High-fidelity Simulation Scenarios Research Articles

A pilot initiative to enhance quality improvement teaching with simulation.

Quality Improvement and Patient Safety (QIPS) is a recognised competency across residency programmes. Although a variety of teaching modalities exist, many do not represent the multifaceted clinical environment that trainees work in. Residents have reported challenges in linking QIPS classroom-based learning with their clinical duties. High-fidelity simulation has been used to bridge this gap within clinical skills teaching and therefore has potential to address this issue in QIPS learning. We developed and piloted four high-fidelity simulation scenarios with 15 surgical residents (Orthopaedics, General Surgery, Gynaecology and Neurosurgery). Each scenario contained elements of both latent and active safety errors. Residents were provided with a short pre-reading from an open-access resource on basic QIPS methodology and underwent a debriefing by a trained QIPS faculty. Residents were then tasked to apply their learning to their scenario to develop a QIPS-focused solution. Objective knowledge acquisition was assessed with the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R) in conjunction with a survey based upon the Kirkpatrick Model of Learning. Overall, residents agreed that the simulation was helpful in learning QIPS methodology and agreed that they could perform fundamental QIPS tasks. The average QIKAT-R score demonstrated a trend towards improvement. High-fidelity simulation is a potential means to provide residents with hands-on experience in QIPS knowledge acquisition and application. Future directions should aim to compare the efficacy of simulation with other teaching modalities and evaluate the long-term impact of QIPS teaching on resident behaviours and motivation to take part in QIPS initiatives.

Assessing Clinical Judgment and AACN Domains in Self-Reflection of Video Recorded High-Fidelity Simulation Scenarios.

Clinical judgment is the hallmark of safe patient care. Nurse educators continue to explore best practices to assist prelicensure nursing students in developing clinical judgment. The 3-part purpose of this study was to identify what students learned about themselves related to clinical judgment after viewing their video-recorded high-fidelity simulation scenarios, to assess if video recording is an effective post-debriefing teaching strategy, and to evaluate if the 2021 American Association of Colleges of Nursing (AACN) Domains can be assessed longitudinally. Qualitative interpretive description study of 37 prelicensure nursing students. Ten codes were derived from 314 excerpts: communication, body language, confidence in self, putting data together, collaboration, leadership, safety, skillfulness, areas of improvement, and growth. Longitudinal data showcased the development of clinical judgment, effectiveness of self-evaluation of video recorded simulations as a teaching strategy, and assessment of 5 AACN Domains.

Assessing satisfaction in simulation among nursing students: psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale

BackgroundThe Satisfaction with Simulation Experience scale is a 5-point Likert scale that measures students’ satisfaction in medium and high-fidelity simulation scenarios. This study aims at investigating the psychometric properties of the Satisfaction with Simulation Experience - Italian Version scale.MethodsA multi-centre cross-sectional study was conducted. The scale was administered to a sample of 266 undergraduate nursing students from two Italian universities after attending a medium- and high-fidelity simulation session in November 2022 and March 2023. Cronbach’s alpha coefficient and item-total correlation were sorted out to assess internal consistency and reliability. The test-retest method was used as a measure of scale stability over time as well as the confirmatory factor analysis to verify construct validity.ResultsThe Cronbach’s alpha value was 0.94 for the overall scale, indicating excellent reliability, and it was 0.84 or higher for each subscales, indicating good reliability. A large correlation coefficient of 0.60 or higher was found between each item and its subscale and between each item and the overall scale score. A medium test-retest correlation coefficient was found for most items (r > 0.30). The confirmatory factor analysis confirmed the factorial structure found in the original study.ConclusionsSatisfaction is an important teaching and learning quality indicator along with the achievement of learning outcomes in simulation. The Satisfaction with Simulation Experience - Italian Version scale showed good reliability and validity; therefore, it could be a useful tool to assess simulation impact in Italian nursing students. The extensive utilization of the Satisfaction with Simulation Experience scale, along with its various validated versions, could facilitate assessing satisfaction in simulation across diverse contexts and enable comparisons of findings across studies in different countries.

