High-fidelity Simulation Manikins Research Articles

Usability evaluation of high-fidelity simulation manikin for cardiopulmonary resuscitation training for medical students

Usability evaluation of high-fidelity simulation manikin for cardiopulmonary resuscitation training for medical students

Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy

Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.

Skin Tone and Gender of High-Fidelity Simulation Manikins in Emergency Medicine Residency Training and their Use in Cultural Humility Training.

It is important for physicians to learn how to provide culturally sensitive care. Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another's culture as well as performing self-exploration about one's own beliefs, identities, and biases. One way to teach cultural humility in medicine is simulation. However, there are no peer-reviewed published studies that examine whether the skin tone or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine (EM) residency programs reflects the US population nor whether high-fidelity simulation is used to teach cultural humility. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EM residency programs use HFS to teach cultural humility. Our secondary objective was to evaluate whether the skin tone and gender breakdown of the EM residency program HFSM is representative of the US population. We conducted a simple random sample of 80 EM residency programs to characterize HFSM and cultural humility training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin tone and gender and whether cultural humility was taught via HFSM. We calculated point and interval estimates for the proportion of dark-, medium-, and light-toned skin and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin tone was 20/20/60 and that the female/male ratio was 50/50. Both ratios were extrapolated from the US Census data. Our response rate was 74% (59/80). Fifty-five of 59 EM residency programs that had manikins (0.93, 95% confidence interval [CI] 0.88-0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 programs with manikins reported using HFS to teach cultural humility (0.71, 95% CI 0.60-0.82). Proportions of light-, medium-, and dark-toned manikins were 0.52 (0.43-0.62), 0.38 (0.29-0.47), and 0.10 (0.07-0.14), respectively. Proportions of male and female HFSM were 0.69 (0.64-0.76) and 0.31 (0.24-0.36), respectively. The null hypotheses that skin tone follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values. While most EM residency programs surveyed use high-fidelity simulation to teach cultural humility, the manikins do not reflect either the skin tone or gender of the US population.

Dedicated chest compressor team: A quality improvement initiative to improve chest compression performance at in-hospital cardiac arrest events through quarterly training

BackgroundHigh-quality cardiopulmonary resuscitation (CPR) is foundational to all resuscitative efforts. Spaced practice improves learners’ skill retention. We evaluated the implementation of a quarterly CPR curriculum and skills training program for a dedicated chest compressor team to improve the quality of CPR performed during in-hospital cardiac arrest (IHCA) events and its impact on patient survival of event. MethodsBaseline observations on CPR performance within the hospital were collected in October 2018. The CPR quarterly training program was implemented in November 2018. Training included use of high-fidelity simulation manikins and team members received real-time feedback scores related to compression rate, depth and recoil. High-quality CPR scores were set at ≥ 70%. Yearly IHCA event survival data was examined in relation to the implementation of training. ResultsQuarterly CPR training of the team led to retention of CPR skills (chest compression rate, depth, and recoil). The team’s initial CPR training performance average score was 49.1%, increasing to 80.3%, with 95% (n = 37) of participants achieving a higher score after feedback during their initial training. A two-sample t-test was used for numerical data and chi-square was used for proportional data analysis. The survival of event prior to this training was 61.0% January-October 2018. Post -training, event survival rose to 73.5% (p-value 0.03) in 2019. ConclusionImplementation of a team that attends quarterly CPR training with a high-fidelity simulation manikin is attainable. This training resulted in improved CPR quality and benefited IHCA event survival.

Effect of the Use of High-Fidelity Manikin Simulation for Learning Emergency Cardiovascular Care Skills: A Critically Appraised Topic

Clinical Scenario: Athletic trainers must be confident when performing life-saving skills, such as a cardiovascular assessment and cardiopulmonary resuscitation. Learning and performing skills on high-fidelity simulation manikins may improve athletic training students’ self-confidence and self-efficacy. Clinical Question: What are the effects of high-fidelity manikin simulation on athletic training students’ self-confidence and self-efficacy in performing emergency cardiovascular care? Summary of Key Findings: Three good-quality cohort studies were included. Two studies assessed the effect of high-fidelity cardiopulmonary resuscitation simulation, and one study assessed the effect of high-fidelity cardiovascular assessment. Two studies evaluated self-confidence, while the other study evaluated self-efficacy. All three studies found that high-fidelity simulation improved athletic training students’ self-confidence and self-efficacy. Clinical Bottom Line: There is currently consistent, good-quality evidence that supports the use of high-fidelity manikin simulation to improve athletic training students’ self-confidence and self-efficacy in performing cardiovascular skills and assessment. Future research should examine the effects of high-fidelity manikin simulation on the same academic levels of athletic training students to ensure generalizability of results. Strength of Recommendation: The grade of B is recommended by the Strength of Recommendation Taxonomy for consistent, good-quality evidence.

