Simulation Mannequin Research Articles

Digital vs formal teaching of vaginal breech delivery: Which is the residents’ choice?

Objective(s)A critical area of obstetrics that demands proficient training is the management of breech deliveries. There was a notable decline in the number of vaginal breech deliveries in the following years, establishing CS as the preferred method of delivery for such cases. Cohort studies using targeted screening and skilled practitioners demonstrated little differences between the two delivery. Skills acquisition at the patient’s bedside is very difficult to obtain, particularly in the youngest trainees. Simulation teaching has largely become a part of the training curricula for many obstetrics and gynecology residency programs. Study designThis was a prospective, randomized, controlled, single-center study. Residents were randomly assigned in two groups with similar characteristics. Group A attended a formal lecture. Group B received the study material and recording of the lecture as digital home learning. Lecture and simulation focused on vaginal breech delivery. After one month both groups underwent a simulation test addressed to assist a vaginal breech birth. Four supervisors evaluated all videos. Time needed for birth, and evaluation scales as Objective Structured Clinical Examination were recorded. A questionnaire was completed online using Google Forms with 6 questions. The primary outcome was to compare the evaluation for each item and globally within groups. A secondary outcome was the evaluation of questionnaire results within the two groups. ResultsThirty-two participants were recruited and randomized. None of the participants withdrew from the study. For the primary outcome, all examined variables (Time, Rumping, Legs, Body, Arms, Head, Total Point) did not present differences in supervisors’ evaluations. For the secondary outcome, Group B showed higher values in two questions. Conclusion(s)The major finding of our study is that digital learning and formal lecture presented similar results on resident knowledge. Teaching programs involving mannequin simulation − both high and low fidelity − are reproducible and efficient for skill retain in obstetric emergencies, particularly in low incidence emergencies. The main limitation of our study was the small sample size. In addition, it is possible that a scenario without deviation or a lecture more focused on possible deviation from normal could modify residents’ results facing breech delivery.

Maximizing Learning in Caring for Older Patients Through a Multi-Specialty Simulation Approach

Background: Simulation-based learning has been utilized in medical education and studied to enhance its educational impact since the 1960s (Hallinger, & Wang, 2020). However, there is a lack of multispecialty simulations in the literature (Fisher, & Walker, 2014; Age UK. 2023; NHS England, 2021; Romero-Ortuno, Stuck, & Masud, 2022; Keijsers, et al., 2016). We developed and delivered simulations on Orthopaedics and Geriatric topics. Simulation mannequins, role players, imaging, and simulated clinical documentation were incorporated into scenarios. We evaluated the effectiveness of this approach on students’ knowledge and confidence when caring for older patients. Methods: Fourth-year medical students at the University of Nottingham received simulation-based teaching during their Geriatrics placement at Queens Medical Centre. Their knowledge and confidence levels were assessed before and after the simulations. We utilized six knowledge-based and six confidence-level questions mapped to their learning outcomes for hip fractures, pressure ulcers, and discharge planning stations. In addition, we asked students to provide scenario-specific feedback and their thoughts on whether the simulation workshop was pitched at the right level. Results: Students’ knowledge and confidence levels improved significantly following the simulation workshop. About 75% of the students displayed enhanced results in the knowledge-based category. In terms of their confidence level, there was improvement seen across all simulation stations, with most learners feeling four times more confident when comparing proportions pre and post-simulation. Furthermore, 99% of the students thought the simulations had positively impacted their learning. Conclusion: Our findings demonstrate the effectiveness of the multispecialty simulation approach in undergraduate geriatrics teaching. Given significant improvements in students’ knowledge, confidence levels, and positive feedback, we aim to continue delivering this multispecialty simulation-based teaching to our students. To measure the long-term efficacy of this approach, we can perhaps re-evaluate students learning after a month to assess the efficacy of this simulation workshop.

