Clinical Simulation Research Articles

The Role of Chatbot GPT Technology in Undergraduate Dental Education.

This comprehensive article explores the transformative role of Chatbot GPT, based on the GPT-3 architecture, in revolutionizing dental education. The focus is on its impact across various facets, including personalized learning pathways, integration into virtual patient simulation scenarios, 24/7 accessibility, multilingual support, interactive dental dictionary functionality, evidence-based learning, and assessment and evaluation of dental students. The objective is to showcase how Chatbot GPT enhances educational experiences, promotes inclusivity, and aligns with contemporary pedagogical principles. Chatbot GPT emerges as a powerful ally in dental education, offering personalized learning experiences, risk-free clinical simulations, continuous accessibility, multilingual support, instant terminology assistance, evidence-based learning resources, and real-time assessment capabilities. Its adaptability caters to diverse learning needs, fostering a learner-centered approach and promoting lifelong learning for both dental students and practitioners. As a versatile tool, Chatbot GPT not only transforms the educational journey but also serves as a valuable asset for continuous professional development in the dynamic landscape of dentistry.

Forced Esthetic Position: A Diagnostic Strategy for Anteroposterior Repositioning in Orthognathic Surgeries.

Considering the esthetic goals involved in orthognathic surgeries, one of the challenges is to define the horizontal projection of the jaws. Most of the cephalometric analyses are focused on the position of the upper incisor and upper lip. Planning the correction of a mandibular retrognathism can be simplified by clinical simulation asking the patient to project their mandible. A forced esthetic position protocol is presented as a starting point for the planning in orthognathic cases.

Simulation-based evaluation of personalized dosing approaches for anti-FGFR/KLB bispecific antibody fazpilodemab.

Personalized dosing approaches play important roles in clinical practices to improve benefit: risk profiles. Whereas this is also important for drug development, especially in the context of drugs with narrow therapeutic windows, such approaches have not been fully evaluated during clinical development. Fazpilodemab (BFKB8488A) is an agonistic bispecific antibody which was being developed for the treatment of nonalcoholic steatohepatitis. The objective of this study was to characterize the exposure-response relationships of fazpilodemab with the purpose of guiding dose selection for a phase II study, as well as to evaluate various personalized dosing strategies to optimize the treatment benefit. Fazpilodemab exhibited clear exposure-response relationships for a pharmacodynamic (PD) biomarker and gastrointestinal adverse events (GIAEs), such as nausea and vomiting. Static exposure-response analysis, as well as longitudinal adverse event (AE) analysis using discrete-time Markov model, were performed to characterize the observations. Clinical trial simulations were performed based on the developed exposure-response models to evaluate probability of achieving target PD response and the frequency of GIAEs to inform phase II dose selection. Dynamic simulation of personalized dosing strategies demonstrated that the AE-based personalized dosing is the most effective approach for optimizing the benefit-risk profiles. The approach presented here can be a useful framework for quantifying the benefit of personalized dosing for drugs with narrow therapeutic windows.

Can 3D Printed Tablets Be Bioequivalent and How to Test It: A PBPK Model Based Virtual Bioequivalence Study for Ropinirole Modified Release Tablets.

As the field of personalized dosing develops, the pharmaceutical manufacturing industry needs to offer flexibility in terms of tailoring the drug release and strength to the individual patient's needs. One of the promising tools which have such capacity is 3D printing technology. However, manufacturing small batches of drugs for each patient might lead to huge test burden, including the need to conduct bioequivalence trials of formulations to support the change of equipment or strength. In this paper we demonstrate how to use 3D printing in conjunction with virtual bioequivalence trials based on physiologically based pharmacokinetic (PBPK) modeling. For this purpose, we developed 3D printed ropinirole formulations and tested their bioequivalence with the reference product Polpix. The Simcyp simulator and previously developed ropinirole PBPK model were used for the clinical trial simulations. The Weibull-fitted dissolution profiles of test and reference formulations were used as inputs for the model. The virtual bioequivalence trials were run using parallel design. The study power of 80% was reached using 125 individuals. The study demonstrated how to use PBPK modeling in conjunction with 3D printing to test the virtual bioequivalence of newly developed formulations. This virtual experiment demonstrated the bioequivalence of one of the newly developed formulations with a reference product available on a market.

