High-fidelity Mannequin Research Articles

Virtual Reality for Pediatric Trauma Education - A Preliminary Face and Content Validation Study

PurposePediatric trauma education remains expensive and available only to a few providers worldwide. Innovative educational technologies like virtual reality (VR) can be key to decentralizing trauma education. This preliminary validation study evaluates the face and content validity of a VR software designed to enhance pediatric trauma skills. MethodsPhysicians were invited to test a VR software simulating a child with blunt head and truncal trauma. After the simulation, they filled out surveys assessing the face and content validity of the scenario, including the software's realism, interaction, ease of use, and educational content. Additionally, they completed a cybersickness questionnaire. A descriptive statistical analysis was performed. ResultsEleven physicians from eight different countries tested the VR software. Most found it valuable, and realistic and would prefer using it over high-fidelity mannequins for training. The software received more favorable evaluations for non-technical skills training than for technical skills. Regarding cybersickness most participants reported discomfort during the simulation. ConclusionParticipants agreed that a VR platform for pediatric trauma is realistic and immersive, and they endorsed it for enhancing performance, particularly in non-technical skills. Most participants, however, faced some discomfort with the technology, and efforts to minimize cybersickness should be made in future implementation, feasibility, and effectiveness studies. Level of EvidenceIV.

Effect of Infection Control Simulation Based on a Negative Pressure Isolation Room Using Mixed Reality.

This study aimed to examine the effectiveness of an infection control simulation using mixed reality, comparing simulation fidelity with a high-fidelity mannequin (MN) group and problem-based learning with written cases group. This study used a three-group pretest-posttest quasi-experimental design. Two universities with similar curricula were conveniently selected, and a total of 72 nursing students were recruited. Participants were randomly assigned to three groups of 24 each. In the final analysis, there were 22 participants in the mixed reality groups, 21 in the mannequin groups, and 23 in the problem-based learning with written cases groups. Data were analyzed using descriptive statistics and the χ 2 , Kruskal-Wallis, and Wilcoxon signed rank tests. The mixed reality groups had a significantly positive effect on clinical reasoning ability and clinical competence than the problem-based learning with written cases groups, whereas the mannequin groups had a significantly positive effect on clinical competence than the problem-based learning with written cases groups. Mixed reality simulation is an appropriate simulation method that enhances learning immersion, satisfaction, and self-confidence in simulation. Additionally, it can substitute for mannequin simulation in terms of clinical reasoning ability and clinical competence. This study suggests that it is important to the various approaches in simulation fidelity to diversely enhance the competency of nursing students in simulation outcomes.

Improving Neonatal Resuscitation Knowledge in Advanced Providers Through Simulation: A Quality Improvement Project.

Advanced neonatal resuscitation events are high-risk, low-volume critical situations. Healthcare systems have placed emphasis on improving resuscitation skills for advanced providers based on evidence showing that it can directly impact patient outcomes. Neonatal resuscitation program (NRP) renewal is only required every 2 years. This gap and low usage of skills can result in lack of competency and expertise leading to an increased risk of poor patient outcomes. This project aimed to provide simulation education based on NRP curriculum for a large group of advanced providers at multiple level II, III, and IV neonatal intensive care units (NICUs) and to improve confidence and knowledge in advanced resuscitation. A high-fidelity mannequin was used to simulate a reproducible, critical scenario that spanned the entire NRP algorithm. NRP knowledge and the effectiveness of simulation on confidence and knowledge in neonatal resuscitation were measured. The average knowledge score from the pretest to the posttest improved by 7%. Based on the simulation evaluation tool-modified (SET-M), debriefing was the most effective in improving confidence and knowledge. The neonatal nurse practitioners (NNPs) with the most years of clinical experience had the largest improvement in knowledge. With the most experienced NNPs providing majority of coverage in the Level II NICUs, a correlation may be drawn that the effect of simulations on NRP knowledge has a greater impact on these groups due to the low exposure of advanced resuscitation events at these sites. Debriefing stood out as the most critical component of simulation.

The impact of simulation-based training in medical education: A review.

