Role Of Simulation In Training Research Articles

A needs assessment for simulation in African surgical education.

There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.

The role of simulation training in the formation of professional competence among postgraduate students of the specialty “Family Medicine”

Simulation training at Karaganda Medical University allows students to develop professional competence in a safe and reliable environment. Simulation training implemented at the Center for Simulation and Educational Technologies using mannequins and simulators of varying complexity depending on the level of realism. Visual, tactile, reactive, automated, hardware and interactive levels of realism of mannequins are used at different levels of training, allowing the formation of the necessary learning outcomes. The use of simulators and mannequins with a higher level of realism helps postgraduate students master critical and clinical skills, including as part of a multidisciplinary team, improving the quality of training for postgraduate students in the Family Medicine.

An exploration of simulation-based education from other health professionals, to create an informed and effective simulation delivery in a new diagnostic radiography programme

IntroductionThe recent validation of three Diagnostic Radiography programmes in the south of England involved a rigorous approval process with multiple Professional and Statutory Regulatory Bodies (PSRB's). Part of the validation process was evidencing that approximately 50% of each programme is spent undertaking practice-based learning. As well as clinical placements, practice-based learning includes simulation-based education (SBE). MethodologyFrom May 2022 to June 2022, a questionnaire was sent to all 22 simulation education facilitators from health courses belonging to the University School Simulation Group. Ethical approval was reviewed and approved by the Learning and Teaching Hub Research Ethics Panel. ResultsOf the initial 22 participants invited, the response rate was 59% (13 participants). The main themes arising from the analysis was the use of a theoretical or conceptual framework, a breakdown of the simulation session components and the role of simulation training. ConclusionThis questionnaire study demonstrated that there was a need for a standardised guide on how to deliver SBE. There is also a lack of feedback, training, and reassurance for facilitators. However, facilitators would welcome training or further training and HEE and the University have taken steps to prioritise SBE. Implications for practiceThe study highlighted how health professionals are delivering SBE within their subjects in innovative and creative ways. These ideas have helped to structure SBE within the new diagnostic radiography courses at the University.

Possibilities of simulation training of bronchoscopy on a phantom

   Simulation training in medicine has proven to be an initial method for mastering practical skills and transferring them to the marginal conditions. Since 2016, accreditation of specialists created for these purposes, including endoscopists and thoracic surgeons, has been carried out, the list of labor obligations includes the performance of bronchoscopy. At the moment, in the domestic literature there are only a few publications on the role of simulation training in mastering the skills of bronchoscopy. The simulation center on the basis of the St. Petersburg Research Institute of Phthisiopulmonology wasestablished in 2018.   Considering all of the above, it seems relevant to discuss the results of using the phantom in teaching the bronchoscopy technique, which was the purpose of this work.

Introducing medical emergency simulation to ‘preparation for practice’ for fifth year medical students

We introduced a pilot of medical emergency simulations using a high-fidelity manikin to fifth year medical students. These students were undertaking ‘Preparation for Practice’ two months before they started as junior doctors in the UK. The University specified a number of medical emergencies that students should experience during this time, but the timing of these can be sporadic leading to a lack of student exposure. High-fidelity simulation has been shown to lead to higher retention of knowledge and skill in the longer term within medical students compared to lecture alone [1], while increasing confidence and performance of learned skills when applied to real patients [2]. The aims of this project were to increase student exposure to medical emergencies, improve confidence, and ability to manage acute emergencies, and improve patient care and outcomes. Our cohort were 42 fifth year medical students who had passed final examinations and were undertaking ‘Preparation for Practice’ in a district general hospital. There were varying levels of previous simulation exposure within these students. There was no previous simulation incorporated into ‘Preparation for Practice’. The in-person scenarios included recreating life-threatening conditions on a high-fidelity manikin that can closely mimic a human presentation. The scenarios correlated with the core medical emergencies specified by the University for students to experience, discuss, and record in their logbooks. A session had four students, with four medical emergency scenarios per session. Each student was lead for one scenario, helper for another, and then observed two further scenarios. The lead student assessed the patient, initiated management, and prescribed in real time. There was discussion and feedback at the end of each scenario. Afterwards, students anonymously filled out an online feedback questionnaire. We assessed confidence regarding management of medical emergencies pre- and post-simulation via a subjective rating scale. The data collected from students demonstrated an overall improvement in confidence by 25% after the high-fidelity simulation. 95% stated they felt confident in their ability to manage the case mix presented to them as a junior doctor after the session. 95% felt there was a role for simulation training within ‘Preparation for Practice’. We believe that simulation should be a core part of university curriculum, particularly in the transition period from medical student to junior doctor. We plan to incorporate this to future ‘Preparation for Practice’ programmes at our hospital, whilst bringing the idea to the University for consideration at other sites. 1. Waters PS, McVeigh T, Kelly BD, Flaherty GT, Devitt D, Barry K, Kerin MJ. The acquisition and retention of urinary catheterisation skills using surgical simulator devices: teaching method or student traits. BMC medical education. 2014;14(1):1–8. 2. Tuggy ML. Virtual reality flexible sigmoidoscopy simulator training: impact on resident performance. J Am Board Fam Pract. 1998;11(6):426–433.