Phase 2A Learnings Incorporated into RewinD-LB, a Phase 2B Clinical Trial of Neflamapimod in Dementia with Lewy Bodies

BackgroundIn an exploratory 91-participant phase 2a clinical trial (AscenD-LB, NCT04001517) in dementia with Lewy bodies (DLB), neflamapimod showed improvement over placebo on multiple clinical endpoints. To confirm those results, a phase 2b clinical study (RewinD-LB, NCT05869669 ) that is similar to AscenD-LB has been initiated.ObjectivesTo optimize the choice of patient population, primary endpoint, and biomarker evaluations in RewinD-LB.DesignEvaluation of the efficacy results from AscenD-LB, the main results of which, and a re-analysis after stratification for absence or presence of AD co-pathology (assessed by plasma ptau181), have been published. In addition, the MRI data from a prior phase 2a clinical trial in Early Alzheimer’s disease (AD), were reviewed.Setting22 clinical sites in the US and 2 in the Netherlands.ParticipantsProbable DLB by consensus criteria and abnormal dopamine uptake by DaTscan™ (Ioflupane I123 SPECT).InterventionNeflamapimod 40mg capsules or matching placebo capsules, twice-a-day (BID) or three-times-a-day (TID), for 16 weeks.Measurements6-test Neuropsychological Test Battery (NTB) assessing attention and executive function, Clinical Dementia Rating Sum-of-Boxes (CDR-SB), Timed Up and Go (TUG), International Shopping List Test (ISLT).ResultsWithin AscenD-LB, patients without evidence of AD co-pathology exhibited a neflamapimod treatment effect that was greater than that in the overall population and substantial (cohen’s d effect size vs. placebo ≥ for CDR-SB, TUG, Attention and ISLT-recognition). In addition, the CDR-SB and TUG performed better than the cognitive tests to demonstrate neflamapimod treatment effect in comparison to placebo. Further, clinical trial simulations indicate with 160-patients (randomized 1:1), RewinD-LB conducted in patients without AD co-pathology has >95% (approaching 100%) statistical power to detect significant improvement over placebo on the CDR-SB. Preliminary evidence of positive treatment effects on beta functional connectivity by EEG and basal forebrain atrophy by MRI were obtained in AscenD-LB and the Early AD study, respectively.ConclusionIn addition to use of a single dose regimen of neflamapimod (40mg TID), key distinctions between phase 2b and phase 2a include RewinD-LB (1) excluding patients with AD co-pathology, (2) having CDR-SB as the primary endpoint, and (3) having MRI studies to evaluate effects on basal forebrain atrophy.

Implementation of a Stereoscopic Camera System for Clinical Electron Simulation and Treatment Planning

PurposeA 3D stereoscopic camera system developed by .decimal was commissioned and implemented into the clinic to improve the efficiency of clinical electron simulations. Capabilities of the camera allowed simulations to be moved from the treatment vault into any room with a flat surface that could accommodate patient positioning devices, eliminating the need for clinical patient setup timeslots on the treatment machine. This work describes the process used for these simulations and compares the treatment parameters determined by the system to those used in delivery. MethodsThe Decimal3D scanner workflow consisted of: scanning the patient surface; contouring the treatment area; determining gantry, couch, collimator, and source-to-surface distance (SSD) parameters for en face entry of the beam with sufficient clearance at the machine; and ordering custom electron cutouts when needed. Transparencies showing the projection of in-house library cutouts at various clinical SSDs were created to assist in choosing an appropriate library cutout. Data from 73 treatment sites were analyzed to evaluate the accuracy of the scanner-determined beam parameters for each treatment delivery. ResultsClinical electron simulations for 73 treatment sites, predominately keloids, were transitioned out of the LINAC vault using the new workflow. For all patients, gantry, collimator, and couch parameters along with SSD and cone size were determined using the Decimal3D scanner with 57% of simulations using library cutouts. Tolerance tables for patient setup were updated to allow differences of 10, 20 and 5 degrees for gantry, collimator and couch, respectively. Approximately 7% of fractions (N=181 total fractions) were setup outside of the tolerance table based on physician-direction during treatment. This reflects physician preference to adjust the LINAC rather than patient position during treatment setup. No scanner-derived plan was untreatable due to cutout shape inaccuracy or clearance issues. ConclusionClinical electron simulations were successfully transitioned out of the LINAC vault using the Decimal3D scanner without loss of setup accuracy as measured through machine parameter determination and electron cutout shape.

