Medical Simulation Center Research Articles

II International Conference “Medical Simulation-Practical Applications and Technologies”

Medical simulation is a practical field of education. Its indirect goal is to inspire and connect specialists responsible for various roles in simulation centers. Medical simulation is a highly developed professional field which, along with the development of educational paths, has become a permanent part of the didactic process. Therefore, the audience of the conference consisted of everyone who starts or continues a career in the field of medical simulation. “Science has no homeland because human knowledge covers the whole world.” Therefore, we should remember that everything we have learned and taught our students: professionalism, understanding, empathy, humanity, not only in medical areas, will be lost if we are not able to find application for this knowledge. We are aware that the implementation of a medical simulation is a long process, often raising many questions and prompting all of us to make an effort that gives didactic and scientific satisfaction. Taking into account this challenge related to the creation of Medical Simulation Centers in the disciplines of medicine, nursing, obstetrics and paramedics, dentistry, physiotherapy or pharmacy, we meet the needs of the teaching staff of our universities. Sharing good practices and our own very valuable experience is principal goal for today and building a network of medical simulation centers mutually supporting this task for tomorrow and the nearest common future. Therefore, the II International Conference “Medical Simulation-Practical Applications and Technologies” (11th–12th March 2022, http://medsim2022.bok-ump.pl) brings together enthusiasts of modern medical education and simulation, experts and specialists. The event is organized in Poznan at the Poznan University of Medical Sciences in close cooperation with the Pomeranian Academy in Slupsk, the Polish Nursing Society and the Polish Society of Medical Simulation. That meeting was dedicated such important issues as: • New tools in medical simulation education • Organizing the osce exam • “in-situ” medical simulation • Experiences and best practices

SIMULATION-BASED TRAINING OF REGIONAL ANESTHESIA MEDICAL SIMULATION CENTER, UNIVERSITY MEDICAL CENTER LJUBLJANA, SLOVENIA.

Simulation-based training is a technique, which uses technological devices to reproduce different clinical situations like in the real world. Procedures and simulation scenarios performed on simulators can be planned and repeated with no harm for the patient. Simulation-based training introduced new educational applications in medicine to improve patient safety. Simulation education was introduced in the anesthesia curriculum in 2017 as a first specialization in Slovenia.

Creating Macao Medical Simulation Centre to improve safety, quality and education in health care (Center of Excellence for Medical Professional Development)

Creating Macao Medical Simulation Centre to improve safety, quality and education in health care (Center of Excellence for Medical Professional Development)

Ocena umiejętności komunikacyjnych studentów ostatniego roku kierunku lekarskiego Warszawskiego Uniwersytetu Medycznego w zakresie przekazywania niepomyślnych informacji

Introduction. An important element of general medical skills is the ability to deliver bad news in an effective and emotionally burdensome manner for medical personnel as doctors usually are. Preparing graduates for such a challenge is to familiarize them with the elements of the SPIKES protocol, referring to the 6 elements of the interview that should be included during the giving information. Material and methods. The study has been conducted among the last-year students of the Faculty of Medicine, Medical University of Warsaw, participating in classes at the Medical Simulation Centre (MSC) as part of the “Specialty chosen by the student” block. As a part of that course was the participation of students in a scenario assuming the need to deliver bad news to the family of a patient who has died due to cardiac arrest. Students worked in four-person therapeutic teams, in which 1 student acted as the head of the therapeutic team, 3 other students acted as team member. A previously trained person played the role of a family member. The students’ behaviour was assessed by an independent observer based on audiovisual recordings. Results. Out of 369 students participating in the simulation classes described above at the MSC, 148 people making up 37 Emergency Medical Team (EMT) agreed to an audiovisual recording enabling the study to be carried out. 86% of those speaking with the simulated patient playing the role of the patient’s family ensured a sufficiently long conversation time related to the needs of the family. About 2/3 of the respondents (68.5%) reflected the emotions of the interlocutor and was able to name them and reacted on an ongoing basis to the patient’s reactions in terms of the bad news delivered (63%). Less than half of the respondents (48.5%) took care to maintain intimacy during the conversation. 20% of students provided preliminary information about the incident to introduce them to the interview, and less than 10% of the respondents summed up the interview and suggested further proceedings. Conclusions. The analysis of last year Faculty of Medicine students behaviour showed that practically all elements of the SPIKES protocol require a lot of attention and thorough discussion in the education of subsequent years of students of the medical faculty. Teaching the ability to communicate unfavourable information should take place both at the stage of undergraduate education and its completion in postgraduate education.