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

Ward-based in situ simulation: lessons learnt from a UK District General Hospital

IntroductionIn situ simulation (ISS) enables multiprofessional healthcare teams to train for real emergencies in their own working environment and identify latent patient safety threats. This study aimed to determine ISS...

A Comparison of 2 Debriefing Rubrics to Assess Facilitator Adherence to the PEARLS Debriefing Framework.

Many educators have adopted the Promoting Excellence and Reflective Learning in Simulation (PEARLS) model to guide debriefing sessions in simulation-based learning. The PEARLS Debriefing Checklist (PDC), a 28-item instrument, and the PEARLS Debriefing Adherence Rubric (PDAR), a 13-item instrument, assess facilitator adherence to the model. The aims of this study were to collect evidence of concurrent validity and to evaluate their unique strengths. A review of 130 video recorded debriefings from a synchronous high-fidelity mannequin simulation event involving third-year medical students was undertaken. Each debriefing was scored utilizing both instruments. Internal consistency was determined by calculating a Cronbach's α. A Pearson correlation was used to evaluate concurrent validity. Discrimination indices were also calculated. Cronbach's α values were 0.515 and 0.714 for the PDAR and PDC, respectively, with ≥0.70 to ≤0.90 considered to be an acceptable range. The Pearson correlation coefficient for the total sum of the scores of both instruments was 0.648, with a values between ±0.60 and ±0.80 considered strong correlations. All items on the PDAR had positive discrimination indices; 3 items on the PDC had indices ≤0, with values between -0.2 and 0.2 considered unsatisfactory. Four items on both instruments had indices >0.4, indicating only fair discrimination between high and low performers. Both instruments exhibit unique strengths and limitations. The PDC demonstrated greater internal consistency, likely secondary to having more items, with the tradeoff of redundant items and laborious implementation. Both had concurrent validity in nearly all subdomains. The PDAR had proportionally more items with high discrimination and no items with indices ≤0. A revised instrument incorporating PDC items with high reliability and validity and removing those identified as redundant or poor discriminators, the PDAR 2, is proposed.

Acoustic velocity and stability of tissue-mimicking echogenic materials for ultrasound training phantoms

Purpose. High-fidelity mannequins are increasingly used to train the medical staff on many medical procedures. Lately, a new challenge regarding echogenic materials to build ultrasound-responding phantoms has emerged. The challenge is to find materials with a suitable combination of ultrasound velocity and consistency to the touch. Methods. Bibliographic research was performed to identify materials with promising stiffness, shape retention, and ultrasound velocity combinations. As-standardized-as-possible specimens were realized and tested using an A-mode ultrasound machine to evaluate the US velocity through them. Four differently doped silicones, five gelatin-based materials, five synthetic gelatins, and a 3D printable resin were included in the study. After being tested, the materials were monitored for 12 days to assess their durability and shape retention and tested again to evaluate the ultrasound velocity’s stability. In the paper, the results of the characterization and follow-up of the materials are presented. Results. Outcomes show that gelatins are exceptional soft tissue-mimicking materials in terms of ultrasound velocity and consistency to the touch, but are poor in terms of overtime stability and therefore suitable for disposable short-term phantoms only. Doped silicones present lower ultrasound velocity compared to the reference value of 1540 m/s found in the literature, but excellent overtime stability, and shape retention properties. Values close to biological ones were also given by the Elastic 50A and by polyvinyl chloride plastisol. Conclusion. The paper gives a quantitative overview of the fidelity of both already-in-use and non-conventional materials, focusing on the ultrasound velocity value through them and their longevity in terms of macroscopically observed dehydration, shape retention, and bacterial onset.

Pragmatic Approach to In Situ Simulation to Identify Latent Safety Threats Before Moving to a Newly Built ICU.

Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU. Descriptive review of a patient safety initiative. A newly built 24-bed neurocritical care unit at a tertiary care academic medical center. Care providers working in neurocritical care unit. We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with "test" patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose. We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats. In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.

Multidisciplinary Simulation for Blunt and Penetrating Pediatric Trauma Utilizing Standard and Rapid Cycle Deliberate Practice Models.

