High-fidelity Patient Simulation Research Articles

Assessment of Death Notification Skills Among Emergency Medicine Residents Using GRIEV_ING in High-Fidelity Patient Simulation

Death notification, the verbal communication to a next-of-kin survivor after a patient has died, is a stressful and high-stakes procedure. Trainees in emergency medicine should achieve competency in death notification delivery by the completion of residency, but this has not been previously demonstrated. GRIEV_ING is a validated assessment tool for death notification skills. This study utilized the GRIEV_ING checklist in a high-fidelity simulation environment to assess the performance of emergency medicine residents compared to a minimum passing standard. Post-graduate year 1–4 residents participated in a simulation case in which the patient died. Residents were asked to deliver a death notification to a standardized patient playing the role of the patient’s next-of-kin. Resident performance on the GRIEV_ING checklist was scored by the standardized patient and by a faculty member. A minimum passing standard was determined using the Ebel and Hofstee methods. Resident performance was compared to the minimum passing standard. Agreement between standardized patient and faculty physician raters was good (K = 0.6572; 95% CI 0.6121–0.7024). The minimum passing standard as determined by the Ebel and Hofstee methods was 56.2 and 54%, respectively. Residents did not uniformly meet or exceed the minimum passing standard. There was no statistically significant difference in faculty rated resident performance by post-graduate year on any of the 28 checklist items. Workplace-based instruction alone is insufficient for all emergency medicine residents to achieve mastery of death notification skills. Future efforts should focus on ensuring resident competency in this critical domain.

Simulation debriefing based on principles of transfer of learning: A pilot study.

Upon completion of undergraduate nursing courses, new graduates are expected to transition seamlessly into practice. Education providers face challenges in the preparation of undergraduate nurses due to increasing student numbers and decreasing availability of clinical placement sites. High fidelity patient simulation is an integral component of nursing curricula as an adjunct to preparation for clinical placement. Debriefing after simulation is an area where the underlying structure of problems can consciously be explored. When central principles of problems are identified, they can then be used in situations that differ from the simulation experience. Third year undergraduate nursing students participated in a pilot study conducted to test a debriefing intervention where the intervention group (n=7) participated in a simulation, followed by a debriefing based on transfer of learning principles. The control group (n=5) participated in a simulation of the same scenario, followed by a standard debriefing. Students then attended focus group interviews. The results of this pilot test provided preliminary information that the debriefing approach based on transfer of learning principles may be a useful way for student nurses to learn from a simulated experience and consider the application of learning to future clinical encounters.

Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study.

Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance. Prospective, randomized simulator study. High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland). Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three. None. We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition. We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.

Preparing for Cardiopulmonary Bypass: A Simulation Scenario for Anesthesia Providers

This simulation on cardiopulmonary bypass (CPB) introduces learners to the relevant critical actions and concepts involved in going onto and off of CPB. It is intended that junior residents experience this simulation immediately prior to beginning their cardiac anesthesia rotation. Thus, this simulation serves to segue to the trainee's initial clinical experience with CPB. The case is fully presented for facilitators in the simulation case file, which includes a brief narrative description of the case, learning objectives to be covered by the simulation, and a summary of critical actions to be performed by the learner during the educational activity. It is optimal to run this simulation using a high-fidelity human patient simulator with anesthesia machine and relevant monitors. The simulation was carried out by eight CA-1 or CA-2 residents during the 2016 academic year. Cardiac anesthesia faculties observed a significantly improved learning curve for trainees who had experienced this simulation prior to their first clinical case. Overall, this simulation has been found to be a very effective learning tool at the University of Iowa. To that end, this simulation has been incorporated into the cardiac anesthesia curriculum, and all junior residents experience this simulation prior to beginning their rotation.

Isoniazid Overdose: A Pediatric Simulation Case.

Unintentional toxic ingestions are a common occurrence in the pediatric population, and it is therefore important for resident physicians to learn to both recognize and effectively manage these events. Seizures caused by isoniazid overdose are a well-described clinical entity for which pyridoxine serves as an effective antidote. We developed a pediatric simulation case using a high-fidelity patient simulator to engage learners in a case of status epilepticus in a toddler caused by accidental isoniazid ingestion. The learning objectives of this activity are for participants to recognize that toxic ingestion has occurred, execute appropriate initial management of status epilepticus, and administer pyridoxine as an antidote. Equipment and personnel needed for this activity include a high-fidelity patient simulator, simulated medical supplies, a patient simulator operator, and one actor. This simulated case debuted among resident physicians at a simulation competition event within the emergency medicine residency program of an academic medical center. Feedback elicited after the event included a high proportion of respondents agreeing that the cases used were "sufficiently complex" and "relevant for my clinical practice." Despite some barriers to effective implementation, this simulation case was well received and may serve as a valuable educational tool for training resident physicians to effectively manage toxic ingestions. The effectiveness of this simulation in accomplishing its specific learning objectives was not formally assessed, but participant evaluations suggest that it was well received by its target audience.

