvement in the items related to the development of critical thinking and the mobilizing concepts from theory to practice in the gamification sessions. The intervention was effective in improving the satisfaction of the sessions received and in knowledge development.

Use of different debriefing methods after in situ simulation with intensive care unit nurses.

The debriefing phase is the simulation phase where performance improves and learning occurs. This study examined the effects of the learning conversation (LC)-based, 3D (defusing, discovering and deepening) model-based and unstructured debriefing methods on satisfaction and debriefing experience after in-situ simulation among intensive care unit (ICU) nurses. In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In- situ simulation was performed with an intensive care patient scenario. p < .05 was considered statistically significant. The total Debriefing Experience Scale-Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p > .05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics. Debriefing experience and satisfaction do not differ between the methods. Implementation of the simulation in the ICU in - situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards.

Implications of clinical simulation in motivation for learning: scoping review.

To identify, synthesize, and analyze the scientific knowledge produced regarding the implications of using clinical simulation for undergraduate nursing or medical students' motivation for learning. The search for articles was conducted between July 28 and August 3, 2022, on the PubMed/MEDLINE, Scopus, Web of Science, and SciELO databases. The following was used for the search: P - undergraduate students attending Nursing or Medicine courses; C - motivation for learning, and C - skills and clinical simulation laboratory. The following research question guided the study: "What are the implications of clinical simulation on the motivation for learning of undergraduate students of nursing and medicine?" Of the 1,783 articles found, 13 were included in the sample for analysis. All stages of the selection process were carried out by two independent evaluators. The results were presented as charts and a discursive report. The studies analyzed indicated the beneficial effects of clinical simulation on students' motivation, in addition to other gains such as competencies, technical and non-technical skills, knowledge, belonging, autonomy, clinical judgment, critical and reflective thinking, self-efficacy and decreased anxiety, self-management, and improvements in learning and learning climate. Clinical simulation provides a positive learning environment favorable to the development of technical and interpersonal skills and competencies, and raising the level of motivational qualities.

A Mathematical Model Based on Stratifying the Severity of Medical Errors for Building Scenarios for Clinical Cases With Branching.

Background There are no mathematical models or score systems available for assessing and creating clinical case simulations based on branching scenario scripts. Objective This study aimed to develop a mathematical model based on stratifying the severity of medical errors for building clinical cases with branching scenarios for clinical simulation. Methods This study was undertaken from August 2020 to August 2023. To build a mathematical model for building scenarios of clinical cases with branching, the classification of the seriousness of medication errors was used. A mathematical model was built for predicting and modeling the development of a clinical situation and as an assessment strategy.The study recruited a total of 34 participants, with 16 participants assigned to the branching scenarios without the mathematical model group and 18 participants assigned to the branching scenarios with the mathematical model group. Results A simple diagram of score based on stratification of the severity of medical errors and correct decisions in clinical practice for building interactive training scenarios with branching was proposed. According to this score system algorithm, each clinical decision-making step is scored points with plus or minus, from 0 to 10.The sum of the points for each block in the decision-making process is then added up. Each step in the overall clinical decision-making strategy is stratified by the proposed algorithm, and finally, the results of internal validation and implementation are presented. Conclusion A mathematical model and score system for building clinical case scenarios based on branching and classification of the seriousness of medication errors was developed. This system could help in the prediction and modeling of the development of events in particular clinical situations and the assessment of competency formation in medical simulation as well.

Impact of covariate model building methods on their clinical relevance evaluation in population pharmacokinetic analyses: comparison of the full model, stepwise covariate model (SCM) and SCM+ approaches.

Covariate analysis in population pharmacokinetics is key for adjusting doses for patients. The main objective of this work was to compare the adequacy of various modeling approaches on covariate clinical relevance decision-making. The full model, stepwise covariate model (SCM) and SCM+ PsN algorithms were compared in a clinical trial simulation of a 383-patient population pharmacokinetic study mixing rich and sparse designs. A one-compartment model with first-order absorption was used. A base model including a body weight effect on CL/F and V/F and a covariate model including 4 additional covariates-parameters relationships were simulated. As for forest plots, ratios between covariates at a specific value and that of a typical individual were calculated with their 90% confidence interval (CI90) using standard errors. Covariates on CL, V and KA were considered relevant if their CI90 fell completely outside the reference area [0.8-1.2]. All approaches provided unbiased covariate ratio estimates. For covariates with a simulated effect, the 3 approaches correctly identify their clinical relevance. However, significant covariates were missed in up to 15% of cases with SCM/SCM+. For covariate with no simulated effects, the full model mainly identified them as non-relevant or with insufficient information while SCM/SCM+ mainly did not select them. SCM/SCM+ assume that non-selected covariates are non-relevant when it could be due to insufficient information, whereas the full model does not make this assumption and is faster. This study must be extended to other methods and completed by a more complex high-dimensional simulation framework.

Assessing the equivalency of face-to-face and online simulated patient interviews in an educational intervention

BackgroundIn adapting to COVID-19, many health professional training programs moved abruptly from in-person to online simulated patient interviews for teaching and evaluation without the benefit of evidence regarding the efficacy of this mode of delivery. This paper reports on a multi-methods research project comparing in-person and online simulated patient interviews conducted by allied health professionals as part of an educational intervention offered at a large university teaching hospital.MethodsTwenty-three participants conducted two 15-min interviews with simulated patients using previously validated scenarios of patients presenting with suicide risk. In order to assess the equivalency of the two modalities, physiological and psychological stress were measured using heart rate variability parameters and the State-Trait Anxiety Inventory respectively, and then were compared across cohorts using t-tests. Reflective interviews elicited qualitative impressions of the simulations that were subject to thematic qualitative analysis.ResultsThere were no statistical differences in measures of psychological stress or physiological arousal of participant health care professionals who engaged with in-person versus online simulated interviews, suggesting they were equally effective in eliciting reactions commonly found in challenging clinical situations. In reflective interviews, participants commented on the realism of both modalities of simulated patient encounters and that simulated interviews provoked emotional and physiological responses consistent with actual patient encounters.ConclusionsThese findings provide developing evidence that carefully designed online clinical simulations can be a useful tool for the education and assessment of healthcare professionals.