Simulation in surgical education: a review of a multi- tiered gynaecological laparoscopy workshop

Background: While minimally access approach has become the gold standard for many gynaecological procedures, laparoscopic surgery has a steep learning curve and many trainees face challenges acquiring the necessary skills. The aim of our study was to evaluate the effectiveness of a multi-tiered laparoscopy simulation workshop for gynaecology residents. Approach: An observational study was conducted at SingHealth Duke-National University of Singapore (NUS) Institute of Medical Simulation Centre (SIMS) between November 2016 and November 2017. Gynaecology residents were recruited to attend two separate one-day workshops held in November 2016 and November 2017 respectively, involving didactic lectures, dry-lab simulation and animal training. Participants rated various learning domains of the training workshops using a five-point scale Likert in pre- and post-workshop surveys. Findings: The study enrolled 16 residents in total. On a Likert scale from 1 to 5 (1 being poor and 5 being excellent), participants rated significant improvement in domains of general laparoscopy skills acquisition (1.7 + 0.6 to 4.9 + 0.4; p<0.001), dry lab simulation (1.9 + 0.5 to 4.8 + 0.4; p<0.001), confidence in laparoscopy suturing skills (1.1 + 0.3 to 4.8 + 0.4; p<0.001) and laparoscopy knowledge (2.1 + 0.5 to 4.7 + 0.5; p<0.001). Conclusion: A combination of didactic lectures, dry-lab simulation and animal training under expert supervision and guidance dramatically improved surgical skills and confidence in gynaecology residents. Such a multi-tiered format allows for effective learning and acquisition of laparoscopic skills.

The Effect of Simulation-Based Vaginal Birth and Obstetrical Emergency Training for Emergency Health Professionals: A Quasi Experimental Study

Aim: The aim of the study is to determine the effect of simulation-based vaginal birth and obstetric emergencies training given to health professionals (physicians and nurses) working in emergency department on their knowledge level, active learning, team collaboration, and satisfaction with learning.
 Material and Method: This study is a semi-experimental study consisting of pre-test and post-test. The sample of the study consists of health professionals working in the emergency department. It was carried out in the obstetric unit of Medical Simulation Center in a university hospital. Health professional were given training 8 hours on vaginal birth and obstetric emergencies with simulation-based technique with high fidelity simulator with a guided scenario by trainers. The data were collected using 5 forms as follow: Descriptive Form, Survey Questionnaire, Student Satisfaction and Self-Confidence in Simulation Learning Scale, Simulation Design Scale and Educational Practices Questionnaire. Percentage, minimum-maksimun value, average score, and Mc Nemar test were used in the analysis of the data. 
 Results: Compared to pre-training, the post-training percentage of health professionals' correct answers to the questions about “vaginal birth” and “shoulder dystocia”, one of the obstetric emergencies, increased (p

