Standardized Patient Research Articles

Effectiveness and safety of half-dose thrombolysis in intermediate-high risk pulmonary embolism: a single centre experience

Abstract Funding Acknowledgements None. Introduction According to current guidelines, full-dose systemic thrombolysis for pulmonary embolism (PE) is limited to patients either classified as high risk or presenting intermediate risk with hemodynamically instability. As evidenced by recent clinical trials, "low" half-dose (50 mg) tissue plasminogen activator (HDrtPA) appears to offer a safe, effective alternative with a low bleeding risk, especially if catheter directed therapies are not available. Purpose we aimed to evaluate if HDrtPA in intermediate-high risk PE could improve right ventricular (RV)-arterial coupling by means of TAPSE/PAPs ratio, right ventricular basal dimensions in 4 chambers (RVD1), and tricuspid velocity (TV) between admission and discharge, exploring eventual associated bleeding risk. Methods we retrospectively analized 90 intermediate-high risk PE patients consecutively admitted to our intensive cardiac care unit between January 2016 and May 2023. Diagnosis was achieved by computed tomography in all cases. All patients underwent echocardiographic assessment upon admission and at discharge along with baseline lab values. HDrtPA patients (Group A, n=28) received low-dose thrombolytic therapy (0,6 mg/kg maximum 50 mg in 1 hour) combined with unfractionated heparin. Standard anticoagulation patients (Group B) included patients exclusively treated with parenteral anticoagulants. Primary endpoint was echocardiographic improvement of RV-arterial coupling (TAPSE/PAPS), and of pulmonary pressures (tricuspid velocity, TV) and right ventricular basal dimension (RVD1) between admission and dis-charge in the two treatment arms. To perform this analysis, linear regression models with Inverse Probability Weighting (IPW) propensity scores were used. Secondary endpoint was presence of mayor or minor bleeding between groups, and a descriptive analysis of mortality due to paucity of events. Results in the whole population mean age was 73.48 ± 12.49 (mean ± sd) and n=43 (47.8%) were males. Between admission and discharge, group A (HDrtPA) had an improvement of TAPSE/PAPs (+0.16, p=0.05, CI 95%: -0.002; 0.325), of RVD1 (-6.00 mm, p <0.01, CI 95%: -2.59; 9.41). Reduction of TV values (-0.45 m/s, p=0.108, CI 95%: -1.02; 0.10) was not statistically significant at IPW propensity score, but deserves further investigations. No significant increase of major bleedings were recorded between two groups (Group A: 1/28 3.5%, Group B: 0/52 0%) with an acceptable number of minor, non fatal bleedings (Group A: 7/28: 25%, Group B 1/62 1.6%). Death occurred in 3 patients in group A (10%) and 1 patient in group B (1.6%). Conclusion half dose of tissue plasminogen activator (HDrtPA) offer a promising alternative to anticoagulation alone therapy in selected patients with high-intermediate risk pulmonary embolism. In our experience, this approach seems to acutely improve RV-arterial coupling and right ventricular dimensions, without an increase of major bleeding risk.

An evaluation of outpatient satisfaction based on the national standard questionnaire: a satisfaction survey conducted in a tertiary hospital in Shenyang, China.

Patient satisfaction survey serves as a pivotal tool in evaluating the quality of healthcare services. China's nationwide standard patient satisfaction measurement tool was introduced in 2019. This study aimed to assess the model fit of the national standard outpatient satisfaction questionnaire in a tertiary hospital and evaluate the outpatient satisfaction levels using this tool. A cross-sectional survey using the national outpatient satisfaction questionnaire was conducted via message links to all hospital outpatients who registered between April and July 2022. The data collected underwent descriptive analysis, comparative analysis, and confirmatory factor analysis (CFA). A total of 6,012 valid responses were received and analyzed during this period, with 52.9% of the participants being women. The confirmatory factor analysis (CFA) model showed a good fit and identified doctor communication as having a positive effect and environmental factors as having a negative effect on outpatients' satisfaction, with standardized regression weights of 0.46 and 0.42, respectively. Despite the remarkably high satisfaction levels, patients' recommendation for using the services of this hospital surpassed the overall evaluation and total satisfaction scores. A disparity was identified between the expectations and real experiences of outpatients, leading to some extent of dissatisfaction. To enhance satisfaction levels, the hospital should improve the communication skills of all clinical staff, simplify the environment layout for first-time visitors, and manage patient overloads.

