High-fidelity Mannequin Research Articles

267 Research Protocol Training Through an Electronic Learning Module and in Situ Simulation

We describe the process of clinical staff training of a complex emergency research study through a layered approach to disseminating study protocol information to clinical staff. The Established Status Epilepticus Treatment Trail (ESETT) seeks to compare effectiveness of fos-phenytoin, levetiracetam, or valproic acid in subjects with benzodiazepine-refractory status epilepticus. ESETT is an EFIC trial in which qualifying subjects can be enrolled by the clinical staff within minutes of ED admission often in the absence of the research team. An e-learning module was created to emphasize crucial clinical care elements of the protocol including: the importance of benzodiazepine dosing and timing, rationale for use of Exception From Informed Consent (EFIC), study drug dosing and administration, the post-infusion assessments, and how to contact the study team. A seizure SIM scenario was drafted based on clinical learning objectives for a successful ESETT enrollment including: recognizing a potential ESETT subject as a patient with seizures despite adequate benzodiazepine dosing (without coordinator prompting); proper study drug administration and follow-up assessments. The study protocol assist device (iPod touch) was set to practice mode and mock-drug (saline) was loaded into the study drug kit. On the day of the SIM, a seizure code was called into ED dispatch and clinical staff to treat a high-fidelity SIM mannequin in status epilepticus. The clinical staff administered mock benzodiazepine doses and then identified the seizing SIM mannequin as a potential ESETT subject. Clinical staff located the ESETT study drug box, verified inclusion/exclusion and study dose, utilized the administered mock study drug and followed the prompts from the protocol assist device through the first post infusion assessment. Immediately after the in situ SIM, a SIM de-brief occurred that included the clinical staff (physicians, nurses and pharmacy staff) and the clinical research team (co-investigator, lead coordinator). The LMS report showed 40/45 (89%) of ED RN staff viewed the e-learning module. During the SIM debriefing, clinical staff and the research team jointly identified logistical barriers to address including: study poster location, slow iPod, procedure to un-blind study drug, proper “next steps for care” in the event of study drug failure. The feedback from the ED staff was that they learn better by doing (kinesthetic learning style). “Hands on is always the best, easier to learn when you get to see and do.” In situ simulation (SIM) is used in clinical education and training, but evidence on its utility for protocol training in research trials is limited. A layered approach to disseminating study protocol information to clinical staff including an e-learning module and kinesthetic learning through an in situ SIM helped the clinical staff incorporate protocol training into their clinical care.

Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis.

Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.

UNDERGRADUATE NURSING STUDENTS’ EXPERIENCES CARING FOR PATIENTS WITH ALZHEIMER'S DISEASE AFTER BEING PREPARED WITH SIMULATION: A PHENOMENOLOGICAL APPROACH

As people with Alzheimer's gradually lose their ability to find words, express thoughts and follow conversations, they also have more difficulty understanding others. Communication changes during the middle stages include trouble finding the right word, repeating questions, losing the train of thought, reverting to a native language and relying on nonverbal communication. The middle stages of Alzheimer's are typically the longest and can last for many years. As dementia progresses, the person with Alzheimer's will require a greater level of care (Middle-StageCaregiving,2017). The care of the patient with AD, especially in the moderate stage (middle-stage) of the illness, requires an expertise, as care needs are changing, and is the disease stage most nursing students may encounter in a clinical rotation. Simulation in nursing education is used as an experiential teaching strategy, with high fidelity mannequins, as a means for nursing students to experience clinical situations in a safe environment before experiencing the situation in a real clinical setting. Studies have demonstrated that simulations that focus on care of older adults can lead to improved clinical judgment and empathy among nursing students. Much of the research focusing on gerontological education includes studies detailing negative student attitudes toward older adults and the effects of curriculum and learning activities on attitudes (Gutheil, Chernesky, & Sheratt, 2006; Holroyd, Dahlke, Fehr, Jung, & Hunter, 2009; Koh, 2012; McLafferty & Morrison, 2004; Scerri & Scerri, 2013). The purpose of this study was to describe the meaning of experiences of senior nursing students who have cared for patients with AD during their clinical rotations one year after they experienced a simulation during their laboratory rotation, junior year. Design and Philosophy: This study used Colaizzi's (1978) method of descriptive phenomenology which is based on Edmund Husserl's philosophy of phenomenology. Sample: Purposive sampling was used to ensure nursing students who had this experience are chosen. The sample criteria of three was chosen as part of this assignment. Themes: Utilizing Colazzi's (1978) method of data analysis, 55 significant statements emerged from transcribed interviews of the nursing student's experiences caring for a patient with AD after being prepared with simulation.