Collaborating on medication errors in nursing.

Nurse educators are faced with changing roles and expanding responsibilities for medication administration and monitoring in pursuit of improved patient safety. The aims of this study were to develop, implement and evaluate clinical simulation experiences that included, along with nursing faculty members, a pharmacist educator for the teaching of preventable medication errors in undergraduate nursing education. Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems in nursing practice. Post-simulation evaluation of perceptions and experiences of undergraduate nursing students (n=69) were assessed using a questionnaire of Likert-type items, including: (1) an evaluation of the simulation experience; and (2) self-reported perceived benefits for clinical ability and confidence in recognising, managing and reporting medication errors. Four hospital-based simulations on select preventable medication errors were piloted with 72 undergraduate nursing students. The majority of students (60.8-84.1%) evaluated the experience positively with regards to time pressure, type/severity of events, challenges, and benefits for critical thinking and decision making regarding patient safety and medication errors. Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems DISCUSSION: The use of a pharmacy educator as a medication expert and member of the interprofessional health care teaching team in nursing education can be beneficial for training on medication safety, and on adverse effects, in a nursing programme in order to enhance nursing students' education.

Overcoming Reluctance towards High Fidelity Simulation - A Mutual Challenge for Nursing Students’ and Faculty Teachers

BACKGROUND: One strategy to develop nursing students’ clinical judgment are the use of high-fidelity patient simulation (HFS). The aim of the study was twofold. Firstly, the aim of this study was to describe the nursing students’ experiences while participating in HFS, and secondly to describe faculty teachers’ reflections about nursing students’ need in HFS and the related teaching challenges.METHOD: Data was collected in focus group discussions and individual interviews, analyzed using thematic qualitative content analysis.FINDINGS: The nursing students’ experienced HFS as being thrown into an uncertain, exposure situation. This were for some, reason for reluctance. The teachers challenge was motivating and coaching the students throughout a demanding teaching situation. DISCUSSION: Students’ ability to perform in HFS is influenced by self-perceived efficacy, own attitudes and responsibility for one’s learning, which are a challenge for the teachers.CONCLUSION: HFS methodology can be useful to identify gaps and strengths in students’ professional transition towards becoming registered nurses. Overcoming reluctance towards HFS is a mutual challenge for faculty teachers and nursing students. By entering the scenario with a positive mindset, nursing students can improve their ability to perform clinical judgments.

Battlefield Trauma Training: A Pilot Study Comparing the Effects of Live Tissue vs. High-Fidelity Patient Simulator on Stress, Cognitive Function, and Performance

Within the Canadian Armed Forces (CAF), the Tactical Medicine (TACMED) course is used to train medical technicians (i.e., medics) in battlefield trauma care. Although training is administered using both simulators (SIM) and live tissue (LT), little is known about their relative effects on stress and cognitive function in this context. To address this shortcoming, we conducted a pilot study and collected self-report (State-Trait Anxiety Inventory [STAI]) and biological measures of stress (salivary cortisol and dehydroepiandrosterone [DHEA]), as well as working memory (WM) and short-term memory (STM) data from medics (N = 20) assigned randomly to training and skill assessment using either SIM or LT. Skill assessment resulted in the elevation of STAI scores and salivary cortisol and DHEA levels. WM and STM performance were better at the time of skill assessment, and WM performance exhibited a positive correlation with salivary cortisol level. Salivary cortisol and DHEA levels, STAI scores, and memory performance did not predict pass/fail rates on combat casualty care skills. Although the TACMED course was associated with elevated stress and improved memory performance, those effects were not affected by the training modality. We end by discussing lessons learned from our pilot study and highlight outstanding questions that remain to be addressed in future studies on this topic.

