High-fidelity Human Simulation Research Articles

WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies

Abstract Aim The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact. Methods The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire. Results Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills. Conclusion The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.

Combining Virtual and High-fidelity Simulation to Foster Confidence and Competency in Postpartum Assessment Complications among Undergraduate Nursing Students

Background: Since maternal mortality is a key indicator of a country's health status, it is important to explore how undergraduate nursing programs are preparing nurses to for maternal child settings. Lack of appropriate clinical placements, increasing numbers of retiring Registered Nurses (RN) and faculty shortages are several of the contributing challenges to preparation for undergraduate nurses. Method: The study used the quasi-experimental single cohort preintervention and post intervention design using convenience sampling methodology. The participants were second year undergraduate nursing students (n = 95). All participants completed a five-hour simulation intervention that included a screen-based virtual simulation and two manikin-based simulations related to maternal assessment and postpartum complications. Results: The hybrid simulation intervention showed statistically significant increases in perceived competence and confidence in maternal postpartum assessment (p < .05). There was a significant positive relationship between general self-efficacy and perceived competence levels in maternal postpartum assessment (r = 0.35). Conclusions: A hybrid simulation that included an asynchronous virtual simulation component and a high-fidelity human simulation experience that was repeated can positively impact perceived competence and confidence in postpartum assessment competencies among undergraduate nursing students. Despite the sequencing of the virtual simulation (either before or after the high-fidelity simulation), students reported a significant increase in competence with learning through both asynchronous virtual simulation and in person manikin-based simulation.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning.

To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes. The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed. A scoping review was conducted using the Arksey and O'Malley framework. CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used. Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation. The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes. Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

Technical note: Using Johnson distributions to model trunk kinematics

As we seek to develop high fidelity human simulation models for ergonomic applications, the characterisation of the variability in human performance is needed. This technical note describes a method for generating probability density functions (PDFs) for one performance characteristic: trunk kinematics. A PDF from the Johnson family of distributions is defined by four parameters (γ, ξ, δ and λ) and can represent a variety of distributions. In this study, previously published trunk kinematic data were fit to Johnson distributions and regression equations for each of the four parameters were created as a function of starting lift height. Using regression coefficients and Monte Carlo simulation, PDFs for novel lifting conditions were generated. These predicted PDFs were compared with histograms of empirical data collected from a new group of ten lifters performing lifts in these novel conditions. A Kolmogorov–Smirnov goodness of fit test was performed to assess the quality of the fit. Seven of the predicted distributions of these kinematic variables were found to be a good fit with the novel empirical data.

Exploration of a Simulation-Based Learning Experience in Critical Care: The Use of Standardized Patients for Early Mobility Training

Purpose: The purpose of this study was to examine the influence of a simulation experience, using standardized patients (SPs), on physical therapy students' perceptions of comfort with early mobilization of patients in a critical care environment. Methods: To explore the influence of the simulation experience on students' confidence in the assessment and treatment of critically ill patients, a survey investigating the skills associated with cardiovascular and pulmonary physical therapy was developed and administered before and after the experience. In addition, focus group interviews explored the students' perceptions of the simulation scenarios. Results: Similar to studies using high-fidelity human simulators, students reported increased comfort with the skills required for early rehabilitation of patients in critical care settings. In addition, students discussed the realism of scenarios, the practical application of previously acquired knowledge, and the need to adapt to the patient response during the scenarios. Conclusions: With the advancement of the simulation technology, SPs can be used to accurately portray patients in critical care units. The use of SPs allows for the unrestricted ability to mobilize the patient and, therefore, the ability to practice the skills associated with early rehabilitation in the intensive care setting.