Use of Real Patients and Patient-Simulation-Based Methodologies for Teaching Gastroenterology to Pre-Clinical Medical Students.

In recent years, there has been an increasing focus on the need to integrate formal knowledge with clinical experience in the pre-clinical years since the initial years of medical education play an important role in shaping the attitudes of medical students towards medicine and support the development of clinical reasoning. In this study, we describe approaches that involve real patients and patient-simulation-based methodologies to teach gastroenterology to second year medical students. Our goals were to (i) demonstrate bio-psychosocial aspects of clinical practice, (ii) demonstrate commonality of gastrointestinal ailments, and (iii) help understand complex gastroenterology concepts. We used two main approaches including brief, pre-prepared questions and answers discussing with the patients in various sessions throughout the course and a two-hour session that included patient participation, patient simulation modalities with high fidelity mannequins, a lightening round of interactive cases, and a Patient Oriented Problem Solving (POPS) session. The approaches improved the effectiveness of the delivery of the content-heavy, fast-paced GI course and provided opportunities for the students to think about gastroenterology from both basic and clinical points of view. The approaches involved peer teaching, which supports knowledge acquisition and comprehension. Very positive feedback and overall engagement of students suggested that these approaches were well-received.

In situ simulation in the management of anaphylaxis in a pediatric emergency department.

Anaphylaxis is a potentially life-threatening, rapid-onset hypersensitive reaction, usually treated in the emergency department (ED). Failure to recognize anaphylaxis leads to under-treatment with epinephrine and even when correctly diagnosed, epinephrine is not always administered. In addition, often patients who are treated in the ED are not referred for allergy work-up. Simulation is a tool that increases exposure to events in a safe environment, allowing trainers to develop skills without harming patients. The main purpose of our study was to determine whether in situ simulation training increases the frequency of epinephrine use. The secondary aim was to observe whether simulation modifies the number of children investigated over the years before and after the setting up of the simulation training. All patients with anaphylaxis referred to the Pediatric Emergency Department (PED) of the Anna Meyer Children's Hospital from 2004 to 2010 [pre-simulation (PRE-s) period], and from 2011 to 2016 [post-simulation (POST-s) period], were retrospectively included in this observational study. Simulation was carried out using a high-fidelity patient simulator mannequin (SimBaby, Laerdal Medical, Inc, Stavanger, NY). The diagnosis of anaphylaxis was based on the EAACI guidelines. The use of epinephrine significantly increased (p < 0.05) between the PRE-s and POST-s time periods: 2.4% versus 10% patients, respectively. During the two time periods, we also observed a significant increase (p = 0.011) in the number of patients who underwent a complete allergy work-up: 36% versus 51% patients, respectively. According to our results, the in situ simulation program improved the correct management of anaphylaxis in terms of prompt use of epinephrine, and it also led to a higher number of patients being referred to the allergy unit for evaluation.

P107: The development of a mentorship based, near-peer simulated resuscitation training program for medical trainees