Pediatric trauma resuscitations are low-frequency, high-stakes events that require skilled multidisciplinary teams with strong medical knowledge and communication skills. This pediatric trauma simulation training session included two cases and formats. The first case was designed in a traditional format and featured a 12-month-old child with inflicted blunt head and abdominal trauma. The second case was organized in successive rounds utilizing the rapid cycle deliberate practice (RCDP) model and featured an 18-month-old with gunshot wounds to the abdomen and chest. Educational objectives included effective communication in a multidisciplinary team, timely completion of primary and secondary surveys, awareness of systems and processes related to trauma care, and increasing competency with low-frequency pediatric trauma skills. Necessary equipment included high-fidelity toddler-sized mannequins, chest tube task trainer or applicable mannequin and equipment, intubation equipment and supplies, intraosseous access, and blood products with rapid delivery infusers. This training session was designed for learners in a multidisciplinary team including physician trainees, nurses, and advanced practice providers; adjustments could be made to the team members as desired. Quantitative and qualitative evaluations demonstrated high learner satisfaction and engagement, particularly in the RCDP style of learning. Multidisciplinary team practice of pediatric trauma scenarios, particularly utilizing the RCDP simulation model, provides the opportunity to improve teamwork and communication, practice procedural skills, and deepen team members' understanding of and comfort with trauma resuscitations.

Simulation-based Training for Anaesthesiology Residents: A Boon

Training in anaesthesiology necessitates exposure to diverse clinical situations, demanding quick thinking, decision-making, and intervention. Achieving expertise in this field traditionally requires years of clinical practice and exposure to various scenarios. Simulation-Based Medical Education (SBME) revolutionises anaesthesiology training by providing a controlled environment where trainees can acquire knowledge, refine clinical skills, and develop clinical and non clinical competencies. This approach includes training in soft skills, critical analysis of clinical scenarios, and receiving constructive feedback from qualified instructors. In alignment with industries like aviation and the military, various countries have incorporated SBME into medical curricula. The present scoping review explores the benefits, limitations, and diverse applications of SBME for anaesthesiology trainees. The historical progression of SBME, from basic procedural models to advanced simulations and virtual reality, underscores its transformative impact on medical education. Standards and accreditation for simulation laboratories ensure quality maintenance in training programs. SBME in anaesthesiology focuses on technical skill development and cultivating crucial non technical skills essential for patient safety. The review emphasises the need for a comprehensive curriculum, qualified instructors, reliable equipment, and ethical considerations to establish standards for simulation in anaesthesia. The versatility of simulation types, including low-fidelity task trainers, high-fidelity mannequins, and virtual simulations, enhances training opportunities. Anaesthesia simulation encompasses a spectrum of scenarios, from cardiothoracic anaesthesia to airway management, addressing technical and soft skills. While SBME offers advantages such as enhanced teamwork, regulated skill development, and exposure to rare situations, drawbacks include costs, ethical concerns, and replicating real-world complexity. Ongoing research is crucial to assess the effectiveness of SBME and its impact on patient outcomes. The evolving significance of SBME in anaesthesiology suggests its continued promise for breakthroughs in medical education.

Relationship Between Cognitive Load Theory, Intrinsic Motivation and Emotions in Healthcare Professions Education: A Perspective on the Missing Link.

Cognitive Load Theory (CLT) is one of the key cognitive theories that have been used to assess learners' information and working memory load. CLT has been applied to Simulation Based Education (SBE) and optimizing instructional design. However, a challenge that occurs is that these high-fidelity simulations and mannequins of critically ill patients can elicit negative emotions in learners which can unfavorably impact the learning process. There is also a potential for cognitive overload if the simulation is more authentic and requires more dynamic interactions and lead to high levels of anxiety due to a novel learning environment, which can also have detrimental effects on learning process. Hence, it is critical for health professional educators (HPE) to know how to minimize cognitive load to improve learning as a professional in a workplace setting. The literature on the role of emotions, intrinsic motivation, cognitive load is scarce in HPE literature. Specifically when not being studied together at once since they move dynamically together and affect the learning for the learner. Therefore, the purpose of this perspective paper is to cover the gap in the literature and propose a framework and recommendation for future HPE research.