Effectiveness of a Haemorrhage-Control Task Simulator for Training Nursing Students: A Quasi-Experimental before-after Study

Aim. To assess the efficacy of a low-cost haemorrhage-control task simulator integrated in a high-fidelity simulation scenario to facilitate knowledge and practical skills acquisition, as well as self-efficacy in haemorrhage control among nursing students. Design. A quasiexperimental before-after design was conducted at the University of Almeria. Methods. A one-group preintervention, immediate postintervention, and a third assessment at three months were performed, with the Stop the Bleed Education Assessment Tool used to evaluate knowledge of haemorrhage control, as well as a 5-point Likert scale used to evaluate perceived self-efficacy. The success of controlling exsanguinating bleeding was determined by quantifying the millilitres lost during the intervention and calculating the time required to control the haemorrhaging. The data were reported using the TREND guidelines. Results. One hundred and three final-year nursing students participated in this study. Significant improvements (p<0.001) were observed in pre- and posttest total scores on knowledge of bleeding control, self-efficacy, as well as time is taken and volume loss to control the haemorrhage. Similar results were observed between preassessment and three months postassessment with significant improvements (p<0.001) in all measures. Conclusions. The use of a haemorrhage-control task simulator within a high-fidelity simulation scenario resulted in noteworthy improvements in nursing students’ practical skills, knowledge retention, and self-efficacy. After three months, performance decreased but remained greater than pretraining levels. Thus, broadening the use of this task-training simulator would be of great value to further develop a first responder training approach with healthcare professionals and other laypersons, allowing for greater knowledge distribution and reaching a larger audience. Implications for Nursing Management. The findings underscore the potential efficacy of this simulator as a valuable resource for nursing educators and supervisors to train nursing students and professionals in terms of practical skills, knowledge retention, and self-efficacy in haemorrhage control, fostering a train-the-trainer cascade approach to reach a wider audience and enhance bleeding control proficiency among professionals.

Educating for capability and preparing for practice: Integrating theory and skills.

Capability is the ability to perform clinical skills in ever-changing real world contexts, adapting to challenges and integrating technical and non-technical skills and competencies, for example, cannulating an uncooperative patient at night. Going beyond teaching competency and ensuring capability is imperative, as recommended by the national outcomes for medical graduates. A course on intravenous cannulation was developed with e-learning modules and high-fidelity complex simulation scenarios, aiming to promote capability in practice. The course delivered an intravenous cannulation e-learning package between two practical simulations to 10 final-year medical students. The hybrid simulation design consisted of an actor with a bespoke cannulation part-task trainer strapped to their arm. Each simulation delivered a challenging scenario, requiring the integration of procedural and behavioural skills to succeed. Simulations were video recorded, and participants reviewed their performances before completing semi-structured interviews. Transcribed interviews were thematically analysed. Interview analysis demonstrated two overarching themes: 'Impact on Capability' and 'Preparedness for Practice'. There was consistent recognition of improved capability from the interviews. Simulation exercises were described as the most valuable tool for developing capability. The e-learning helped with structure, facilitating students' adaptation to scenarios. Participants felt that training in medical school was largely competency-based and did not tackle complex interactions. Following e-learning and simulations, students felt more prepared for clinical practice. The course structure has value for medical professionals in developing capability and preparing for clinical practice, helping to reach standards expected of graduates. Plans to assess capability across multiple undergraduate programmes through Entrustable Professional Activities are in progress.

Communication of medical errors in a simulated clinical scenario. Experience with a pediatric residency group.