Clinical Simulation in Palliative Care for Undergraduate Nursing Students: A Randomized Clinical Trial and Complementary Qualitative Study.

a lack of adequate training in palliative care leads to a greater emotional burden on nurses. to assess the effect of a simulation using standardized patients on self-efficacy in palliative care, ability to cope with death, and emotional intelligence among nursing students. a randomized clinical trial and qualitative study. A total of 264 nursing students in a palliative care module completed the Bugen, trait meta-mood, and self-efficacy in palliative care scales after active participation in the simulation (n = 51), watching the simulation (n = 113), and the control group (n = 100). An ANOVA with a multi-comparative analysis and McNemar's tests for paired samples were calculated. Active participants were interviewed, and a thematic analysis was conducted. there was an improvement after the assessment in all three groups assessed for coping with death (p < 0.01), emotional intelligence (p < 0.01), and self-efficacy (p < 0.01). In addition, the active group improved more than the observer group and the control group in coping with death, attention, and repair. The students in the interviews identified sadness and an emotional lack of control. the simulation improved nursing students' self-efficacy in palliative care. This effect was partially stronger in the active group.

An observational study exploring soundscapes in clinical simulation

An observational study exploring soundscapes in clinical simulation

Integration of clinical simulation into a post-registration neurological course: Insights from the students on the use of a flexible approach to debriefing

Integration of clinical simulation into a post-registration neurological course: Insights from the students on the use of a flexible approach to debriefing

Exploring eye-tracking data as an indicator of situational awareness in nursing students during a cardiorespiratory arrest simulation

AimTo examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels. BackgroundEye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction. DesignA comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels. MethodsThirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale. ResultsThe first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = −0.640, p = 0.010). ConclusionEye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies.

Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.

Development of Interprofessional Socialization in a Multifaceted Live Action Clinical Role-Play Simulation for Speech-Language Pathology and Social Work Students

Development of Interprofessional Socialization in a Multifaceted Live Action Clinical Role-Play Simulation for Speech-Language Pathology and Social Work Students

Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods.

The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. Quasi-experimental mixed methods using co-production. Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays. Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning. Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

Bumping along: Healthcare students' perspectives on interprofessional education

Background: Global regulatory bodies and the PM&amp;DC (Pakistan Medical and Dental Council) share a competency framework that emphasizes the importance of graduates being effective communicators and collaborators in the healthcare system to achieve positive patient outcomes. However, due to unclear roles, conflicting power dynamics, and varying educational qualifications among healthcare professionals, effective interprofessional teamwork is often not realized, leading to suboptimal outcomes. Objective: To evaluate the attitudes and readiness of healthcare students towards inter-professional education. Methods: This comparative cross-sectional study was conducted from March to August 2020 by utilizing a prevalidated inventory called the Readiness of Interprofessional learning scale (RIPLS) to assess the readiness of students in healthcare programs. Data was collected using Google Forms, and the Kruskal-Wallis Test was employed to compare perceptions among the four groups. Results: 157 students completed the questionnaire, resulting in a response rate of 58%. All four groups demonstrated high readiness for mutual learning (mean rank=78.78) although physiotherapy students had higher scores (mean rank=79.36) compared to the other groups, while nursing students had the lowest scores (mean rank=77.92). Conclusion: The positive attitude of students towards interprofessional education and collaboration highlights the need for integration with other healthcare disciplines at both the curricular and co-curricular levels. Clinical case studies, problem-based learning, and simulations can be effective methods for fostering students' understanding of each profession's role.

Using Clinical Simulation to Evaluate AI-Enabled Decision Support.

Clinical simulation is a useful method for evaluating AI-enabled clinical decision support (CDS). Simulation studies permit patient- and risk-free evaluation and far greater experimental control than is possible with clinical studies. The effect of CDS assisted and unassisted patient scenarios on meaningful downstream decisions and actions within the information value chain can be evaluated as outcome measures. This paper discusses the use of clinical simulation in CDS evaluation and presents a case study to demonstrate feasibility of its application.

Construction and Validation of a Simulation Scenario for Teaching Family-Focused Care in Pediatric Oncology.

Clinical simulation can be a promising teaching strategy to help nurses develop behaviors that improve family care actions, promoting safe and high-quality care. The objective of this study was to build, validate, and test a simulation scenario in pediatric oncology family-focused care (FFC) following an initial diagnosis of cancer. It is a six-step methodological study based on the philosophy of Family-Centered Care (FCC), with a user-centered design. The evaluators established a Content Validity Index (CVI) > 0.8 for validation. Pilot testing included the Simulation Design Scale. The data were analyzed by descriptive statistics. A total of 35 experts participated in this study. All 19 items in the scenario were validated and considered relevant, in a single round, with the item-level CVI ranging between 0.8 and 1 and a scale-level CVI of 0.92. The high-fidelity developed and validated clinical simulation scenario is a consistent tool for the education of advanced practice nurses.

