Simulation Debriefing Research Articles

Approaches to interpersonal conflict in simulation debriefings: A qualitative study.

Conflict during simulation debriefing can interfere with learning when psychological safety is threatened. Debriefers often feel unprepared to address conflict between learners and the literature does not provide evidence-based guidance within the simulation setting. The purpose of this study was to describe debriefers' approach to mediating interpersonal conflict and explore when, why and how they adopt mediation strategies. We performed a secondary analysis of qualitative data collected as part of a larger study examining simulation debriefers' approaches to debriefing scenarios with different learner characteristics. For this study, we applied thematic analysis to transcripts from simulated debriefings (n = 10) and the associated pre-simulation (n = 11) and post-simulation (n = 10) interviews that focused on interpersonal conflict between learners. Debriefers described struggling with mediating conflict and the importance of self-awareness. Specific mediation strategies included intervening, addressing power relations, reconciling unproductive differences, leveraging different perspectives, circumventing the conflict, and shifting beyond the conflict; each of these strategies encompassed a number of particular skills. Situations that triggered a mediation approach were related to psychological safety, emotional intensity, and opportunities for shared understanding and productive learning. Debriefers applied mediation strategies and skills in a flexible and creative way. The strategies we have described for mediating interpersonal conflict between learners in simulation debriefing align with notions of psychological safety and may be useful in guiding future professional development for simulation educators.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum.

The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4). The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions. To provide residents with an introduction to teaching techniques that can be utilized on-shift to facilitate an excellent educational experience for junior learners while balancing the resident's patient care responsibilities. The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing. A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course. Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student's t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies post-curriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session. The educational content was effective in improving the residents' comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated the feasibility and utility of running a RAT curriculum entirely in a virtual format. Residents-as-teachers, distance learning, role-playing, virtual curriculum, video conferencing, One Minute Preceptor, feedback, "What if?" game, Aunt Minnie, SPIT, activated demonstration, self-directed teaching tools, teaching scripts, Post-It Pearls.

An End-of-Life Communication Performance Rubric: Reliability Assessment.

Nurse educators still struggle with teaching and assessing end-of-life communication skills. Many resources are available to assist in teaching end-of-life communication, but few tools exist to assess performance learning outcomes. Behavior evaluation tools must be user-friendly and provide beneficial student feedback. Quality end-of-life patient care and nursing job satisfaction depend on skillful communication. The purpose of this study was to evaluate the reliability of an end-of-life communication clinical simulation evaluation performance rubric. Moderate interrater consistency and agreement were found between 3 evaluators when assessing the same students. All simulation evaluators agreed that the performance rubric was user-friendly and provided rich feedback for students during simulation debriefing. The performance evaluation tool was moderately effective when evaluating end-of-life communication performance and appears as a worthy framework for other behavior evaluations.

COVID-19 educational innovation: Hybrid in-person and virtual simulation for emergency medicine trainees.

The COVID‐19 pandemic has dramatically affected medical education. Emergency medicine (EM) requires excellence in multiple core competencies, including leadership, teamwork, and communication skills as well as procedural experience. To meet these objectives, we developed a hybrid simulation model that accommodated a reduced number of learners in our simulation center to allow for physical distancing, seamlessly integrated with an online integrated experience for remote learners. All learners participated or watched one adult and one pediatric simulation case. Fourteen residents participated in live simulation, while six residents and six medical students comprised the remote group. At the end of each case, the live feed was ended, and separate debriefings were conducted by different EM faculty, in person and online (via Zoom). An electronic survey was then sent to participants to rate the effectiveness of the intervention; 23 survey responses were collected: 52.2% (12) from the live session and 47.2% (11) from the virtual session. Survey results demonstrated that the online simulation observation and debriefing had the same, if not better, satisfaction than in‐person simulation sessions and debriefings. Due to its success, this new method of hybrid simulation will be our plan for the foreseeable future, at least until COVID‐19 abates.

Cultural Considerations in Debriefing.