In Situ Simulation in an Ambulatory Surgery Center

<h3>Background Information</h3> An ambulatory surgery center exemplifies a positive trend of successful transformation in healthcare delivery outside of a hospital setting that has proven to improve quality and customer service. Yet, with the development of shorter-acting anesthetic drugs, multimodal analgesia and minimally invasive surgery within this environment, perioperative emergencies can occur. Due to the rarity of occurrence in this setting, management has the potential to be challenging due to the limited resources and fast-paced environment. In situ simulation is an educational modality built on the principles of adult learning theories geared towards cultivating emergency response preparedness, professionals' competencies and collaborative practice to promote patient safety and outcomes. <h3>Objectives of Project</h3> To implement efficient in situ simulations in the operating room and perianesthesia units to foster optimal performance in crisis resource management situations. Enhance professional skills and behaviors such as collaboration, communication, leadership, self-efficacy, decision-making, role responsibility and situational awareness to ensure team functioning for safe patient care. <h3>Process of Implementation</h3> An interprofessional team was developed and members had the opportunity to attend a comprehensive instructor workshop from the Center for Medical Simulation. They learned how to develop a simulation with measurable objectives and how to implement the components consisting of pre-briefing, the scenario and debriefing. A Laerdal SimMan Essential was provided and education on how to navigate the computer system and become familiarize with the capabilities of the manikin occurred. Team members collaborated to develop scenarios to disseminate simulations tailored to our specific patient populations. Currently simulations are performed once or twice monthly in either OR or perianesthesia settings. The processes are continuously being re-evaluated based on the feedback from the team, our participants and the addition of services. <h3>Statement of Successful Practice</h3> Based on the interdisciplinary Simulation Effectiveness tool (ID-SET) secure real-time online-survey, participants response has been overwhelmingly positive. The opportunity to breakdown the causes of poor communication, ambiguity of roles, correct diagnosis, treatment and team functioning is commended. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Opportunity to develop and disseminate real-life scenarios in a safe, controlled environment. Debriefing encourages an engaging environment for participants to evaluate their response to a critical event, working individually and as a team to care for a patient.

Revisiting the Genicular Nerve Block: An Up-to-Date Guide Utilizing Ultrasound Guidance and Peripheral Nerve Stimulation – Anatomy Description and Technique Standardization

Over the last decade, several authors have reported that percutaneous peripheral nerve stimulation (PNS) can be used to assist in verifying the position of the procedure needle tip in relation to nerve structures, and that the combined technique using both ultrasound (US) guidance and PNS may serve as a reliable method for confirmation of the correct position of the procedure needle tip. It has also been reported that, when combined with US guidance, PNS may increase the success rate of pain management interventions. The aim of this technical report was to standardize an effective and easy to learn illustrated step-by-step technical approach to nerve identification during US-guided genicular nerve blocks, using percutaneous PNS as a verification instrument for procedure needle tip location. This technical protocol was developed based on the results of the authors' most recent cadaveric study on the innervation of the knee joint capsule. The technique was developed and tested by 4 different interventionists with different levels of expertise in US-guided procedures. The cadaveric study of the knee joint capsule innervation was performed at the laboratory of the Division of Anatomy of one institution. The technical protocol using US and PNS was later developed at the medical simulation center of a different institution. A team of anatomists from a division of anatomy of one institution performed the cadaveric study on the innervation of the knee joint capsule. A team of physicians then developed the step-by-step approach to this technical protocol at the medical simulation center of a different institution. Finally, the illustrated step-by-step approach was tested by 4 different interventionists with different levels of expertise in US-guided procedures (1 beginner-level user; 1 intermediate-level user; 2 expert-level users), using a portable percutaneous PNS and 2 different US transducers at 2 different institutions. This technical protocol was successfully developed based on the results of the cadaveric study on the innervation of the knee joint capsule. Additionally, it was later successfully tested by interventionists with various levels of expertise utilizing different US equipment at separate institutions. By combining US and nerve stimulation, this protocol requires the availability of both US equipment and necessary equipment for nerve stimulation that must all be made available in the sterile field. Another potential disadvantage is that nerve stimulation controls and the US image screen are generally located on 2 separate display panels, which could cause difficulty with visualization and simultaneous calibration for 2 individual devices. Our illustrated step-by-step technical protocol can be effectively and safely utilized as a reliable method of training, by which physicians with little to moderate US experience can improve their skills in accurately identifying the genicular nerves while performing US-guided examinations with the intent of executing a peripheral nerve block.

