Human Patient Simulator Research Articles

Who Needs High-Fidelity Human Patient Simulator Manikins and What Scope of Simulation-Based Training is Necessary for Nurses?

Who Needs High-Fidelity Human Patient Simulator Manikins and What Scope of Simulation-Based Training is Necessary for Nurses?

Student acceptability of human patient simulators in undergraduate OSCEs.

For many years low-fidelity, medium-fidelity and high-fidelity simulation within various undergraduate healthcare professional (HCP) curricula has been widely used in the provision of clinical education. Part task trainers, cardiopulmonary resuscitation (CPR) manikins and human patient simulators (HPS) are now routinely used at varying stages of training to allow learners to practise the required skills in a ‘safe environment’. Similarly, many of these educational establishments will use the same part task trainers and CPR manikins to assess competency and performance of clinical skills. However, as the use of simulation in its various forms continues to rise in both undergraduate and postgraduate education, there still remains a sparsity of evidence with regard to its acceptance in undergraduate degree examinations.1 This paper describes the development and subsequent use of an anaphylaxis/cardiac arrest scenario in a final-year medicine objective structured clinical examination (OSCE) and the postexamination student acceptability of including a simulation-based scenario in a high-stakes final-year examination. The objectives of the examination station were to test the student's ability to perform a logical and rapid patient assessment and demonstrate clinical decision making in a resuscitation situation. An anaphylactic reaction was chosen for the clinical situation, as all of the students had undertaken a similar scenario during their …

The Effect of Using Human Patient Simulation on Undergraduate Nursing Student Skill Performance and Anxiety Level

Background and Aim Human patient simulators provide a very realistic situation for nursing students, centers on the opportunity for the learner to practice and learn in an environment as close to reality as possible, allows students to construct knowledge, explore assumptions, and develop psychomotor skills in a safe environment. The study aims to assess the effect of using human patient simulation on undergraduate nursing students’ skill performance and anxiety levels at the college of Nursing in Mosul University. Method and Materials: A case control study design has been used for the 1st February 2014 till 30th of May 2014. A non-probability convenience sampling of (90) under graduate nursing students (60) females and (30) males were chosen, the study sample was divided into two groups, an experimental group of (45) nursing students with human patient simulation laboratory setting experience and control group of (45) nursing students with clinical practice setting experience. The validity of this study instruments was established through a panel of (12) experts of different specialties related to the field of the present research, Reliability of the study tools was determined through the use of split half -approach of the computation of Cronbach alpha correlation coefficients for the checklist and The Cronbach’s alpha for the questionnaire. Data collection tools include the checklist which is consisted of (25) question items that related to the physical examination for thorax and lungs and the questionnaire consisted of (15) question items respondents were asked to rate the individual items on a (5)-point scale according to their response to each item, Data were prepared and entered into a computer files; Statistical Package for the Social Science (SPSS, version 21) is used for data analysis. Conclusions: The study result show that there is a significant effect of simulation in Students’ skills performance level while there is no effect in control group, and there is a significant relationship between students' skill performance and gender for case group, while there were no significant relationship between students' skill performance and gender for control group. The male students is more improvement than female in their skill level after simulation course. Anxiety level were higher in student who apply physical examination on a patient comparing with those students who apply physical examination on a HPS. Recommendation: The study recommended to introduce the modern technology (HPS) in students' training process because it decrease students' anxiety level so the skill performance of students will be more confident and reduce errors when skilled nursing application and thus reflected repercussions on public health and a better way than the old classical training.

Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical Residents

The human patient simulators that are currently used in multidisciplinary operating room team training scenarios cannot simulate surgical tasks because they lack a realistic surgical anatomy. Thus, they eliminate the surgeon's primary task in the operating room. The surgical trainee is presented with a significant barrier when he or she attempts to suspend disbelief and engage in the scenario. To develop and test a simulation-based operating room team training strategy that challenges the communication abilities and teamwork competencies of surgeons while they are engaged in realistic operative maneuvers. This pre-post educational intervention pilot study compared the gains in teamwork skills for midlevel surgical residents at Wake Forest Baptist Medical Center after they participated in a standardized multidisciplinary team training scenario with 3 possible levels of surgical realism: (1) SimMan (Laerdal) (control group, no surgical anatomy); (2) "synthetic anatomy for surgical tasks" mannequin (medium-fidelity anatomy), and (3) a patient simulated by a deceased donor (high-fidelity anatomy). Participation in the simulation scenario and the subsequent debriefing. Teamwork competency was assessed using several instruments with extensive validity evidence, including the Nontechnical Skills assessment, the Trauma Management Skills scoring system, the Crisis Resource Management checklist, and a self-efficacy survey instrument. Participant satisfaction was assessed with a Likert-scale questionnaire. Scenario participants included midlevel surgical residents, anesthesia providers, scrub nurses, and circulating nurses. Statistical models showed that surgical residents exposed to medium-fidelity simulation (synthetic anatomy for surgical tasks) team training scenarios demonstrated greater gains in teamwork skills compared with control groups (SimMan) (Nontechnical Skills video score: 95% CI, 1.06-16.41; Trauma Management Skills video score: 95% CI, 0.61-2.90) and equivalent gains in teamwork skills compared with high-fidelity simulations (deceased donor) (Nontechnical Skills video score: 95% CI, -8.51 to 6.71; Trauma Management Skills video score: 95% CI, -1.70 to 0.49). Including a surgical task in operating room team training significantly enhanced the acquisition of teamwork skills among midlevel surgical residents. Incorporating relatively inexpensive, medium-fidelity synthetic anatomy in human patient simulators was as effective as using high-fidelity anatomies from deceased donors for promoting teamwork skills in this learning group.

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.

Development of a Smartphone App for Visualizing Heart Sounds and Murmurs

Background: Auscultation is one of the basic techniques for the diagnosis of heart disease. However, the interpretation of heart sounds and murmurs is a highly subjective and difficult skill. Objectives: To assist the auscultation skill at the bedside, a handy phonocardiogram was developed using a smartphone (Samsung Galaxy J, Android OS 4.4.2) and an external microphone attached to a stethoscope. Methods and Results: The Android app used Java classes, “AudioRecord,” “AudioTrack,” and “View,” that recorded sounds, replayed sounds, and plotted sound waves, respectively. Sound waves were visualized in real-time, simultaneously replayed on the smartphone, and saved to WAV files. To confirm the availability of the app, 26 kinds of heart sounds and murmurs sounded on a human patient simulator were recorded using three different methods: a bell-type stethoscope, a diaphragm-type stethoscope, and a direct external microphone without a stethoscope. The recorded waveforms were subjectively confirmed and were found to be similar to the reference waveforms. Conclusions: The real-time visualization of the sound waves on the smartphone may help novices to readily recognize and learn to distinguish the various heart sounds and murmurs in real-time.

Human Patient Simulator based CBRN Casualty Management Training

<p>Chemical, biological, radiological and nuclear (CBRN) emergency are becoming an impending threat. Effective preparedness needs to be raised for prompt response of CBRN incidents. During mass casualty incidents the strategy of the first responders must be beyond the triage, evacuation and medical first aid. Response process is advanced by the presence of CBRN contaminants and it becomes more complex when the rescue operations have to be performed immediately after the incident. Methodological approach is required to identify and decontaminate the CBRN victims. To manage CBRN emergencies, skill based training of appropriate degree is a key to the right level of preparedness. Intervention by first responders requires specialised inputs in knowledge, skills and aptitude. In India, CBRN defence training has traditionally been a military oriented domain, involving the quick reaction team, quick reaction medical team, rapid action medical team, etc. The training concept discussed in this study contemplates around standardised simulated CBRN casualty referred to as CBRN human patient simulator (HPS), which conceptualised in the division of CBRN Defence, Institute of Nuclear Medicine and Allied Sciences, Delhi. HPS provides an opportunity to learn about the health impact of CBRN contaminants and practise medical management. Simulation as training and planning tools, offers repeatability, controllability, possibility for evaluation and provides a platform to learn from costly mistakes. Group training and demonstrations conducted on the HPS offers an additive benefit to enhance performance as a team and also help to reduce errors. This paper provides the information on the potentials of simulation based training of emergency response teams in the management of CBRN victims.</p><p> </p>

An Innovative and Successful Simulation Day.

This article discusses the development of a creative and innovative plan to incorporate independent activities, including skill reviews and scenarios, into a single eight-hour day, using small student groups to enhance the learning process for pediatric nursing students. The simulation day consists of skills activities and pediatric simulation scenarios using the human patient simulator. Using small student groups in simulation captures the students' attention and enhances motivation to learn. The simulation day is a work in progress; appropriate changes are continually being made to improve the simulation experience for students.

Pediatric Motor Vehicle-Pedestrian Accident: a Simulation Scenario for Emergency Medicine Trainees.