A108Using a high-fidelity part-task model as a replacement for animal models to enhance emergency medicine thoracotomy training

A local course has been delivered since 2018 to provide training in rare, time-critical, life-saving procedures that emergency medicine trainees may need to perform, including emergency lateral thoracotomy. Previously pig thoraxes have been used to provide thoracotomy training in this course. In 2022 a part-task model was purchased for thoracotomy training to replace this. We compare the use of this to animal models in our provision of simulation teaching of this skill. Animal models are useful due to availability, low cost, and provision of hands-on experience for learners. However, there are associated ethical, religious, psychological limitations with using animals for educational purposes. They may less accurately represent human anatomy and pathology. Their timely acquisition can pose a challenge with defrosting requirements and variable condition which can impact on the quality of training. There are infection risks due to fluid leakage, associated unpleasant odour and animal products require incineration for disposal. The high-fidelity part-task mannequin can anatomically and physiologically replicate the thoracotomy experience to provide realistic simulation training. The mannequin is equipped with realistic external human features and internal organ anatomy, including a beating heat and blood, to provide an immersive training experience. It is reusable with repair, which could be cost-effective long term and more environmentally-friendly. This model enables thoracotomy skill practice in a safe, controlled environment without infection risk. Another advantage is the ability to provide standardized training, better allowing for objective evaluation of performance which can be challenging with animal models. This model ( The immersive lateral thoracotomy model we are using, which is fully repairable to be used multiple times for authentic learner experience There are disadvantages to use of this model for the department, but the overall learning experience and sustainability is felt to be superior to animal models for training in emergency thoracotomy. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Comparison of Cardiac Auscultation Features on Four Different Simulation Mannequins Performed by Pediatric Residents.

Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels of medical training. So, supplementary training methods started to evolve, including simulation for auscultation skills training. Over the years, mannequins have evolved with different types of technology. Therefore, we decided to compare cardiac auscultation accuracy among high-fidelity mannequins as the primary objective and compare the performance of various postgraduate-level residents as a secondary objective. Pediatric residents at King Abdulaziz University Hospital were given a lecture on the basics of cardiac auscultation and then requested to auscultate four mannequins, namely SimJumior® (Laerdal Medical, Stavanger, Norway), SimBaby™ (Laerdal Medical), Pediatric HAL® (Gaumard Scientific, Miami, FL, USA), and Cardiac Patient Simulator K-Plus (Kyoto Kagaku Co. Ltd., Kyoto, Japan). The accuracies of murmur type, diagnosis, and auscultation time were compared. Results: A total of 56 pediatric residents were enrolled. Median murmur accuracy ranged from 50% to 53% (p-value 0.79), and median diagnosis accuracy ranged from 33% to 36% (p-value 0.77), with a nonsignificant difference between mannequins. Comparing resident levels in all mannequins, median murmur accuracy ranged from 49% to 56% (p-value 0.70), and median diagnosis accuracy ranged from 29% to 41% (p-value 0.09). While the median average auscultation time was between 41 and 50 seconds (p-value 0.34). Auscultation skills can be taught through simulation on any mannequin used in this comparison, not necessarily the cardiac one. For better accuracy, future comparisons might include more advanced cardiac mannequins based on cardiac auscultation expertise (i.e., consultant level). The introduction of an auscultation program from the undergraduate level throughout the training process and monitoring of these skills are mandated.

The impact of simulation-based training on the knowledge and skills of postgraduate medical students in the management of cardiac arrest

