Post-simulation Questionnaire Research Articles

Interprofessional Paediatric High-Fidelity Simulation Training: A Mixed Methods Study of Experiences and Readiness among Nursing and Medical Students.

Training in communication skills between nursing and medical students during interprofessional paediatric emergency simulation training represents a significant aspect of safe patient care. Evidence highlights that poor communication in paediatric emergency scenarios jeopardises patient safety. Through realistic simulations, students practice the communication strategies of crisis resource management (CRM), such as "closed-loop communication", "speaking up", and "team time-out". In this study, we aimed to evaluate the impact of interprofessional simulation on enhancing teamwork and communication skills. Additionally, we sought to assess the occurrence of contexts for the three CRM communication strategies during simulations. Employing a mixed methods research design, the analysed students completed pre- and post-simulation online questionnaires. To measure attitudes towards interprofessional collaboration, we used the German version of the University of West England Interprofessional Questionnaire (UWE-IP_german), and to measure interprofessional attitudes, we used the Greifswald Questionnaire for the Measurement of Interprofessional Attitudes (Greif Mie), also in German, for both pre- and post-simulation. For qualitative video analysis, we utilised Grounded Theory Methodology (GTM). Following simulation training, we observed a significant improvement (p > 0.001) in the subscale "attitude towards interprofessional learning" of the UWE-IP_german among nursing and medical students. Medical students consistently exhibited a significantly (p < 0.001) more positive attitude towards other professionals in both the pre- and post-simulation assessments. Overall, all the students expressed satisfaction with the interprofessional simulation training. In the qualitative selective coding process, the central phenomenon "participation" could be identified in the coding paradigm. This study presents substantial evidence of the learning impact of interprofessional paediatric simulation training on nursing and medical students.

Vesicovaginal Fistula Repair Simulation Model and Hierarchical Task Analysis.

There is a need for surgeons skilled in vesicovaginal fistula (VVF) repair, yet training opportunities are limited. This study aimed to create a low-fidelity simulation model for transvaginal VVF repair, identify essential steps of VVF repair, and evaluate the model's ability to replicate essential steps. First, a low-fidelity VVF repair simulation model was designed and built by the authors. Next, a hierarchical task analysis was performed by urogynecologic surgeons with expertise in VVF repair. Each expert submitted an outline of tasks required to perform VVF repair. To control for bias, an education specialist de-identified, reviewed, and collated the submitted outlines. The education specialist then led a focus group, and through a modified Delphi process, the experts reached consensus on the essential steps. A separate group of urogynecologic surgeons then tested the model and completed an anonymous questionnaire assessing how well the model replicated the essential steps. Descriptive analyses were performed. Five experts submitted an outline of steps for transvaginal VVF repair, and 4 experts participated in a focus group to reach consensus on the essential steps. Nine urogynecologic surgeons, with a median of 10 years in practice (interquartile range, 7-12 years), tested the model and completed the postsimulation questionnaire. Most testers thought that tasks involving identification and closure of the fistula were replicated by the model. Testers thought that tasks involving cystoscopy or bladder filling were not replicated by the model. We developed a novel, low-fidelity transvaginal VVF repair simulation model that consistently replicated tasks involving identification and closure of the fistula.

Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model

BackgroundEndoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. MethodWe used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. ResultsTen participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a post-simulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. ConclusionsThe endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.