Design and research on the posture-adjustable mannequin for chest-up and hunchbacked posture

The development of garment personalization has put forward diverse requirements for mannequins. In this paper, we present a garment mannequin that can continuously alter the body posture in response to changes in human body posture in the chest and back regions. This research is founded on an analysis of the patterns and ranges of movement in the mannequin's chest and hunchbacked motions. We segmented the mannequin into six modules: neck, front chest, back, left and right shoulders, and waist and abdomen. By employing stepper motors, we independently drive the front chest, back, and left and right shoulders to achieve the simulation and continuous adjustment of the mannequin's body posture for chest and hunchbacked positions. The comparison of the 3D scans shows that the mannequin fits well in several cross-sections with the corresponding body variations of real people, and the results of the real shirt also show that the shirt made based on the simulated hunchbacked body mannequin is significantly better than the standard shirt in terms of comfort and aesthetics for a person with a hunchbacked body posture. The body posture adjustable mannequin can replace multiple static mannequins, which can provide strong support for the business model of personalized clothing customization. Compared with the existing dynamic mannequin, it has the advantages of high relevance, simple structure and low production cost.

3D young female waist-leg modelling based on a hybrid 3d-scan and 2d-image approach

To enhance the pant fit for individuals, this study proposed a method for constructing a 3D waist-leg mannequin based on body images and 3D point-clouds of young women. A total of 288 females aged 18–25 were measured using 3D body scanner and 2D image-shooting method to obtain 3D point-cloud data and body images. The 3D point-cloud data were analyzed to extract 33 sectional curves, including the cross-sectional curves and crotch curve, to identify key points on each curve. For the body images, key parameters related to curve position and shape, such as height, width, and thickness, were automatically extracted for modelling parameters. Curve generation rules were established based on correlation and regression analysis of the key points. The Individualized 3D mannequin was simulated by adjusting the curve centers at each characteristic position to align with the body images, and was validated by comparing the body sizes of the 3D mannequin with the actual measurements. The results indicated that the final simulated mannequin accurately represents the basic characteristics of the waist-leg shape, with significance values above 0.05, which showed the feasibility of the modelling method. Furthermore, 73.9% of the samples had an absolute error of less than 1 cm between the 3D mannequin and the actual measurements. This study can facilitate 3D body modelling from body images, and provide a reference to develop individualized apparel patterns for clothing customization.

Effect of Infection Control Simulation Based on a Negative Pressure Isolation Room Using Mixed Reality.

This study aimed to examine the effectiveness of an infection control simulation using mixed reality, comparing simulation fidelity with a high-fidelity mannequin (MN) group and problem-based learning with written cases group. This study used a three-group pretest-posttest quasi-experimental design. Two universities with similar curricula were conveniently selected, and a total of 72 nursing students were recruited. Participants were randomly assigned to three groups of 24 each. In the final analysis, there were 22 participants in the mixed reality groups, 21 in the mannequin groups, and 23 in the problem-based learning with written cases groups. Data were analyzed using descriptive statistics and the χ 2 , Kruskal-Wallis, and Wilcoxon signed rank tests. The mixed reality groups had a significantly positive effect on clinical reasoning ability and clinical competence than the problem-based learning with written cases groups, whereas the mannequin groups had a significantly positive effect on clinical competence than the problem-based learning with written cases groups. Mixed reality simulation is an appropriate simulation method that enhances learning immersion, satisfaction, and self-confidence in simulation. Additionally, it can substitute for mannequin simulation in terms of clinical reasoning ability and clinical competence. This study suggests that it is important to the various approaches in simulation fidelity to diversely enhance the competency of nursing students in simulation outcomes.

Reproducibility of the 3D-Models for Baby and Mother phantom using the platform 3D-Slicer

The evolution of segmentation over the years has offered unlimited potential, with extensive applications in the field of Anatomy. Female pelvis anatomy is reaping great benefits, especially in terms of surgical planning and guidance. Personalize mannequin design are the basic element in virtual garment simulation and visualization and mannequin construction from scanned point cloud and regenerates their shapes by inputting variant dimension., we will describe the segmentation of an existing mannequin and regenerating a new one through 3D Slicer platform, this work is the result of cooperative work between CIGT (Image Guided Therapy Center in the Faculty of Medicine in Nouakchott University-Mauritania) and the IUIBS (Institute for Biomedical and Healthcare Research- University of Las Palmas de Gran Canarias- Spain), involving the segmentation and generation of 3D models for both baby and mother using the 3D Slicer platform.