EVALUATING THE IMPACT OF HYBRID SIMULATION IN ENHANCING THE LEARNING DOMAINS OF MEDICAL UNDERGRADUATES: A QUASI-EXPERIMENTAL STUDY

Objectivs: Medical education, crucial for understanding physiological processes and clinical application, faces limitations in traditional methods. Simulation-based training addresses this gap, providing a secure environment for hands-on skill practice. The objectives of the study are to (1) evaluate the impact of simulation on enhancing the learning domains of medical undergraduates and (2) gauge students’ perceptions of simulation based medical education (SBME) through a pre-validated, pre-designed questionnaire. Methods: A quasi-experimental study, involving 60 medical undergraduates, selected by convenient sampling. The study began after obtaining approval from the Institutional Human Ethics Committee and obtaining informed consent from students. A pre-test was conducted for all 60 students followed by a lecture on simulation and then a post-test. The students were then divided into two groups: Group A – SBME using part-task trainers and standardized patients and Group B – (non-SBME) with video lectures on simulation. After 1 month, an assessment of all domains, namely cognitive, affective, and psychomotor, was done by post-test and objective structured clinical examination, respectively. Perception was obtained using the pre-validated questionnaire. Results: The assessment scores of all domains of Group A (SBME) showed significant improvement p<0.05 except cognitive domain. Conclusion: SBME is an effective teaching method for improving the learning domains of medical undergraduates.

Categorization of the amyotrophic lateral sclerosis population via the clinical determinant of post-onset ΔFS for study design and medical practice.

The amyotrophic lateral sclerosis (ALS) functional rating scale-revised (ALSFRS-R) has become the most widely utilized measure of disease severity in patients with ALS, with change in ALSFRS-R from baseline being a trusted primary outcome measure in ALS clinical trials. This is despite the scale having several established limitations, and although alternative scales have been proposed, it is unlikely that these will displace ALSFRS-R in the foreseeable future. Here, we discuss the merits of delta FS (ΔFS), the slope or rate of ALSFRS-R decline over time, as a relevant tool for innovative ALS study design, with an as yet untapped potential for optimization of drug effectiveness and patient management. In our view, categorization of the ALS population via the clinical determinant of post-onset ΔFS is an important study design consideration. It serves not only as a critical stratification factor and basis for patient enrichment but also as a tool to explore differences in treatment response across the overall population; thereby, facilitating identification of responder subgroups. Moreover, because post-onset ΔFS is derived from information routinely collected as part of standard patient care and monitoring, it provides a suitable patient selection tool for treating physicians. Overall, post-onset ΔFS is a very attractive enrichment tool that is, can and should be regularly incorporated into ALS trial design.

Pilot study of interprofessional learning and engagement in culturally responsive nutrition simulations

BackgroundThis single-group pre-/post-test quantitative pilot study with prelicensure nursing students (n = 6) used multi-disciplinary and multi-ethnic faculty to develop culturally responsive learning scenarios on nutritional care for diverse patients experiencing type 2 diabetes, anemia, and irritable bowel syndrome. MethodsInterprofessionaly designed nutrition simulations used standardized patients, a pre-event nutrition concepts worksheet, pre-briefing, anonymized pre-/post-test, data collection, instructor-supervised feedback by trained patient actors to students, and PEARLs debriefing. SIM interaction diverse learning practices were measured by the NLN's EPQ-C tool. ResultsInterprofessional team-developed culturally responsive nutrition simulations enhanced factual and cultural quality of scenarios with perspectives from nursing, dietetics, social work, simulation science, and multicultural backgrounds. Trained actors as patients added realism and depth to student simulation. ConclusionOffering multiple authentic, active learning experiences on nutritional nursing care is possible in a single half-day format.