A Comparison of High Fidelity Patient Simulations and Computerized Clinical Cases on Undergraduate Student Learning of Physiology

High fidelity patient simulations (HFPS) have been shown to improve learning of science knowledge and skills in nursing and medical students. A few studies have shown improved learning in undergraduate students. Because HFPS are expensive and resource intensive, it is important to determine whether the increase in learning is worth the high cost. The purpose of this study was to determine if computerized clinical cases (CC), a low cost alternative, could produce similar learning as HFPS.MethodsThirty‐two undergraduate biomedical students were randomly assigned to two groups. Group A participated in a HFPS about asthma and then a CC on hemorrhage. Group B participated in a CC on asthma and then a HFPS on hemorrhage. The HFPS and CC were identical cases. A pretest with 10 questions was given before their activities and a post‐test was given after their activities. Students also took a survey regarding their confidence levels after the simulation activities. The 10 questions consisted of 4 related to asthma, 4 to hemorrhage and 2 unrelated to the cases as controls.ResultsBoth groups achieved higher scores on the posttest for the asthma questions with no difference between groups. There was no significant increase in scores on either the hemorrhage or control questions. There was a significant increase in 2 of the 7 statements about confidence. One involved confidence in understanding pathophysiology of a patient and the other was the relevance of physiology to medicine.DiscussionThese data suggest that CC and HFPS are similar in short term learning for some material. Future studies are needed to determine if there are other benefits of HFPS in undergraduate students and whether these justify the cost of this pedagogy in undergraduate students.

Training and Maintaining: Developing a Successful and Dynamic Continuous Renal Replacement Therapy Program.

Continuous renal replacement therapy (CRRT) is commonly used to support critically ill patients with acute kidney injury or chronic renal disease whose condition is too unstable for them to tolerate intermittent hemodialysis. Current publications related to CRRT programs in the United States and Canada note key themes related to the development and maintenance of CRRT training programs. A successful CRRT training program should consider and incorporate adult learning principles whenever possible. A variety of teaching methods to deliver information to nurses, including online learning modules, didactic lecture, return demonstration, and high-fidelity patient simulation are key to training programs for this high-risk complex therapy. This article outlines the approach to training nurses to care for patients receiving CRRT at a health care system in Arizona.

A Systematic Review of Team Training in Health Care: Ten Questions

As a result of the recent proliferation of health care team training (HTT), there was a need to update previous systematic reviews examining the underlying structure driving team training initiatives. This investigation was guided by 10 research questions. A literature search identified 197 empirical samples detailing the evaluation of team training programs within the health care context; 1,764 measures of HTT effectiveness were identified within these samples. Trained coders extracted information related to study design and training development, implementation, and evaluation to calculate percentages detailing the prevalence of certain training features. HTT was rarely informed by a training needs analysis (k = 47, 23.9%) and most commonly addressed communication strategies (k = 167, 84.8%). HTT programs that incorporated practice (k = 163, 82.7%) often employed high-fidelity patient simulators (k = 38, 25.2%) and provided participants with feedback opportunities (k = 107, 65.6%). Participants were typically practicing clinicians (k = 154, 78.2%) with a lower prevalence of health care students (k = 35, 17.8). Evaluations primarily relied on repeated measures designs (k = 123, 62.4%) and self-reported data (k = 1,257, 71.3%). Additional trends were identified and are discussed. Many trends in HTT practice and evaluation were identified. The results of this review suggested that, in the literature, HTT programs are more frequently following recommendations for training design and implementation (for example, providing feedback) in comparison to findings from previous reviews. However, there were still many areas in which improvement could be achieved to improve patient care.

An Innovative Classroom Teaching Strategy Using High-Fidelity Patient Simulation

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Simulation in preclinical medical student education: getting started

High-fidelity patient simulation allows deliberate practice1 of clinical skills, and is now commonly deployed as an educational platform for trainees, staff and teams across healthcare. In our medical school simulation...

Defeating information overload in health surveillance using a metacognitive aid innovation from military combat systems

Modern sensors for health surveillance generate high volumes and rates of data that currently overwhelm operational decision-makers. These data are collected with the intention of enabling front-line clinicians to make effective clinical judgments. Ironically, prior human–systems integration (HSI) studies show that the flood of data degrades rather than aids decision-making performance. Health surveillance operations can focus on aggregate changes to population health or on the status of individual people. In the case of clinical monitoring, medical device alarms currently create an information overload situation for front-line clinical workers, such as hospital nurses. Consequently, alarms are often missed or ignored, and an impending patient adverse event may not be recognized in time to prevent crisis. One innovation used to improve decision making in areas of data-rich environments is the Human Alerting and Interruption Logistics (HAIL) technology, which was originally sponsored by the US Office of Naval Research. HAIL delivers metacognitive HSI services that empower end-users to quickly triage interruptions and dynamically manage their multitasking. HAIL informed our development of an experimental prototype that provides a set of context-enabled alarm notification services (without automated alarm filtering) to support users’ metacognition for information triage. This application is called HAIL Clinical Alarm Triage (HAIL-CAT) and was designed and implemented on a smartwatch to support the mobile multitasking of hospital nurses. An empirical study was conducted in a 20-bed virtual hospital with high-fidelity patient simulators. Four teams of four registered nurses (16 in total) participated in a 180-minute simulated patient care scenario. Each nurse was assigned responsibility to care for five simulated patients and high rates of simulated health surveillance data were available from patient monitors, infusion pumps, and a call light system. Thirty alarms per nurse were generated in each 90-minute segment of the data collection sessions, only three of which were clinically important alarms. The within-subjects experimental design included a treatment condition where the nurses used HAIL-CAT on a smartwatch to triage and manage alarms and a control condition without the smartwatch. The results show that, when using the smartwatch, nurses responded three times faster to clinically important and actionable alarms. An analysis of nurse performance also shows no negative effects on their other duties. Subjective results show favorable opinions about utility, usability, training requirement, and adoptability. These positive findings suggest the potential for the HAIL HSI system to be transferrable to the domain of health surveillance to achieve the currently unrealized potential utility of high-volume data.