Beyond the surface: A comparative study of intraoral scanners in subgingival configuration scanning

ObjectivesThis study conducted a comprehensive comparative analysis of three intraoral scanners (CEREC Primescan, TRIOS, CEREC Omnicam) and a lab scanner (inEosX5) assessing their precision in simulating subgingival tooth preparations. MethodsUtilizing a dental simulation mannequin with a 3D-printed resin structure, 100 structures with depths ranging from 0.5 to 4.0 mm were created within a square mimicking a rectangular tank surface. Four scanner groups (A-D) and five subgroups were established. Two digitization methods, a customized parallelometer and an intraoral simulation, were applied, ensuring a standardized scanning sequence. Trueness was evaluated by comparing CAD-calculated surface areas with actual dimensions, and qualitative trueness analysis was conducted using MeshLab. Surface areas were computed using the formula SA = 2lw + 2lh + 2wh. Statistical analyses, including Pearson’s correlation coefficient, Kolmogorov–Smirnoff and Levene’s tests, three-way ANOVA, and paired sample t-tests, elucidated relationships and differences (a=0.05). ResultsA robust correlation (r = 0.850, p < 0.001) between intraoral scanner choice and scanned area depth was found. Inverse correlations were noted for experimental methods. Three-way ANOVA demonstrated significant scanner-depth interaction (F(12,760) = 760.801, p < 0.001). SignificanceEmphasizing high-resolution sensors and advanced technologies, the study underscores the optimal choice for subgingival digitization, acknowledging variations among scanners.

Implementation and Evaluation of a Bystander Naloxone Training Course.

Bystander provision of naloxone is a key modality to reduce opioid overdose-related death. Naloxone training courses are available, but no standardized program exists. As part of a bystander empowerment course, we created and evaluated a brief naloxone training module. This was a retrospective evaluation of a naloxone training course, which was paired with Stop the Bleed training for hemorrhage control and was offered to administrative staff in an office building. Participants worked in an organization related to healthcare, but none were clinicians. The curriculum included the following topics: 1)background about the opioid epidemic; 2)how to recognize the signs of an opioid overdose; 3)actions not to take when encountering an overdose victim; 4)the correct steps to take when encountering an overdose victim; 5)an overview of naloxone products; and 6)Good Samaritan protection laws. The 20-minute didactic section was followed by a hands-on session with nasal naloxone kits and a simulation mannequin. The course was evaluated with the Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales for take-home naloxone training evaluation. We used the paired Wilcoxon signed-rank test to compare scores pre- and post-course. Twenty-eight participants completed the course. The OOKS, measuring objective knowledge about opioid overdose and naloxone, had improved scores from a median of 73.2% (interquartile range [IQR] 68.3%-79.9%) to 91.5% (IQR 85.4%-95.1%), P < 0.001. The three domains on the OOAS score also showed statistically significant results. Competency to manage an overdose improved on a five-point scale from a median of 2.5 (IQR 2.4-2.9) to a median of 3.7 (IQR 3.5-4.1), P < 0.001. Concerns about managing an overdose decreased (improved) from a median of 2.3 (IQR 1.9-2.6) to median 1.8 (IQR 1.5-2.1), P < 0.001. Readiness to intervene in an opioid overdose improved from a median of 4 (IQR 3.8-4.2) to a median of 4.2 (IQR 4-4.2), P < 0.001. A brief course designed to teach bystanders about opioid overdose and naloxone was feasible and effective. We encourage hospitals and other organizations to use and promulgate this model. Furthermore, we suggest the convening of a national consortium to achieve consensus on program content and delivery.

A Comparison of 2 Debriefing Rubrics to Assess Facilitator Adherence to the PEARLS Debriefing Framework.

