Human Patient Simulator Research Articles

High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

Normal 0 false false false EN-GB X-NONE X-NONE MicrosoftInternetExplorer4 Background: The continued use of high fidelity full sized human patient simulation manikins (HF-HPSMs) for developing decision making skills of nursing students has led to growing research focusing its value on student learning and decision making skills. Methods: In October 2012, a cross-sectional survey using the 24-item Nurse Decision-Making Instrument was used to explore the decision making process of 232 pre-registration nursing students (age 22.0 ± 5.4; 83.2% female) in Singapore. Results: The independent samples t -tests demonstrated three significant predictive indicators. These indicators include: prior experience in high fidelity simulation based on pre-enrolled nursing course ( t = 70.6, p = .001), actual hands-on practice ( t = 69.66, p < .005) and active participation in debrief ( t = 70.11, p < .005). A complete experience based on role-playing followed by active discussion in debrief was a significant contributor to the decision making process ( t = 73.6667, p < .005). However, the regression model indicated active participation in debrief as a significant variable which explained its development ( t = 12.633, p < .005). Conclusions: This study demonstrated the usefulness of active participation in simulation learning for an analytic- intuitive approach to decision making, however active participation in debrief was a more important influencing element than role-playing. In situations where resources are limited for students to experience hands-on role-playing, peer reviewing and feedback on others’ experiences could benefit students, just as much. However, further study is warranted to determine the development of HF-HPSMs as a pedagogic tool for enhancing the decision making process of nursing students.

The Comprehensive Textbook of Healthcare Simulation

The use of human patient simulation for teaching aspects of anesthesiology has grown significantly over the last decade and a half. Anesthesia has been in the forefront of developing this technology and its use in medical education. Simulation has gone from a novelty to being recognized as an important modality for delivering curricula. All Canadian anesthesia residency programs, in varying degrees, incorporate simulation in their postgraduate medical education. The future use of simulation will become even more important. As residents’ duty hours become more limited, there will be heavier reliance on simulation to provide experience with rare life-threatening situations such as malignant hyperthermia or local anesthetic toxicity. The Royal College of Physicians and Surgeons of Canada is moving towards competency-based medical education (CanMEDs 2015 and other initiatives). Integrating simulation in this process is essential for successful transition into a competency-based educational model. As the field of medical simulation has grown, so have the literature, technologies, and accompanying educational theories associated with it. Healthcare simulation is now at a point where a comprehensive textbook is needed. Dr. Levine and his associates identified the absence of a definitive resource and attempted to fill that void. As stated in the text’s introduction, ‘‘Many educators, researchers, and administrators are seeking a definitive up-to-date resource that addresses solutions to their needs in terms of training, assessment, and patient safety. Hence, we present this book The Comprehensive Textbook Of Healthcare Simulation’’. This textbook is very useful for those involved in healthcare simulation. It is an inclusive, current manual. The contributing authors list reads like a ‘‘who’s who’’ of healthcare simulation. It includes many pioneers in the field as well as numerous authors from Canadian universities who have provided chapters in their fields of expertise. There is also a global perspective, with contributors from the United States, Europe, and the Middle East. The textbook is well organized into five sections; Introduction, Simulation Modalities and Technologies, Simulation for Healthcare Disciplines, Professional Development in Simulation, and Program Development in Simulation. The Introduction covers the basics of simulation, including learning theory, simulation environments, and debriefing. It also tackles more complex subject matter such as crisis resource management and patient safety in simulation. I was surprised to see the chapters ‘‘Competency Assessment’’ and ‘‘Simulation for Licensure and Certification’’ in the Introduction. Both of these topics are timely and worthy of discussion within the simulation community. Competencybased medical education is looming on the horizon as CanMEDs 2015 is being developed. Simulation has already been introduced in high-stakes examinations, such as the Royal College examination process for anesthesiology, albeit not yet in a comprehensive fashion. The second section – Simulation Modalities and Technologies – serves as an excellent resource as it provides a detailed view of more than just high-fidelity simulation. There is comprehensive information on standardized patients as well as computerand web-based simulation. It also explores emerging technologies such as virtual reality and haptic simulation (tactile sensation in virtual reality). N. O’Regan, MD (&) Memorial University of Newfoundland, St. John’s, NL, Canada e-mail: noel.oregan@med.mun.ca

Human patient simulation versus case study: Which teaching strategy is more effective in teaching nursing care for the hypoglycemic patient?