Introduction: High quality Cardiopulmonary Resuscitation (CPR) saves lives, however skill retention after standard Basic Life support (BLS) courses has been shown to be poor. Our goal was to develop a student-run, mentorship based program to allow repetitive practice of BLS skills while minimizing resource commitment and time requirements. Methods: We developed a top down training program that relied on online teaching resources, regular simulation training and near-peer feedback. First year medical students were given the opportunity to participate in the program and baseline CPR quality was documented. They were then divided into intervention and control groups. The intervention group participated in bi-monthly 40-minute small group training sessions directed by senior medical students and monitored by a staff physician. The control group received no further training. At the end of the 8-month study period CPR quality was documented for all participants. Results: We included data from 54 medical students. Overall compression depth and rate were monitored using Laderall SimMan 3G(TM) high-fidelity CPR mannequins. Average rate and depth of compression were significantly improved in the intervention group relative to both the control group that did not receive training, as well as relative to the intervention groups own pre intervention values (both with p values below 0.05 using Mann-Whitney tests and an intention to treat analysis for loss to follow up). Conclusion: Our study demonstrated a significant improvement in CPR quality as a result of our intervention. Survey data also indicated positive feedback from participants in relation to comfort with in-hospital CPR. As such we intend to continue to run this program, identifying participants each year whom can move into training and leadership roles to help foster CPR and basic resuscitation in our medical community.

Pediatric Emergency Medicine Simulation Curriculum: Electrical Injury.

Electrical injuries are rare but potentially life-threatening medical emergencies that require providers to manage a critically ill patient while recognizing and treating the unique sequelae associated with the diagnosis. This simulation case is designed to give pediatric and emergency medicine residents, fellows, attendings, and nurses the opportunity to practice these skills in a realistic setting. This simulation-based curriculum was designed for a high-fidelity mannequin in an emergency department resuscitation room but can be adapted to fit a variety of learning environments. The case featured a 16-year-old boy presenting to the emergency department after arresting in the field after sustaining an electrical injury. He developed ventricular tachycardia during the simulation and had significant hyperkalemia, requiring emergent management. The included debriefing tools assisted instructors in providing formative feedback to learners. A total of 40 residents, medical students, and fellows participated in this scenario and provided overwhelmingly positive feedback about the learning experience. Mean Likert scores for participant confidence related to learning objectives after the simulation were 4 or greater on a 5-point scale. This case was developed to help learners at various levels of training recognize and manage a low-frequency, high-acuity scenario in a standardized environment. Participants specifically had the opportunity to perform airway management, cardiopulmonary resuscitation, defibrillation, and management of hyperkalemia, which may present in real life from a multitude of etiologies. The included materials helped prepare and assist facilitators with debriefing, supplemental education, and bidirectional feedback.

Performance and retention of basic life support skills improve with a peer-led training program

Background and purposePharmacy students’ performance and retention of Basic Life Support (BLS) skills were evaluated 120 days after completion of a peer-led BLS training program. Educational activity and settingThis was a single-center, parallel group, observational study. Doctor of pharmacy (PharmD) students in their third professional year completed a peer-led BLS training program (n = 148) and participated in a high-fidelity mannequin simulation activity 120 days later. Students were randomly assigned to rapid response teams (n = 24) of five to six members and the American Heart Association's standardized form for BLS assessment was used to assess BLS skills performance. The performance of skills was compared to that of students two years prior to the implementation of the peer-led BLS program. Findings and discussionStudents who received peer-led BLS training demonstrated retention of BLS skills 120 days after the BLS training program. The teams also displayed significant improvement of the skills evaluated when compared to student teams prior to implementation of the peer-led training (n = 22). Improvement was demonstrated for assessment of responsiveness (96% vs. 41%, p < 0.001), assessment for breathing (100% vs. 32%, p < 0.001), assessment for pulse (96% vs. 36%, p < 0.001), and administration of appropriate ventilation (100% vs. 32%, p < 0.001). Numerical superiority was exhibited for high-quality cardiopulmonary resuscitation (CPR) initiation by teams who received peer-led training (100% vs. 86%, p = 0.101). SummaryStudents who received peer-led BLS training demonstrated significant improvement in BLS skills performance and retention 120 days after the training program. Data suggests that peer-led BLS training can improve student BLS skills performance and retention.

Comparison of the Efficacy and Efficiency of the Use of Virtual Reality Simulation With High-Fidelity Mannequins for Simulation-Based Training of Fiberoptic Bronchoscope Manipulation.