Simulation Training Facilitates Physical Therapists' Self-efficacy in the Intensive Care Unit

Purpose: Physical therapists (PTs) perform early mobilization in the intensive care unit (ICU), but specialized knowledge, skills, and behaviors for ICU clinical practice pose unique challenges. High-fidelity human simulation (HFHS) training prepares medical professionals for ICU practice, but evidence on HFHS training for PTs is limited. The purpose was to develop and evaluate an HFHS-based training program focused on improving PTs' self-efficacy for ICU clinical practice. Methods: Six PTs participated in 3 immersive HFHS experiences, each including a simulation and group debriefing. All participants completed self-efficacy surveys pre- and posttraining. A focus group was conducted to gather participant perspectives on the learning experience. Results: Significant improvements in 3 self-efficacy categories occurred: performing a chart review, understanding precautions/medications, and implementing early mobilization. Qualitative analysis of the focus group revealed 4 themes: simulation facilitates positive reinforcement and confidence building; collaborative learning in a safe environment promotes skill acquisition, teamwork in training improves clinical collaboration; and simulation provides effective orientation to complex line management. The small sample size and unknown psychometric properties of the self-efficacy scale limit these results. Conclusions: The HFHS program facilitated PTs' teamwork, collaboration, and self-efficacy for ICU clinical practice. Further investigation is recommended to evaluate the efficacy of HFHS as a training tool to enhance PT practice in the ICU.

A Perspective on Wearable Sensor Measurements and Data Science for Parkinson's Disease.

Miniaturized and wearable sensor-based measurements enable the assessment of Parkinson’s disease (PD) motor-related features like never before and hold great promise as non-invasive biomarkers for early and accurate diagnosis, and monitoring the progression of PD. High-fidelity human movement reconstruction and simulation can already be conducted in a clinical setting with increasingly precise and affordable motion technology enabling access to high-quality labeled data on patients’ subcomponents of movement (kinematics and kinetics). At the same time, body-worn sensors now allow us to extend some quantitative movement-related measurements to patients’ daily living activities. This era of patient movement “cognification” is bringing us previously inaccessible variables that encode patients’ movement, and that, together with measures from clinical examinations, poses new challenges in data analysis. We present herein examples of the application of an unsupervised methodology to classify movement behavior in healthy individuals and patients with PD where no specific knowledge on the type of behaviors recorded is needed. We are most certainly leaving the early stage of the exponential curve that describes the current technological evolution and soon will be entering its steep ascent. But there is already a benefit to be derived from current motion technology and sophisticated data science methods to objectively measure parkinsonian impairments.

Undergraduate Nursing Students’ Evaluation of the Debriefing Phase in Mental Health Nursing Simulation

The debriefing phase in mental health nursing simulation promotes a reflexive learning process with the opportunity to develop metacognitive and nontechnical skills. The aim of this quantitative study was to describe undergraduate nursing students’ evaluation of their experience during the debriefing phase following high fidelity human simulation (HFHS). Data was collected using the “Debriefing Experience Scale” and analysed with descriptive and comparative tests. The debriefing phase was evaluated as very good. Background data and group size revealed few significant differences. Students with little clinical praxis evaluated having time to acknowledge feelings as important. Differences between groups revealed that groups should consist of up to eighteen students.

Enhancing Prelicensure Nursing Students' Use of an Electronic Health Record

BackgroundNursing students must develop competency in the use of electronic health records (EHRs). This pilot investigates the impact of using a simulated EHR during high-fidelity human simulation. MethodPrelicensure students were evaluated pre- and postsimulation on accuracy and time to complete an EHR-based scavenger hunt. Focus groups evaluated student perception of the experience. ResultsNavigation time improved significantly (p < .0001) without decline in accuracy (p = .141). Student focus group comments support movement in level of proficiency from novice to competent. ConclusionIntegration of a simulated EHR into high-fidelity simulation improves student speed while maintaining accuracy in the utilization of health care technologies.

Student Clinical Performance in Acute Care Enhanced Through Simulation Training

Purpose:High-fidelity human simulation (HFHS) is implemented in physical therapy (PT) curricula to prepare students for acute care clinical experiences (CEs). Nursing and medical education literature supports HFHS in preparation for clinical practice, but there is limited evidence describing efficac

Effects of the Use of High-Fidelity Human Simulation in Nursing Education: A Meta-Analysis.