Teaching Note—The Dynamic Duo: Use of Standardized Clients Across the Social Work Practice and Field Curricula

ABSTRACT This reflection from one department of social work showcases the use of simulation as an integrated tool of practice-based education and assessment for social work education within generalist and specialized practice classes. We show several ways we are using simulation as both a learning and assessment tool for social work practice skills. This includes in-class simulations using paid standardized patient as clients, the use of objective standard clinical examination as an assessment tool in the standardized patient suite within the university, the use of field instructors as feedback mechanisms for standardized patient experiences, and translating and linking student skills in the classroom to real-world field experiences. Challenges, lessons learned, and opportunities for future exploration are discussed.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Abstract PO5-12-12: Implementation of a comprehensive monitoring protocol for the prevention and treatment of interstitial lung disease in patients undergoing treatment with trastuzumab deruxtecan

Abstract Background: In the DESTINY-BREAST studies, Trastuzumab deruxtecan (T-DXd) demonstrated significant antitumor activity in heavily pretreated patients (pts) with HER2-positive and HER2-low advanced breast cancer (ABC). T-DXd is associated with an increased risk of interstitial lung disease (ILD), which occurs in 10-15% of patients with a 2.2% rate of fatal events. Increased monitoring for ILD within DESTINY-BREAST03 showed a reduction in grade 3-5 events. Patients with a history of clinically significant lung disease were excluded from this study, however this may not be reflective of the standard community patient population treated with T-DXd. There are currently no standardized monitoring protocols for ILD/pneumonitis for pts treated with T-DXd. We conducted a retrospective chart review to assess the benefit of implementing an ILD monitoring protocol in a cohort of patients receiving treatment with T-DXd at the Duke Cancer Institute. Methods: Patients with HER2-positive or HER2-low ABC who received ≥ five cycles of T-DXd between Jan 1, 2020- April 30, 2022 were included. Imaging with CT chest ILD protocol and pulmonary function testing with diffusing capacity for carbon monoxide (DLCO) were performed at baseline prior to initiation of T-DXd, prior to cycle 3 and cycle 5 in conjunction with ILD chest CT and then every 6 weeks to monitor for ILD. DLCO was corrected for hemoglobin. Clinical symptoms including cough, shortness of breath, dyspnea, and new or worsening respiratory symptoms were recorded. For pts that experienced more than a 10% decrease in corrected DLCO (DLCOc), a pulmonology consult was recommended. DLCOc was reviewed in combination with chest imaging and clinical history to evaluate for ILD and guidance was provided for continuation or cessation of T-DXd. Results: A total of 33 patients with HER2-positive (N=27) and HER2-low (N=6) ABC were monitored as per the predefined ILD monitoring protocol. There were 5 confirmed cases of ILD/pneumonitis within the pt cohort. 16 patients (48%) experienced DLCOc decreases &amp;gt;10% warranting a pulmonology consult or further review. Upon further assessment, ILD/pneumonitis was ruled out based on chest imaging and/or asymptomatic presentation in 11 patients and therapy continued without treatment delay or discontinuation. There were 5 confirmed cases of ILD/pneumonitis within the patient cohort. 3 of the 5 patients diagnosed with ILD experienced DLCOc decreases ≥10%, while 2 of the 5 diagnosed patients had DLCOc changes of &amp;lt; 10% but had concern for ILD on ILD/chest CT and were diagnosed after pulmonology consult. Additional results to be presented at meeting. Conclusion: For patients receiving T-DXd, implementation of a comprehensive protocol to monitor and assess for ILD secondary to treatment may allow patients with suspected ILD to begin treatment sooner or prevent permanent discontinuation by excluding ILD diagnosis. While PFT monitoring can be helpful for some patients to monitor for ILD, continuous PFT monitoring is not recommended for all patients given inconsistency. However, baseline PFTs prior to initiation and with suspected ILD in combination with imaging warrants further investigation. The use of a multidisciplinary team including pulmonologists experienced with T-DXd-induced ILD may assist in diagnosing or excluding ILD and allow for continuation of T-DXd therapy. Citation Format: Heather Moore, Kelly Westbrook, Thomas Bagwell, Scott Shofer, Carey Anders, Amy Guisinger, Olivia White, Susan Dent. Implementation of a comprehensive monitoring protocol for the prevention and treatment of interstitial lung disease in patients undergoing treatment with trastuzumab deruxtecan [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-12.