Evaluating the Instructional Design and Effect on Knowledge, Teamwork, and Skills of Technology-Enhanced Simulation-Based Training in Obstetrics in Uganda: Stepped-Wedge Cluster Randomized Trial.

BackgroundSimulation-based training is a common strategy for improving the quality of facility-based maternity services and is often evaluated using Kirkpatrick’s theoretical model. The results on the Kirkpatrick levels are closely related to the quality of the instructional design of a training program. The instructional design is generally defined as the “set of prescriptions for teaching methods to improve the quality of instruction with a goal of optimizing learning outcomes.”ObjectiveThe aim of this study is to evaluate the instructional design of a technology-enhanced simulation-based training in obstetrics, the reaction of participants, and the effect on knowledge, teamwork, and skills in a low-income country.MethodsA stepped-wedge cluster randomized trial was performed in a university hospital in Kampala, Uganda, with an annual delivery volume of over 31,000. In November 2014, a medical simulation center was installed with a full-body birthing simulator (Noelle S550, Gaumard Scientific), an interactive neonate (Simon S102 Newborn CPR Simulator, Gaumard Scientific), and an audio and video recording system. Twelve local obstetricians were trained and certified as medical simulation trainers. From 2014 to 2016, training was provided to 57 residents in groups of 6 to 9 students. Descriptive statistics were calculated for ten instructional design features of the training course measured by the 42-item ID-SIM (Instructional Design of a Simulation Improved by Monitoring). The Wilcoxon signed rank test was conducted to investigate the differences in scores on knowledge, the Clinical Teamwork Scale, and medical technical skills.ResultsThe mean scores on the ten instructional design features ranged from 54.9 (95% CI 48.5-61.3) to 84.3 (95% CI 80.9-87.6) out of 100. The highest mean score was given on the feature feedback and the lowest scores on repetitive practice and controlled environment. The overall score for the training day was 92.8 out of 100 (95% CI 89.5-96.1). Knowledge improved significantly, with a test score of 63.4% (95% CI 60.7-66.1) before and 78.9% (95% CI 76.8-81.1) after the training (P<.001). The overall score on the 10-point Clinical Teamwork Scale was 6.0 (95% CI 4.4-7.6) before and 5.9 (95% CI 4.5-7.2) after the training (P=.78). Medical technical skills were scored at 55.5% (95% CI 47.2-63.8) before and 65.6% (95% CI 56.5-74.7) after training (P=.08).ConclusionsMost instructional design features of a technology-enhanced simulation-based training in obstetrics in a low-income country were scored high, although intervals were large. The overall score for the training day was high, and knowledge did improve after the training program, but no changes in teamwork and (most) medical technical skills were found. The lowest-scored instructional design features may be improved to achieve further learning aims.Trial RegistrationISRCTN Registry ISRCTN98617255; http://www.isrctn.com/ISRCTN98617255International Registered Report Identifier (IRRID)RR2-10.1186/s12884-020-03050-3

The effect of emergency manuals on team performance during two different simulated perioperative crises: A prospective, randomized controlled trial

