Low-fidelity Group Research Articles

High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study

ObjectiveTo compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. Methods70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. ResultsIn the theory test there was an increase in scores in both methodologies (p < 0.001); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). ConclusionThe two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

The Effect of Two Different Simulation Modalities in Palliative Care Teaching on Nursing Students' Knowledge, Satisfaction, Self-confidence, and Skills: A Randomized Controlled Trial.

Nursing students from developing countries have limited opportunities to experience palliative care. Standardized patient and low-fidelity simulations can provide realistic palliative care experiences for students. However, limited research is available on simulation-based education in Palestine. Testing and using these two types of simulation methods may be the best solution for developing countries that lack adequate resources. This study aimed to test the effects of low-fidelity simulation compared with standardized patient simulation in palliative care teaching on nursing students' knowledge, satisfaction, confidence, and skills. The study was a randomized controlled trial of 70 nursing students in their sophomore year. Students' knowledge was assessed with the Palliative Care Quiz for Nursing test; satisfaction and confidence with the Learner Satisfaction and Self-confidence in Learning; and skills rated by two researchers. Students' knowledge improved significantly on the posttest compared with the pretest, without significant differences between both groups. The findings showed that the utilization of the two methods in students' clinical training for scenario has the same effect on the satisfaction and confidence. The skills of the standardized patient group improved significantly more than the low-fidelity group. The study revealed that both simulation modalities are effective for palliative care nursing students.

What is Transferred and How Much is Retained? A Simulation Study of Complex Surgical Skills

IntroductionStudies indicate that learning surgical skills on low-fidelity models is equally beneficial to learning on high-fidelity models in terms of skills retention and transfer. However, it is unclear how low-fidelity simulation training impacts retention and transfer in novice learners, particularly on complex surgical tasks that incorporate multiple challenging skills. This study explores the capacity of complete novices to learn and transfer complex surgical skills from a low-fidelity model to a high-fidelity simulation after a delay. MethodsTask-naïve medical and nonmedical undergraduate students (n = 62) participated in a three-phase prospective double-arm randomized (2:1) experimental study. Participants completed two skills training sessions (end-to-side anastomosis) on a low-fidelity bench model. After a 4-week delay, participants completed the task again either using the low-fidelity model or a high-fidelity model (cadaver) and were assessed using a validated checklist. ResultsThere was a significant time × fidelity group interaction (P = 0.004). Simple effects analysis indicated the high-fidelity group (Mdiff = 4.18, P < 0.001) performed significantly worse (P = 0.003) in phase 3 relative to phase 2 compared to the low-fidelity group (Mdiff = 0.75, P = 0.39). Post hoc logistic regression analysis indicated that radial suturing technique and economy of motion skills were less likely to be completed correctly for those in the high-fidelity group. ConclusionsThese findings suggest that for novice populations, relying on low-fidelity simulation training as a source of teaching complex skills may not provide a reliable transfer to high-fidelity models and in turn clinical settings.

Effects as a function of implementation fidelity of a transdiagnostic prevention program in young school-aged children

Super Skills for Life (SSL) is a transdiagnostic prevention program for school-aged children with internalizing problems. The current study aimed to examine the short- and long-term (12-month follow-up) effectiveness of SSL, depending on implementation fidelity. Participants were 123 Spanish-speaking children aged 6–8 years with internalizing symptoms and their parents. High (n = 41) and low fidelity (n = 26) groups were established and compared with a control group (CG) (n = 56). Compared to CG, the high-fidelity group (HFG) achieved better outcomes than the low-fidelity group (LFG) at short and long term, including symptoms of anxiety, depression, and internalizing problems, and also externalizing problems at long-term. The LFG improved key symptoms at short term (depression) and long term (anxiety and depression). Findings suggest that SSL is beneficial even if not delivered at maximum fidelity, although considering the influence of implementation fidelity is critical because the high-fidelity implementation yielded the greatest effects when compared to the CG. This research provides valuable data, analyzing for the first time the influence of fidelity on SSL outcomes in young school-aged children exhibiting internalizing symptoms, while there is still a lack of studies of these characteristics concerning transdiagnostic prevention programs targeting childhood anxiety and depression.

Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study

PurposeThe individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs).MethodsA prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups.ResultsThere were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes.ConclusionHigh-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future.Clinical Trial RegistrationUMIN000025648

Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics’ resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments.

A Randomized Cross-Over Trial Focused on Clinical Breast Exam Skill Acquisition Using High Fidelity versus Low Fidelity Simulation Models in Rwanda

Breast cancer incidence is rising for women in low and middle income country (LMIC)s. Growing the health care workforce trained in clinical breast exam (CBE) is critical to mitigating breast cancer globally. We developed a CBE simulation training course and determined whether training on a low-fidelity (LF) simulation model results in similar skill acquisition as training on high-fidelity (HF) models in Rwanda. A single-center randomized educational crossover trial was implemented. A preintervention baseline exam (exam 1), followed by a lecture series (exam 2), and training sessions with assigned simulation models was implemented (exam 3)-participants then crossed over to their unassigned model (exam 4). The primary outcome of this study determined mean difference in CBE exam scores between HF and LF groups. Secondary outcomes identified any provider level traits and changes in overall scores. The study was implemented at the University Teaching Hospital, Kigali (CHUK) in Rwanda, Africa from July 2014 to March 2015 PARTICIPANTS: Medical students, residents in surgery, obstetrics and gynecology, and internal medicine residents participated in a 1-day CBE simulation training course. A total of 107 individuals were analyzed in each arm of the study. Mean difference in exam scores between HF and LF models in exam 1 to 4 was not significantly different (exam 1 0.08 standard error (SE) = 0.47, p = 0.42; exam 2 0.86, SE = 0.69, p = 0.16; exam 3 0.03, SE = 0.38, p = 0.66; exam 4 0.10 SE = 0.37, p = 0.29). Overall exam scores improved from pre- to post-intervention. Mean difference in exams scores were not significantly different between participants trained with HF versus LF models. LF models can be utilized as cost effective teaching tools for CBE skill acquisition, in resource poor areas.

Simulation-Based Instruction in Continuing Education

ContextThe results of this study will provide direction for integrating simulation into continuing professional education (CPE) for athletic trainers (ATs).ObjectiveCompare the effects of 2 simulation techniques on knowledge and skill acquisition of a cardiovascular assessment.DesignRandomized pretest-posttest design.SettingContinuing professional education course hosted at a simulation center.Patients or Other ParticipantsAthletic trainers recruited to a CPE course. Twenty-two (age 22–49) of 30 ATs attended, consented, and completed the course. Participants were randomly assigned to a high-fidelity (12 participants) or low-fidelity (10 participants) group.Intervention(s)High-fidelity and low-fidelity simulation.Main Outcome Measures(s)A 31-question knowledge examination and a 4-station objective structured clinical examination (OSCE) measured knowledge and clinical skills, and specifically the ability to identify heart sounds as part of a comprehensive cardiovascular assessment.ResultsFrom pretest to posttest, all participants significantly improved knowledge (P &amp;lt; .001), clinical skills (P &amp;lt; .001), and heart-sound identification skill (P = .010). The high-fidelity group scored significantly higher (P = .48) than the low-fidelity group on the clinical skills portion of the OSCE.ConclusionsBoth simulation types can be used in CPE courses for ATs to reinforce the knowledge and skills that are a part of a cardiovascular assessment. High-fidelity simulation improved skill more than low-fidelity simulation because of the active nature of the intervention. Baseline scores were low, thereby strengthening the value to offer CPE to ATs specifically on the elements of conducting a comprehensive cardiovascular assessment. Adding a pretest can help identify knowledge and skill deficits before CPE participation.

High-fidelity simulation and student performance in the Capstone Field Internship

Despite the increased use of high-fidelity simulation in the education of paramedics, little research has been done into its impact on paramedic student performance. The objective of this quasi-experimental quantitative analysis was to investigate differences in the performance of students in the paramedic field internship between those trained using low-fidelity and those trained using high-fidelity simulation practices. Data were derived from the student field internship records from a community college-based paramedic programme in the United States, with students in two groups: a low-fidelity simulation group (2010–2013) and a high-fidelity simulation group (2014–2017). The students in the high-fidelity simulation group required fewer patient contacts to complete the internship than the students in the low-fidelity simulation group, demonstrating a significant improvement in student performance. While further studies are required to more fully investigate the use of high-fidelity simulation in paramedic education, this study provides necessary insight into the impact of high-fidelity simulation in the training of paramedics.