Many educators have adopted the Promoting Excellence and Reflective Learning in Simulation (PEARLS) model to guide debriefing sessions in simulation-based learning. The PEARLS Debriefing Checklist (PDC), a 28-item instrument, and the PEARLS Debriefing Adherence Rubric (PDAR), a 13-item instrument, assess facilitator adherence to the model. The aims of this study were to collect evidence of concurrent validity and to evaluate their unique strengths. A review of 130 video recorded debriefings from a synchronous high-fidelity mannequin simulation event involving third-year medical students was undertaken. Each debriefing was scored utilizing both instruments. Internal consistency was determined by calculating a Cronbach's α. A Pearson correlation was used to evaluate concurrent validity. Discrimination indices were also calculated. Cronbach's α values were 0.515 and 0.714 for the PDAR and PDC, respectively, with ≥0.70 to ≤0.90 considered to be an acceptable range. The Pearson correlation coefficient for the total sum of the scores of both instruments was 0.648, with a values between ±0.60 and ±0.80 considered strong correlations. All items on the PDAR had positive discrimination indices; 3 items on the PDC had indices ≤0, with values between -0.2 and 0.2 considered unsatisfactory. Four items on both instruments had indices >0.4, indicating only fair discrimination between high and low performers. Both instruments exhibit unique strengths and limitations. The PDC demonstrated greater internal consistency, likely secondary to having more items, with the tradeoff of redundant items and laborious implementation. Both had concurrent validity in nearly all subdomains. The PDAR had proportionally more items with high discrimination and no items with indices ≤0. A revised instrument incorporating PDC items with high reliability and validity and removing those identified as redundant or poor discriminators, the PDAR 2, is proposed.

A prospective randomized comparative study of effectiveness of simulation-based training in improving the performance of non-technical skill among postgraduate students during anaesthesia crisis resource management

Background Non-technical skills are pivotal in ensuring patient safety during anaesthesia crisis resource management. Simulation-based training has emerged as a promising educational approach for enhancing these skills. This study protocol outlines a prospective randomised comparative study aimed at assessing the impact of simulation-based training on the performance of anaesthesia residents during anaesthesia crisis resource management, with a focus on task management, teamwork, situational awareness, and decision-making skills, using the Assessment of Non-Technical Skills (ANTS) scoring system. Methods Anesthesia residents in postgraduate years 1 and 2 from the Department of Anesthesia at Acharya Vinoba Bhave Rural Hospital will be included as study participants. Informed consent will be obtained, and no exclusion criteria will be applied. Participants will undergo an orientation session covering essential crisis management and simulation knowledge. The study will employ advanced simulation equipment, including a Human Patient Simulator (HPS) mannequin, an anaesthesia machine, and a simulated operating room. Faculty members have selected six distinct perioperative emergency scenarios for simulation sessions. Participants will be grouped in pairs and exposed to three scenarios during each session. Debriefing and feedback will follow each scenario, reinforcing non-technical skills. Experienced staff anesthesiologists, trained in the Assessment of Non-Technical Skills (ANTS) scoring system, will serve as assessors to evaluate participant performance. Expected outcomes Data collected will include ANTS scores, debriefing feedback, and post-test results. Statistical analysis will be employed to assess the effectiveness of simulation-based training in enhancing non-technical skills among anaesthesia residents during anaesthesia crisis resource management.

The confidence and competence of primary school staff to administer an adrenaline auto-injector

School teachers are often inadequately prepared to use an adrenaline auto-injector (AAI), resulting in potentially dangerous treatment delays. The purpose of this study was to assess the observed competence, and self-reported confidence, of primary school teachers in the Republic of Ireland (RoI) to use an AAI. An evaluation of whether there was a link between confidence and competence was also assessed. Teachers from four primary schools in the RoI completed a questionnaire to assess their prior level of experience, training, and confidence levels with AAI administration. The four steps in administrating trainer AAI to a mannequin simulator were then assessed. A total of 61 teachers participated (out of a population of 80). The mean self-reported confidence was 1.82 out of 5 (SD = 0.96). There was no significant difference in confidence between trained and untrained participants (U = 240.5, NS). Participants who had received AAI administration training performed significantly more of the steps correctly (mean = 3.85, SD = 0.95) as compared to those who had received no training (mean = 2.97, SD = 1.10; U = 180.5, p = 0.008). There was no correlation between confidence in administrating AAI and the percentage of steps in the procedure performed correctly (rho = −0.17, NS). Conclusion: Improvements in readiness to administer AAIs can be achieved through the application of more effective approaches to teaching clinical skills, changes to school policies and practices, and consideration of the design of AAIs in order to make their operation safer and simpler. It is important that teachers have the confidence and competence to safely administer an AAI.What is Known:• Poor ability in adrenaline auto-injector use seen across population groups—healthcare professionals, patients, carers, and school staff• Training in the use of adrenaline auto-injectors has positive impact on competencyWhat is New:• Irish school teachers show poor levels of competency in adrenaline auto-injector use• No observed correlation between reported confidence and competency