Background: Use of simulation as a teaching learning method is said to improve the learners’ skills and clinical decision making in a risk-free environment. The effectiveness of simulation in imparting protocol-based training of a critical situation like cardiac arrest to postgraduate students, needs to be evaluated. We aimed to train students in a simulation-based training session for Advanced Cardiac Life Support (ACLS) in the management of in-hospital cardiac arrest, and assess the effect on the pre-training efficacy.
 Methodology: Thirty post-graduate students were subjected to a pre-test in knowledge and skills regarding ACLS, followed by a didactic lecture and a training session on a high-fidelity mannequin for the same. The assessment was conducted one week later. A self-perception questionnaire from the students was obtained at the end of the whole program. Mean score of knowledge, skill, time to initiating CPR and time to defibrillation in pre-test and post-test were compared using the paired-t test. P < 0.05 was considered statistically significant.
 Results: There was statistically significant improvement in the post-test knowledge score (13.5 ± 2.87; P < 0.0001) and skills score (6.066 ± 1.25; P < 0.0001). Objective improvement was noticed in time to start cardiopulmonary resuscitation (pre-test 60 ± 19.76 sec vs. post-test 26.56 ± 16.07 sec; P = 0.0001). Time to defibrillation was markedly reduced (pre-test 118.6 ± 28.28 sec vs. post-test 93 ± 33.38 sec; P = 0.0022). Majority of the students strongly agreed that the training session resulted in improved confidence (76.7%), which enhanced clinical decision making in emergency situations (83.3%).
 Conclusion: The simulation-based training session significantly increases the knowledge and psychomotor skills of the post-graduate students with enhanced confidence to manage a victim of cardiac arrest as self-judged by the participants.
 Abbreviations: ACLS – Advanced Cardiac Life Support; CBME - Competency Based Medical Education CPR - Cardiopulmonary Resuscitation; CVR - Content Validity Ratio
 Key words: Simulation Training; Cardiopulmonary Resuscitation
 Citation: Patil A, Kadam S, Monnaiah P, Patil S, Sethiya S. Singh S. The impact of simulation-based training on the knowledge and skills of medical postgraduate students in the management of cardiac arrest. Anaesth. pain intensive care 2023;27(4):496−501. DOI: 10.35975/apic.v27i4.2258
 Received: October 13, 2022; Reviewed: June 09, 2023; Accepted: June 13, 2023

Developing a Surgical Simulation Curriculum for the Rwandan Context

We report on the development and implementation of a surgical simulation curriculum for undergraduate medical students in rural Rwanda. This is a narrative report on the development of scenario and procedure-based content for a junior surgical clerkship simulation curriculum by an interdisciplinary team of simulation specialists, surgeons, anesthesiologists, medical educators, and medical students. University of Global Health Equity, a new medical school located in Butaro, Rwanda. Participants in this study consist of simulation and surgical educators, surgeons, anesthesiologists, research fellows and University of Global Health Equity medical students enrolled in the junior surgery clerkship. The simulation training schedule was designed to begin with a 17-session simulation-intensive week, followed by 8 sessions spread over the 11-week clerkship. These sessions combined the use of high-fidelity mannequins with improvised, bench-top surgical simulators like the GlobalSurgBox, and low-cost gelatin-based models to effectively replace resource intensive options. Emphasis on contextualized content generation, low-cost application, and interdisciplinary design of simulation curricula for low-income settings is essential. The impact of this curriculum on students' knowledge and skill acquisition is being assessed in an ongoing fashion as a substrate for iterative improvement.

Standardized Patients Versus Mannequins in Mental Health Simulation.

Mental health nursing simulation using various modalities can be useful in increasing student confidence, satisfaction, knowledge, and communication skills. Studies comparing the benefits of mental health nursing simulation using standardized patients versus mannequins are scarce. The purpose of this study was to explore differences in knowledge, clinical learning, clinical reasoning, communication, confidence, and learner satisfaction when conducting mental health nursing simulation with standardized patients compared to mannequins. A convenience sample of 178 senior level baccalaureate nursing students enrolled in the mental health nursing course participated in this study. Of the total sample, 41.6% (n = 74) participated in high-fidelity mannequin simulation and 58.4% (n = 104) in standardized patient simulation. Measures included a knowledge assessment, Satisfaction with Simulation Experience Scale (SSE), and a simulation evaluation survey. While knowledge levels increased regardless of simulation modality, clinical reasoning, clinical learning, communication, realism, and overall rating of the simulation experience were significantly higher among participants in standardized patient simulation compared to mannequins. Mental health simulations can be a useful learning tool for engaging in mental health scenarios in a safe simulated learning environment. While both mannequins and standardized patient modalities are helpful in increasing mental health nursing knowledge, standardized patient simulation has a greater impact on several other aspects including clinical reasoning and communication. Future multisite studies with larger samples are needed, including a wider variety of mental health scenarios.