High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students

BackgroundSimulation has become integral to the training of both undergraduate medical students and medical professionals. Due to the increasing degree of realism and range of features, the latest mannequins are referred to as high-fidelity simulators. Whether increased realism leads to a general improvement in trainees’ outcomes is currently controversial and there are few data on the effects of these simulators on participants’ personal confidence and self-assessment.MethodsOne-hundred-and-thirty-five fourth-year medical students were randomly allocated to participate in either a high- or a low-fidelity simulated Advanced Life Support training session. Theoretical knowledge and self-assessment pre- and post-tests were completed. Students’ performance in simulated scenarios was recorded and rated by experts.ResultsParticipants in both groups showed a significant improvement in theoretical knowledge in the post-test as compared to the pre-test, without significant intergroup differences. Performance, as assessed by video analysis, was comparable between groups, but, unexpectedly, the low-fidelity group had significantly better results in several sub-items. Irrespective of the findings, participants of the high-fidelity group considered themselves to be advantaged, solely based on their group allocation, compared with those in the low-fidelity group, at both pre- and post-self-assessments. Self-rated confidence regarding their individual performance was also significantly overrated.ConclusionThe use of high-fidelity simulation led to equal or even worse performance and growth in knowledge as compared to low-fidelity simulation, while also inducing undesirable effects such as overconfidence. Hence, in this study, it was not beneficial compared to low-fidelity, but rather proved to be an adverse learning tool.

Improvements in Attention and Cardiac Autonomic Modulation After a 2-Weeks Sprint Interval Training Program: A Fidelity Approach.

This study aimed to: (1) investigate the influence of a 2-weeks sprint interval training (SIT) program on aerobic capacity, cardiac autonomic control, and components of attention in young healthy university students; and (2) to ascertain whether training fidelity would influence these adaptations. One hundred and nine participants were divided into an experimental (EG) and control (CG) groups. The EG performed a SIT program that consisted of 6 sessions of 4 × 30 s “all-out” efforts on a cycle ergometer, interspersed with active rests of 4 min. The criterion for fidelity was achieving >90% of estimated maximum heart rate (HR) during sprint bouts. After analyses, the EG was divided into HIGH (n = 26) and LOW (n = 46) fidelity groups. Components of attention were assessed using the Attention Network Test (ANT). Aerobic capacity (VO2max) was estimated while the sum of skinfolds was determined. Autonomic control of HR was assessed by means of HR variability (HRV) and HR complexity at rest and during ANT. Both HIGH and LOW significantly increased aerobic capacity, vagal modulation before and during ANT, and executive control, and decreased body fatness after SIT (p < 0.05). However, only participants from HIGH showed an increase in HR complexity and accuracy in ANT when compared to LOW (p < 0.05). Two weeks of SIT improved executive control, body fatness, aerobic fitness, and autonomic control in university students with better results reported in those individuals who exhibited high fidelity.

Teacher Fidelity to a Physical Education Curricular Model and Physical Activity Outcomes

Background:This study was informed by the bodies of literature emphasizing the role of physical education in promoting physical activity (PA) and addressing teacher fidelity to curricular models.Purpose:The purpose of this study was to compare student PA levels, lesson context, and teacher PA promotion behavior among classes where teachers were using the Dynamic Physical Education (DPE) curricular model with low, moderate, and high fidelity.Methods:Participants were 20 physical education teachers, and their 4th and 5th grade students. Each teacher was observed teaching three times during the study. Fidelity data were collected using a validated observation instrument. PA, lesson context, and teacher behavior data were collected using the System for Observing Fitness Instruction Time (SOFIT). Data analysis included descriptive statistics and group difference tests.Results:Significant differences among the three fidelity groups were identified in several items of the observation instrument. No significant moderate-to-vigorous PA or lesson context differences were found among the three groups. Students taught by teachers in the high fidelity group spent a significantly higher proportion of lesson time (7.5%) in vigorous PA than students taught by teachers in the low fidelity group. Teachers in the moderate and high fidelity groups spent a significantly higher proportion of lesson time promoting in-class PA than teachers in the low fidelity group.Discussion:Fidelity of implementation to the DPE model had little impact on student PA. The findings of this study can inform future researchers about the methodological importance of examining teacher fidelity to curricular models and associated outcomes.