Birth in the Emergency Department

The use of high-fidelity simulation increases emergency department (ED) staff preparedness in high-risk, low-volume obstetric emergencies. ED staff will be better prepared and more confident in providing appropriate standards of care to the obstetric and newborn populations. A variety of evidence was used, including professional nursing association position statements, evidence-based procedures, nationally recognized care guideline, well-designed case control and cohort studies, and single descriptive studies. Two obstetric/ED simulation scenarios for an unexpected, precipitous birth were developed using high-fidelity simulation manikins. Eighty-five ED staff completed the simulation and debrief session. All survey questions addressing staff confidence and preparedness saw large increases in staff feeling prepared and confident. In addition, for knowledge-based questions, there was an 80% increase in correct answers. The obstetric–newborn population in the ED saw a 90% decrease in incident reports after the simulation sessions. The results suggest that simulation-based educational interventions have a strong effect on nurse confidence, knowledge and preparedness when preparing for the low volume, high risk OB/newborn patient population.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Use of High-fidelity Simulation Manikins to Teach Pharmacology to Pharmacy Undergraduates

Use of High-fidelity Simulation Manikins to Teach Pharmacology to Pharmacy Undergraduates

Teaching Neonatal Abstinence Syndrome Using Simulation

BackgroundThe National Survey on Drug Use and Health reported that the rate of illicit drug use among pregnant women ranged from 3.2% to 14.6%. Maternal drug use during pregnancy may result in neonatal abstinence syndrome (NAS). This study explored whether simulation training is more effective than traditional didactic and video instruction in teaching nursing students' assessment skills for scoring NAS. MethodsTwenty-six nursing students participated in this randomized intervention study that incorporated simulation scenarios. The simulation/experimental group received a lecture/video and hands-on training using a high-fidelity simulation manikin. The didactic/control group received lecture/video training only. Both groups were asked to score the infant's withdrawal symptoms using the NAS scoring system. The student scores were compared with the nurse expert rater NAS scores. ResultsAn independent sample t-test was conducted to compare the tendency score, dangerous score, and overall discrepancy score between the experimental group and the control group. There were no significant differences in NAS scores between the experimental group and the control group. However, the overall discrepancy scores were lower among the experimental group indicating that the experimental group scored closer to the nurse expert. ConclusionThe findings will be used to develop an evidence-based clinical experience using high-fidelity simulation training to enhance patient safety.

Performances of low level hospital health caregivers after a neonatal resuscitation course.

BackgroundHigh fidelity simulation has been executed to allow the evaluation of technical and non-technical skills of health caregivers. Our objective was to assess technical and non-technical performances of low level hospitals health caregivers who attended a Neonatal Resuscitation course using high fidelity simulation in a standard-setting scenario.MethodsTwenty-three volunteers were asked to manage a simple scenario (infant with secondary apnea) after the course. Technical and non-technical skills were assessed by using previously published scores. Performances were assessed during the scenario and after 2 months by filmed video recordings.ResultsSixteen (69.5%) participants failed to pass the minimum required technical score. Staff experience and participation in previous courses were associated to higher score in technical and non-technical skills, while working in level I or II hospitals did not affect the scores. Previous experience in neonatal resuscitation requiring positive pressure ventilation was associated to better non-technical performance. Technical and non-technical scores were significantly correlated (r = 0.67, p = 0.0005). Delayed and direct evaluation of technical skills provided the same scores.ConclusionsA neonatal resuscitation course, performed by using a high fidelity simulation manikin, had a limited impact on technical and non-technical skills of participants working in low level hospitals. Training programs should be tailored to the participants’ professional background and to the more relevant sessions.