Identifying an Effect of Simulation Role Assignment on Critical Thinking Development in Baccalaureate Nursing Students

With an increase in the number of nursing students and the limited number of open clinical positions, high-fidelity patient simulators (HFPS) have become the new norm. Multiple studies have evaluated HFPS effectiveness and several suggest that HFPS does has an effect on critical thinking. This study intends to provide data to support that suggestion. In addition, this study was designed to identify a possible correlation between role assignment and improvements in critical thinking after completion of a HFPS scenario. Analysis revealed that role assignment, for most of the roles, did have a statistically significant effect on the post-simulation critical thinking assessment scores. The relationship between role assignments and HFPS scenario outcomes (such as critical thinking), as well as the nature of the correlation, may help scenario developers better understand how critical thinking improvement can be affected by the involvement of the participant based on the roles assigned to them.

High-Fidelity Patient Simulation Increases Dietetic Students' Self-Efficacy Prior to Clinical Supervised Practice: A Preliminary Study

ObjectiveThis study examined the effect of high-fidelity patient simulation (HPS) on dietetics students' self-efficacy before supervised clinical practice. MethodsThis repeated-measures study was conducted during the 2012–2013 academic year. All students in a masters coordinated program cohort (n = 19) participated in an interprofessional HPS experience before clinical supervised practice. The students completed a 4-point self-efficacy scale in which 0 = not at all confident and 3 = fully confident, at 3 time points: before and after the simulation experience and 2 weeks after beginning clinical supervised practice. ResultsUsing the Wilcoxon signed-rank test, median confidence level differed before and after the simulation (1.5; interquartile range [IQR] 1.2–1.8; and IQR 1.3–2.0, respectively; P = .03) as well as after the simulation vs during the clinical rotation (2.2; IQR 2.0–2.4; P = .002). Conclusions and ImplicationsThis study supports the use of HPS with dietetics students in a coordinated program. High-fidelity patient simulation increases dietetics students' self-efficacy before supervised clinical practice.

Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

Progress in the utilization of high-fidelity simulation in basic science education.

High-fidelity patient simulators are mainly used to teach clinical skills and remain underutilized in teaching basic sciences. This article summarizes our current views on the use of simulation in basic science education and identifies pitfalls and opportunities for progress.

Optimizing the Reflective Observer Role in High-Fidelity Patient Simulation.

The purpose of this descriptive secondary analysis of qualitative data was to gain insights into the role and opportunities of the reflective observer in high-fidelity patient simulation (HFPS). Although the value of HFPS in nursing education has been documented, the reflective observer role in HFPS may not be used to its potential. This secondary data analysis of a broader study included qualitative interviews of those in observer roles (N = 23). This secondary analysis used content analysis to address research questions related to the reflective observer role. Three themes emerged related to using the reflective observer role for self-assessment, peer review and debriefing, and team-focused learning. Implications for nursing education, including orienting all HFPS participants to reflective observer roles and opportunities, are addressed. Further study of this important role for both individual and team learning is indicated. [J Nurs Educ. 2016;55(6):353-356.].

Acquisition of Competencies by Medical Students in Neurological Emergency Simulation Environments Using High Fidelity Patient Simulators.

The training of medical students demands practice of skills in scenarios as close as possible to real ones that on one hand ensure acquisition of competencies, and on the other, avoid putting patients at risk. This study shows the practicality of using high definition mannequins (SimMan 3G) in scenarios of first attention in neurological emergencies so that medical students at the Faculty of Medicine of the University of Salamanca could acquire specific and transversal competencies. The repetition of activities in simulation environments significantly facilitates the acquisition of competencies by groups of students (p < 00.5). The greatest achievements refer to skills whereas the competencies that demand greater integration of knowledge seem to need more time or new sessions. This is what happens with the competencies related to the initial diagnosis, the requesting of tests and therapeutic approaches, which demand greater theoretical knowledge.