Culture influences how we communicate, teach, and learn. Debriefings are laden with cultural influences. Without attention to cultural considerations, accepted debriefing techniques might not reach the desired outcome and, in certain cultures, may even harm teacher-learner relationships. We explore cultural considerations in healthcare simulation debriefing and offer guidance for debriefers to gain awareness of potential cultural biases.

Measuring the impact of productive failure on nursing students' learning in healthcare simulation: A quasi-experimental study

BackgroundPrevious research suggests that making errors in a non-threatening simulated environment can facilitate learning. Productive failure, which combines problem-solving tasks followed by instruction, enables students to learn from making mistakes. This teaching approach has demonstrated improved learning outcomes such as explanatory knowledge and transfer of knowledge compared to a direct instruction approach where students receive instruction prior to problem-solving tasks. However, no previous studies have examined the impact of productive failure on nursing students' learning in manikin-based simulation. ObjectiveTo measure the impact of productive failure on nursing students' declarative knowledge, explanatory knowledge, and transfer of knowledge compared to a direct instruction approach in a paediatric closed head injury simulation. MethodsSecond year undergraduate nursing students (n = 349) from one Australian university were invited to participate in the study. Consenting participants (n = 344) were randomised into two groups: productive failure and direct instruction. The intervention consisted of two paediatric closed head injury simulations separated by a simulation debrief. Knowledge tests were administered before and immediately after the simulation. ResultsData from 331 participants were analysed. The productive failure group outperformed the direct instruction group in the post-test (p < 0.001). Learning gains for participants in the productive failure group were significantly higher than the direct instruction group for both explanatory knowledge (p < 0.001) and the ability to apply learning to solve novel clinical problems (p < 0.001). The difference in the median scores for declarative knowledge was not significant (p = 0.096). ConclusionThis study demonstrated that a productive failure simulation that leads learners to make mistakes before receiving instruction can facilitate deeper levels of explanatory knowledge and enable the transfer of learning to new clinical situations. These results suggest the need for further exploration of pedagogies that foster learning from errors in simulation-based learning.

Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on\u2010call simulation

BackgroundCurrent research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training.Methods30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students’ clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes.ResultsSix key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning ‘on the job’.ConclusionsThe combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through ‘whole task’ training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong ‘learning while working’.

P0676 / #912: RAPID CYCLE DELIBERATE PRACTICE FOR INTER PROFESSIONAL EDUCATION IN A NON TRAINEE STAFFED PEDIATRIC INTENSIVE CARE UNIT

Aims & Objectives: Rapid Cycle Deliberate Practice (RCDP) is a simulation debriefing methodology that has been compared to post simulation debriefing (PsD) in simulation based medical education (SBME) studies, mostly focused on resuscitations and procedure skills. The aim of this study is to compare the RCDP versus PsD training as methods for experiential learning in the pediatric intensive care unit (PICU) interprofessional SBME sessions. We also measure PICU team workload perception during the simulation scenario using the National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaire. We hypothesize the RCDP will be more effective than PsD in improving team performance and minimizing cognitive load of learners and facilitators. Methods: Pediatric Critical Care attending physicians, Nurses, Pharmacists and Respiratory Therapists will participate in a 3-hour simulation workshop. Workshops are being conducted from October 2019 - March 2020, and include 5 workshops covering two medical sepsis scenarios. Each session will schedule 1 physician, 2-3 nurses, 1 pharmacist and 1 RT. The first part of the SBME workshop will be PsD and the second half will be RCDP with hard stops and soft stops. The learners complete pre and post-test crew resource knowledge assessments and cognitive load assessments (NASA Task Load Index). Facilitators complete the validated teamwork assessment tool (TEAM Assessment) andNASA Task Index. Results: Raw scores of crew resource knowledge test, TEAM Assessment and NASA Task Load Index between the two studies will be examined. Conclusions: RCDP during interporfessional SBME is feasible and needs to be designed differently in a trainee versus non trainee environment.

Effects of hot and cold debriefing in simulation with case-based learning.