Simulation-based medical education is an evolving field that allows trainees to practice skills in a safe environment with no risk to patients. Recently, technology-enhanced simulation for emergency medicine learners has been shown to have favorable effects on learner knowledge and patient outcomes. In this report, a human patient simulator is used to familiarize emergency medicine trainees with the presentation and management of a pediatric motor vehicle-pedestrian accident is described.

Experiences of Male Nursing Students in Simulation Training for Maternal and Child Nursing Care

BackgroundThe purpose of this study was to explore experiences of simulation for maternal and child nursing in male nursing students in Korea. MethodTwo human patient simulators, a pregnant woman underwent emergency childbirth and a premature newborn infant, were developed. After 14 male students completed simulation, data were collected through interviews and analyzed by Colaizzi's phenomenological analysis. ResultsEducational, professional, and personal dimensions emerged from 5 theme clusters under which 11 themes were classified. Five theme clusters included vicarious role-training experiences, machine–human interaction, gender segregation at work, life-stage challenge to fatherhood, and development of future roles. ConclusionSimulation for maternal and child nursing provided male nursing students with a viable alternative to clinical practicum.

Impact of simulation-based teaching of applied physiology of the cardiovascular system on the undergraduate medical student

Background: The undergraduate medical student, in his I year of studies, is required to know about Applied Physiology. The teaching of Applied Physiology concepts that occur in real life situations in a classroom is understandably difficult. Simulation-based teaching in medical education is an active learning format which imparts enduring knowledge. Medical simulation is an imitation of human physiological processes and changes observed in disease using a computerized model system called a human patient simulator (HPS), and the medical student acquires knowledge by practicing on them through role play, when they are given a clinical scenario. Aims and Objectives: To analyze if simulation-based teaching has an impact on the knowledge and skills of undergraduate medical students in Applied Physiology of the cardiovascular system. Materials and Methods: 150 undergraduate students of I year MBBS, of both sexes were included in this experimental study. Each student had a hands-on experience on the HPS and underwent simulation-based teaching with clinical case scenarios to facilitate better understanding of Applied Physiology of the cardiovascular system. A self-administered, pretested questionnaire was given as pre- and post-test questionnaire. The data were analyzed using SPSS version 22.0 and paired t-test. Results: Our results showed that simulation-based teaching has a significant impact on the knowledge and skills of undergraduate medical students in Applied Physiology of the cardiovascular system and both male and female students have been shown to have received the same level of impact. Conclusion: This study has highlighted that simulation-based teaching is an innovative method to impact the knowledge and skills of undergraduate medical students in Applied Physiology of the cardiovascular system.

Back to Reality: The Use of the Presence Questionnaire for Measurement of Fidelity in Simulation

Background and Purpose: Simulation fidelity includes three aspects: physical, conceptual, and psychological. This study reports on strengths and limitations of the Presence Questionnaire (PQ) for measurement of fidelity in human patient simulation. Methods: This nonexperimental correlational study includes a convenience sample of 83 undergraduate nursing students who participated in an emergency simulation and completed the PQ. Analysis of variance (ANOVA) on the 7-item PQ Realism subscale between groups who did or did not experience simulation equipment malfunction measured the PQ's sensitivity to this challenge to fidelity. Results: Students (n = 23) experiencing simulation equipment malfunction scored significantly lower on the PQ Realism subscale than students (n = 58) not experiencing equipment malfunction. Conclusions: The modified PQ Realism subscale is a valid measure of physical fidelity in nursing simulation and may advance the study and development of simulation for researchers and nursing educators.

Manikin Human-Patient Simulator Training.

Human-patient simulators (HPSs) may help enhance medical education. Manikin HPS devices respond to common field medical interventions, such as cricothyroidotomy, and have realistic feedback features, such as respirations and pulses. This study surveys Special Operations Medics for evaluations of HPS features. Of 518 subjects, 376 completed testing and surveys with valid responses. A total of 102 variables were divided into three categories-general characteristics, procedures, and injuries-and assessed on a fivepoint Likert scale. The Student t test was used to analyze data together and as separate groups against each other and against an aggregated mean. Features that received high scores (i.e., higher than 4.5/5) corresponded closely with pillars of the Tactical Combat Casualty Care (TCCC) curriculum, basic life support, and realism. US Army Special Operations Command and US Special Operations Command Medics have overall high confidence in manikin HPS devices and specifically in those that align with TCCC training and lifesaving procedures. The skills most valued coincide with difficult-to-practice measures, such as cricothyroidotomy and wound packing. Features such as prerecorded sounds, sex, automated movements, skin color, defibrillation, bowel sounds, and electrocardiogram are rated lower. These evaluations may guide future development or procurement of manikin HPS devices.