This study compared the efficacy and efficiency of virtual reality simulation (VRS) with high-fidelity mannequin in the simulation-based training of fiberoptic bronchoscope manipulation in novices. Forty-six anesthesia residents with no experience in fiberoptic intubation were divided into two groups: VRS (group VRS) and mannequin (group M). After a standard didactic teaching session, group VRS trained 25 times on VRS, whereas group M performed the same process on a mannequin. After training, participants' performance was assessed on a mannequin five consecutive times. Procedure times during training were recorded as pooled data to construct learning curves. Procedure time and global rating scale scores of manipulation ability were compared between groups, as well as changes in participants' confidence after training. Plateaus in the learning curves were achieved after 19 (95% confidence interval = 15-26) practice sessions in group VRS and 24 (95% confidence interval = 20-32) in group M. There was no significant difference in procedure time [13.7 (6.6) vs. 11.9 (4.1) seconds, t' = 1.101, P = 0.278] or global rating scale [3.9 (0.4) vs. 3.8 (0.4), t = 0.791, P = 0.433] between groups. Participants' confidence increased after training [group VRS: 1.8 (0.7) vs. 3.9 (0.8), t = 8.321, P < 0.001; group M = 2.0 (0.7) vs. 4.0 (0.6), t = 13.948, P < 0.001] but did not differ significantly between groups. Virtual reality simulation is more efficient than mannequin in simulation-based training of flexible fiberoptic manipulation in novices, but similar effects can be achieved in both modalities after adequate training.

The use of high-fidelity mannequin training to improve the quality of healthcare providers? performance of CP

The use of high-fidelity mannequin training to improve the quality of healthcare providers? performance of CP

Bag Valve Mask Ventilation as a Perceptual-Cognitive Skill.

Objective This study used a high-fidelity infant mannequin to examine the relationship between the quality of bag valve mask ventilation (BVMV) and how providers of varying levels of experience use visual feedback (e.g., electronic vital signs) to guide their performance. Background BVMV is a common and critical procedure for managing pediatric respiratory emergencies. However, providers do not consistently deliver effective BVMV. Efforts to improve BVMV have ignored the question of how providers effectively use feedback often available during BVMV. Method Six expert and six novice respiratory therapists completed two simulations of an infant requiring BVMV. In one, the technology failed to display SpO2, an important but somewhat redundant visual cue. Eye movements, verbal reports, and ventilation rate (in breaths per minute) were measured in each simulation. Results Regardless of SpO2 availability, eye movements and verbal reports suggested that novices depended strongly on electronic vital signs and when SpO2 was absent ventilated at a faster rate (exceeding the recommended range of ventilation rates) than when SpO2 was present. Experts' ventilation rates were comparable and within the recommended range in both conditions. When SpO2 was absent, experts emphasized information from direct observation of the patient that novices neglected. Conclusion Individual differences in the use of feedback during BVMV contribute to the quality of BVMV. This work bears on the theoretical discussions involving the use of automation and nontechnological cues to guide performance. Application These results have the potential to expand the current understanding of factors underlying effective BVMV with implications for training novice providers.

Mobile emergency simulation training for rural health providers.

Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. Furthermore, satisfaction is a critical element for active learning. Together, the authors evaluated Canadian rural healthcare providers' satisfaction from high fidelity emergency simulation training using a modified motorhome as a mobile education unit (MEU). Over a 5-month period, data was collected during 14 educational sessions in nine different southern Manitoban communities. Groups of up to five rural healthcare providers managed emergency simulation cases including polytrauma, severe sepsis, and inferior myocardial infarction with right ventricular involvement, followed by a debrief. Participants anonymously completed a feedback form that contained 11 questions on a five-point Likert scale and six short-answer questions. Data from 131 respondents were analyzed, for a response rate of 75.6%. Respondents included nurses (27.5%), medical residents (26.7%), medical first responders (16.0%), and physicians (12.2%). The median response was 5 for overall quality of learning, development of clinical reasoning skills and decision-making ability, recognition of patient deterioration, and self-reflection. The post-simulation debrief median response was also 5 for summarizing important issues, constructive criticism, and feedback to learn. Respondents also reported that the MEU provided a believable working environment (87.0%, n=114), they had limited or no previous access to high fidelity mannequins (82.7%, n=107), and they had no specific training in crisis resource management or were unfamiliar with the term (92%, n=118). A high level of satisfaction was reported in rural health providers with mobile emergency simulation. Access to and experience with high fidelity mannequins was limited, suggesting areas for potential educational growth.