Study objectiveWhether having an emergency manual (EM) available for use during perioperative crises enhances or detracts from team performance, especially for multi-factorial diagnostic situations that do not explicitly match a chapter of the EM. DesignA simulation-based, prospective randomized trial based upon two perioperative crises, one involving a patient with a transfusion reaction for which the EM contains a specific chapter, and the other involving a patient with refractory hypotension progressing into septic shock for which the EM does not have a specific chapter. Setting52 regularly scheduled 6-h courses at the Center for Medical Simulation in Boston, Massachusetts, USA. Study group304 US-trained practicing anesthesiologists. InterventionsThe absence or presence of the EM during the simulation case. MeasurementsTeams were rated in the following categories: primary underlying diagnosis, fluid resuscitation, treatment of primary diagnosis, cardiac arrest management, overall crisis management, and (if applicable) EM usage. Also, raters recorded free-text ‘field notes’ about the usage-patterns and perceived utility of the EM. Using these ‘field notes’ and a two-stage, inductively revised procedure, two independent reviewers examined a subset of case videos for action analysis. Main resultsPerformance ratings for a total of 51 teams and 95 simulations were included in the final analysis. No effect on performance was demonstrated with providing the EM in either the refractory hypotension/septic shock case or the transfusion reaction case, with the exception of the PEA arrest category. In the subset of simulations in which resuscitation from PEA arrest performance could be evaluated, EM availability was associated with an adjusted mean 1.3 point (99% confidence interval [CI]: 0.2, 2.4) improvement in performance in the transfusion reaction case (p = 0.004), but only an adjusted mean 0.2 point (99% CI, −0.7, 1.1) improvement in the refractory hypotension/septic shock case (p = 0.530) (p for interaction = 0.069). Analysis of actions found that when available, the EM was usually used, but often not until after cardiac arrest had occurred. In some cases, teams persisted with incorrect diagnoses and treatments irrespective of the presence or absence of an EM. ConclusionsProviding an EM did not affect team performance in areas like diagnosis, treatment, fluid resuscitation, communication, and teamwork in management of perioperative crises such as transfusion reaction where an explicit chapter in the EM exists and refractory hypotension / septic shock where an explicit chapter does not exist. A suggestion of improved cardiac arrest resuscitation with the availability of an EM was found, but should be interpreted with caution given a limited sample size. Observed actions using the EM demonstrated that only about half of the teams used the EM to any substantive degree and most used it relatively late in the crisis. By observation, the EM appeared to be helpful in about half of the cases and did not, by itself, deter from appropriate management.

Extracorporeal Membrane Oxygenation (ECMO) for Refractory Cardiac Arrest.

Extracorporeal Membrane Oxygenation (ECMO) for Refractory Cardiac Arrest.

Howard University College of Medicine.

Howard University College of Medicine.

Application of medical simulation in the education of medical students in the area of gynecology and obstetrics.

The education of new generations of doctors faces major challenges. The education system should ensure access to modern and effective educational techniques. Medical simulation is a method that is developing very dynamically. Currently, every medical university in Poland has access to the facilities of a Medical Simulation Centre. Many types of simulations can be used. The variety of techniques is considerable. Starting from simple trainers, through advanced patient simulators to hybrid simulation or virtual reality. Thanks to their use, it is possible to teach basic medical procedures in a safe way, without compromising the patient's intimacy. An additional advantage is the possibility to train in an interdisciplinary team. The aim of this work was to present the possibility of using medical simulation as a method of effective and interesting teaching of medical students in the field of gynaecology and obstetrics. The authors described different techniques and levels of simulation sophistication. The basic tasks of the teacher were also described. The paper may be an interesting complement to the knowledge of education for each physician involved in the work with students.

Epidemiology, prevention and management of early postpartum hemorrhage - a systematic review.

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies. The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect. However, carbetocin seems to be the most effective in certain situations. Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine tamponade should be considered due to its high effectiveness. Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment. It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

Unique Experience of Implementing Assessment Procedures for Candidates for Posts of Medical Officer in Medical Organizations of the Public Health System of the City of Moscow on the Basis of Training and Accreditation Center - medical Simulation Center, Botkin Hospital

An important challenge of the entire Russian healthcare system is to improve the quality of medical care throughout the Russian Federation by enhancing the quality of medical care and improving the organization of medical care in each region of our great country.