This study was conducted to evaluate the effects of high-fidelity human simulation (HFHS) on cognitive, affective, and psychomotor outcomes of learning. PubMed, Cochrane Library, EMBASE, CINAHL, and Korean databases were searched. The RevMan program was used for analysis. A meta-analysis was conducted of 26 controlled trials, with a total of 2,031 nursing students. The use of HFHS tended to have beneficial effects on cognitive and psychomotor domains of learning. In analysis of cognitive outcomes, the weighted average effect size across studies was -0.97 for problem-solving competency, -0.67 for critical thinking, and -2.15 for clinical judgment. The effect size for clinical competence of the psychomotor domain was -0.81. Use of HFHS might positively impact a high level of cognitive skill and clinical skill acquisition. Further research is required to determine the effectiveness of use of HFHS as an educational strategy to improve knowledge acquisition and communication skills.

High Fidelity Human Simulation Improves Physical Therapist Student Self-Efficacy for Acute Care Clinical Practice

Purpose.High fidelity human simulation (HFHS) is a pedagogical tool implemented in physical therapy curricula to prepare students for acute care clinical experiences. While evidence in nursing and medical education supports implementing HFHS in preparation for clinical practice, there is limited lit

Comparison of Baccalaureate Nursing Students' Experience of Video-Assisted Debriefing versus Oral Debriefing following High-Fidelity Human Simulation

High-Fidelity Human Simulation (HFHS) is used in many disciplines, including nursing, as an innovative teaching pedagogy that offers an active learning process. The simulation process involves a number of stages with the most critical stage identified as debriefing. The main focus of debriefing is to stimulate reflection and encourage communication while exploring the emotions of the participants. These emotions assist in framing the experience that aids in enhancement of learning for the student. This quantitative, quasi-experimental study explored the comparison of two debriefing processes, video-assisted and oral, by assessing the students' opinion of the debriefing experience and the students' rating of the importance of the debriefing experience. Participants were first semester baccalaureate nursing students. The overall finding and the four subscales for both dependent variables showed no statistical significance. This article provides further evidence to guide educators to a preferred method of debriefing students after a simulated experience.

Board #118 - Research Abstract Real Time Quantification of Stress during High-fidelity Human Simulation for a Standardized Learning Experience (Submission #9956)

Hypothesis A curvilinear relationship exists between stress and learning, implying that both extremes of high or low stress negatively impacts learning and performance. Stress is a central component of the High-fidelity Human Simulation (HFHS), which is increasingly being used in nursing education as an active learning tool. A degree of stress during participation arises from factors intrinsic to HFHS, including anticipation of the event, requirement for quick clinical decision-making and acuity of the scenario. Additionally, being watched by peers or educators and being afraid of getting embarrassed in front of everyone adds to the total stress experienced. This study investigated how stress level changes on a real time basis during standardized HFHS and if participants with different personality types and learning styles show distinctive patterns of stress evolution. These results will have significant implications for optimizing stress and maximizing learning in HFHS. Methods First-year novice learners, who have no clinical or HFHS experience were included. Nursing students were involved in an hour-long clinical simulation experience, including a pre-brief session a 20-minute simulation session followed by a debriefing session. Salivary cortisol (pre and post simulation) and heart rate variability low frequency to high frequency ratio (LF/HF-HRV) calculated every 5-minute from real time EKG data (pre, during and post simulation) were used for stress quantification. The BIG 5 Personality test and the Honey and Mumford Learning Styles Inventory that were used to assess personality and learning style respectively were completed at a later time. Multiple regression analysis was used to examine the strength of association. Results Salivary Cortisol levels and LF/HF-HRV showed statistically significant increase from pre to post simulation p<0.05. There was a moderate positive correlation between Salivary Cortisol concentration and LF/HF-HRV, r(20) = .371, p < .0005, with LF/HF-HRV explaining 14% of the variation in salivary cortisol concentration. The Neuroticism personality trait and theorist style of learning had significant positive regression weights, indicating students with higher scores on these scales had higher post-simulation stress levels. Moreover, openness personality trait had a significant negative weight, indicating that students with higher scores on openness to experiences had lower post-simulation stress level. Conclusion Optimal level of stress is essential for effective use of HFHS for acquisition and retention of knowledge and skills. Therefore, this pilot study is important as it provides the first data elucidating the pattern of change in stress during a standardized HFHS scenario. Importantly, results show that LF/HF-HRV is a valid tool that can be used to provide stress level on a real time basis giving the researcher a very high temporal resolution for stress quantification that can be used non-invasively and without interfering the scenario performance. Future research should include larger participants with performance assessment.