The Role of Simulation Training in the Formation of Practical Skills of Medical Students

A prerequisite for the formation of skills and abilities is the training of students in the implementation of individual skills and abilities on simulators. The results of a differentiated test for summer industrial practice of students of the medical faculty are given. According to 96.62% of respondents, preparation for certification using simulators improved practical training in nursing skills, increased confidence in the possibility of independent professional activity.

Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair

BackgroundThe role of simulation training in paediatric surgery is expanding as more simulation devices are designed and validated. We aimed to conduct a training needs assessment of UK paediatric surgical trainees to prioritise procedures for simulation, and to validate a novel 3D-printed simulation model for oesophageal atresia and tracheo-oesophageal fistula (OA-TOF) repair.MethodsA questionnaire was sent to UK trainee paediatric surgeons surveying the availability and utility of simulation. The operation ranked as most useful to simulate was OA-TOF repair. 3D-printing techniques were used to build an OA-TOF model. Content, face and construct validity was assessed by 40 paediatric surgeons of varying experience.ResultsThirty-four paediatric surgeons completed the survey; 79% had access to surgical simulation at least monthly, and 47% had access to paediatric-specific resources. Perceived utility of simulation was 4.1/5. Validation of open OA-TOF repair was conducted by 40 surgeons. Participants rated the model as useful 4.9/5. Anatomical realism was scored 4.2/5 and surgical realism 3.9/5. The model was able to discriminate between experienced and inexperienced surgeons.ConclusionUK paediatric surgeons voted OA-TOF repair as the most useful procedure to simulate. In response we have developed and validated an affordable 3D-printed simulation model for open OA-TOF repair.

Modern Аpproaches to Knowledge Management and Development of Medical Personnel

The article is devoted to the urgent problem of personnel management through knowledge management and the role of simulation training in the development of skills and career of personnel.

Modern pedagogical technologies in the professional training of middle-level specialists

The article examines the importance of modern pedagogical technologies in the practice-oriented training of students of medical colleges. In particular, the role of simulation training and WorldSkills technology is considered. The article analyzes modern trends in the development of education focused on the formation of practical skills and abilities.

The role of simulation training in the medical workers’ professional adaptation

The role of simulation training in the medical workers’ professional adaptation

Announcing fetal pathology: Challenges encountered by physicians and potential role of simulation in training for breaking bad news

BackgroundInforming couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain. Materials and methodsA questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news. Results193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions. ConclusionThis survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.