Methodological Support in the Implementation of State Control (Supervision) in the Field of Education

Describes an important component of the medical simulation center's activity-methodological support, state control, functions of the center's website

Distance Medical Education System as an Essential Element of Simulation Training in the Learning-Accreditation Center - Medical Simulation Center of the Botkin Clinical Hospital, Moscow

The concept of distance learning system is revealed, the importance of introducing the system into the educational process at the present stage. In addition, the author has described the positive and negative features of using the distance learning system in the LearningAccreditation Center-Medical Simulation Center of the Botkin Clinical Hospital.

THE USE OF SIMULATION TECHNOLOGIES IN ACCELERATED TRAINING OF STUDENTS IN MANUAL SKILLS IN RHINOLOGY

This program was implemented in the medical simulation center of the Botkin Hospital. In the period from April 2016 to April 2017 in the simulation center, 14 inpatient practitioners were trained in the “Basic principles of endoscopic endonasal surgery. Basic course without previous experience in endoscopic endonasal surgery. During the development of the original methodology, developed specifically for this course, the analysis of learning curves, fatigue, the formation of coordination of movements and adaptation of the visual analyzer was carried out.

Insertion of four different types of supraglottic airway devices by emergency nurses. A mannequin-based simulation study.

Background:During medical emergencies, one of the main steps to improve patient outcomes is to achieve airway management. Orotracheal intubation is highly effective for advanced airway management, but it requires experienced health professionals. The use of a supraglottic airway device (SAD) is an acceptable alternative.Aim:To assess which of the four considered SADs takes the shortest time and the lowest number of attempts to be correctly placed. The secondary aim was to evaluate the influence of some characteristics of the study population on time taken and number of attempts required. Methods: A crossover trial was conducted at the Advanced Medical Simulation Center of the University of Perugia (Italy) between June and September 2017. Eighty-three nurses were enrolled in the study. Each participant was asked to place four different SADs in a manikin: Laryngeal Tube Suction-D (LTS-D), i-gel™, Ambu® Laryngeal Mask AuraGain™ and LMA® Protector™ Cuff Pilot™.Results:The median insertion time for the different devices was: 8.0 seconds (s) for LTS-D, 6.0 s for i-gel, 5.4 s for AuraGain, 5.8 s for LMA Protector (p<0.05); the median number of insertion attempts was: 2 for LTS-D, 1 for i-gel, AuraGain and LMA Protector (p<0.05). There was no significant relationship between insertion time and attempts required and the participants’ working experience, training, or knowledge of the devices.Conclusion:With the exception of LTS-D, which had the worst performance, there was a high degree of homogeneity between the studied SADs in terms of time and attempts required to achieve correct placement. (www.actabiomedica.it)

Feasibility of Telesimulation and Google Glass for Mass Casualty Triage Education and Training.

IntroductionOur goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas.MethodsWe conducted a feasibility study to establish the process for successful delivery of educational content to learners overseas via telesimulation over a five-month period. Participants were registrants in an EMS course on MCI triage broadcast from University of California, Irvine Medical Simulation Center. The intervention was a Simple Triage and Rapid Treatment (START) course. The primary outcome was successful implementation of the course via telesimulation. The secondary outcome was an assessment of participant thoughts, feelings, and attitudes via a qualitative survey. We also sought to obtain quantitative data that would allow for the assessment of triage accuracy. Descriptive statistics were used to express the percentage of participants with favorable responses to survey questions.ResultsAll 32 participants enrolled in the course provided a favorable response to all questions on the survey regarding their thoughts, feelings, and attitudes toward learning via telesimulation with wearable/mobile technology. Key barriers and challenges identified included dependability of Internet connection, choosing appropriate software platforms to deliver content, and intercontinental time difference considerations. The protocol detailed in this study demonstrated the successful implementation and feasibility of providing education and training to learners at an off-site location.ConclusionIn this feasibility study, we were able to demonstrate the successful implementation of an intercontinental MCI triage course using telesimulation and wearable/mobile technology. Healthcare providers expressed a positive favorability toward learning MCI triage via telesimulation. We were also able to establish a process to obtain quantitative data that would allow for the calculation of triage accuracy for further experimental study designs.