The acquisition and retention of urinary catheterisation skills using surgical simulator devices: teaching method or student traits.

BackgroundThe acquisition of procedural skills is an essential component of learning for medical trainees. The objective of this study was to assess which teaching method of performing urinary catheterisation is associated with most efficient procedural skill acquisition and retention. We evaluated factors affecting acquisition and retention of skills when using simulators as adjuncts to medical training.MethodsForty-two second year medical students were taught urinary catheter insertion using different teaching methods. The interactive group (n = 19) were taught using a lecture format presentation and a high fidelity human urinary catheter simulator. They were provided with the use of simulators prior to examination. The observer group (n = 12) were taught using the same method but without with simulator use prior to examination. The didactic group (n = 11) were taught using the presentation alone. Student characteristics such as hand dexterity and IQ were measured to assess for intrinsic differences. All students were examined at four weeks to measure skill retention.ResultsCatheter scores were significantly higher in the interactive group (p < 0.005). Confidence scores with catheter insertion were similar at index exam however were significantly lower in the didactic group at the retention testing (p < 0.05). Retention scores were higher in the interactive group (p < 0.001). A significant positive correlation was observed between laparoscopy scores and time to completion with overall catheter score (p < 0.05). Teaching method, spatial awareness and time to completion of laparoscopy were significantly associated with higher catheter scores at index exam (p = 0.001). Retention scores at 4 weeks were significantly associated with teaching method and original catheter score (p = 0.001).ConclusionThe importance of simulators in teaching a complex procedural skill has been highlighted. Didactic teaching method was associated with a significantly higher rate of learning decay at retention testing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-014-0264-3) contains supplementary material, which is available to authorized users.

The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

Providing high-quality clinical experiences for students has been a perennial challenge for nursing programs. Short patient length of stays, high patient acuity, disparities in learning experiences, and the amount of time instructors spend supervising skills have long been issues. More recently, other challenges have emerged: more programs competing for limited clinical sites, faculty shortages, facilities not granting students access to electronic medical records, and patient safety initiatives that decrease the number of students allowed on a patient unit or restrict their activity to observing care. With high-fidelity simulation, educators can replicate many patient situations, and students can develop and practice their nursing skills (cognitive, motor, and critical thinking) in an environment that does not endanger patients. As the sophistication of simulation has grown over the last 10 years, the number of schools using it has increased as well, and boards of nursing (BONs) have received requests from programs for permission to use simulation to replace some traditional clinical experience hours. However, the existing literature does not provide the level of evidence that BONs need to make a decision on simulation as a replacement strategy. Though studies indicate that simulation is an effective teaching pedagogy, they lack the rigor and generalizability to provide the evidence needed to make policy decisions. The NCSBN National Simulation Study, a large-scale, randomized, controlled study encompassing the entire nursing curriculum, was conducted to provide the needed evidence. Incoming nursing students from 10 prelicensure programs across the United States were randomized into one of three study groups: ●Control: Students who had traditional clinical experiences (no more than 10% of clinical hours could be spent in simulation) ●25% group: Students who had 25% of their traditional clinical hours replaced by simulation ●50% group: Students who had 50% of their traditional clinical hours replaced by simulation. The study began in the Fall 2011 semester with the first clinical nursing course and continued throughout the core clinical courses through graduation in May 2013. Students were assessed on clinical competency and nursing knowledge, and they rated how well their learning needs were met in both the clinical and simulation environments. A total of 666 students completed the study requirements at the time of graduation. At the end of the nursing program, there were no statistically significant differences in clinical competency as assessed by clinical preceptors and instructors (p=0.688); there were no statistically significant differences in comprehensive nursing knowledge assessments (p=0.478); and there were no statistically significant differences in CLEX® pass rates (p=0 737) among the three study groups The study cohort was also followed for the first 6 months of clinical practice There were no differences in manager ratings of overall clinical competency and readiness for practice at any of the follow-up survey time points: 6 weeks (p=0 706), 3 months (p=0.511), and 6 months (p=0.527) of practice as a new registered nurse. The results of this study provide substantial evidence that substituting high-quality simulation experiences for up to half of traditional clinical hours produces comparable end-of-program educational outcomes and new graduates that are ready for clinical practice.