To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

A70Novel high-fidelity Surgical Simulation Educational Program (SSEP) – a systems-based approach for enhanced patient safety

Increased pressures within the NHS, shortened learning hours and disruptions caused by the COVID-19 pandemic has significantly impacted surgical training. Current courses focus on single training levels, but errors occur through systemwide failures [1]. We developed a SSEP targeting cross specialty and team-based patient management, focused on clinical knowledge and skills, cognitive simulation, leadership and human factors based upon real life events to optimize training in a system that lacks time and exposure. A six-month pilot program was designed with monthly sessions, attended by surgical nurses, junior doctors and consultants, covering common surgical scenarios mapped to the ISCP curriculum [2], and topics highlighted through local clinical governance. Immersive interactive sessions were delivered by a dedicated consultant led education team to provide a mixed reality environment for each simulated scenario. Faculty encompassed emergency, anaesthetic and surgical consultants to facilitate realistic multidisciplinary team working. The professional identity and grade of participants were maintained during each simulation to ensure sessions were representative of real-life events with a clear mutual goal to improve knowledge and skills to transpose into safer patient care at all levels of seniority. Sessions combined simulated scenarios with structured teaching, clear learning objectives, detailed peer feedback and opportunity for juniors to complete work-based assessments with consultants. Senior trainees benefited from participation in the design and delivery of sessions providing opportunities to strengthen their leadership skills. We recorded participants pre- and post-simulation confidence, and knowledge, were measured using 5-point Likert scale feedback forms, and multiple-choice questionnaire (MCQ) paper respectively. Two-paired T analysis showed statistically significant improvements in participant confidence across all 4 simulations ( Pooled two-paired T-Test analysis of participant self-rated confidence, in managing clinical scenarios and core topics, before and after participation in 4 high-fidelity simulated scenarios, at the 95% confidence interval (*Significance α = ≤0.05). Our SSEP is an effective strategy for the improvement of trainees’ confidence and knowledge in managing challenging surgical scenarios, which actively contributes to the development of skills for clinical practice. Evaluation of long-term knowledge retention is necessary. Our ambition is to develop the program as a quality improvement project (QIP) that implements learning from significant events and demonstrate improved outcomes in these domains. We endeavour to embed this simulation training across the region. 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.

Person-Centered Care and Clinical Judgment: Mapping the AACN Essentials with Simulation in Prelicensure Nursing Programs

The purpose of this article is to describe simulation as a strategy for teaching and mapping the AACN Essentials domain of Person-Centered Care and the concept of clinical judgment with prelicensure nursing students. A validated assessment tool, Lasater clinical judgment Rubric, may be used to evaluate the AACN concept of clinical judgment with simulation. A variety of high-fidelity simulation scenarios, standardized clients, and embedded participants increase realism and student learning. Encompassing a variety of clients across the lifespan, while incorporating cultural diversity in each scenario, offers an opportunity to teach the AACN domain of Person-Centered Care. Evaluating student performance progressively in interactive simulation activities aims to prepare practice-ready nurses.

A WeChat applet-based national remote emergency system for malignant hyperthermia in China: a usability study

BackgroundMalignant hyperthermia (MH) is a rare anesthetic emergency with a high mortality rate in China. We developed a WeChat applet–based National Remote Emergency System for Malignant Hyperthermia (MH-NRES) to provide a real-time emergency system to help Chinese anesthesiologists deal with MH crises. However, it is imperative that close attention should be paid to the usability of the applet.PurposeThe objectives of this study were to (1) evaluate the usability of the applet-based MH-NRES for anesthesiologists; and (2) to test the validity and reliability of a modified mHealth app usability questionnaire.MethodsA modified User Version of the Mobile Application Rating Scale (uMARS) was designed. Together with System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ), another two well-validated questionnaires, uMARS were then used to evaluate the usability of MH-NRES. The Cronbach alpha of the total score and the subscales of uMARS was calculated to evaluate the internal consistency. The correlation coefficients among three questionnaires were calculated.ResultsIn this study, 118 anesthesiologists provided responses to the questionnaire. The overall mean uMARS score was 4.43 ± 0.61, which ranged from 3 to 5. The mean PSSUQ score were in good to excellent range with mean of 6.02 ± 0.97, which ranged from 3.19 to 7. The overall SUS score was 76.0 ± 17.6, which ranged from 45 to 100. The total uMARS score had excellent internal consistency (Cronbach alpha = 0.984). uMARS and its subscales were strongly correlated with PSSUQ (coefficient 0.758–0.819, P < 0.001) and SUS (coefficient 0.535–0.561, P < 0.001), respectively.ConclusionsData obtained from the usability evaluation questionnaires in this study indicated a high quality of the MH-NRES on the ease of use, satisfaction and perceived usefulness, which suggest this system might be a useful tool for anesthesiologists’ education and management of MH crises. Future feedback from high-fidelity simulation and clinical scenarios are need for further usability evaluation of this system.