Simulation as an Innovative Teaching Pedagogy for Baccalaureate Male Students Undertaking a Maternal Health Course in the Arab world: A Pilot Project

Background: The nursing profession is attracting more male students at the baccalaureate level. Nursing faculty face difficulty in finding appropriate clinical opportunities in obstetrics for male baccalaureate nursing students in the conservative Arab culture.Methods: A simulated environment was created comprising four beds in a ward setting. A standardized patient (SP) was placed on each bed. Each SP was trained to provide a history and respond to triggers based on questions posed by male students. The scenarios were: an antenatal patient admitted for induction of labor, a primipara with edema and severe headache, a multigravida who delivered spontaneously and was preparing for discharge, and a cesarian case on the first postoperative day. In the latter two scenarios, newborns were placed in bassinettes near the SP’s and the male students were also expected to take care of the baby. This innovative educational project highlighted simulation using low fidelity manikins and SPs. Male students reported simulation was an effective teaching strategy to acquire obstetric knowledge and develop critical thinking as they responded to cues given by the SP (e.g., antenatal abdominal pain). In addition, the students gained a level of proficiency in examining antenatal and postnatal women. Furthermore, they reported that debriefing following the training consolidated their learning.Conclusion: Male students reported they would not have been able to achieve the course outcomes for thematernity clinical rotation without the introduction of simulation. This project sets the stage for introducingsimulation into other clinical courses across the baccalaureate curriculum.

The effectiveness of virtual reality training on knowledge, skills and attitudes of health care professionals and students in assessing and treating mental health disorders: a systematic review

Background Virtual reality (VR) training can enhance health professionals’ learning. However, there are ambiguous findings on the effectiveness of VR as an educational tool in mental health. We therefore reviewed the existing literature on the effectiveness of VR training on health professionals’ knowledge, skills, and attitudes in assessing and treating patients with mental health disorders.MethodsWe searched MEDLINE, PsycINFO (via Ovid), the Cochrane Library, ERIC, CINAHL (on EBSCOhost), Web of Science Core Collection, and the Scopus database for studies published from January 1985 to July 2023. We included all studies evaluating the effect of VR training interventions on attitudes, knowledge, and skills pertinent to the assessment and treatment of mental health disorders and published in English or Scandinavian languages. The quality of the evidence in randomized controlled trials was assessed with the Cochrane Risk of Bias Tool 2.0. For non-randomized studies, we assessed the quality of the studies with the ROBINS-I tool.ResultsOf 4170 unique records identified, eight studies were eligible. The four randomized controlled trials were assessed as having some concern or a high risk of overall bias. The four non-randomized studies were assessed as having a moderate to serious overall risk of bias. Of the eight included studies, four used a virtual standardized patient design to simulate training situations, two studies used interactive patient scenario training designs, while two studies used a virtual patient game design. The results suggest that VR training interventions can promote knowledge and skills acquisition.ConclusionsThe findings indicate that VR interventions can effectively train health care personnel to acquire knowledge and skills in the assessment and treatment of mental health disorders. However, study heterogeneity, prevalence of small sample sizes, and many studies with a high or serious risk of bias suggest an uncertain evidence base. Future research on the effectiveness of VR training should include assessment of immersive VR training designs and a focus on more robust studies with larger sample sizes.Trial registrationThis review was pre-registered in the Open Science Framework register with the ID-number Z8EDK.

Comparing Peer-Taught Student Tutors to Faculty-Taught Student Tutors in Educating Medical Students on Musculoskeletal Ultrasound.

In recent years, medical education has witnessed a shift in the integration of ultrasound into the preclinical years of medical school. Given the exponential increase in accessibility to ultrasound technology, students now have the opportunity to create peer learning groups in which ultrasound concepts can be taught from peer to peer, empowering students to work together to integrate ultrasound concepts early in their preclinical education. This project investigates the efficacy of peer-taught student tutors (PTSTs) in imparting the fundamentals of basic ultrasound techniques to first-year medical students in the setting of identifying and labeling upper extremity musculoskeletal (MSK) anatomy. Methods: First-year medical students were instructed to identify volar forearm structures with an ultrasound probe. Students and instructors were given access to an ultrasound probe, ultrasound gel, an iPad, and a standardized patient. Students were taught either by an ultrasound instructor (UI) or PTST. After a hands-on demonstration by a UI or PTST, participating students were told to take screenshots and label their images as accurately as possible, identifying the aforementioned volar structures on a standardized patient without any feedback. The labeled screenshot images of volar structures were graded based on the ability to clearly visualize the intended structures. Results: The results of this study comparethe efficacy of PTSTs as educators of basic sonographic identification techniques with that of UI faculty members. A chi-square analysis was performed between the images obtained by the UI and PTST students, and there was no statistically significant difference in identification accuracy between the groups (p = 0.7538, 0.1977, 0.1812, 0.301). When using the Mann-Whitney U rank test, there remained no statistically significant difference between the accuracy of the students taught by STs compared to students taught by UIs (p = 0.7744, 0.09538, 0.07547, 0.1846). Another finding showed that students belonging to both teaching groups were generally not able to infer the pathology of volar wrist structures when given pathology identification questions regarding upper extremity ultrasound. Using chi-square with Yates correction, there is nosufficient evidence to justify an association between the ability to answer pathology-based ultrasound questions and instructor type (p = p = 0.6299, 0.8725). This study supports the interpretation that the capability of first-year medical students to learn novice MSKsonographic identification is independent of whether the educator is a PTST or UI. This interpretation reveals a promising avenue toward the integration of the fundamentals of ultrasound identification early in medical education with little to no concern for the exhaustion of institutional resources. Along with the other well-documented benefits of the utilization of STs in medical school, a peer tutoring system centered on ultrasound skills designed in the way this study describes can be an effective, resource-sparing system that enhances medical students' sonographic capabilities early in their preclinical years.