Simulation Enhances Self-Efficacy in the Management of Preeclampsia and Eclampsia in Obstetrical Staff Nurses

BackgroundPreeclampsia and eclampsia are associated with high morbidity and mortality rates, which can be greatly influenced by proactive and competent nursing care. The infrequent occurrence of these emergencies provides limited exposure for nurses to remain highly skilled and effective. MethodThis prospective cohort study investigated the impact of high-fidelity human simulation on the self-efficacy of nurses in the management of preeclampsia and eclampsia. Bandura's theory of self-efficacy and NLN/Jeffries' Simulation Framework provided the foundation for this project. Pretest, immediate posttest, and 8-week posttest single-group design was used to compare preintervention data with postintervention data for family birth place staff nurses (N = 49) attending the simulation training. Results, ConclusionsObstetric nurses' overall self-efficacy with preeclampsia and eclampsia management significantly increased with high-fidelity human simulation training. More important, the level of self-efficacy was sustained over time. Staff nurse satisfaction responses were also overwhelmingly positive regarding the training experience. This study supports the use of high-fidelity human patient simulation as an effective training approach and suggests that other high-risk, low-incidence obstetric emergencies may also be suitable topics for simulation training.

Improving Obstetrical Staff Nurse Self-Efficacy Through High Fidelity Human Simulation (HFHS) Training

Improving Obstetrical Staff Nurse Self-Efficacy Through High Fidelity Human Simulation (HFHS) Training

High fidelity simulation in critical care: A Canadian perspective

The use of high fidelity human simulation has exploded into the nursing education context over the last decade. In Ontario, Canada an innovative Critical Care e-learning program was established in 2007 to create accessible critical care education for nurses across Ontario and Canada. The program has a three-pronged approach including online, simulation and practicum components. The purpose of this paper is to present lessons learned during the last five years of development and growth of this program. The paper will focus on the use of simulation to build confidence and prepare registered nurses for critical care nursing practice. In addition, subsequent development of a network of ten simulation partners that deliver critical care simulation will be discussed. High fidelity simulation delivery in the critical care context will be explored and the use of summative or 'high stakes' simulation competency evaluation will be elaborated on.

High-fidelity multiactor emergency preparedness training for patient care providers

Providing comprehensive emergency preparedness training (EPT) for patient care providers is important to the future success of emergency preparedness operations in the United States. Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce in a training environment. Few EPT programs possess both competency-driven goals and metrics to measure life-saving performance during a multiactor simulated disaster. The development of an EPT curriculum for patient care providers-provided first to medical students, then to a group of experienced disaster medical providers-that recreates a simulated clinical disaster using a combination of up to 15 live actors and six high-fidelity human simulators is described. Specifically, the authors detail the Center for Health Professional Training and Emergency Response's (CHPTER's) 1-day clinical EPT course including its organization, core competency development, medical student self-evaluation, and course assessment. Two 1-day courses hosted by CHPTER were conducted in a university simulation center. Students who completed the course improved their overall knowledge and comfort level with EPT skills. The authors believe this is the first published description of a curriculum method that combines high-fidelity, multiactor scenarios to measure the life-saving performance of patient care providers utilizing a clinical disaster scenario with > 10 patients at once. A larger scale study, or preferably a multicenter trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.