Impact of simulation on multidisciplinary NICU teamwork during delivery and transport of extremely preterm infants.

Multidisciplinary teamwork during delivery room (DR) resuscitation and timely transport to the neonatal intensive care unit (NICU) can reduce morbidity and mortality for infants born Extremely Preterm (EP). We aimed to assess the impact of a multidisciplinary high-fidelity simulation curriculum on teamwork during resuscitation and transport of EP infants. In a prospective study conducted at a Level III academic center, seven teams (each consisting of one NICU fellow, two NICU nurses, and one respiratory therapist) performed three high-fidelity simulation scenarios. Videotaped scenarios were graded by three independent raters using the Clinical Teamwork Scale (CTS). Times of completion of key resuscitation and transport tasks were recorded. Pre- and post- intervention surveys were obtained. Overall, time of completion of key resuscitation and transport tasks decreased, with significant decreases in the time to attach the pulse oximeter, transfer of the infant to the transport isolette, and exit the DR. There was no significant difference in CTS scores from Scenario 1 to 3. Scenarios led by first-year fellows showed a trend towards improvement in all CTS categories. A comparison of teamwork scores pre- and post-simulation curriculum during direct observation of high-risk deliveries in real time revealed a significant increase in each CTS category. A high-fidelity teamwork-based simulation curriculum decreased time to complete key clinical tasks in the resuscitation and transport of EP infants, with a trend towards increased teamwork in scenarios led by junior fellows. There was improvement of teamwork scores during high-risk deliveries on pre-post curriculum assessment.

Development and psychometric testing of the non-technical skills scale in medical and surgical hospital units for nursing students

ObjectiveTo develop and validate a tool to assess the non-technical skills of medical and surgical hospital units undergraduate nursing students. BackgroundIn the area of healthcare, non-technical skills complement technical ones, and contribute to patient safety. High-fidelity simulation is an ideal resource for working on these skills. Thus, evaluation instruments are needed to understand the efficiency of this methodology. Although many evaluation instruments already exist, none measure non-technical skills of undergraduate nursing students in medical and surgical hospital units. DesignAn instrumental study design was employed. MethodsTwo-phases were used to develop and validate the scale: 1) Scale development. A group of experts defined the dimensions and components. Afterwards, the content was validated by experts, and a pilot study was conducted with undergraduate Nursing students. 2) Analysis of the psychometric properties of the scale. A total of 393 students were evaluated in high-fidelity simulation scenarios by three evaluators, through the use of the Non-Technical Skills in Medical and Surgical Hospital Units (NTS-Nursing) Scale. ResultsThe content validity indexes were adequate for the total of the items and the total of the scale. The statistical descriptors of the items, the internal structure, and the reliability (internal consistency and inter-evaluator reliability) were analyzed, as well as the external evidence of validity, with adequate values obtained. ConclusionThe NTS-Nursing scale is a valid and reliable instrument. Its structure of 10 items makes its use fast and easy.