Effectiveness of simulation models and digital alternatives in training ophthalmoscopy: A systematic review

Purpose Traditional direct ophthalmoscopy (TDO) is the oldest method of fundus examination; however, it has fallen out of use due to its technical difficulty and limitations to clinical utility, amidst the advent of potentially better options. A spectrum of new technologies may help in addressing the shortcomings of TDO: simulation mannequins with non-tracked TDO, simulation models with tracked TDO, and smartphone ophthalmoscopy (SFO). Methodology A systematic search of PubMed, Embase, and Cochrane databases for all studies evaluating usage of simulation mannequins/models and SFO in ophthalmology education was performed, from inception till April 2023 with no language restriction. We ensured that we included all possible relevant articles by performing backward reference searching of included articles and published review articles. Results We reviewed studies on non-tracked TDO (n = 5), tracked TDO (n = 3) and SFO (n = 12). Non-tracked TDO and SFO were superior in training competency relative to control (TDO on real eyes). Intriguingly, tracked TDO was non superior to controls. SFO appears to enhance the learning effectiveness of ophthalmoscopy, due to real-time projection of the retina view, permitting instantaneous and targeted feedback. Learners reported improved ergonomics, including a wider field of view and more comfortable viewing distance. Retention of images and recordings permitted the audit of learning and paves the way for storage of such images in patients’ electronic medical record and rapid dissemination for specialist referral. Conclusions Smartphone ophthalmoscopy (SFO) permits integration of both the practice and learning of ophthalmoscopy, and the auditing of both. These advantages over traditional methods (with simulation or otherwise) may lead to a paradigm shift in undergraduate ophthalmology education. However, the nascency of SFO necessitates preservation of traditional techniques to tide through this period of transition.

Instrumented Pre-Hospital Care Simulation Mannequin for Use in Spinal Motion Restrictions Scenarios: Validation of Cervical and Lumbar Motion Assessment.

A mid-fidelity simulation mannequin, equipped with an instrumented cervical and lumbar spine, was developed to investigate best practices and train healthcare professionals in applying spinal motion restrictions (SMRs) during the early mobilization and transfer of accident victims with suspected spine injury. The study objectives are to (1) examine accuracy of the cervical and lumbar motions measured with the mannequin; and (2) confirm that the speed of motion has no bearing on this accuracy. Accuracy was evaluated by concurrently comparing the orientation data obtained with the mannequin with that from an optoelectronic system. The mannequin's head and pelvis were moved in all anatomical planes of motion at different speeds. Accuracy, assessed by root-mean-square error, varied between 0.7° and 1.5° in all anatomical planes of motion. Bland-Altman analysis revealed a bias ranging from -0.7° to 0.6°, with the absolute limit of agreement remaining below 3.5°. The minimal detectable change varied between 1.3° and 2.6°. Motion speed demonstrated no impact on accuracy. The results of this validation study confirm the mannequin's potential to provide accurate measurements of cervical and lumbar motion during simulation scenarios for training and research on the application of SMR.

The Rising Tide of Point-of-Care Ultrasound (POCUS) in Medical Education: An Essential Skillset for Undergraduate and Graduate Medical Education.

As point-of-care ultrasound (POCUS) becomes an integral component of healthcare, both undergraduate and graduate medical POCUS education is urgently necessary in curricula. Despite the apparent need of POCUS curricula, there remains a lingering question: Are there evidence-based benefits to POCUS training in undergraduate and/or graduate medical education settings? Qualitative review of research was conducted to identify common themes for benefits of POCUS and the requirements and/or characteristics for effective POCUS educational curricula. Results for undergraduate medical education were separated into preclinical and clinical education. In preclinical POCUS education, POCUS education improves anatomy education and physical examination skills for sonographic assessment of abdominal, reproductive, cardiovascular, and renal structures. Further enhancement can be achieved via simulation devices that are generalized ultrasound simulation mannequins, one defined body region such as the abdomen, or local regions of interest such as the femoral triangle. In clinical undergraduate POCUS education, benefits involved greater performance on knowledge tests and general ultrasound competency in emergency medicine, surgical, family medicine, and physical medicine and rehabilitation clerkships. These studies also found improved comprehension of specific POCUS examinations such as those for ultrasound-guided injections, FAST, eFAST, and RUSH. Further integration of POCUS education into graduate medical education was found to successfully improve ultrasound knowledge and competency in both academic and military internal medicine residencies. One limitation of this study is that this article is a review resulting in no specific intervention being introduced. The resultant hypothesis of this systematic review cannot be tested; rather evidence-based recommendations are restricted to the currently available literature within the searched databases. From this review, it was found that the inclusion of a properly integrated POCUS curriculum can result in greater confidence in ultrasound use, increased knowledge of anatomy and basic sciences for various organ systems, improved ultrasound knowledge and performance in clinical clerkships, and offers improved confidence and knowledge in ultrasound during residency.