Association between cardiopulmonary resuscitation audit results with in-situ simulation and in-hospital cardiac arrest outcomes and key performance indicators

IntroductionIn-situ simulation (ISS) is a method to evaluate the performance of hospital units in performing cardiopulmonary resuscitation (CPR). It is conducted by placing a high-fidelity mannequin at hospital units with simulated scenarios and having each unit’s performance evaluated. However, little is known about its impact on actual patient outcomes. Therefore, we aimed to evaluate the association between the ISS results and actual outcomes of patients with in-hospital cardiac arrest (IHCA).MethodsThis retrospective study was conducted by reviewing Siriraj Hospital’s CPR ISS results in association with the data of IHCA patients between January 2012 and January 2019. Actual outcomes were determined by patients’ outcomes (sustained return of spontaneous circulation (ROSC) and survival to hospital discharge) and arrest performance indicators (time-to-first-epinephrine and time-to-defibrillation). These outcomes were investigated for association with the ISS scores in multilevel regression models with hospital units as clusters.ResultsThere were 2146 cardiac arrests included with sustained ROSC rate of 65.3% and survival to hospital discharge rate of 12.9%. Higher ISS scores were significantly associated with improved sustained ROSC rate (adjusted odds ratio 1.32 (95%CI 1.04, 1.67); p = 0.01) and a decrease in time-to-defibrillation (-0.42 (95%CI -0.73, -0.11); p = 0.009). Although higher scores were also associated with better survival to hospital discharge and a decrease in time-to-first-epinephrine, most models for these outcomes failed to reach statistical significance.ConclusionCPR ISS results were associated with some important patient outcomes and arrest performance indicators. Therefore, it may be an appropriate performance evaluation method that can guide the direction of improvement.

Acute Exacerbation of COPD.

This case is targeted to emergency medicine residents of all levels. Shortness of breath (SOB) is one of the top ten most common chief complaints seen in the Emergency Department, accounting for close to 10% of presenting complaints.1 An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a frequent culprit, accounting for roughly 15.4 million visits and 730,000 hospitalizations per year.2 The diagnosis of treatment of mild to moderate AECOPD can be relatively uncomplicated; however, multiple factors can increase the complexity of management and pose additional challenges that the emergency physician (EP) must be prepared for. Severe AECOPD can necessitate the need for both Non-invasive positive pressure ventilator (NIPPV) such as bi-level positive airway pressure (BiPAP) as well as emergent intubation. Furthermore, managing the ventilator settings in patients with an AECOPD is far from routine, requiring an intricate understanding of pulmonary physiology.3. By the end of this simulation, learners will be able to (1) assess for causes of severe shortness of breath, (2) manage severe COPD exacerbation by administering appropriate medications, (3) identify worsening clinical status and initiate NIPPV, (4) assess the causes of hypoxia after establishing endotracheal intubation and, (5) identify indication for needle decompression and perform chest tube thoracostomy. This simulation was conducted with a high-fidelity mannequin with a separate low fidelity chest tube mannequin that allowed for hands-on practice placing a chest tube. A total of 16 PGY-1 residents participated in the simulated patient encounter. Following the simulation and debrief session, all residents were sent a Likert scale survey via surveymonkey.com to assess the educational quality of the simulation. The survey contained the following questions; 1) Overall, this simulation was realistic and could represent a patient presentation in the Emergency Department, 2) Overall, the case contained complexity that challenged me as a learner, 3) This case helped to expand my medical knowledge, 4) I feel more confident in diagnosing and treating AECOPD, 5) I feel more confident in recognizing the indications for NIPPV and intubation, 6) This simulation offered an opportunity to improve my procedural skills, 7) I feel more confident in setting up the ventilator, 8) I feel more confident in addressing ventilator alarms. Following the simulation and debrief session, all the participants (n=16), were provided a survey to assess the educational quality of the simulation. There were a total of 12 respondents and a hundred percent of them agreed or strongly agreed that the case contained complexity that challenged them. All of the respondents agreed that the simulation case was realistic and that the case helped expand their medical knowledge. Furthermore, all the learners agreed or strongly agreed that the case helped them in improving their procedural skills. This case combines a mixture of high fidelity and medium fidelity components to encompass both clinical knowledge and procedural skills. This case is effective in expanding beyond the basic approach to managing an AECOPD patient and forces learners to address clinical deterioration, escalate airway interventions, manage ventilator settings, and address ventilator alarms, including placement of a chest tube. Residents commented that this case was very realistic and particularly challenging because it highlighted gaps in their clinical knowledge and procedural skills. Residents were most challenged by identifying when to escalate care as well as how to manage ventilator settings in AECOPD patients. Acute exacerbation COPD, intubation, positive pressure ventilation, ventilator alarms, chest tube thoracostomy.