Mental Health Simulation Training for Pharmacy workforce in Secondary Care

Abstract Introduction Simulation involves life-like scenarios followed by reflection within a facilitated debrief and is widely used in healthcare education. The NHS Long Term plan1 and HEE2 reports highlight the need for the pharmacy workforce in different sectors to be confident and competent in providing care for people with mental health illnesses. Similarly, local integrated care services (ICSs) are prioritising parity of esteem and bridging gaps between services through an improved workforce. Aim To increase the pharmacy workforce’s confidence in supporting and caring for patients with mental health illnesses, reduce stigma, and empower staff to provide a safe, effective, and equitable service. Specific objectives were to: become familiar with substance misuse &amp; learning disabilities; improve effective communication (verbal and non-verbal); and build confidence in formulating treatment plans, talking to patients in distress and taking appropriate histories within a mental health context. Methods Participants included medicines management pharmacy technicians (MMPTs) and pharmacists who volunteered from the acute and mental health Trusts within ICS. The training format included pre-reading clinical material, simulation scenarios co-produced with service users, multi-disciplinary team teaching, and debriefs. Ethical approval not required for the evaluation of the training. We collected quantitative and fee-text data via pre- and post-simulation questionnaires (two validated scales and course specific questionnaire). The data were subjected to descriptive statistical analysis and thematic grouping of free-text data with frequency counting. Results The whole group (n=29) showed an increase in empathy and improvement in attitudes towards people with mental health illness from pre to post simulation training. The 15 measures (course specific questionnaire) and the qualitative feedback indicated that the learning objectives were met. 100% of participants either strongly agreed/agreed that the simulation training helped improve their communication skills and found the debrief and service user participation valuable. The qualitative data supported these findings: “…gained confidence in speaking to patients with different forms of mental health conditions and patients who are in distress.” Discussion/Conclusion This project was a pioneer to assess the use of mental health simulation training within secondary care between two different practice settings. Whilst a small-scale study only, the findings showed improved communication and confidence within a mental health context, particularly in talking to patients in distress. The simulation training was well received by participants and supports the use of simulation in our aim of increasing pharmacy workforce confidence in caring for those with mental illness and reducing stigma. In addition to improving clinical knowledge and skills, simulation training can also help improve pharmacy staff perceptions, attitudes, and address stigma and hence contribute towards a high quality patient care service. This project indicates the potential value of training the pharmacy workforce on a wider scale, regardless of sector, in collaboration with MDT and service users.

A96Whole System Transformed: Making Discharge Everyone’s Business

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge. Empower any member of staff to have discharge conversations. Emphasis on early discharge conversations. Join up acute and community staff involved in the discharge process. The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families. To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session. The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants ( Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios. Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety. 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.

Outcomes of End-User Testing of a Care Coordination Mobile App With Families of Children With Special Health Care Needs: Simulation Study.

Care for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record-integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. This study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. Caregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non-English-speaking users. A Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. Internet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development.

Identifying the barriers faced by medical students using virtual reality simulation

BackgroundVirtual reality technology is increasingly used in medical education to facilitate immersive experiences allowing users to interact with a simulated environment to foster learning. However, the potential barriers to this experience from a user perspective have not been fully explored.MethodsTwenty final-year medical students participated in answering a pre- and post-simulation questionnaire as part of a facilitated virtual reality simulation session. The questionnaire explored participants’ expectations and experiences of virtual reality, in relation to adverse effects, interest and usefulness through 0–10 rating scales. Free-text questioning was used for further discussion.ResultsRatings of all assessed adverse symptoms experienced by students were significantly lower than their expected ratings (p < 0.01), and ratings of reported usefulness and interest in virtual reality significantly increased post-simulation (p < 0.01). The median ratings given for all symptoms experienced by students were either 0 or 1/10 (none/minimal). Free-text comments raised problems of visual focussing in those who wear glasses.DiscussionOur results suggest that virtual reality is an appropriate simulation modality which is acceptable to students. Potential barriers such as cybersickness and discomfort were minimally experienced and did not impact reported usefulness. We promote the generalisability of these findings by demonstrating them on commonly used consumer equipment and a common use case.

A palliative care communication simulation for undergraduate nursing and midwifery students: A pilot study.