Perceptions on the Efficacy of Simulation

This qualitative case study addressed recent graduates’ perception of the efficacy of simulation in registered nursing education. Finding clinical placement is one of the greatest challenges faced by schools of nursing. One possible solution is to use high-fidelity simulation manikins to substitute for clinical experience. The research that exists regarding nursing simulation laboratory experiences focuses on improvement on exam scores and preparation for national board examinations. Very little research explores recently graduated nurse’s perceptions about the efficacy of simulation experiences. The conceptual framework for this study was the constructivist theory. This is a process of experience and reflection. It is a dynamic process that changes as the learner internalizes the experience. This study allowed the researcher to understand how recent graduates perceive the value of simulation experiences. Two research questions were identified: 1) How do recent graduates of registered nurse (RN) education programs view the simulation lab experiences from nursing school? 2) In what ways do the perceptions of simulation experiences differ between associate degree RN program graduates and bachelors program RN graduates? A case study research design was used to explore the perceptions of recently graduated RN about their experience with simulation. By interviewing recent graduates’ perceptions about their experiences with high-fidelity simulation in nursing school, and documenting their perceptions about the efficacy of those simulation experiences, information was obtained that might allow schools of nursing to increase the effectiveness of the simulation experience or validate its applicability in the real world setting.

High-Fidelity Simulation Meets Athletic Training Education: An Innovative Collaborative Teaching Project

High-fidelity simulation is frequently used in nursing education to provide students with simulated experiences prior to and throughout clinical coursework that involves direct patient care. These high-tech exercises take advantage of the benefits of a standardized patient or mock patient encounter, while eliminating some of the drawbacks experienced when using healthy “live” mock patients. These same technologies have the potential to benefit athletic training students (ATSs). The purpose of our project was to expand a partnership of interdisciplinary education for ATSs and integrate simulated patient encounters for ATSs enrolled in a general medical conditions in athletic training class. The project is a collaborative teaching experience that combines an athletic training faculty member, a nursing faculty member, and a nursing simulation specialist for skill training and assessment of clinical integration proficiencies (CIPs). With the introduction of the updated (CIPs) in the Fifth Edition Athletic Training Competencies document, opportunities exist to utilize high-fidelity simulation for training and assessments that may not occur during a student's clinical experience. Our athletic training program utilized the nursing simulation laboratory equipped with a high-fidelity manikin to simulate a student-athlete who suffers an asthma attack. Athletic training students, under the supervision of their faculty member and a simulation specialist, engaged in hands-on simulations to demonstrate CIPs related to respiratory assessment and intervention. The opportunity to combine expertise in medical conditions with the availability of high-fidelity simulation manikins presents opportunities for ATSs to experience patient encounters with conditions not frequently presented or difficult to stage in real-time clinical training. In conclusion, our project showcases an interdisciplinary collaboration that provides ATSs with learning experiences using emerging technology. Athletic training students were satisfied with the opportunity to engage in simulated patient encounters in this medical conditions class.

Board 113 - Program Innovations Abstract Internal Medicine Resident Code Team Leadership Training Using Multimedia Support and High Fidelity Simulation (Submission #406)