Medical schools as cisgendered organizations

Organizations and their practices contribute to the marginalization of transgender and gender diverse (TGD) populations by rewarding gender normativity and punishing gender transgression. The present study draws on data gleaned from four focus groups completed in 2023 with a total of 19 participants to explore TGD U.S. medical students’ perceptions of TGD content inclusion in their medical school curricula. Using abductive analysis, I argue that curricular oversights which omit socio-political contexts regarding TGD health and healthcare, as well as continued pathologization of TGD communities and people, contribute to a hostile learning environment for TGD medical students and residents. I conceptualize medical schools as cisgendered organizations where inequities devaluing TGD people and experiences are embedded in the organizational structure, including curriculum development and implementation. I provide recommendations for medical schools and stakeholders to align their formal, informal, and hidden curricula through practical means (e.g., incorporating TGD standardized patients throughout) and structural means (e.g. hiring and supporting TGD faculty across disciplines to assist with curriculum development and training), and argue for governing bodies to push back against legislative restriction and criminalization of TGD medical care.

P009 Improving axial spondyloarthritis time to diagnosis: a quality improvement project

Abstract Background/Aims The average UK time to diagnosis for axial spondyloarthritis (axSpA) remains unacceptably long, i.e., 8.3 years, with high economic costs and impact on patients' outcomes. Until October 2021, the Rheumatology department at Ipswich Hospital did not have an axSpA service, no specific referral pathways, no dedicated clinics, and no standardized patient journey. The main objective was to develop an axSpA service from scratch and to raise awareness on axSpA amongst health professionals. A more specific quantifiable objective was to reduce the time from patient presentation in primary and secondary care to axSpA diagnosis in rheumatology. Methods For the first year since service inception (November 2021 to February 2022), we have set up the ambitious aim of developing an axSpA service, focusing on designing a referral pathway, on establishing connections with primary and secondary care, and on providing education on axSpA. To evaluate improvement in time from patient presentation in primary/ secondary care to axSpA diagnosis, we have audited all new suspected axSpA cases in the first three months of service inception (November 2021 - February 2022) and compared data from the same period of time, a year later (October 2022 - February 2023). The Plan-Do-Study-Act (PDSA) methodology was used. The quality improvement project is part of Aspiring to Excellence programme (endorsed by National Axial Spondyloarthritis Society/NASS). Results Our axSpA service was established in November 2021. We initially established connections with primary and secondary care. Within a year, we have developed an axSpA referral pathway for primary care which was designed to reflect NICE guidelines. All suspected axSpA referrals were triaged in rheumatology as urgent rather than routine and booked into a dedicated axSpA clinic running once weekly. All patients benefited from a specialized physiotherapy review. Formal and informal referral patwhays were also developed with secondary care. Additionally, we have established monthly multidisciplinary team meetings with dermatology, ophthalmology, spinal team, as well as community physiotherapy. Regular education sessions were delivered to primary care. A specific radiology- MRI pathway was also established. The audit on time until diagnosis included a total of 94 patients with suspected axSpA. The waiting time from initial presentation in primary/ secondary care to rheumatology first appointment decreased from a median of 17 weeks to 5 weeks; the time from first rheumatology appointment to diagnosis decreased from 17 weeks to 7 weeks. Overall, patients with axSpA had to wait a median of 13 weeks from initial presentation to diagnosis in rheumatology versus 29 weeks at service inception. Conclusion In only a year, we have established an axSpA service de novo with clear and standardized pathways. There was a significant improvement in waiting times for patients waiting to be referred and diagnosed with axSpA. Disclosure S. Voules: None. C. Kelly: None. M. Alcala: None. S. Premraj: None. T. Gudu: None.

Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction

BackgroundThis study investigates the potential of ChatGPT-4, developed by OpenAI, in enhancing medical decision-making processes, particularly in preoperative assessments using the American Society of Anesthesiologists (ASA) scoring system. The ASA score, a critical tool in evaluating patients' health status and anesthesia risks before surgery, categorizes patients from I to VI based on their overall health and risk factors. Despite its widespread use, determining accurate ASA scores remains a subjective process that may benefit from AI-supported assessments. This research aims to evaluate ChatGPT-4's capability to predict ASA scores accurately compared to expert anesthesiologists' assessments. MethodsIn this prospective multicentric study, ethical board approval was obtained, and the study was registered with clinicaltrials.gov (NCT06321445). We included 2851 patients from anesthesiology outpatient clinics, spanning neonates to all age groups and genders, with ASA scores between I-IV. Exclusion criteria were set for ASA V and VI scores, emergency operations, and insufficient information for ASA score determination. Data on patients' demographics, health conditions, and ASA scores by anesthesiologists were collected and anonymized. ChatGPT-4 was then tasked with assigning ASA scores based on the standardized patient data. ResultsOur results indicate a high level of concordance between ChatGPT-4 predictions and anesthesiologists' evaluations, with Cohen's kappa analysis showing a kappa value of 0.858 (p = 0.000). While the model demonstrated over 90% accuracy in predicting ASA scores I to III, it showed a notable variance in ASA IV scores, suggesting a potential limitation in assessing patients with more complex health conditions. DiscussionThe findings suggest that ChatGPT-4 can significantly contribute to the medical field by supporting anesthesiologists in preoperative assessments. This study not only demonstrates ChatGPT-4's efficacy in medical data analysis and decision-making but also opens new avenues for AI applications in healthcare, particularly in enhancing patient safety and optimizing surgical outcomes. Further research is needed to refine AI models for complex case assessments and integrate them seamlessly into clinical workflows.

Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial

BackgroundHistory taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents.MethodsPostgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time.ResultsThe mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group.ConclusionVPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.

Effects of Standardized Patient Simulation and Mobile Applications on Nursing Students' Clinical Competence, Self-Efficacy, and Cultural Competence: A Quasi-Experimental Study.

Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students. A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction. There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion. Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

The impact of incorporating a simulation program into the undergraduate nursing curricula: A cross-sectional descriptive study

AimTo determine the degree of satisfaction for each academic year and according to the type of simulation performed (simulated patient actor/advanced simulator) among nursing students after the use of clinical simulation. IntroductionClinical simulation is currently being incorporated in a cross-cutting manner throughout undergraduate nursing education. Its implementation requires a novel curricular design and educational changes throughout the academic subjects. DesignA cross-sectional descriptive study was performed. MethodsDuring the academic years 2018–2019 and 2019–2020, 425 students completed the High-Fidelity Simulation Satisfaction Reduced Scale for Students based on 25 questions and six factors, with a total score between 0 and 125. In total, 91 simulation sessions were performed among students who had different degrees of clinical and previous experience with simulation as well as standardized patient versus advanced simulator. A bivariate analysis was performed, comparing the total scores and the different subscales by sex, previous experience, academic year, and simulation methodology. Linear regression was used for both bivariate and multivariate analysis. ResultsThe mean scale score was 116.8 (SD=7.44). The factor with the highest score was "F2: feedback or subsequent reflection", with a mean score of 14.71 (SD=0.73) out of 15. Fourth year students scored the highest (mean=119.17; SD=5.28). Students who underwent simulation training with a simulated patient actor presented a higher level of overall satisfaction (p<0.05) (Mean=120.31; SD=4.91), compared to students who used an advanced simulator (Mean=118.11; SD=5.75). ConclusionsSatisfaction with the simulation program was higher in fourth-year students compared to first-year students and was also higher when a simulated patient actor was used compared to an advanced simulator. The most highly valued aspect was the subsequent debriefing or reflective process.