With the ever-increasing safety concerns presented in a health care setting, it is imperative that nursing students are prepared for the demand of utilizing the skill of critical thinking while providing care to patients experiencing hypoglycemia. Nurse educators strive to implement different teaching strategies to promote critical thinking skills. The purpose of the study was to evaluate the effectiveness of two teaching strategies: human patient simulation (HPS) and a single case study during diabetes education. In addition, the study was used to validate the inclusion of HPS in the authors' nursing program curriculum. A quasi-experimental, two-group pretest and posttest design was utilized to evaluate these teaching strategies. Faculty also completed an objective clinical evaluation, which evaluated students' clinical reasoning, and all students completed a postsurvey evaluating the teaching strategies. Study results indicated the pretest average scores for both groups were identical. The posttest results for the case study group were slightly higher than the simulation group results. On the clinical evaluation tool, the simulation group scored much greater than the case study group. Both results were statistically significant. The postlesson survey results were greater overall for the simulation group on all statements. All students agreed or strongly agreed that simulation was effective. According to the student test results and clinical evaluations, both teaching strategies are beneficial in nursing education; moreover, the student surveys and comments validated the addition of simulation as a valuable teaching strategy. As a result of this research, HPS was formally implemented into the nursing curriculum.

Presence with scenario-based high fidelity human patient simulation.

The aim of this grounded theory study was to explain the nature of presence among nursing students participating in scenario-based high fidelity human patient simulation. Data were derived from observations and interviews with 145 participants. Among participants, presence was found to be a multidimensional, dynamic interaction characterized by a centricity between the simulation and the natural environment. Presence, the core concept from the explanatory model that emerged from this study, is delineated in this article. Presence centricity in simulation may impact the learning experience and outcomes. These study results may support development of the educational science related to clinical simulation.

High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise

High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA. Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.

Development of a High Fidelity Human Patient Simulation Curriculum to Improve Residents’ Critical Assessment

Background Family medicine residency training in critical patient assessment is often limited. Simulation has been shown to be an effective method to enhance learning in a safe environment.

The effectiveness of tools used to evaluate successful critical decision making skills for applicants to healthcare graduate educational programs: a systematic review protocol

The effectiveness of tools used to evaluate successful critical decision making skills for applicants to healthcare graduate educational programs: a systematic review protocol

Human patient simulation education in the nursing management of patients requiring mechanical ventilation: A randomized, controlled trial

Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation. A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice-after the clinical and simulation settings, respectivley. After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (P(g) = .03) differences and time-group interactions (P(t*g) = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (P(t) = .29) or time-group interactions (P(t) = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire). Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants' factual knowledge.

Nursing Faculty Use of High-Fidelity Human Patient Simulation in Undergraduate Nursing Education: A Mixed-Methods Study

High-fidelity human patient simulation (HFHPS) is an innovative teaching tool. However, limited data exist regarding factors affecting faculty use of HFHPS in undergraduate nursing education. Using a convergent, parallel, mixed-methods design, predictors of undergraduate faculty (N = 139) use of HFHPS were explored. Data were collected using a Web-based survey. Results indicated a high percentage of HFHPS use in nursing programs but a low percentage of HFHPSs substituting for traditional clinical hours. Faculty who substituted clinical hours with HFHPS had lower self-efficacy beliefs around HFHPS than other faculty surveyed. Qualitative data supported the quantitative findings, including themes that HFHPS provided a safe environment for learning, but it was a mixed result. Results support that nursing faculty's beliefs about HFHPS were strongly associated with HFHPS use. Specifically, self-efficacy beliefs and further exploration of the meaning of a safe environment for student learning should be addressed in future studies.