Introduction/Background Resident work hour limitations and the evolution of safety and quality improvement (QI) initiatives have resulted in fewer opportunities for trainees to participate in code blue events. One study showed a 41% reduction in hospital codes between 2002 and 2008, with an annual decrease of 13% after QI implementation. In 2008, these medical residents experienced 5 codes/year, compared to 29 in 2002.1 ACLS training is a common method used to prepare residents to manage codes. A survey of Canadian medicine residents at 13 schools showed that 49% lacked confidence to lead a code. Of those, 50.9% noted that ACLS did not address leadership and 40% received no training beyond ACLS. Respondents requested high fidelity simulation (HFS), leadership training and post-event debriefing/feedback to improve skills.2 Simulation improves compliance with ACLS guidelines. Second year medical residents completing a simulator-based ACLS training program had higher adherence to standards (correct responses 68%, SD 20%) compared to third year residents who completed a traditional ACLS course (correct responses 44%, SD 20%; p = 0.001).3 To address similar deficiencies, UC Davis Medical Center has implemented an innovative online and simulation-based curriculum to train medical residents in Code Team leadership. Methods The UC Davis SmartSite learning management system was used to create an online training course that teaches the fundamentals of code blue leadership. Internal Medicine interns are expected to complete the module near the end of their intern year (before carrying the code pager as a resident). The course offers a comprehensive review of the responsibilities associated with responding to codes. Course modules in Code Leadership, Basic Airway Management, Code Pharmacology and Cardiocerebral Resuscitation are comprised of seven-ten minute online lectures supported with audio overlay and video clips. Successful completion of the online portion of the module is measured using randomly generated 10-question timed pre and post-tests. A post-test score of 80% is required to pass. Proficiency is then evaluated in the simulation lab. Task trainers are used to demonstrate basic airway management and CPR. Direct guidance ensures proper technique. Leadership is assessed with a code blue event scenario using an HFS manikin and multiple confederates. Performance is scored using a standardized checklist. Immediate debriefing and feedback is provided. Residents are then required to complete a refresher session during the first week of their Medical ICU rotation. A repeat scoring checklist is obtained at that time. We report initial results from the pilot program, conducted in the Spring of 2013. Twenty-eight of twenty-nine (97%) medicine interns have completed the online training. Average pre-test score was 60%, 95% CI (52-68%, range 0-80%). Average post-test score was 89%, 95% CI (85-93%, range 60-100%). Three interns will need to retest due to a failing score. For the simulation training, the task training portion was tracked in seven categories and measured on a scale of one-three, with three showing proficiency. Interns mostly demonstrated proficiency in these basic resuscitation skills. The leadership assessment was a binary measurement (yes/no) for 27 critical actions. Comments were tracked. Interns were noted to be less proficient in demonstrating these critical actions. Refresher sessions to date have shown improvement but data analysis is forthcoming to determine the overall effect of the course. Conclusion We feel that this course is an innovative approach to code blue leadership training. Initial results indicate that the online course is successful; further analysis is necessary to determine the effect of the simulation session. We intend to compare senior medicine residents (who have not completed the online portion of the course) to determine the effect of the educational intervention. Overall, this program has been well received by the Internal Medicine residents. We intend to involve other specialties as time and scheduling permits.

Basic Life Support:A Call for Reevaluation by Nurse Educators

FORMAL EVALUATION OF THE STUDENT'S NURSING SKILLS IS FUNDAMENTAL TO THE UNDERGRADUATE NURSING CURRICULUM. An exception is basic life support (BLS) skills. The fact that these skills elude formal evaluation is alarming as research demonstrates that nursing students perform BLS skills poorly (Madden, 2006; Moule & Knight, 1997). This author urges that schools of nursing incorporate BLS skill evaluation into the undergraduate curriculum. Typically, schools of nursing require that students certify in BLS, but certification only validates the student's knowledge at one point in time. Following certification, a period of skill and knowledge deterioration takes place that Alspach (2005) attributes to the inability of the brain to form a procedural memory of the task. Students may complete the nursing program with the false notion that they are still competent in BLS. Formal skill evaluation is the accurate appraisal of a skill using techniques that have been tested for reliability and validity. Without formal evaluation of BLS, lack of competence may go unnoticed, and minimal learning may take place. As a nursing student, I had first-hand experience with the deterioration of skills and knowledge. Prior to joining the emergency response team (ERT), I had been through the certification process and considered myself an expert in BLS. However, following formal evaluation by the ERT team, my areas of deficiency were clearly apparent. I was able to remedy my errors and learn from my mistakes. I also worked as a peer mentor in my school's nursing laboratory for the last two years of the nursing program and observed students practicing other nursing skills, but never their BLS skills. As a student and mentor, I can attest that students will not practice a skill unless they know they cannot perform it correctly, or unless the skill is to be evaluated. Since the evaluation of BLS skills is not incorporated into the curriculum and appears to be inconsequential, students do not spend time fine-tuning these skills. But Niemi- Murola, Makinen, and Castren (2007) studied nursing and medical students' attitudes toward cardiopulmonary resuscitation and current practice guidelines and reported that nursing students would have liked to learn more BLS in their prelicensure education. Simulation and monitoring feedback devices are useful tools for maintaining BLS competency. The use of such devices may eliminate questions such as how hard do I push? and how fast should I go? Ackermann (2007) found that nursing students' BLS performance in a mock cardiac arrest scenario using high-fidelity simulation manikins was significantly better than the performance of a control group trained using standard American Heart Association training. …