For successful simulation-based learning (SBL), a structured interactive and bidirectional debriefing should be a prerequisite. The purpose of this study is to identify the effects of instructor-led hot debriefing (debriefing immediately after simulation) and cold debriefing (debriefing occurring after a certain period following simulation) in simulation with case-based learning (CBL). This study used a nonequivalent control group pretest-posttest design. A sample of 59 fourth-year nursing students in South Korea were invited and randomly divided into two groups, a post-simulation hot debriefing (PSHD, male = 4, female = 26), and cold debriefing (PSCD, male = 3, female = 26). We used clinical performance competency, satisfaction with CBL and SBL, and debriefing tools. The study period was from October to December of 2019. We analyzed the data with SPSS 23.0 software, using descriptive statistics and the t test. Clinical performance competency means that the scores of both groups were significantly improved in the posttest (PSHD = 33.13 ± 5.11, PSCD = 34.10 ± 4.15) as compared to those in the pretest (t = -7.010, p < .001). The knowledge (t = -12.689, p < .001) and skill (t = -5.338, p = .001) scores of clinical performance competency in the PSCD were higher than those in the PSHD. The mean satisfaction scores of the PSHD group with CBL (4.53 ± 0.60) and debriefing (4.66 ± 0.55) was higher than for those in the PSCD group. As a result of this study, PSHD and PSCD led by an instructor improved student clinical performance competency. The PSHD method, in particular, might be a positive influence on learner satisfaction with CBL, SBL, and debriefing.

A Web Platform (MOSAICO) to Design, Perform, and Assess Collaborative Clinical Scenarios for Medical Students: Viewpoint.

BackgroundThe collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universität de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms.ObjectiveThe goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model.MethodsThe design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic.ResultsMOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students’ collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total).ConclusionsMOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment.

Simulation debriefing: a perspective from emergency medical care students at three South African Higher Education Institutions.

Introductionsimulation-based learning (SBL) is an educational technique that is used to create lifelike experiences within a controlled setting. Feedback and debriefing have been described as most important components in healthcare simulation. Providing feedback or debriefing loses its efficacy if it is not performed correctly. The results of poor feedback or debriefing practice may negatively affect future student performance. It is important to identify both positive and negative current practice so as to better understand the potential effects on student learning. There is a paucity of evidence relating to debriefing within the resource-constrained environment.Methodsa cross-sectional design collected data using a purpose-designed, paper-based questionnaire that was validated using a pilot study. We collected data from three South African higher education institutions (HEI) offering emergency medical care qualifications. Questionnaires were distributed on-site at each HEI by an academic staff member and were returned to the researchers via courier. Participants were recruited from the second, third and fourth academic years of study. Responses were captured manually and imported into Microsoft Excel for analysis.Resultswe collected 153 completed questionnaires from three South African Higher Education Institutions (HEIs). Student perceptions of debriefing practices were generally positive. There were general feelings of psychological safety and an understanding between students and facilitator related to why debriefing took place. Linking debrief and learning outcomes was perceived as making debriefing meaningful to students. Question-asking techniques by facilitators were mixed, but were generally asked in a manner that encouraged self-reflection. Peer-led debriefing was perceived as good practice and a single facilitator was preferred to multiple facilitators.Conclusionseveral strategies related to effective feedback and debriefing were identified by the student participants as already being employed by facilitators. The potentially negative effect of multiple facilitators was highlighted by participants who indicated that they preferred a single debriefer for the entire academic year. Peer-led debriefing was perceived as a positive practice and has a number of advantages and disadvantages that should be considered and mitigated by the facilitator.

Coronavirus-19 Multisystem Inflammatory Syndrome in Children (MIS-C): A Pediatric Simulation Case for Residents, Fellows, and Advanced Practice Providers.