Accuracy of patient-specific CT organ doses from Monte Carlo simulations: influence of CT-based voxel models

Monte Carlo simulations using patient CT images as input are the gold standard to perform patient-specific dosimetry. However, in standard clinical practice patient’s CT images are limited to the reconstructed CT scan range. In this study, organ dose calculations were performed with ImpactMC for chest and cardiac CT using whole-body and anatomy-specific voxel models to estimate the accuracy of CT organ doses based on the latter model. When the 3D patient model is limited to the CT scan range, CT organ doses from Monte Carlo simulations are the most accurate for organs entirely in the field of view. For these organs only the radiation dose related to scatter from the rest of the body is not incorporated. For organs lying partially outside the field of view organ doses are overestimated by not accounting for the non-irradiated tissue mass. This overestimation depends strongly on the amount of the organ volume located outside the field of view. To get a more accurate estimation of the radiation dose to these organs, the ICRP reference organ masses and densities could form a solution. Except for the breast, good agreement in dose was found for most organs. Voxel models generated from clinical CT examinations do not include the overscan in the z-direction. The availability of whole-body voxel models allowed to study this influence as well. As expected, overscan induces slightly higher organ doses.

Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD-11 (CAL-CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study.

The ICD-11 classification of chronic pain comprises seven categories, each further subdivided. In total, it contains over 100 diagnoses each based on 5-7 criteria. To increase diagnostic reliability, the Classification Algorithm for Chronic Pain in the ICD-11 (CAL-CP) was developed. The current study aimed to evaluate the CAL-CP regarding the correctness of assigned diagnoses, utility and ease of use. In an international online study, n = 195 clinicians each diagnosed 4 out of 8 fictitious patients. The clinicians interacted via chat with the virtual patients to collect information and view medical histories and examination findings. The patient cases differed in complexity: simple patients had one chronic pain diagnosis; complex cases had two. In a 2 × 2 repeated-measures design with the factors tool (algorithm/standard browser) and diagnostic complexity (simple/complex), clinicians used either the algorithm or the ICD-11 browser for their diagnoses. After each case, clinicians indicated the pain diagnoses and rated the diagnostic process. The correctness of the assigned diagnoses and the ratings of the algorithm's utility and ease of use were analysed. The use of the algorithm resulted in more correct diagnoses. This was true for chronic primary and secondary pain diagnoses. The clinicians preferred the algorithm over the ICD-11 browser, rating it easier to work with and more useful. Especially novice users benefited from the algorithm. The use of the algorithm increases the correctness of the diagnoses for chronic pain and is well accepted by clinicians. The CAL-CP's use should be considered in routine care and research contexts. The ICD-11 has come into effect in January 2022. Clinicians and researchers will soon begin using the new classification of chronic pain. To facilitate clinicians training and diagnostic accuracy, a classification algorithm was developed. The paper investigates whether clinicians using the algorithm-as opposed to the generic tools provided by the WHO-reach more correct diagnoses when they diagnose standardized patients and how they rate the comparative utility of the diagnostic instruments available.

Perceived authenticity across three forms of educational simulations—the role of interactant representation, task alignment, and continuity of simulation

Authenticity in simulation-based learning is linked to cognitive processes implicated in learning. However, evidence on authenticity across formats is insufficient. We compared three case-based settings and investigated the effect of discontinuity in simulation on perceived authenticity. In a quasi-experiment, we compared formats of simulation in the context of medical education. All formats simulated anamnestic interviews with varying interactant and task representations using highly comparable designs. Interactants (patients) were simulated by (a) live actors (standardized patients), (b) live fellow students (roleplays), or (c) question menus and videoclips (virtual patients). The continuity of simulations varied. We measured perceived authenticity with three subscales: Realness, Involvement, and Spatial Presence. We employed confirmatory factor analysis (CFA) to assess measurement invariance across settings and analysis of variance on authenticity ratings to compare the effects of setting and discontinuous simulation. CFA supported the assumption of invariance. Settings differed in Realness and Spatial Presence but not Involvement. Discontinuous simulations yielded significantly lower ratings of authenticity than continuous simulations. The compared simulation modalities offer different advantages with respect to their perceived authenticity profiles. Lower levels of interactivity and reduced subtask representation do not necessarily lead to lower ratings of perceived authenticity. Spatial Presence can be as high for media-based simulation as for roleplays. Discontinuation of simulations by offering scaffolding impairs perceived authenticity. Scaffolds may be designed to avoid discontinuation of simulation to uphold perceived authenticity.