Implementation fidelity for promoting the effectiveness of an adolescent sexual health program

The goal of the present study was to examine COMPAS program (Competencies for adolescents with a healthy sexuality) outcomes based on implementation fidelity: dose, adherence, and acceptance. Participants were 716 adolescents aged 14–16 years (46.5% boys). Two fidelity groups were established: high (n=83) and low (n=312), with the remaining sample serving as a non-program control group (n=321). Knowledge about sexually transmitted infections (STIs), attitudes towards HIV, intention to use condoms, and sexual behavior were evaluated. Results indicated that adolescents receiving the intervention displayed improved STI knowledge (p<0.001) and improved attitudes toward HIV (p<0.05) as compared to the control group. Between the two intervention groups, a high-fidelity group intended to engage more in safe sex behaviors (p=0.05) and displayed greater STI knowledge (p=0.05) as compared to the low-fidelity group. The present study revealed improved efficiency when applying prevention programs with implementation fidelity.

The effectiveness of varied levels of simulation fidelity on integrated performance of technical skills in midwifery students — A randomised intervention trial

Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking. To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students. Randomised three arm intervention trial. Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination. Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients. There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026). Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.

Fidelity's Effect on Student Perceived Preparedness for Patient Care

PurposeThe purpose of this study was to explore students' perception of how well their learning needs were met by (a) comparing high- versus low-fidelity simulation groups within simulated and traditional clinical environments and (b) comparing simulated versus traditional clinical environments based on high- and low-fidelity groups. MethodThe quasi-experimental study design was implemented with a convenience sample of nursing students enrolled in the fundamental/assessment course and laboratories during the first clinical semester of a five-semester program. ResultsAfter the simulation and traditional clinical experiences were finished, participants completed the Leighton Clinical Learning Environment Comparison Survey. Participants in the high-fidelity group perceived their learning needs was better that when compared with the low-fidelity group. ConclusionsFidelity of the mock hospital unit simulation as the initial clinical experience did impact the student's perception of how well their learning needs were met. Students perceived high-fidelity simulation as an equal to traditional clinical experience in meeting their learning needs.

The Effect of Model Fidelity on Colonoscopic Skills Acquisition. A Randomized Controlled Study

Colonoscopic simulators offer the opportunity for skill acquisition in the preclinical setting. Currently available simulators vary widely with respect to level of fidelity and technological sophistication. Despite the belief that more realistic is better, there is a paucity of evidence regarding the relative effectiveness of simulator fidelity (high vs low) on the acquisition of basic colonoscopic skills. We hypothesized that novice learners can acquire basic colonoscopic skills using simulators, however fidelity of the simulator does not make a difference. We randomly assigned novice third-year and fourth-year medical students to practice on either a low-fidelity or high-fidelity colonoscopy model. The low-fidelity model used is described in the module 16 of the American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for residents, Phase 1: basic or core skills and tasks < http://elearning.facs.org/mod/resource/view.php?1d=450 >. The high-fidelity model was the AccuTouch colonoscopy simulator, Immersion Medical (AccuTouch CS) that has 6 different simulated scenarios for diagnostic colonoscopy (level 1-6). Both groups had 16 students and were given standard instruction by an expert with respect to the procedure and instrument handling on both models. Both groups were pretested and posttested on level 1 of the AccuTouch CS. The high-fidelity group practiced on level 2 and 4 of the AccuTouch CS, whereas the low-fidelity group practiced on the low-fidelity model for 2 sessions of 1 hour each. The computer-based evaluation parameters available on the AccuTouch CS were used to compare performances. Both groups had similar demographics. There were no significant differences in the baseline performances of either group. Each group demonstrated significant improvement for insertion time and percentage of mucosa visualized. However, there were no significant differences between the groups on posttesting on any of the measured parameters. Colonoscopic skill training on a low-fidelity model appears to be as effective as high-fidelity model training for basic endoscopic skill acquisition for novice learners.