450 Assessment of Basic Cardiopulmonary Resuscitation (CPR) technique in professionals of a Pediatric Department in a IIb level hospital. Analysis through simulation mannequins with a feedback system

450 Assessment of Basic Cardiopulmonary Resuscitation (CPR) technique in professionals of a Pediatric Department in a IIb level hospital. Analysis through simulation mannequins with a feedback system

A82‘Simulation for Finals and Real Life’ – is it ever too early to jump in the deep end?

Surveying University of Nottingham (UoN) medical students in their final year with regards to applying an A-E approach in a medical emergency context, we found that they lacked confidence. In order to address this curriculum gap, we designed a low-fidelity simulation-based workshop which has been shown to improve confidence in developing key skills relating to medical emergencies [1]. This consists of a 2-hour session for groups of 6, for all students undertaking their medical placements at Nottingham University Hospitals (NUH). After successfully implementing this workshop for students in their final year, we asked ourselves ‘when is it too early for medical students to cover A-E assessments in medical training?’ Considering this is an essential skill to develop and part of their intended learning outcomes (ILOs) that is also tested in their 3rd year examinations, we introduced an adapted version of this workshop for the more junior cohort. We constructed this workshop with alignment to both the final and third year UoN curriculum ILOs. Google forms were used to survey students’ confidence pre and post-session. We used a low-fidelity simulation mannequin, focusing on an otherwise realistic clinical environment using medical notes, a portfolio of investigations and props. This included an observation monitor, a real-time display with altering vital parameters and a fully equipped emergency trolley. Pre‐reading handouts on A-E assessment by the Resuscitation Council UK [2] were provided. We watched a pre‐recorded demonstration video of the management of hypoglycaemia prior to students working in pairs on three scenarios. During the simulation scenarios, faculty members acted as either the patient or team members, including as a nurse and medical registrar. We showed that participation in our workshop significantly improved student confidence in the specific domains (see Summary of the student questionnaire results Written feedback from students suggested active participation in a simulated learning environment together with a detailed debrief and facilitated discussion was a powerful learning experience. This workshop has now been embedded into the teaching timetable at NUH. A-E assessment is a key template doctors of all grades use when facing the most critical situations. Considering the feedback, introducing more junior students to the structure of an A-E assessment early is essential for creating a scaffold in their long-term memory, ingraining this into their professional practice. This will prepare them for their OSCEs and the new GMC mandated MLA examinations [3] and, more importantly, for when they start their roles as foundation doctors. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

This study evaluated the aerosol exposure risks while using common noninvasive oxygenation devices. A simulated mannequin was designed to breathe at a minute ventilation of 20 L/min and used the following oxygen-therapy devices: nasal cannula oxygenation (NCO) at 4 and 15 L/min, nonrebreathing mask (NRM) at 15 L/min, simple mask at 6 L/min, combination of NCO at 15 L/min and NRM at 15 L/min, high-flow nasal cannula (HFNC) at 50 L/min, and flush rate NRM. Two-dimension of the dispersion distance and the aerosol concentrations were measured at head, trunk, and foot around the mannequin for over 10 min. HFNC and flush-rate NRM yielded the longest dispersion distance and highest aerosol concentrations over the three sites of the mannequin than the other oxygenation devices and should use with caution. For flow rates of < 15 L/min, oxygenation devices with mask-like effects, such as NRM or NCO with NRM, decreased aerosol dispersion more effectively than NCO alone or a simple mask. In the upright position, the foot area exhibited the highest aerosol concentration regardless of the oxygenation device than the head–trunk areas of the mannequin. Healthcare workers should be alert even at the foot side of the patient while administering oxygenation therapy.