Learning abnormal physical examination signs: an introductory course.

The acquisition of clinical skills is an essential part of the osteopathic medical school curriculum. Preclinical medical students, especially at osteopathic medical schools, have limited exposure to abnormal physical examination (PE) findings that are not typically seen in a student's peers or in a standardized patient (SP). The early exposure of first-year medical students (MS1s) to normal and abnormal findings in the simulation settings better equips them to identify abnormalities when they encounter them in a clinical setting. The aim of this project was to develop and implement the introductory course on learning abnormal PE signs and pathophysiology of abnormal clinical findings to address the educational needs of MS1s. The didactic part of the course consisted of PowerPoint presentations and lecture on the topics related to the simulation. The practical skill session was 60min, during which time students first practiced PE signs and then were assessed on their ability to accurately identify abnormal PE signs on a high-fidelity (HF) mannequin. Faculty instructors guided students through clinical cases and challenged them with probing questions in clinically relevant content. Before- and after-simulation evaluations were created to assess students' skills and confidence. Student satisfaction levels after the training course were also assessed. This study demonstrated significant improvements in five PE skills (p<0.0001) after the introductory course of abnormal PE clinical signs. The average score for five clinical skills increased from 63.1 to 88.74% (before to after simulation). The confidence of students in performing clinical skills and their understanding of the pathophysiology of abnormal clinical findings also increased significantly (p<0.0001) after simulation activity and educational instruction. The average confidence score increased from 3.3 to 4.5% (before to after simulation) on a 5-point Likert scale. Survey results demonstrated high satisfaction with the course among learners with mean satisfaction score 4.7±0.4 on 5-point Likert scale. The introductory course was well received by MS1s and they left positive feedback. This introductory course offered MS1s with novice PE skills the ability to learn a variety of abnormal PE signs, including heart murmurs and rhythms, lung sounds, measurement of blood pressure (BP), and palpation of the femoral pulse. This course also allowed abnormal PE findings to be taught in a time-efficient and faculty-resource-efficient manner.

Evaluation of Virtual Reality High-Fidelity Adult Mannequin-based Simulation of Real-Life Clinical Scenarios in Teaching Clinical Pharmacology to Medical Students

BackgroundPresently, competency-based medical (CBME) curriculum challenges the medical educators to provide continuing education with new approaches to make learning more stimulating, motivating, and entertaining, fostering excellence in clinical practice. To address these issues, educators have advocated the use of virtual reality and mannequins to teach clinical pharmacology.ObjectivesTo study the effect, perception, and feedback of virtual reality high-fidelity adult mannequin-based (VHFM) simulation of real-life clinical scenarios over conventional tutorials in teaching clinical pharmacology to medical students.Material and MethodsAn interventional study was designed for 2nd year MBBS students for a period of 6 months. The enrolled students were randomly assigned to the test group (VHFM) or control group (tutorials). The CAE Healthcare Ltd. maestro, high-fidelity prehospital mannequin (APOLLO) was used in the test group. Three sessions consisting of six different cases were discussed, and multiple-choice questions (MCQs)-based pre-test, post–test, and retest after a month were conducted in both groups and compared. The perception and feedback of faculty and students were obtained by using a modified and revalidated questionnaire.ResultsThe test group outperformed the control group ( p &lt;.001) in all sessions based on pre-test, post-test, and retest scores, and within-group comparisons revealed significant improvements in both groups. Students’ perceptions and feedback regarding VHFM were more enthusiastic and promising than in the tutorial group.ConclusionsVHFM is student-centered, provides an active learning environment, and aids in skill development. We strongly suggest VHFM-based learning as a complement to traditional teaching strategies in pharmacology, especially for teaching clinical reasoning to medical students.