The Effect of Bench Model Fidelity on Fluoroscopy-Guided Transforaminal Epidural Injection Training

The purpose of this study was to determine whether high-fidelity simulators provide greater benefit than low-fidelity models in training fluoroscopy-guided transforaminal epidural injection. This educational study was a single-center, prospective, randomized 3-arm pretest-posttest design with a control arm. Eighteen anesthesia and physical medicine and rehabilitation residents were instructed how to perform a fluoroscopy-guided transforaminal epidural injection and assessed by experts on a reusable injectable phantom cadaver. The high- and low-fidelity groups received 30 minutes of supervised hands-on practice according to group assignment, and the control group received 30 minutes of didactic instruction from an expert. We found no differences at posttest between the high- and low-fidelity groups on global ratings of performance (P = 0.17) or checklist scores (P = 0.81). Participants who received either form of hands-on training significantly outperformed the control group on both the global rating of performance (control vs low-fidelity, P = 0.0048; control vs high-fidelity, P = 0.0047) and the checklist (control vs low-fidelity, P = 0.0047; control vs high-fidelity, P = 0.0047). Training an epidural procedure using a low-fidelity model may be equally effective as training on a high-fidelity model. These results are consistent with previous research on a variety of interventional procedures and further demonstrate the potential impact of simple, low-fidelity training models.

Coordinating Progressive Levels of Simulation Fidelity to Maximize Educational Benefit

To evaluate the effectiveness of a novel, simulation-based educational model rooted in scaffolding theory that capitalizes on a systematic progressive sequence of simulators that increase in realism (i.e., fidelity) and information content. Forty-five medical students were randomly assigned to practice intravenous catheterization using high-fidelity training, low-fidelity training, or progressive training from low to mid to high fidelity. One week later, participants completed a transfer test on a standardized patient simulation. Blinded expert raters assessed participants' global clinical performance, communication, procedure documentation, and technical skills on the transfer test. Participants' management of the resources available during practice was also recorded. Data were analyzed using multivariate analysis of variance. The study was conducted in fall 2008 at the University of Toronto. The high-fidelity group scored higher (P < .05) than the low-fidelity group on all measures except procedure documentation. The progressive group scored higher (P < .05) than other groups for documentation and global clinical performance and was equivalent to the high-fidelity group for communication and technical skills. Total practice time was greatest for the progressive group; however, this group required little practice time on the resource-intensive high-fidelity simulator. Allowing students to progress in their practice on simulators of increasing fidelity led to superior transfer of a broad range of clinical skills. Further, this progressive group was resource-efficient, as participants concentrated on lower fidelity and lower resource-intensive simulators. It is suggested that clinical training curricula incorporate exposure to multiple simulators to maximize educational benefit and potentially save educator time.

Fiberoptic Oral Intubation

Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure. Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted "easy" intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured. Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between "fidelity of training model" and "first versus second attempt" scores. There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.

Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers

A decline in emergency surgical airway procedures in recent years has resulted in a decreased exposure to cricothyrotomy. Consequently, residents have very little experience or confidence in performing this intervention. In this study, we compared cricothyrotomy skills acquired on a simple inexpensive model to those learned on a high fidelity simulator using valid evaluation instruments and testing on cadavers. First and second year anesthesiology residents were recruited. All subjects performed a videotaped pretest cricothyrotomy on cadavers. Subjects were randomized into two groups: The high fidelity group (n = 11) performed two cricothyrotomies on a full-scale simulator with an anatomically accurate larynx. The low fidelity group (n = 11) performed two cricothyrotomies on a low fidelity model constructed from corrugated tubing. Within 2 wk all subjects performed a posttest. Two blinded examiners graded and timed the performances using a checklist and a global rating scale. There was no significant difference in the change from pretest to posttest performance between the model groups as evaluated by all three measures (all: P = NS). Training on both models significantly improved performance on all measures (all: P < 0.001). Inter-rater reliability was strong (checklist: r = 0.90; global rating scale: r = 0.89). Our study shows that a simple inexpensive model achieved the same effect on objectively rated skill acquisition as did an expensive simulator. The skills acquired on both models transferred effectively to cadavers. Training for this life-saving skill does not need to be limited by simulator accessibility or cost.