IntroductionA rare but serious condition often requiring intensive care, multisystem inflammatory syndrome in children (MIS-C) is characterized by hyperinflammatory shock related to the SARS-CoV-2 pandemic. This resource teaches residents, pediatric emergency medicine fellows, and advanced practice providers who care for children to recognize and manage MIS-C and associated sequelae while applying the basic principles of pediatric resuscitation.MethodsThe simulation case was based on a real patient who presented to the emergency department with fever, rash, and cardiogenic shock. We designed the scenario to be used with a high-fidelity school-age mannequin in an emergency center resuscitation room or simulation lab. The case took 25 minutes to run, followed by a 15- to 20-minute debrief session. Personnel required for the case included a simulation technician, case instructor, emergency department nurse, parent, and consultant. Learners had to recognize the syndrome and treat the resultant shock and arrhythmia with a combination of vasopressors, antiarrhythmics, and defibrillation. Afterward, learners participated in a formal debriefing session and completed a written evaluation.ResultsTwenty-five learners (six pediatric emergency medicine fellows, 12 residents, and seven advanced practice providers) participated in the scenario over a 3-month period. The written evaluation was completed by 20 of the 25 participants; all 20 felt their confidence, comfort, and knowledge regarding the topic had increased, with an average score of 5 (strongly agree) on a 5-point Likert scale.DiscussionThis simulation case offers an effective experience for learners to become comfortable and confident in recognizing and managing MIS-C.

Measurable reflection in simulation: A pilot study.

Debriefing is considered a cornerstone in the success of simulated learning practices. For debriefing to be productive and meaningful, reflection of the learners is essential. Measuring reflection during debriefing has proven to be difficult. This study aimed to validate a reflection rubric based on Kolb's Theory of Experiential Learning and integrate the assessment tool into simulation debriefing practice. This research was a non-experimental mixed-methods, sequential explanatory design. Validation for the rubric was accomplished by expert content review and an observation process. Students participated in a standardized patient simulation (SPS) portraying a patient with bipolar disorder. The SPS debriefings were recorded and thematically coded to determine the quality and level of reflection of the students according to the following rubric criteria based on Kolb's theory: (1) Concrete Experience, (2) Reflective Observation, (3) Abstract Conceptualism, and (4) Active Experimentation. A descriptive statistical analysis of student responses was applied. The Debriefing Reflection Rubric was successful in determining the level of reflection in the dental hygiene students; further descriptive results were evaluated by a thematic analysis of student responses (N=173). Student responses demonstrated reflective observations and concrete experiences (n=112); however, dental hygiene students demonstrated limited responses (n=61) to abstract conceptualism and connecting their experience to future goals and experimentation. The Debriefing Reflection Rubric, based on Kolb's Theory of Experiential Learning, was successful in measuring a learner's level and quality of reflection during a simulation debriefing.

End of life simulation to improve interprofessional competencies: A mixed methods study

BackgroundThe Accreditation Council for Pharmacy Education “Standards 2016” require that pharmacy student education include training in the management of patients “across the lifespan” (Standard 12). Standards 2016 also require that students are practice-ready to participate as a contributing member of an interprofessional (IP) team (Standard 11). Didactic and experiential education in palliative or end-of-life (EOL) care is limited. Palliative care represents unique patient and team challenges in providing patients with empathetic and holistic care. Interprofessional education activityThis study describes an IP, palliative care simulation that achieved both IP and “across the lifespan” educational standards. The goals of the activity included increasing communication skills, recognizing roles and responsibilities, and enhancing the value of various healthcare providers' perspectives and expertise when caring for patients at the EOL. Pharmacy, physical therapy, nursing, and counseling students participated in a low fidelity palliative care simulation. The event consisted of a presentation on anticipatory grief and active listening followed by a role-playing simulation and group debrief. The Interprofessional Socialization and Value Scale were administered to assess student perceptions of IP skills. DiscussionQuantitative and qualitative data demonstrated achievement of the goals of the activity. Reflections revealed students felt the simulation improved teamwork and communication skills and that using humility and listening in team-based palliative care transformed wisdom for future practice. ImplicationsThis activity used a cost-effective, low fidelity, role-play simulation to achieve IP education competencies and demonstrated the value of multiple professions in EOL care.

Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19

BackgroundMultiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic.MethodsWe reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10–25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed.ResultsDuring the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7–13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%).ConclusionDebriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.