Ambulatory Anesthesia, An Issue of Anesthesiology Clinics, Volume 37, Number 2

“We’re all ambulatory anesthesiologists now” is the striking introduction to Anesthesiology Clinics Ambulatory Anesthesia. This is indeed correct; there are few anesthesiologists today for whom the ambulatory patient does not play a daily and expanding role in their work schedule. Against this backdrop and aimed at anesthesiology practitioners, this book sets out to review the different facets that contribute to a successful ambulatory anesthesia practice. The editor of this issue of Anesthesiology Clinics is Dr Michael T. Walsh, the current vice-chair of the Standards Committee of the American Association for Accreditation of Ambulatory Surgery Facilities. As the former President of the Society for Ambulatory Anesthesia, Dr Walsh is well positioned to examine the clinical and organizational challenges of modern ambulatory anesthesia. The book utilizes a multiauthor approach, with 38 contributors creating 14 chapters, spanning 4 main areas—the relevant clinical topics, quality improvement, practice management, and leadership. Each chapter is approximately 10 pages long, beginning with a key points section that neatly emphasizes the important aspects of the topic before expanding into a broad examination of the relevant issues. As might be expected with multiple contributors, the style, layout, and use of diagrams vary somewhat between chapters. The overall result is, nonetheless, a book that is for the most part concise, informative, and clearly written by experienced practitioners. The first 10 chapters focus primarily on clinical aspects and display a good balance between highlighting of key points, judicious referencing of guidelines, and practical advice from appropriate experts. The insightful overviews are achieved without getting bogged down in minute detail. Complex topics, such as preoperative assessment, are simplified through use of contemporary guidelines and algorithms. In the chapter “Enhanced Recovery Programs in Outpatient Surgery,” the authors explain the objectives and rationale that underlie a successful enhanced recovery program. Their experience is clearly evident, and less established features of the process—such as patient education—are discussed in a concise and engaging manner. The chapter on regional anesthesia details the fundamentals underlying a wide number of blocks while remaining succinct and easy to read. The considered use of annotated ultrasound stills greatly enhances most explanations. Perhaps, the truncal blocks (paravertebral and erector spinae) section would benefit from better clinical images because visualization is difficult for all but the most experienced regional practitioner. In addition to covering commonplace regional techniques, the authors also include a number of increasingly popular blocks such as the erector spinae and interspace between popliteal artery and capsule of the knee block (iPACK Block) approaches. The result is an outstanding overview of a topic that rarely lends itself so well to the purely written form. “Pediatric Ambulatory Anesthesia Challenges” covers all aspects of the pediatric anesthetic pathway. Preoperative evaluation is emphasized as the “lynch pin” of successful pediatric practice, and the chapter wisely focuses heavily on this aspect, with clear guidelines on the most common and serious comorbidities that present. The sections on risk assessment and postoperative challenges are also highly informative. The later chapters focus on the nonclinical aspects of ambulatory practice which are frequently overlooked in texts on the subject. For the most part, the authors succeed in distilling these nonclinical areas down into the essential points. However, some of the chapters in this section are somewhat prosaic and less visually appealing, which detracts from the usefulness of the material therein. “Quality Improvement in Ambulatory Anesthesia: Making Changes That Work for You” presents a useful, albeit academic, discussion of current thinking on quality improvement methodologies. “Value-Based Payment in Ambulatory Anesthesia: MACRA, MIPS, and More” superbly deciphers a complex topic in a manner aimed primarily toward the North American reader. “Office-based Anesthesia: A Comprehensive Review and 2019 Update” offers an interesting review of the issues, both past and present, facing this ambulatory anesthesia subspecialty. However, the discussion on relevant legislation and regulations in different states feels a little misplaced. The final chapter, “Ambulatory Surgery Center Medical Director: Visionary Leader,” focuses on how leadership and organizational behavior in a unit can enhance patient safety and contribute to service enhancement. While not a typical subject for the review-style book, it is an enjoyable read that examines an often-undervalued component of all successful anesthesia practices. The impact of a repetitive case-mix on practitioners, the potential deskilling effect of limited exposure to acute surgical cases, and the role of simulation training may be useful adjuncts to future editions. Anesthesiology Clinics Ambulatory Anesthesia can be purchased in its entirety by subscription online, or alternatively individual chapters may be purchased in PDF format at www.anesthesiology.theclinics.com. The online version is identical to the paper one. Practitioners must now be well versed in the nuances of ambulatory anesthesia. This text brings together the pertinent components. While a publication of this nature could never be expected to be exhaustive, it would serve as an excellent ambulatory anesthesia reference especially for senior residents, fellows, and attendings. That said, any anesthesiologist would find it beneficial to have the clinical chapters to hand on a daily basis and should gain from familiarizing themselves with the nonclinical topics addressed. The authors are to be congratulated for an excellent contribution to what is likely to be an ever-advancing field of anesthesia practice. Osmond Morris, MRCPI, FCAIDermotKelly, MRCPI, FFARCSI, DABADepartment of AnaesthesiaSt Vincent’s University HospitalDublin, Ireland[email protected]

In Response.