Undergraduate nursing education prepares student for entry into the profession. Palliative care is an essential component of nursing education; however, a focus on the management of symptom burden fails to prepare the undergraduate in communication skills required for palliative or end-of-life care (EoLC). Simulation to teach acute care is well researched; however, limited studies explore simulation for palliative care or EoLC. Fewer studies combine communication with palliative care simulation. The overarching aim is to explore the influence of a palliative care communication simulation on undergraduate nursing students. Participants were students recruited from two campuses at a major Australian university in 2021. Students attended a compulsory simulation for all nursing or nursing and midwifery students. Pre- and post-simulation questionnaires collected qualitative and quantitative responses from participants. This paper reports that the quantitative data captured included demographic information, and the Frommelt Attitude Toward Care of the Dying (FATCOD-B) tool, to assess the attitudes. The qualitative component of the research will be reported as a separate paper. A statistically significant increase in FATCOD-B scores was observed between pre- and post-simulation questionnaires, as well as a statistically significant difference related to the gender of participants. Age and previous experience with death also impacted FATCOD-B results. The increase in FATCOD-B scores demonstrate that the positive impact of simulation suggests the importance of educational interventions such as the one conducted in this study. Education to improve the attitude toward caring for the dying and communication skills for difficult conversations are relevant and valuable. Further research is indicated.

The Utility of a Novel Walk-Through/Talk-Through Stroke Simulation Model for Medical Student Education. (S10.008)

<h3>Objective:</h3> Our aim is to evaluate the perceptions of medical students regarding a novel “Walk-Through/Talk-Through” style stroke simulation in which trainee stress is minimized, and demonstration, self-pacing, and frequent debriefing are emphasized. <h3>Background:</h3> Medical simulation exercises have become a standard of modern medical education and proved beneficial for trainees in acquiring both technical (1) and non-technical (2) skills. However, simulation exercises are often purposefully emotionally and physiologically stressful for learners (3,4). No research was found that studied simulation efficacy and trainee perspectives when simulation stress was minimized, and demonstration, self-pacing, and frequent debriefing were emphasized. <h3>Design/Methods:</h3> Thirty-two upper-level medical students (study ongoing) participated in a one-hour “code-stroke” small-group simulation led by upper-level neurology residents utilizing a novel Walk-Through/Talk-Through model of learning. This simulation began with an overview presentation, followed by a resident-led NIH-SS demonstration, a student Walk-Through/Talk-Through NIH-SS exam, a resident-led code-stroke demonstration, and lastly a student Walk-Through/Talk-Through code-stroke session. Pre-/post-simulation questionnaires were collected regarding medical students’ perspectives of the simulation. <h3>Results:</h3> Of the 27/32 students who completed both questionnaires, significant improvement (p&lt;0.001) in trainee comfort scale (1–10) was found in pre-/post-simulation scores in managing a code-stroke (median 4 pre-sim vs. 8 post-sim), performing the NIH-SS (median 4 pre-sim vs. 8 post-sim), performing a focused stroke history (median 5 pre-sim vs. 8 post-sim), and making decisions regarding thrombolytics (median 5 pre-sim vs. 8 post-sim). The pace, frequent debriefing, and overall Walk-Through/Talk-Through simulation model were perceived as very helpful for student learning in 81%, 78%, and 78% of participants, respectively. Additionally, 85% of participants indicated that the Walk-Through/Talk-Through model would be helpful in other clinical simulations. <h3>Conclusions:</h3> This novel Walk-Through/Talk-Through stroke simulation model that aims to minimize stress while maximizing demonstration, self-pacing, and frequent debriefing is perceived by medical student as beneficial for their learning and likely applicable to other clinical simulations. <b>Disclosure:</b> Dr. Dolbow has received publishing royalties from a publication relating to health care. Dr. Sadek has nothing to disclose. Dr. Al-Shaibi has nothing to disclose. Miss Sponaugle has nothing to disclose. Dr. Xiong has nothing to disclose.

Determinants of self-efficacy of driving behavior among young adults in the UAE: Impact of gender, culture, and varying environmental conditions in a simulated environment

Research on traffic accidents have acknowledged that human error is the leading cause of road accidents around the world. In the UAE, those aged between 18 and 30 years are involved in the most accidents. As a result, this study examines the perception, attitude and driving behavior of young adults in the UAE. Virtual Reality (VR) was used to examine driving behavior because it offers alternatives to assess driving behavior with a high degree of immersive experience in a safe and replicable environment. Participants drove through a virtual environment that resembled the urban environment of Abu Dhabi in the UAE, which included six traffic events. A sample of 12 females and 27 males also completed a pre and post-simulation questionnaire to report and evaluate their personal driving experience in Abu Dhabi. The volunteer group represented young drivers with limited driving experience and diverse cultural backgrounds. Results indicated that male drivers were less adhering to safe driving behavior compared to females. Even though both males and females exceeded the designated speed limit, males traveled longer distances over the limit. Additionally, it was found that young drivers tend to overestimate their skills with factors like gender, cultural background, and driving experience being key contributors. The results indicate that traffic authorities should take into consideration different approaches in the formulation of policies related to young drivers with periodic reassessment of skills and training to enhance the safety of driving in the UAE and the region.