Effectiveness of positive pressure ventilation during newborn care unit evacuation

ObjectiveAssess the utility of high fidelity simulation in understanding effectiveness of bag-valve ventilation in a simulated newborn intensive care unit vertical evacuation. ParticipantsA total of 70 participants, (13 teams of 4–6 staff) including physicians, nurses, respiratory therapists and other support personnel participated in a 90-min evacuation sessions. MethodsTwo wireless high-fidelity newborn mannequins (Gaumand ScientificR) provided real-time data of ventilation support during a NICU evacuation exercise. Trained evaluators also recorded data related to performance. Following the exercises, the simulator data were downloaded and analyzed for rate and consistency of respirations. ResultsUsing the data from the simulators and evaluator comments, it was found the infants received proper airway management during the evacuation only 58% of the time. This study highlights the need for ongoing training for NICU staff around safe, effective, coordinated, and timely care of these fragile newborns in the event of an evacuation.

Rapid Cycle Deliberate Practice: Application to Neonatal Resuscitation.

This curriculum includes two simulation cases for neonatal resuscitation training using the rapid cycle deliberate practice (RCDP) technique. RCDP is a simulation-based curriculum that presents participants with rounds of increasing difficulty in rapid repetition, interspersing brief, direct feedback within the simulation. In contrast, traditional debriefing focuses on learning after the scenario is complete. Traditional debriefing usually utilizes advocacy-inquiry debriefing but allows less opportunity for practice. Each case provides a neonatal resuscitation scenario (respiratory failure secondary to perinatal compromise and cardiac arrest secondary to placental abruption) for a term newborn in the delivery room. The curriculum utilizes high-fidelity neonatal mannequins with learner teams of three to six multidisciplinary teammates who participate in scenarios of increasing difficulty to revive a neonate. Learners can include a spectrum from beginning to advanced neonatal resuscitation providers. Learners are expected to perform the appropriate steps per the neonatal resuscitation program algorithm in addition to exhibiting effective crisis resource management skills. Immediate assessment of learner performance and feedback within the RCDP model is more directive, which allows for rapid resumption of practice. The instructor may also choose to pause and back up or to pause and restart, depending on the correction needed. Neonatal resuscitation program teaching utilizes a neonatal resuscitation performance evaluation, which may be used to guide opportunities for feedback within RCDP.

Shame in Medical Education: A Randomized Study of the Acquisition of Intimate Examination Skills and Its Effect on Subsequent Performance

ABSTRACTTheory: Although medical students are exposed to a variety of emotions, the impact of emotions on learning has received little attention so far. Shame-provoking intimate examinations are among the most memorable events for students. Their emotions, however, are rarely addressed during training, potentially leading to withdrawal and avoidance and, consequently, performance deficits. However, emotions of negative valance such as shame may be particularly valuable for learning, as they might prompt mental rehearsal. We investigated the effect of shame on learning from the perspective of cognitive load theory. Hypotheses: We hypothesized that (a) training modality determines state shame, (b) state shame directly affects the quality of a clinical breast examination as one example of a shame-provoking exam, and (c) students who experience shame during training outperform those who just discuss the emotion during subsequent performance assessments. Method: Forty-nine advanced medical students participated in a randomized controlled, single-blinded study. After a basic, low-fidelity breast examination training, students were randomized to further practice either on a high-fidelity mannequin including a discussion of their emotions or by examining a standardized patient's real breasts. Last, all students conducted a breast examination in a simulated doctor's office. Dependent variables were measures of outcome and process quality and of situational shame. Results: Students training with a standardized patient experienced more shame during training (p < .001, d = 2.19), spent more time with the patient (p = .005, d = 0.89), and documented more breast lumps (p = .026, d = 0.65) than those training on a mannequin. Shame interacted with training modality, F(1, 45) = 21.484, p < .001, η2 = 0.323, and differences in performance positively correlated to decline in state shame (r = .335, p = .022). Conclusions: Students experiencing state shame during training do reenact their training and process germane load—in other words, learn. Furthermore, altering simulation modality offers a possibility for educators to adjust the affective component of training to their objectives.