Model predictive control for formation reconfiguration exploiting quasi-periodic tori in the cislunar environment

Given the numerous possibilities that formation flying space missions can enable, being able to design and govern relative trajectories in this scenario is fundamental. Particularly interesting, due to the installation and operation of the Lunar Gateway, which will represent the next human outpost in the cislunar environment, will be the exploitation of formation flying missions in the vicinity of this lunar station. The nonlinear dynamics by which the Earth-Moon system is characterised offers the possibility to find bounded relative trajectories which can be used to design the formation. In order to best exploit the formation potential, some reconfiguration manoeuvres can be used, which by changing the relative geometry can increase the versatility and adaptation of the mission. In this paper, a Model Predictive Guidance and Control strategy is proposed and applied to perform rephasing manoeuvres in the harsh environment of the Near Rectilinear Halo Orbits. By including first a limited thrust constraint and then a collision avoidance, a more mission-oriented approach is provided to the system. To further increase the robustness of the on-board algorithms, an adaptive logic is provided to the different tuning weights involved in the Model Predictive Control scheme. In this way, a more flexible system is obtained, which is capable of optimally working also in the presence of a high-fidelity simulation scenario, including discrepancies with the simplified on-board dynamical model.

Utilisation of digital authoring platform to enhance simulation delivery

The development and ongoing critique of simulation-based scenarios is critical to ensure a researched and standardised approach to learning [1]. This is achieved by creating scenarios that have set learning objectives to improve clinical practice within multidisciplinary teams and patient safety. Additionally, a robust scenario leads to stimulating and open debriefings [2]. Whilst a paper-based scenario will do this, the aim is to highlight the benefits of using a digital platform for both creating and updating scenarios. Paper scenarios have been used for many years to achieve the goals highlighted above but it became increasingly obvious that the resources needed to review, critique, and update those scenarios were no longer effective. This situation was emphasised due to the need to have multiple copies of scenarios across many sites. In order to maintain a quality service, whilst still being able to maintain resources to redevelop and enhance existing scenarios, we implemented a digital authoring platform called IRIS. Scenarios were transferred and created allowing a centrally controlled catalogue that could be audited and version controlled. Any changes made would automatically update the scenario on all the users’ tablets thus ensuring the same version of the scenario was used across all sites. An immediate benefit was the reduction in time spent redeveloping scenarios. This allowed for added details to be entered dependent on if it was a standardised patient or manikin driven scenario. Another benefit was the ability to rapidly collaborate and co-author with peers and subject matter experts. IRIS interfaces with manikins from leading vendors, sending patient data states directly to the manikins reducing setup time. We noticed an increase in simulation engagement as authors were able to log on remotely to update work. IRIS allows easy design and supports the development of high-quality scenarios. Its implementation saved resources in terms of time, staffing and environmental footprint. It enabled us to have a central hub of scenarios that dismissed the need to do multiple updates in multiple places and enabled us to have an audit trail of changes, by date time and user. Moving to a digital platform enhanced the experience of our users giving them a better learning experience leading to improved patient care. 1. Alinier G. Developing high-fidelity health care simulation scenarios: A guide for educators and professionals. Simulation &amp; Gaming. 2011;42(1):9–26. 2. Dieckmann G, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare Journal. 2007;2(3):183–193.

Form for planning and elaborating high fidelity simulation scenarios: A validation study.

Every human being has the right to safe, dignified and harm-free care in health institutions. High fidelity simulation has been used in teaching for the training and continuing education of health professionals to promote quality, safe and humanized patient care. Elaborating scenarios is an important phase to provide a simulation-based experience, and is relevant in the teaching-learning process. The objective of this study was to validate the content and applicability of the High Fidelity Simulation Scenario Planning and Development Form and its Operational Manual. The form could be used to development of scenarios to medicine, nursing, physiotherapy and as well as other specialties in the healthcare. This was a methodological validation study of the form and its manual content by experts in simulation and its feasibility, conducted in two phases: Phase 1: eight experts were selected using the “snowball” sampling technique to validate the content measured by the content validity index; Phase 2 (test): the form and its operational manual validated by the experts were made available to 28 participants in order to elaborate scenarios for the feasibility assessment and participation in the focus group. All items in the form and in the operational manual reached a content validity index above 0.80. The total content validity index was 0.98. The evaluation of the usability of the instruments carried out by the participants reached a percentage above 96.43% in all alternatives except for the item “It was easy to use the form to build your scenario” (75%). Eight participants were present in the focus group. Focus group discussions were categorized into completeness, practicality and usefulness according to comments and suggestions. The form and its operational manual proved to be valid instruments.