Efficiency of VR-Based Safety Training for Construction Equipment: Hazard Recognition in Heavy Machinery Operations

Machinery operations on construction sites result in many serious injuries and fatalities. Practical training in a virtual environment is the key to improving the safety performance of machinery operators on construction sites. However, there is limited research focusing on factors responsible for the efficiency of virtual training in increasing hazard identification ability among novice trainees. This study analyzes the efficiency of virtual safety training with head-mounted VR displays against flat screen displays among novice operators. A cohort of tower crane operation trainees was subjected to multiple simulations in a virtual towards this aim. During the simulations, feedback was collected using a joystick to record the accuracy of hazard identification while a post-simulation questionnaire was used to collect responses regarding factors responsible for effective virtual training. Questionnaire responses were analyzed using interval type-2 fuzzy analytical hierarchical process to interpret the effect of display types on training efficiency while joystick response times were statistically analyzed to understand the effect of display types on the accuracy of identification across different types of safety hazards. It was observed that VR headsets increase the efficiency of virtual safety training by providing greater immersion, realism and depth perception while increasing the accuracy of hazard identification for critical hazards such as electric cables.

Hospital nurses' management of agitation in older cognitively impaired patients: do they recognise pain-related agitation?

cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses' management of agitation remains unclear and under-researched. the aim of this study was to investigate hospital nurses' management of agitation in older cognitively impaired patients with pain. this was a descriptive correlational study using virtual simulation. a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study. nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants. thirteen nurses (4.7%) recognised and treated the virtual patient's agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5). hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium.

Educational impact of a novel cleft palate surgical simulator: Improvement in surgical trainees’ knowledge and confidence

Trainees' experience in cleft surgery is limited due to the high-risk nature of the surgery and centralization of cleft care. Simulation training allows trainees to learn complex surgical tasks whilst ensuring patient safety. Existing cleft surgical simulators are over-simplified or prohibitively expensive. In this article, we show the development and application of a high-fidelity yet cost-effective simulator for cleft palate repair. Skeletal elements were obtained through high-resolution scanning of a pathologic specimen, 3-dimensional printed, and then molded in plastic. Soft tissue components were formed through molding layers of silicone. The simulator was tested by 26 United Kingdom (UK) specialty trainees who performed a vomerine mucosal flap and intra-velar veloplasty in a 1-hour workshop. Pre- and post-simulation questionnaires assessing cleft knowledge and surgical confidence were compared for statistical significance. The simulator had high acceptability: 23/26 participants confirmed that the simulation training was a valuable learning experience. Baseline experience of cleft palate surgery was low: 24 participants had never performed any part of the procedure before. Following the workshop, mean knowledge score increased by 38%, and confidence by 53%. The paired T-test demonstrated that observed improvements in both knowledge and confidence were statistically significant (p<0.001). Simulation training is increasingly recognized as a crucial component of improving patient safety. Our new cost-effective cleft palate simulator has high acceptability and is a powerful educational tool that is effective in improving cleft palate surgical knowledge and confidence across all grades of surgical trainees.

