High-fidelity Simulation Laboratory Research Articles

Prolonged, High-Fidelity Simulation for Study of Patient Care in Resource-Limited Medical Contexts and for Technology Comparative Effectiveness Testing.

Model development. High-fidelity simulation laboratory. None. We interviewed subject matter experts to identify relevant prolonged casualty care medical challenges and selected two casualty types to further develop our model: a large thermal burn model and a severe hypoxia model. We met with a multidisciplinary group of experts in prolonged casualty care, nursing, and critical care to describe how these problems could evolve over time and how to contextualize the problems with a background story and clinical environment with expected resource availability. Following initial scenario drafting, we tested the models with expert clinicians. After multiple tests, we selected the hypoxia model for refinement and testing with inexperienced providers. We tested and refined this model until two research teams could proctor the scenario consistently despite subject performance variability. We developed a 6-8-hour simulation model that represented a 14-hour scenario. This model of pneumonia evolved from presentation to severe hypoxia necessitating advanced interventions including airway, breathing, and shock management. The model included: context description, caregiver orientation scripts, hourly progressive physiology tracks corresponding to caregiver interventions, intervention/procedure-specific physiology tracks, intervention checklists, equipment lists, prestudy checklists, photographs of setups, procedure, telementor, and role player scripts, business rules, and data collection methods. This is the first standardized, high-fidelity simulation model of prolonged casualty care described in the literature. It may be used to assess caregiver performance and patient outcomes resulting from that performance during a complex, 14-hour prolonged casualty care scenario. Because it is standardized, the model may be used to compare differences in the impact of new technologies upon caregiver performance and simulated patient outcomes..

Virtual Simulation to Increase Self-efficacy Through Deliberate Practice.

To reduce performance anxiety and increase engagement in medical-surgical simulations, virtual simulation (VS) was introduced prior to complex high-fidelity simulation to increase students' self-efficacy. A presimulation preparation needed to be expanded for high-fidelity simulation involving emergent clinical situations. Combined frameworks of Ericsson's theory of deliberate practice and Bandura's self-efficacy theory were applied. Students completed VS scenarios until a specific score of mastery was obtained, and then the same scenario was repeated in the high-fidelity simulation laboratory. A modified self-efficacy scale survey was administered presimulation and postsimulation. Data were collected on 3 cohorts of students (n = 151) over an academic year. VS followed by high-fidelity simulation significantly increased student perception of self-efficacy in all 3 cohorts (P = .001, P = .037, P = .005). Preparation for high-fidelity simulation using VS increases self-efficacy and allows students to engage in the simulation experience, thus achieving higher levels of mastery through deliberate practice.

Integration of simulation components enhances team training in cardiac surgery

ObjectivesSimulation in resident medical education has traditionally focused on isolated components of a surgical procedure. We hypothesized that incorporating an interdisciplinary team into a high-fidelity simulation laboratory would enhance the modeling of real-world challenges during cardiac surgery. MethodsSimulation exercises were performed with staffing by surgeons, anesthesiologists, perfusionists, surgical assistants, and operating room technicians. Twelve accredited cardiothoracic surgical residents were divided into 3 teams. Each team competed in the stations coronary artery bypass grafting, aortic valve replacement, and mitral valve repair. Evaluations were performed on each resident according to the resident's role in the exercise (primary surgeon, first assistant, perfusionist, or anesthesiologist). The relation between scores and years of experience was assessed with the Pearson correlation, and the comparison of scores across the 3 stations was evaluated through analysis of variance. ResultsIndividual scores varied considerably on the basis of simulation role and years of experience. Mean surgical scores were significantly greater for the mitral repair station (score, 4.4) than aortic valve replacement (3.6) and coronary artery bypass grafting (3.6) stations (overall difference, P = .049) and were highly correlated with years of experience. Two thirds of the residents completed the anesthesia portion of the exercise without prompting and demonstrated competence in the perfusion skill sets. ConclusionsThis simulation strategy integrates components from each discipline involved in successful completion of a cardiac surgical procedure. Our findings highlight the importance of team training as a valuable component in the residency curriculum.

JOURNAL CLUB: Benefit of Epinephrine Autoinjector for Treatment of Contrast Reactions: Comparison of Errors, Administration Times, and Provider Preferences.