Nursing students’ clinical judgment in high-fidelity simulation based learning: A quasi-experimental study

Background : Improving students’ decision making and judgment skills becomes an essential part of nursing education. The purpose of this Quasi-experimental study was to assess nursing students’ clinical judgment in high-fidelity simulation based learning using observational measures. Method : Based on Tanner’s clinical judgment model, a single group repeated-measures design was used with a purposive sampling at one nursing school in Macao. A total of 113 baccalaureate nursing students (49 in year two, 64 in year three) completed five simulation sessions within a 36 hour period. Two tutors used the Clinical Judgment Rubric to assess s tudents’ clinical judgment at the end of each simulation session. The inter-rater reliability for the sessions ranged from 0.833 to 0.910. Results: The scores for clinical judgment increased from the first simulation scenario to the last scenario. Compared with third-year students, second-year students had significantly higher scores of clinical judgment in scenarios two, three, four and five. The debriefing was essential to preparing students for improving their thinking and reasoning skills. Students perceived that simulation strengthened their theoretical knowledge and helped them to notice, interpret, and respond appropriately to contingencies and emergencies. Tutors’ comments indicated that second-year students valued the newly learned knowledge and used it to analyze the simulated scenarios while third-year students presented less knowledge and skill preparation. Conclusions: High-fidelity simulation using a computer-controlled human patient simulator has potential to support the development of clinical judgment in nursing students. Tutors are challenged to enhance students' intrinsic motivation for learning, and encourage them to continue their efforts in learning. Further research is needed to explore whether senior students have better performance in clinical judgment than junior students.

A Trauma Resuscitation Team Leader Training Curriculum Based on Eight Human Patient Simulations

Abstract Introduction The trauma resuscitation team leader is primarily responsible for conducting the initial assessment and survey, coordinating and directing team and individual activities, and ...

Costs of ignorance studies in medical education

British Journal of Hospital MedicineVol. 75, No. 2 RegularsCosts of ignorance studies in medical educationKieran WalshKieran WalshSearch for more papers by this authorKieran WalshPublished Online:20 Feb 2014https://doi.org/10.12968/hmed.2014.75.2.117AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Buchan J, Campbell J (2013) Challenges posed by the global crisis in the health workforce. BMJ 347: 6201 Crossref, Google ScholarByford S, Torgerson DJ, Raftery J (2000) Cost of illness studies. BMJ 320: 1335 Crossref, Medline, Google ScholarCarruthers I, Philip P (2006) Safety First – A report for patients, clinicians and health-care managers. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_064159.pdf (accessed 6 January 2014) Google ScholarCrea KA (2011) Practice skill development through the use of human patient simulation. Am J Pharm Educ 75(9): 188 Crossref, Medline, Google ScholarDepartment of Health (2000) An Organisation with a Memory. The Stationery Office, London Google ScholarGordon M, Bose-Haider B (2012) A novel system of prescribing feedback to reduce errors: A pilot study. Int J Risk Saf Med 24(4): 207–14 Medline, Google ScholarHernandez MB, McDonald CL, Gofman Y et al. (2010) Physician Familiarity with the Most Common Misdiagnoses: Implications for Clinical Practice and Continuing Medical Education. The Internet Journal of Medical Education 1(2) (http://ispub.com/IJME/1/2/6945 accessed 6 January 2014) Google ScholarNational Research Council (2007) Preventing Medication Errors: Quality Chasm Series. The National Academies Press, Washington, DC Google ScholarVan Den Bos J, Rustagi K, Gray T, Halford M, Ziemkiewicz E, Shreve J (2011) The $17.1 Billion Problem: The Annual Cost Of Measurable Medical Errors. Health Aff 30(4): 596–603 Crossref, Google ScholarWalsh K (2010) Cost effectiveness in medical education. Radcliffe, Oxon Google ScholarWalsh K (2013) Cost and value in medical education. In: Walsh K, ed. The Oxford Textbook of Medical Education. Oxford University Press, Oxford: 601–12 Crossref, Google ScholarWeingart SN, Wilson RM, Gibberd RW, Harrison B (2000) Epidemiology of medical error. BMJ 320(7237): 774–7 Crossref, Medline, Google ScholarWu AW, Folkman S, McPhee SJ, Lo B (1991) Do house officers learn from their mistakes? JAMA 265(16): 2089–94 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 February 2014Volume 75Issue 2ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 20 February 2014 Published in print 2 February 2014 Information© MA Healthcare LimitedPDF download