Demonstration of caring and motivational interviewing in online simulation: A cross-sectional observational study

AimThe purpose of this paper is to describe an innovative educational approach for pre-licensure nursing students to learn and practice motivational interviewing skills in a telehealth simulation with standardized patients portraying pregnant women with substance use disorder. BackgroundGiven the ongoing need for online delivery of both nursing education and clinical practice, providers must continue to find approaches to facilitate the provision of empathetic and personalized care to achieve optimal patient outcomes. Motivational interviewing integrates a person-centered approach with specific communication strategies to encourage and support patients' commitment to change. Motivational interviewing skills can be implemented across a wide variety of patient situations, including mental health and primary nursing care. DesignThe study followed a pre-/post-test cross-sectional observational design. MethodsAfter completing an online training course to learn motivational interviewing skills, students participated in an online simulation with a standardized patient portraying a woman with substance use disorder during pregnancy. Prior to the simulation, students completed the Caring Behaviors Inventory-24 and the Opening Minds Scale for Health Care Providers. After the simulation, students and standardized patients completed the Simulated Clinical Interview Rating Scale and a 5-item version of the Caring Behaviors Inventory-6. ResultsOf the 252 students in the course, 85 (34%) participated in the study. Twenty-six student participants completed both pre- and post-simulation questionnaires; 40 completed only pre-simulation questionnaires; and 19 completed only post-simulation questionnaires. Prior to the simulated patient encounter, students rated themselves most favorably on ability to demonstrate assurance behaviors. After the training and simulation, students and standardized patients reported successful student demonstration of motivational interviewing skills and caring behaviors consistent with fundamental therapeutic communication and motivational interviewing knowledge. There was no statistically significant difference between self-reported student performance and the standardized patients’ observations. ConclusionsStudents attained and applied motivational skills and demonstrated caring behaviors in a virtual setting with standardized patients.

Physician preferences associated with powered intraosseous access systems: Safety features, reliability, and ease of use.

ObjectiveThis study evaluated physician preferences and values related to the most commonly used (traditional) powered intraosseous (IO) system and a novel powered IO system featuring a passive safety needle, battery life indicator, and snap‐securement/skin attachment.MethodsEmergency physicians participated in an IO simulation using both the traditional and novel IO systems. Participants completed a 27‐item postsimulation questionnaire to state their preferences toward each IO system and values related to the novel IO system features using a multiple choice, 11‐point value ranking scale (0 = no value, 10 = extremely valuable) and free‐text answer questions.ResultsAmong the 22 study participants, 90.9% (95% confidence interval [CI]: 70.8%, 98.9%) preferred the novel IO system; top reasons for this preference were the novel IO system's passive safety needle and snap‐securement/skin attachment. Participants who preferred the traditional IO system (9.1%) noted its ease of use and familiarity. Many physicians preferred the novel IO system's needle (81.8%; 95% CI: 59.7%, 94.8%), powered driver (77.3%; 95% CI: 54.6%, 92.2%), and snap‐securement/skin attachment (100%; 95% CI: 84.6%, 100%) compared with the traditional IO system. Safety and ease of use were the most common preference explanations. Of the participants, 100% provided a value score ≥7 for the novel IO system's passive safety needle (mean score, 9.45), whereas fewer participants (59.1%) gave a value score ≥7 for the multilight battery life indicator (mean score, 6.68).ConclusionThis study demonstrates that emergency physicians prefer and value a novel IO system with features that enhance safety and ease of use. These results provide insight into important factors related to IO systems for emergency physicians.

Impact of “just-in-time” simulation training for COVID-19 pandemic preparedness

Introduction: Personal protection in aerosol-generating procedures is an important skill to safely deliver care to patients in the COVID-19 pandemic. This aim of this study was to evaluate the impact of “just-in-time” simulation training for airway management in a suspected COVID-19 patient. Methods: This was a prospective mixed-method cohort study in a tertiary paediatric department. A mandatory “just-in-time” simulation training session for intubation of a suspected COVID-19 patient was conducted. Pre- and post-simulation questionnaires were administered. Participants were invited to attend focus group interviews to further delineate their experience. Quantitative and qualitative methods were employed to analyse the data. Results: Thirty-three participants, including doctors, nurses and respiratory therapists attended the training. Self-confidence in intubation, managing and leading a resuscitation team and dealing with problems with intubation significantly improved. Simulation was valued for the experiential learning as well as for increasing confidence and awareness. Process improvement suggestions from both participants and trainers were raised. There was a small signal of skill translation to real life scenarios. Conclusion: Simulation-based training is a useful tool for infectious disease outbreak preparedness. Further research will need to be done to determine the impact on actual clinical practice in pandemics.