Given the rarity of contrast reactions in practice, most radiologists have little to no experience in their management, and errors are common. The purpose of this study was to compare treatment of a moderate-severity reaction with intramuscular epinephrine by either the traditional manual method of drawing up and delivering epinephrine with a needle and syringe or the use of an epinephrine autoinjector. All diagnostic radiologists at the study institution were requested to participate in an annual contrast reaction simulation program, which consisted of three simulation scenarios in a high-fidelity simulation laboratory. During the moderate-severity simulation scenario, the time to administer intramuscular epinephrine and any errors in administration were recorded. Groups were randomized to use an autoinjector device or manual delivery. All participants completed a survey assessing the experience with epinephrine and their comfort in treating contrast reactions using a traditional manual approach versus an epinephrine autoinjector. Among 189 participants in the contrast reaction simulation program, 76 participated in a moderate-severity reaction simulation two to five at a time in 25 sessions. Mean total time to administration was significantly longer for manual (108.8 seconds) than for autoinjector (38.7 seconds) delivery (p < 0.001). There were 11 errors in the manual group and one error in the autoinjector group (p = 0.005). Ninety-four percent of participants reported feeling very comfortable or comfortable with the autoinjector as opposed to 60% for manual delivery (p < 0.001). Overall, 96% of participants thought the autoinjector was easier to use. Use of an epinephrine autoinjector for treatment of contrast reactions was associated with a significantly greater degree of provider comfort, shorter time to administration, and fewer errors.

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

Animation Shows Promise in Initiating Timely Cardiopulmonary Resuscitation

Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

The Simulation Olympics: a resuscitation-based simulation competition as an educational intervention

The Department of Emergency Medicine at Queen's University developed, implemented, and evaluated an interprofessional simulation-based competition called the Simulation Olympics with the purpose of encouraging health care providers to practice resuscitation skills and foster strong team-based attitudes. Eleven teams (N = 45) participated in the competition. Teams completed three standardized resuscitation scenarios in a high-fidelity simulation laboratory with teams composed of nurses, respiratory therapists, and undergraduate and postgraduate medical trainees. Trained standardized actors and a dedicated technician were used for all scenarios. Judges evaluated team performance using standardized assessment tools. All participants (100%) completed an anonymous two-page questionnaire prior to the competition assessing baseline characteristics and evaluating participant attitudes, motivation, and barriers to participation. The majority of participants (71%) completed an evaluation form following the event focusing on highlights, barriers to participation, and desired future directions. Evaluations were uniformly positive in short-answer feedback and attitudinal scoring measures. To our knowledge, the Simulation Olympics competition is the first of its kind in Canada to be offered at an academic teaching hospital.

Student-Created Scenarios in the High-Fidelity Simulation Laboratory

As an assignment in a pediatric theory class, small groups of nursing students created and implemented scenarios in the high-fidelity simulation (HFS) laboratory. The project's purpose was to determine whether senior nursing students could create HFS scenarios that increased their knowledge base of pediatric nursing and supported the use of evidence in identifying problems and planning nursing care. After completing the project, students wrote individual reflective papers. Qualitative analysis of these papers revealed the common themes of expanded understanding of pediatric nursing care and professional growth. Data supported achievement of the project objectives; however, this was attributed to the scenario-creation process rather than to the scenarios themselves. Challenges identified included lack of a mechanism to involve each student in every scenario and logistical issues, such as faculty time and laboratory scheduling. With attention to such issues, this project can be implemented successfully in a variety of clinical areas.

Integrating Simulation into a Foundational Gerontological Nursing Course

A simulation fair is one way to increase nursing student satisfaction with how they acquire skills and competencies in nursing. New nursing students must acquire classroom knowledge and clinical skills in a short time. New knowledge and skills must then be applied to the clinical setting with real patients. This article describes the process and outcomes of a successful educational innovation aimed at streamlining knowledge acquisition and enhancing student satisfaction with learning. In this innovative strategy, a case scenario for the high-fidelity simulation laboratory required students to rotate through seven faculty-facilitated learning stations during the day with their clinical cohort. All levels of simulation were used to educate students in gerontological nursing assessments and care. The hands-on experience was successful and satisfying to both the students and the clinical faculty. A suggestion for future modification of this program to suit other clinical courses and settings is offered.

Simulation‐based Morbidity and Mortality Conference: New Technologies Augmenting Traditional Case‐based Presentations

The authors describe the use of a high-fidelity simulation laboratory to re-create a patient encounter for the purposes of enhancing a morbidity and mortality conference. The use of two separate technologies were enlisted: a METI high-fidelity patient simulator to re-create the case in a more lifelike fashion, and an audience response system to collect clinical impressions throughout the case presentation and survey data at the end of the presentation. The re-creation of the patient encounter with all relevant physical findings displayed in high fidelity, with relevant laboratory data, nursing notes, and imaging as it occurred in the actual case, provides a more engaging format for the resident-learner. This technological enhancement was deployed at a morbidity and mortality conference, and the authors report the impressions collected via the audience response system. Guidelines for those who wish to re-create this type of educational experience are presented in the discussion.