Preparing the Frontlines: Delivering Special Pathogen Training to Maryland Hospital Staff.

Healthcare workers (HCWs) at community hospitals, also known as frontline hospitals (FLHs), may encounter patients with possible infectious diseases, including those caused by high-consequence pathogens such as Zaire ebolavirus. We created and piloted a 1-day, in-person, didactic and skills training program to determine the feasibility and acceptability of implementing an educational program to enhance the knowledge and skills needed to respond when a patient with a potential high-consequence pathogen presents to an FLH. The Maryland Department of Health queried all 104 state FLHs to identify their interest in participating in the pilot training program. HCWs from 12 (75%) of the 16 interested FLHs participated in the program before it was interrupted by the COVID-19 pandemic. In addition to pathogen-specific training based on the Identify, Isolate, and Inform framework, we provided skills training in the proper use of personal protective equipment, spill cleanup, and removal of an incapacitated HCW from an isolation area. We conducted a paired pretraining and posttraining knowledge assessment and measured a significant learning gain among 135 participants (2-tailed t test, P<.05). Over 95% of the participants reported that the training was relevant to their daily work and the clinical simulations and reference material were useful and appropriate for their learning level. Findings from this pilot program demonstrated the feasibility and acceptability of a 1-day combined didactic and skills training program focused on high-consequence pathogens. We plan to reengage the original FLHs and add regional FLHs in an updated training effort based on our findings.

Application of artificial intelligence in medical education: A review of benefits, challenges, and solutions

Introduction/objectivesArtificial intelligence (AI) holds indisputable potential in solving global challenges faced in healthcare provision, resulting in its ever-increasing utilization in various medical fields. This review aims to present a thorough evaluation of the advantages, challenges, and leading strategies for utilizing AI in the field of medical education. MethodsIn order to access the latest studies and documents, a comprehensive literature search was conducted in Medline (via PubMed), Scopus, and Web of Science databases, using free keywords and MeSH terms representing artificial intelligence, medical education, curriculum, medical student, and their equivalents, without any restriction in time and language, until October 2023. ResultsThe expanding integration of AI into medical practice, especially in recent decades, has also led to an increase in the use of different AI methods in medical education. However, integrating AI into medical education comes with advantages and obstacles. The advantages include objective student assessment, better clinical simulation organization, and enhanced education transparency. Conversely, the main challenges of AI integration in education are ethical and legal issues, scalability limitations, evaluating the effectiveness of these educational methods, and technical difficulties. ConclusionsFurther research is needed to specifically identify the potential benefits and challenges, and analyze the proposed solutions for these challenges. Also, the academic curriculum should be evaluated periodically in order to improve the effectiveness of incorporating AI in medical education.

Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals.

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.

Efectividad de la formación teórico-práctica en soporte vital básico a monitoras de comedores escolares desde Atención Primaria

Introduction: cardiovascular diseases constitute a public health problem worldwide and among them cardiorespiratory arrest (CPA) stands out. School canteens are spaces with potential risk of witnessing a PCR. Materials and methods: quasi-experimental analytical study of intervention. The participants received training through an interactive virtual platform and a face-to-face clinical simulation session on the Heimlich maneuver, basic cardiopulmonary resuscitation (CPR) and the use of the semiautomatic external defibrillator (SAED). A descriptive analysis of the study population and a comparative statistical analysis between the results obtained in a test before and after the virtual training were carried out. A variable was created by subtracting the score obtained before training from that obtained after it. Clinical simulation was analyzed by direct observation. Statistical significance was defined as p &lt; 0.05. Statistical analysis with SPSS version 19.0. The principles of the Declaration of Helsinki and the guidelines on good clinical practice were followed. Results: the entire sample was women with a median age of 48.50 years. The median mark of the pre-test was 6.7/10 and the post-test had a constant result of 10/10. The difference between the post-test and the pre-test had a median of 3.3 (p 0.01) and was found in the simulation that the learning was optimal. Conclusions: training in CPR is a strategy with a social impact, related to an improvement in the response to a case of CPA, reducing the morbidity and mortality that this implies.