Simulation-based instruction for pharmacy practice skill development: A review of the literature

Background: Simulation is attractive for its potential for applying a control over learning environment, content complexity, teacher time, costs and risk. Simulation-based instruction (SBI) is poised to expand in pharmacy practice and education. This systematic review synthesises published, SBI in first-degree pharmacy programmes, especially those pertaining to psychomotor or cognitive skill development. Materials and Methods: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and some education journals were searched for relevant articles published between January 2000 and December 2015. Results: Of 108 articles identified, 12 were included, which were covering four major simulation-based interventions. These simulation-based interventions were diverse, and they covered a range of competencies and outcome measures. Nine studies included medication, and five studies included physical examination/procedure-related competencies as outcome measures. The evidence from nine studies suggested that skills could be improved through interventions involving human patient simulation. Conclusion: Despite improvements in students’ ability to perform, there is a lack of evidence on how this translates to real settings and to patient satisfaction.

Intervention Fidelity: Monitoring Drift, Providing Feedback, and Assessing the Control Condition.

Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery over time in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial.

Effectiveness of online simulation training: Measuring faculty knowledge, perceptions, and intention to adopt

BackgroundBest practice standards of simulation recommend standardized simulation training for nursing faculty. Online training may offer an effective and more widely available alternative to in-person training. ObjectivesUsing the Theory of Planned Behavior, this study evaluated the effectiveness of an online simulation training program, examining faculty's foundational knowledge of simulation as well as perceptions and intention to adopt. DesignOne-group pretest-posttest design. SettingA large school of nursing with a main campus and five regional campuses in the Midwestern United States. ParticipantsConvenience sample of 52 faculty participants. MethodsKnowledge of foundational simulation principles was measured by pre/post-training module quizzes. Perceptions and the intention to adopt simulation were measured using the Faculty Attitudes and Intent to Use Related to the Human Patient Simulator questionnaire. ResultsThere was a significant improvement in faculty knowledge after training and observable improvements in attitudes. Attitudes significantly influenced the intention to adopt simulation (B=2.54, p<0.001). ConclusionsOnline simulation training provides an effective alternative for training large numbers of nursing faculty who seek to implement best practice of standards within their institutions.

The Effect of Human Patient Simulators on Knowledge and Self-Competence in Graduating Prelicensure Nursing Students

Abstract This research studied the effects of using human patient simulation (HPS) on knowledge and perceived self-competence in prelicensure students in a two-year nursing program. MED-SURG BKAT scores and a self-competence visual analog scale from two cohorts (one without HPS and one with HPS over two years) were compared. A significant difference was found in self-competence scores for the HPS cohort compared to the non-HPS cohort. Knowledge scores did not differ significantly. Limitations of this study include a relatively small sample size and using one school of nursing.

Trauma Resuscitation Evaluation Times and Correlating Human Patient Simulation Training Differences-What is the Standard?

Rapid effective trauma resuscitations (TRs) decrease patient morbidity and mortality. Few studies have evaluated TR care times. Effective time goals and superior human patient simulator (HPS) training can improve patient survivability. The purpose of this study was to compare live TR to HPS resuscitation times to determine mean incremental resuscitation times and ascertain if simulation was educationally equivalent. The study was conducted at San Antonio Military Medical Center, Department of Defense Level I trauma center. This was a prospective observational study measuring incremental step times by trauma teams during trauma and simulation patient resuscitations. Trauma and simulation patient arms had 60 patients for statistical significance. Participants included Emergency Medicine residents and Physician Assistant residents as the trauma team leader. The trauma patient arm revealed a mean evaluation time of 10:33 and simulation arm 10:23. Comparable time characteristics in the airway, intravenous access, blood sample collection, and blood pressure data subsets were seen. TR mean times were similar to the HPS arm subsets demonstrating simulation as an effective educational tool. Effective stepwise approaches, incremental time goals, and superior HPS training can improve patient survivability and improved departmental productivity using TR teams.

PREP-T1 (Preteen Re-Education With Parents-Type 1 Diabetes) Feasibility Intervention Results.

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the "driver's seat." The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens (n = 22) and parents (n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research.

Inherent variability in airway characteristics of simulation manikins: is it time we standardised assessments of crisis management skills?

IntroductionLearning of simulation-based crisis management skills involves technologically advanced manikins and use of automated scenarios. Progressions in preprogrammed scenarios require finite task completion such as successful airway intubations for achieving...