Simulation Education Approaches to Enhance Collaborative Healthcare: A Best Practices Review

Interprofessional simulation can provide health profession program educators with an effective means to prepare future practitioners to engage in meaningful collaboration. This systematic review was conducted to identify best practice recommendations to enhance collaborative healthcare using interprofessional simulation education innovations for learners in pre-licensure nursing programs. Using a systematic review methodology, 375 articles were reviewed and 17 studies met the inclusion criteria. Based on the methodological strength of the research and the impact of the simulation innovations, the following simulation techniques were recommended: high-fidelity human patient simulators, role play, and didactic lecture and audience response didactic lecture, both followed by role play with a standardized patient. Instructor modeling was related to achievement of interprofessional competencies when compared to no modeling. Future research is needed to identify optimal timing for implementing interprofessional education innovations, for development of appropriate evaluation tools, and to determine the effects of collaborative practice on patient care.

Computer-Based or Human Patient Simulation-Based Case Analysis: Which Works Better for Teaching Diagnostic Reasoning Skills?

The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation. Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases. A total of 54 nursing students participated in two case analyses using human patient and computer-based simulations. Participant performance and diagnostic reasoning skills were analyzed. Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer-based simulation. Both human patient and computer-based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.

Eye Tracking as a Debriefing Mechanism in the Simulated Setting Improves Patient Safety Practices

Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

The Changes of Nursing Students’ Assessment Skills at a Simulated Setting: A Quasi Experimental Study

Background: Structured and comprehensive assessment is critical to identify physical and psychological problems and concerns experienced by patients. Simulation can be used for training students’ health as- sessment skills as well as communication skills. Objectives: The purposes of this study were to determine how students’ health assessment skills changed in a simulated setting. Method: A quasi experimental study with one group repeated-measures design was conducted with a purposive sampling of 85 bacca- laureate nursing students at one nursing school in Macao. Two qualified tutors evaluated students’ health assessment skills in terms of introduction and patient identification, symptom assessment, physical ex- amination, patient education, history inquire and communication using the same criteria in each simula- tion session. Results: The overall score of students’ health assessment skills increased from the first ses- sion to the last session. Second-year students achieved higher overall scores of assessment skills than third-year students in some simulated scenarios significantly even though they had less clinical practice experience. Conclusions: Simulation using a human patient simulator helped students to transform knowledge and skills to assess patient condition. Tutors should promote students’ intrinsic motivation for learning, develop their potential and encourage them to keep their efforts in learning.

Modeling and simulation in biomedical engineering: applications in cardiorespiratory physiology [book reviews

Modeling and simulation have developed into indispensable disciplines in many fields including the physiological sciences; yet, there are few accessible texts available that teach the model building process in a methodical way for the physiological model developer. This text fills that need admirably. Uniquely qualified to author such a text, the author is one of the original developers of CAE Healthcare’s Human Patient Simulator (HPS), which, nearly 20 years after its release, stands alone in its physiologic and pharmacologic model sophistication for patient simulation and risk-free caregiver education. His understanding of mathematics, human physiology, pharmacology, control systems, and systems engineering, combined with a conversational writing style, results in a readable text suitable for upper-year undergraduate or early graduate courses in biomedical engineering, physiology, or applied mathematics. For those modelers or aspiring modelers reading the text, an understanding of differential equations is warranted.

The use of human patient simulation to improve academic test scores in nursing students

Many technologies that were not yet invented when today's educators went to nursing school are now staples in nursing colleges and schools worldwide. Although there are numerous studies that examine the relationship between simulation and student success, most focus on the affective and psychomotor domains of learning. This article focuses on the cognitive domain of learning and discusses the correlation between the use of high-fidelity human patient simulation and improved academic test scores.