We thank Drs Hoffman and Riordan1 for their thoughtful comment on our study.2 While we agree that more research is needed on the treatment of postdural puncture headache (PDPH) with epidural blood patch, it is important to point out that accidental dural puncture is not inevitable and could be prevented through better training and quality assurance. The recent root-cause analysis by Haller et al3 revealed that the absence of skilled assistance during epidural placement (ie, nurse anesthetist) and multiple insertion attempts are associated with an increased risk of PDPH.3 Although the current American Society of Anesthesiologists Task Force on Obstetric Anesthesia Practice Guidelines for Obstetric Anesthesia does not recommend any obstetric team composition for labor epidural placement, the Haller et al3 study suggests that having a skilled assistant to the anesthesiologist during the procedure might reduce the incidence of PDPH. Use of lumbar ultrasound imaging has been shown to decrease the number of epidural placement attempts. Given the heightened risk of major neurological complications associated with PDPH, it is sensible to recommend the use of ultrasound imaging for neuraxial anesthesia in obstetrics, particularly among women with known risk factors for difficult placement, such as difficult anatomical landmark palpation.4 The role of simulation training in acquiring and maintaining technical skills and reducing the number of epidural placement attempts also warrants investigation. Jean Guglielminotti, MD, PhDRuth Landau, MDDepartment of AnesthesiologyColumbia University College of Physicians and SurgeonsNew York, New York[email protected]Guohua Li, MD, DrPHDepartment of AnesthesiologyColumbia University College of Physicians and SurgeonsNew York, New YorkDepartment of EpidemiologyColumbia University Mailman School of Public HealthNew York, New York

Interventional Pulmonology: The Role of Simulation Training and Competency-Based Evaluation.

Medical education and training are becoming more complex endeavors as technological and research advancements lead to new tools and methods to care for patients. In recent years, there has been a paradigm shift in medical education to competency-based assessments. Another important recent development in medical education has been the increasing use of simulation-based learning for procedural training. Interventional pulmonology (IP) is a relatively young and rapidly evolving procedural-based subspecialty. There are several well-validated competency-based assessment tools available to measure training adequacy in many of the most commonly performed procedures in IP. These tools have been shown to improve learning curves and training outcomes. The extent of how widely these tools are being used in clinical and educational spheres, however, remains unclear. Moreover, several commonly performed procedures in IP have no or limited validation tools currently available. Standardized training using simulation has also been shown to lead to positive training outcomes as compared with more traditional training models. However, widespread adoption of simulators has been limited due to the cost and availability.

The role of simulation training in anesthesiology resident education.

An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.

Simulation Training for the Office-Based Anesthesia Team.

An OMS office is a complex environment. Within such an environment, a diverse scope of complex surgical procedures is performed with different levels of anesthesia, ranging from local anesthesia to general anesthesia, on patients with varying comorbidities. Optimal patient outcomes require a functional surgical and anesthetic team, who are familiar with both standard operational principles and emergency recognition and management. Offices with high volume and time pressure add further stress and potential risk to the office environment. Creating and maintaining a functional surgical and anesthetic team that is competent with a culture of patient safety and risk reduction is a significant challenge that requires time, commitment, planning, and dedication. This article focuses on the role of simulation training in office training and preparation.

Optimization of competency in obstetrical emergencies: a role for simulation training.