Using simulation as a platform to prepare for ear, nose and throat emergencies in the coronavirus disease 2019 era and beyond.

Following limited clinical exposure during the coronavirus disease 2019 pandemic, a simulation-based platform aimed at providing a unique and safe learning tool was established. The aim was to improve the skills, knowledge and confidence of new ENT doctors. The course was developed through 5 iterations over 28 months, moving from a half-day session to 2 full-day courses with more scenarios. Participant, faculty and local simulation team feedback drove course development. High-fidelity scenarios were provided, ranging from epistaxis to stridor, using technology including SimMan3 G mannequin, mask-Ed™ and nasendoscopy simulators. Participant feedback consistently demonstrated that the knowledge and skills acquired enhanced preparedness for working in ENT, with impact being sustained in clinical practice. Preparing healthcare professionals adequately is essential to enhancing patient safety. This simulation course has been effective in supporting new doctors in ENT and has subsequently been rolled out at a national level.

Comparison of Cardiac Auscultation Features on Four Different Simulation Mannequins Performed by Pediatric Residents.

Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels of medical training. So, supplementary training methods started to evolve, including simulation for auscultation skills training. Over the years, mannequins have evolved with different types of technology. Therefore, we decided to compare cardiac auscultation accuracy among high-fidelity mannequins as the primary objective and compare the performance of various postgraduate-level residents as a secondary objective. Pediatric residents at King Abdulaziz University Hospital were given a lecture on the basics of cardiac auscultation and then requested to auscultate four mannequins, namely SimJumior® (Laerdal Medical, Stavanger, Norway), SimBaby™ (Laerdal Medical), Pediatric HAL® (Gaumard Scientific, Miami, FL, USA), and Cardiac Patient Simulator K-Plus (Kyoto Kagaku Co. Ltd., Kyoto, Japan). The accuracies of murmur type, diagnosis, and auscultation time were compared. Results: A total of 56 pediatric residents were enrolled. Median murmur accuracy ranged from 50% to 53% (p-value 0.79), and median diagnosis accuracy ranged from 33% to 36% (p-value 0.77), with a nonsignificant difference between mannequins. Comparing resident levels in all mannequins, median murmur accuracy ranged from 49% to 56% (p-value 0.70), and median diagnosis accuracy ranged from 29% to 41% (p-value 0.09). While the median average auscultation time was between 41 and 50 seconds (p-value 0.34). Auscultation skills can be taught through simulation on any mannequin used in this comparison, not necessarily the cardiac one. For better accuracy, future comparisons might include more advanced cardiac mannequins based on cardiac auscultation expertise (i.e., consultant level). The introduction of an auscultation program from the undergraduate level throughout the training process and monitoring of these skills are mandated.

A novel medical apparatus for the containment and evaluation of a pediatric patient under suspicion for highly communicable infectious disease.

Highly communicable infectious diseases (HCIDs) such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Ebola are a containment challenge for the emergency department (ED). Donning and doffing personal protective equipment is necessary to protect healthcare workers but is time consuming and rife with errors. Furthermore, children present an additional containment challenge since they are often unable to follow directions or be separated from family members. To address these challenges, a novel child-friendly medical apparatus was developed for the rapid containment and evaluation of a HCID patient in the ED. The primary objective was to determine if routine emergency triage procedures (vital signs and basic physical examination) can be performed using this medical apparatus. The secondary objective was to determine if invasive procedures (bag-valve-mask ventilation and endotracheal intubation) can be performed. This was a prospective pilot study. A clear acrylic apparatus was built containing arm ports with gloves, simulating a specialized HCID barrier. Emergency physicians attempted routine triage procedures on a healthy volunteer and invasive procedures using a simulation mannequin through this apparatus. Twenty-four physicians were enrolled. All physicians (100 percent) successfully obtained vital signs, auscultated heart/lung sounds, completed bag-valve-mask ventilation, and performed intubation through the apparatus. This novel apparatus is a feasible tool in the rapid evaluation of a HCID patient in the ED. A future study is needed to assess protection and training using this apparatus.