Developing a simulation-based learning model for acute medical education during COVID-19 pandemic with Simulation via Instant Messaging – Birmingham Advance (SIMBA)

Simulation-based learning (SBL) is well-established in medical education and has gained popularity, particularly during the COVID-19 pandemic when in-person teaching is infeasible. SBL replicates real-life scenarios and provides a fully...

Implementing COVID-19 Simulation Training for Anesthesiology Residents.

IntroductionDuring the COVID-19 pandemic, anesthesiology residents faced increased risk of exposure to SARS-CoV-2 while performing aerosolizing procedures. We developed an airway simulation on the out-of-operating-room management of COVID-19 patients.MethodsA 90-minute simulation focused on caring for a 45-year-old COVID-19 patient provided training in donning and doffing personal protective equipment, intubation, management of postinduction hypotension, management of ICU ventilators, treatment strategies for acute respiratory distress syndrome (ARDS), interpersonal communication, and resource management. Presimulation, postsimulation, and 3-months postsimulation questionnaires measured changes in confidence, knowledge, and clinical practice. Statistical analysis was completed using related-samples Wilcoxon signed rank tests.ResultsTwenty-four residents participated in the simulation. Questionnaire response rates were 100% presimulation and postsimulation and 88% 3-months postsimulation. Confidence scores (1 = not at all, 5 = extremely) improved with donning and doffing personal protective equipment (from 3.0 to 4.1, p < .001), ARDS management (from 3.1 to 4.0, p < .001), and COVID-19 airway management (from 2.8 to 4.0, p < .001). Correct answers on 10 knowledge questions increased significantly between presimulation and postsimulation (from 5.1 to 9.0, p < .001) but not between presimulation and 3-months postsimulation (from 5.1 to 5.8, p = .27). All participants who cared for COVID-19 patients at 3 months agreed or strongly agreed that their current management of COVID-19 patients was directly influenced by the simulation session (M = 4.4).DiscussionThis simulation is a safe, effective method of providing the experiential training necessary to care for actual COVID-19 patients during an active pandemic.

125 Introducing An &lt;i&gt;in situ&lt;/i&gt; Simulation Programme in an Intensive Care Unit

This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future

43 Learning from COVID-19 and Supporting Staff Using Human Factors and Simulation

The full impact of working in the COVID-19 pandemic surge on NHS staff is yet to be understood. Simulations were run to explore the staff experience following the second COVID surge. From these, it was clear that the staff had powerful stories to tell. A series of further simulation sessions were then delivered, designed to allow staff to explore their experiences and assist with organizational learning within the trust debrief strategy.Firstly, to use simulation to recreate working with uncertainty and unfamiliar staff as a platform within the debrief to explore their experiences of working during the pandemic surges. Secondly, to employ a human factors framework, SEIPS model Simulation sessions, open to all staff, were advertised throughout the organization. In total, 8 sessions were delivered for 38 staff. Multi-disciplinary attendance was encouraged, and a wide range of staff groups participated. During the session, staff were given a brief presentation on human factors, a simulation pre-brief and a pre- and post-simulation questionnaire. A simple patient deterioration scenario unrelated to COVID-19 was used to maintain psychological safety. A system-focussed debrief using the PEARLS model took place after the scenario. Insights shared by candidates were captured by a facilitator and anonymously grouped into the six SEIPS themes.Pre- and post-questionnaires show a general theme of improved confidence post-simulation. Findings were reviewed and the impact on care processes and staff, patient and organizational outcomes were summarized. Information captured within the SEIPS framework showed recurring themes that were condensed into four main categories: psychological trauma and burnout, communication, re-deployment and training, and infection control and PPE.It was clear from facilitating sessions that staff were concerned about patient experience but were also suffering their own trauma from working through the surge. Feedback from participants was positive, emphasizing their sense of validation in sharing their experiences and of feeling part of the hospital community. Staff also had experiences to share about what had helped them and where things could be improved. These insights were synthesized into practical recommendations for managing future pandemic surges that were fed back to the wider organization.