The influence of team workload on team performance in the light of task complexity: a study of nuclear fire brigades

The aim of the study was to explore the effect of perceived team workload on team performance among nuclear fire brigades of the Hungarian nuclear power plant. Our sample consisted of six firefighting teams (N = 42 individuals) who were involved in two high-fidelity simulated scenarios with different task complexity. Team workload was measured by the NASA Task Load Index, while team performance was evaluated by a team of experts. Our results showed that teams generally managed to maintain a standard performance in both cases, although they perceived there to be a higher workload during the complex scenario. Our results further revealed that perceived ‘physical demand’ and ‘effort’ factors contributed to the increased level of workload in the complex task. Finally, in the case of the simple simulated scenario, workload and team performance were not related to each other, while the two were positively correlated in the complex scenario.

Prior Extracorporeal Membrane Oxygenation (ECMO) Experience and Performance in High-Fidelity Simulation Scenarios.

BackgroundExtracorporeal Membrane Oxygenation (ECMO) provides a heart-lung bypass for patients with life-threatening cardiorespiratory failure. It is a classic low-volume, a high-risk procedure that requires specialized training to develop and maintain competence. Therefore, our ability to train efficiently and effectively is essential. The purpose of this study is to determine if specific participant training or experience leads to better performance in emergency ECMO scenarios during high-fidelity simulation training.MethodsFifty-one physicians, nurses, and respiratory/medical technicians participated in a study comparing an animal model vs. simulation-based ECMO education. All completed a multiple-choice questionnaire about prior ECMO experience and other demographics, as well as a four-hour pre-lab didactic session. They completed individual ECMO scenarios with both modalities during two sessions, and task completion times (minutes) and scores (percentage) were measured using a validated ECMO skills assessment tool. The scores of the 19 participants who completed the simulation-based scenarios during their first session were further analyzed in the context of their self-reported ECMO experience, and participants were divided into a novice group and an experienced group. Statistical testing included the Mann-Whitney U test (times) and Fisher’s exact test (scores).ResultsData from the 19 participants who completed the simulation-based ECMO training on the first session showed no statistically significant differences in the task completion time or scores among those in the novice group vs. the experienced group in the years of ECMO experience category (28 vs. 34 minutes; p=0.66 and 61% vs. 62%; p=0.54), a number of cannulations category (30 vs. 25 minutes; p=0.11 and 59% vs. 62%; p=0.82) or the number of ECMO patients cared for category (28 vs. 34 minutes; p=0.30 and 57% vs. 62%; p=0.54). Findings were similar for both the lecture-based training and simulation-based training categories, respectively (33 vs. 28 minutes; p=0.71 and 62% vs. 60%; p=0.91 and 34 vs. 28 minutes; p=0.74 and 63% vs. 58%; p=0.12).ConclusionAmong this small subset of participants, we observed no statistically significant differences in performance based on participant experience during simulation-based ECMO scenarios. The didactic/review sessions preceding the training may have contributed to an effective form of training for participants with no prior ECMO experience. Due to the small sample size of this study, further studies are needed to better elucidate what factors lead to better performance in emergency ECMO scenarios.

Final year undergraduate nursing students’ experience of high-fidelity simulation: results of a survey

Background: Within a Bachelor of Nursing program, high-fidelity simulation optimises student preparation for the clinical environment and promotes the consolidation of clinical skills. It is important to research and evaluate high-fidelity simulation experiences as satisfied students engage in more meaningful learning, which in turn facilitates active and purposeful participation in their simulation experiences. Objective: The aim of this study was to describe undergraduate nursing students’ experience of high-fidelity simulation. Design: An exploratory descriptive design. Setting: Three simulation centres within a university located across metropolitan, regional and rural Victoria. Participants: Undergraduate students (n = 567) from three campuses completing their final clinical nursing unit were invited to participate in the study. Methods: Students participated in a high-fidelity simulation scenario and immediately after the experience completed a survey that included the Satisfaction with Simulation Experience Scale. Data were analysed using the Statistical Package for the Social Sciences for Windows version 27.0. Results: A total of 288 students participated in this study. The majority of students strongly agreed or agreed that high fidelity simulation enhanced their learning (98.9%), developed their clinical reasoning skills (97.2%) and clinical decision-making ability (96.9%), and that simulation was a valuable learning experience (99.3%). Conclusion: Students perceived high-fidelity simulation positively and considered high-fidelity simulation to be a useful teaching and learning strategy.

Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice

Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia care to thousands of patients each year. Despite increased anesthetic safety, low-frequency, high-risk perioperative critical events still occur. Although CRNAs have been expected to rely on memory alone to manage the spectrum of these critical events, the use of an emergency manual (EM) may improve CRNA performance. At one Army community hospital, recent experiences with similar critical events led to the development of the following question: Will the use of high-fidelity simulation training with the staff CRNAs on the use of EMs produce both increased performance in key tasks and positive satisfaction scores related to the use of the emergency manual during critical events now and in the future? Twenty staff CRNAs participated in high-fidelity simulated scenarios involving low-frequency, high-risk critical events before and after training on the use of an EM based on a change strategy developed by Goldhaber-Fiebert and Howard in 2012. Changes in performance after training were evaluated using a tool designed by Arriaga et al. Before EM training, CRNAs completed 46.05% of key tasks in the simulated scenario. After EM training, CRNAs completed up to 94.02% of key tasks in simulated scenarios. The observed increase in the completion of key tasks by CRNAs during simulated critical events after EM training and increase in satisfaction scores demonstrates how a well-constructed training program facilitates the implementation of an evidence-based EM into practice and can improve the quality and consistency of CRNA performance during low-frequency, high-risk perioperative events.

The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial.

To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians. This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer. One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome. Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

105 Nursing Theory and Burn Competency Training Practices to Address Gaps in Post-covid Trained Graduate Nurses

IntroductionRecruitment efforts just after the recent COVID crises brought in several new graduate nurses. They had limited clinical exposure during COVID-19 resulting in difficulty transitioning into practice providing safe patient care. As a result, these nurses lacked the fundamental knowledge needed to care for acutely ill burn and wound patients resulting in the new graduate registered nurses (NGRNs) feeling overwhelmed at the bedside. These findings coincide with assessments noted in Kavanagh and Sharpnack’s (2021), article identifying only 9% of NGRNs were practice ready, with 7% failing to recognize urgency or a change in a patient’s condition.MethodsIn order to achieve the designated American Burn Association (ABA) competencies, our center designed a program based on Patricia Benner’s Novice to Expert nursing theory. Additionally, we divided the competencies into achievable goals and domains using the Donna Wright's nursing competency model.StaRN program: didactics/simulation/skills/unit orientation one on one with a preceptorCompetency based staged orientation program for new staffBurn Specific Education includes:1) Burn and complex wound care didactic2) Burn specific High-fidelity simulation scenario utilizing critical care equipment promoting critical thinking and critical reasoning skills3) Task trainers4) On-going preceptor education5) Nurse Extern programResultsNGRNS arriving at our unit in early 2020 were found to be incapable of performing clinical tasks in the burn ICU (BICU) setting at the level of competency recommended by the ABA. We immediately placed this cohort into the revised training program incorporating Benners Novice to Expert Theory and Wright’s Competency Model. Of the 25, 17 were able to be placed in the BICU (68%), and 8 were able to transfer to a lower level of care (progressive care/med-surg). All 25 were given extended orientation (12 weeks instead of the normal 8, as recommended by our facility). We will follow this group to determine retention rates.ConclusionsCurrent levels of competencies by the ABA creates gaps in care for graduate nurses entering the workforce with deficits. Applying Benner's Novice to Expert Theory and Wright’s Competency Model to modify approaches to training helps identify gaps in care, addresses areas that are weak for the nurse, and help guide the graduate nurse through stages of expertise to arrive more confidently at the level of competency expected by the ABA.