Use of a Hooked Cutting Device Compared With Scissors for the Emergency Exposure of Critically Ill and Injured Patients

The initial assessment of critical patients includes prompt identification of life-threatening conditions. Any device or technique that can aid in this process may ultimately save lives. This study examined whether clothing could be removed faster with the use of a hooked cutting device as compared with the commonly-used heavy-duty, blunt-tipped, serrated scissors. This study took place in an urban academic emergency department of a Level-1 trauma center. Human patient simulator mannequins were clothed in identical shirts and pants. The time required for clinical personnel to expose the patient using each device was measured. Each of the 50 participants was queried regarding their tactile comfort using each device. The mean time for shirt removal using scissors was 83 seconds (SD = 55 seconds; 95% CI, 68-99). The mean time for shirt removal using the hook device was 28 seconds (SD = 21 seconds; 95% CI, 22-34). The mean time for pants removal using scissors was 69 seconds (SD = 40 seconds; 95% CI, 56-73). The mean time for pants removal using the hook device was 19 seconds (SD=15 seconds; 95% CI, 15-23). The hooked device was 69% faster at removing clothing than traditionally-used scissors. Though simple in concept, these implications can be life saving, particularly in conditions of uncontrolled, life-threatening external hemorrhage.

Board 385 - Research Abstract Exposure to a High-Fidelity Simulation of Cardiovascular Physiology Improves First-Year Medical Students

Introduction/Background The Human Patient Simulator is being increasingly utilized in medical education. It is generally acknowledged that simulation is an effective tool for teaching clinical scenarios to medical students,1 but research on its effectiveness for teaching the basic sciences is scarce.2 We hypothesize that supplementation of standard physiology curriculum with high-fidelity simulation (HFS) improves medical student performance on written tests of physiology knowledge. Methods A pilot cardiac physiology HFS lab experience was offered to the Ohio State University first year medical student class. Twelve one hour labs were proctored by one of four anesthesiology faculty trained in simulation instruction and the specific course objectives. The HFS provided real-time illustration of hemodynamics to facilitate understanding of basic diagnostic and pathophysiologic principles of cardiovascular physiology utilizing the CAE® HPS manikin-based simulator. Students start with a basic cardiovascular physical examination and progress to interpretation of external and invasive hemodynamic monitoring to integrate basic science concepts with clinical applications.3 Afterwards, students completed a survey assessing their perception of the utility of the HFS using a standard Likert scale. Results of the student’s cardiovascular physiology examination (held one week following the HFS) were analyzed in order to compare those who participated to those who did not. Comparisons were made between both a subset of exam questions identified as directly emphasized in the HFS and examination scores as a whole. MCAT scores of the two groups were then compared to provide a measure of baseline student aptitude prior to participation. Results Of 183 first year medical students, 93 (50.8%) participated in the HFS. Group size ranged from 5-12 students over the 12 sessions. Mean Likert scale scores ranged from 4.26 to 4.74 out of 5 in response to survey questions assessing the quality, relevance and utility of the HFS. Mean MCAT scores between participants (34.37) and non-participants (33.43) were not significantly different (p = .082). For the subset of examination questions dealing with concepts directly addressed in the HFS, participants scored higher (78.14%) than non-participants (72.41%; p = 0.05). For the examination as a whole, participants scored higher (83.91%) than non-participants (81.08%; p = 0.018). Conclusion We have shown an improvement in medical student performance on their cardiovascular physiology final written examination following exposure to a HFS supplement to their standard curriculum compared to their peers. We believe the lack of any difference in MCAT scores demonstrates a potential absence of a selection bias despite the voluntary nature of participation as opposed to randomization. However, the superior performance on the test as a whole could be interpreted as evidence that a selection bias does exist in the motivation between the two groups. We would point out that while the participants mean total score was roughly three points higher than non-participants, for means on the subset of questions dealing with concepts directly addressed participants scored roughly six points higher. Examination questions dealing with concepts not directly addressed in the HFS would still peripherally involve issues of basic cardiovascular physiology such as those our simulator faculty reviewed. Some may interpret superior performance on the test as a whole as a difference in motivation between the two groups at baseline. We would argue that exposure to simulation in itself can prove to be a motivating “shot in the arm” when provided during the non-clinical years of medical education. Therefore, HFS as teaching tool can be an important adjunct for medical students even during the basic science curriculum.