Simulated Cases in Clinical Training for Pharmacists

Clinical classes are the milestones that help pharmacy students gain clinical competency and to prepare them for their professional life. Although didactic methods provide theoretical knowledge, the retention rate of information is relatively low when compared with problem based teaching methods. Simulators such as high fidelity mannequins or standardized simulated patients are often preferred by clinical teachers in schools that teach health profession. High and low fidelity mannequins, and computerized simulators require a cost and dedicated space, which can be a disadvantage. On the other hand, standardized patients are advantageous to develop communication skills. Hence, use of simulation based methods in clinical training are useful in general, because they lead students to self-directed learning strategies, critical thinking and rational decision-making. Therefore, dissemination of simulation techniques is important to improve clinical skills.

Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses.

The use of simulation in medical training is quickly becoming more common, with applications in emergency, surgical, and nursing education. Recently, registered nurses working in surgical inpatient units requested a mock code simulation to practice skills, improve knowledge, and build self-confidence in a safe and controlled environment. A simulation scenario using a high-fidelity mannequin was developed and will be discussed herein.

Simulation in Undergraduate Psychiatry: Exploring the Depth of Learner Engagement.

Simulation-based methodologies are increasingly used in undergraduate medical education to expand students' exposure to complex clinical scenarios. Engagement of students in these simulation-based methodologies is a key determinant of their success in learning. Thus, the authors conducted a systematic review to (1) identify simulation methods in use within the undergraduate psychiatry curriculum and (2) assess learner engagement using these methods. Following a PRISMA methodology, the authors searched MEDLINE, ERIC, and PsychINFO databases from 1977 to 2015. Studies applying simulation in undergraduate psychiatric education were reviewed. The depth of learner engagement was assessed using Kolb's four-stage learning cycle. Of 371 publications identified, 63 met all the inclusion criteria: 48 used standardized patients and 16 used online or virtual learning case modules. Only one study used high fidelity mannequins. Three studies satisfied multiple stages in Kolb's Learning Cycle, including a single study that addressed all four domains. Despite the varied uses of simulation across other health disciplines, there were few novel or innovative uses of simulation in undergraduate psychiatric education since the last review in 2008. Expanding on the use of simulation to improve communication, build empathy, and decrease stigma in psychiatry is essential given the relevance to all facets of medical practice. Given the complexity of psychiatry, simulation interventions should extend beyond communication scenarios. Medical students need more opportunities to reflect and debrief on simulation experiences and integrate learning into new contexts. Faculty development should focus on these novel approaches to simulation to deeply engage learners and enhance outcomes.

Pediatric Emergency Medicine Simulation Curriculum: Hyponatremic Seizures.

Seizures are a common complaint in the pediatric emergency department. Effective care of this potentially life-threatening medical emergency requires the ability to stabilize the patient while simultaneously identifying and treating the underlying cause. This simulation-based curriculum involves the identification and management of a generalized seizure in a 4-month-old infant secondary to hyponatremia. The target audience is pediatric and emergency medicine residents, fellows, faculty, and nurses. There is no prerequisite preparation for the trainees prior to the case. The simulation scenario, simulation environment preparation, teamwork and communication glossary, and PowerPoint presentation are provided for the instructor in preparation for the simulation case. The setting is the emergency department (ED) resuscitation room. The simulation can be conducted in the ED resuscitation room or in the simulation lab. We used a high-fidelity infant mannequin. The debriefing tools have been tailored specifically for this scenario with advice on how the instructor can edit them for different learners. We have used this curriculum with a group of six pediatric emergency medicine fellows at various stages of their training at our institution. The curriculum received overwhelmingly positive feedback through the evaluation form. This resource will help support standardization of the teaching process, assisting simulation instructors to maximize their impact. In our experience, we have found that instructors who teach intermittently can successfully foster simulation-based education using similar resources. The inclusion of a learner feedback form supports the instructor's ongoing growth while helping faculty to document their teaching efforts.

A trans-atlantic high-fidelity mannequin based telesimulation experience

A trans-atlantic high-fidelity mannequin based telesimulation experience