An Interprofessional Branching Simulation to Introduce RN First Assistant Students to Their Role in the Perioperative Setting.

Simulation can be an effective tool for educating health profession students and can enhance interprofessional education by involving roles across multiple disciplines. Perioperative nurse educators at one institution used a five-part branching simulation of preoperative, intraoperative, and postoperative events for a single patient undergoing a procedure to introduce RN first assistant (RNFA) students to their role in the perioperative environment. The simulation participants included student RN anesthetists, a surgeon, an RN circulator (played by an actor), and a standardized patient. The objectives for this simulation were to assess the implementation of the didactic RNFA curriculum and to enhance the RNFA students' transition into their role in the perioperative setting. The simulation and multiple debriefings reinforced the concepts of role acquisition, surgical conscience, closed-loop communication, and interprofessional collaboration. Perioperative nurse educators can use this type of educational activity to teach these concepts to their students.

Twelve tips for effective simulation debriefing: A research-based approach

Evidence strongly supports simulation-based learning activities as an effective instructional intervention. The debriefing session associated with a simulation event is one of, if not the critical, learning component within the learning activity. Because of its importance, the debriefing portion of a simulation should demand as much planning and forethought as the rest of the event; however, it is often overlooked in the planning process. These twelve steps will help guide faculty who are planning simulation-based learning activities to ensure that their debriefing sessions are effective and successful learning opportunities.

In Situ Simulation: An Essential Tool for Safe Preparedness for the COVID-19 Pandemic.

Working under extreme stress can cause medical professionals to deviate from clinical guidelines even if they know of their existence, let alone in situations such as COVID-19 where guidelines are unclear, fluid, and resources limited. In situ simulation has been proven an effective tool for training medical professionals during previous healthcare crises, eg, Ebola, influenza, as well as for assessing the preparedness of centers by identifying potential latent safety threats. In this article, we describe our ongoing simulation activities to ensure that our staff is best prepared to adapt to the challenges of COVID-19. This is a prospective preparedness assessment and training intervention at a tertiary care academic center in Lebanon during the COVID-19 pandemic. In situ simulations followed by debriefing with good judgment occur daily involving native teams of 3 to 5 professionals in the newly established COVID intensive care unit and wards, the adult and pediatric intensive care unit and wards, and the emergency department. The simulations are assessed by the instructor using the Simulation Team Assessment Tool and by the participants using the Simulation Effectiveness Tool. Transcripts of recorded simulation debriefings are analyzed for content for latent safety threats using the SHELL Framework (Software-Hardware-Equipment-Liveware). In 2 weeks, we conducted 15 simulations with 106 participants and 47 observers. Simulation Team Assessment Tool scores show an overall improvement across the hospital over time [101.5 ± 13 (80-134)]. Participants' feedback on the Simulation Effectiveness Tool has been predominantly positive on the educational and practical benefits of the simulation activity. Data from debriefings and observations demonstrated the following categories of latent safety threats: inadequate preparedness on infection control, uncertainty of guidelines on oxygen supplementation and intubation protocols, lack of leadership and communication, overall panic, and others. Our single-center preparedness intervention demonstrated multiple latent safety threats in relation to COVID-19, which can be recognized through simulation before translating into actual patient care.

A Cost-Effective Solution to Video Debriefing and Livestreaming in Nursing Simulation

BackgroundSimulation and video debriefing are commonplace in nursing education. Cohesive, vendor-supplied technology solutions for livestreaming and debriefing can be cost-prohibitive. MethodsOur team developed a low-cost solution that we validated through informal student and faculty feedback. ResultsOur solution functions as intended, and students indicate overall benefit to their learning. ConclusionsThis proves that it is possible, with careful planning, for nurse educators to effectively implement a low-cost solution for simulation livestreaming and debriefing.

Latent safety threat identification during in situ simulation debriefing: a qualitative analysis

BackgroundLatent safety threats (LSTs) in healthcare are hazards or conditions that risk patient safety but are not readily apparent without system stress. In situ simulation (ISS), followed by post-scenario debriefing...