PurposeIn obstetrical emergency situations, optimal management requires the immediate coordinated actions of a multi-disciplinary and multi-professional team. This study investigated the influence of simulation training on four specific skills: self-confidence, handling of emergency situation, knowledge of algorithms and team communication.MethodsClinical algorithms were first presented to the participants. Training for six emergency situations (shoulder dystocia, postpartum haemorrhage, pre-eclampsia, maternal basic life support, neonatal resuscitation and operative vaginal birth) was performed using high- and low-fidelity simulation mannequins. General impression of the simulation training and the four above-mentioned skills were evaluated anonymously through a self-assessment questionnaire with a five-point Likert scale immediately after the training and 3 months later.ResultsFrom November 2010 to March 2012, 168 participants, distributed over six one-day courses, took part in the training. 156 participants returned the questionnaire directly after the course (92.9 %). The questionnaire return rate after 3 months was 36.3 %. The participants gave higher Likert scale answers for the questions on the four specific skills after 3 months compared to immediately after the course. The improvement was statistically significant (p ≤ 0.05) except for the question regarding team communication.ConclusionImplementation of simulation training strengthens the professional competency.

The role of simulation training in obstetrics

In this review, the role of simulation as a strategy for training and performance improvement is reviewed. The review is timely, as providing safe and high-quality healthcare is the goal of every healthcare system and soon reimbursement will be tied to quality measures. Simulation has emerged as a strategic approach that can result in improved quality and safety through training of individuals and teams, improvement in healthcare systems, and determination of competence. The rationale for this approach will be presented and discussed. In this review, the recent literature that demonstrates the effectiveness of simulation in training of individuals, training of multidisciplinary teams, assessment of healthcare systems, and assessment of competence was reviewed. The literature that supports the role of simulation in improved patient outcomes was also reviewed. There is a rapidly developing body of literature supporting the use of simulation in healthcare. Although research is still needed to demonstrate the effectiveness of simulation for evaluation, healthcare systems should develop strategies to implement and maintain simulation training.

The role of simulation training in anaesthesiology

The role of simulation training in anaesthesiology

Orienting New Respiratory Therapists Into the Neonatal/Pediatric Environment: A Survey of Educators and Managers

Neonatal/pediatric respiratory care is recognized as a unique and complex area of clinical practice. Despite the substantial effort and costs associated with orienting neonatal/pediatric practitioners, few data exist related to the process of training respiratory therapists (RTs) in the acute neonatal/pediatric environment. To gain insight into the adequacy of preparation of RTs entering the neonatal/pediatric environment, the length of orientation necessary to achieve a base level of competency, and the methods used to train new neonatal/pediatric practitioners, we surveyed neonatal/pediatric respiratory care educators and managers. The invitation to participate in the survey was distributed via e-mail to 1,259 members of the AARC education specialty section and 1,828 members of the AARC managers specialty section. The survey included 15 questions (not including the demographics questions), scored on 5-point Likert scale, and asked about: what type of degree program (associate's degree or bachelor's degree) better prepares new RTs for the neonatal/pediatric environment; experience requirements for orientation of neonatal/pediatric RTs; the role of simulation in training neonatal/pediatric RTs; and whether the neonatal/pediatric specialty credentialing exam should be used as a method of competency testing. There were 4 questions regarding simulation (the use of interactive full-body manikins in a realistic patient care environment), orientation times based on experience, and where the majority of the orientation time was spent. We received 251 responses (response rate 8%). The majority of respondents were either affiliated with or worked for urban, not-for-profit, non-government organizations. Sixty-three percent disagreed that an associate's degree respiratory therapy program, and 42% disagreed that a bachelor's degree program adequately prepares a new RT to work in the neonatal/pediatric critical care environment immediately after graduation. Seventy-one percent strongly agreed that children's hospital respiratory care departments should have a dedicated respiratory therapy educator. Seventy-six percent agreed that simulation is an effective tool for training RTs for neonatal/pediatric critical care. Sixty-five percent agreed that RTs should be required to take an exam at the end of the orientation period to verify competency. Fifty-nine percent strongly agreed that neonatal/pediatric RTs should have the National Board for Respiratory Care Registered Respiratory Therapist (RRT) credential. There appears to be a discrepancy in the educational preparation expected prior to entering the acute-care neonatal/pediatric environment and what training methods are most appropriate and cost-effective for orienting new RTs to this specialized environment. A dedicated respiratory therapy educator is valued. Simulation is considered an effective tool for training RTs and provides training opportunities that otherwise would not be available. The neonatal/pediatric specialty certification exam appears to be recognized as a valid method of determining mastery and verifying competence.