Simulated Clinical Scenarios Research Articles

Construction and validation of simulated scenarios in the emergency care of patients with chest pain.

To construct and validate clinical simulation scenarios for emergency care for patients with chest pain. A methodological study carried out in two stages: construction and validity. The construction took place through the survey of evidence from national and international literature. The validity stage took place through instrument assessment by judges, according to the Content Validity Index and application of a pilot test with the target audience. Fifteen judges with expertise in simulation, teaching and/or care participated in the research, in addition to 18 nursing students, in the pilot test. Two scenarios of clinical simulation were constructed, and all the assessed items obtained a value above 0.80, showing evidence of validity, being considered instruments suitable for application. The research contributed to the development and validity of instruments that can be applied for teaching, assessment and training in clinical simulation in emergency care for patients with chest pain.

Com o semblante de médico: experiências de estudantes de medicina durante a simulação clínica em Diabetes tipo 2

This qualitative research aimed to understand the experiences of a fourth-year medical class during two clinical simulation scenarios of type 2 diabetes management in Primary Care. Ten simulated students were interviewed. The results describe the symbolic conception of diabetes and its treatment as anguish, damage, condemnation and an unpleasant sentence that affects the appropriation and performance of the medical role by students. Considering Medical Psychology, we suggest that such subjective factors should be addressed in teaching-learning in addition to commonly cognitive aspects mentioned in the medical education literature in order for students to develop the work profile to cope with diabetes in Primary Care. Clinical simulation facilitates the subjective approach through its group support component to promote reflection, insights and self-awareness.

Clinical simulation scenarios for the planning and management of infusion therapy by nurses

RESUMO Objetivo: construir, avaliar e testar dois cenários de simulação clínica para o planejamento e gerenciamento da terapia infusional pelo enfermeiro. Método: estudo metodológico, com construção de cenários baseado na NLN Jeffries Simulation Theory e no modelo teórico Vessel Health Preservation; avaliação do desenho dos cenários por juízes, com cálculo do Coeficiente de Kappa Modificado (CKM); testagem dos cenários com o público-alvo. Resultados: cenários construídos para: 1. Avaliação do paciente e seleção do dispositivo vascular; e 2. Identificação e gerenciamento de trombose venosa profunda. Na avaliação por juízes, na testagem dos cenários validados em relação às práticas educativas e ao design da simulação, os itens apreciados apresentaram valores do CKM ≥ 0,74. Conclusão: foram construídos dois cenários baseados em evidências relacionadas à terapia infusional, com elevados valores de concordância dos juízes, quanto ao seu desenho. Na testagem com enfermeiros, obteve-se bons resultados quanto ao desenho e estruturação da prática educativa.

Construction and validation of a scenario for recognizing sepsis by nursing students: a methodological study.

To build and validate a clinical simulation scenario for teaching Nursing students about early recognition of signs and symptoms of sepsis in the context of the emergency unit. Methodological study developed in two phases: construction of a simulated scenario and content validation by expert judges. For data analysis, the Content Validity Index (CVI) was calculated considering agreement equal to or greater than 80%. The minimum acceptable CVI value for scenario validation was 1.0. The simulation scenario proved to be appropriate, with a global Content Validity Index equal to 1. Some adjustments related to the clarity of the wording were necessary, as suggested by the judges. Conclusions: A medium-complexity, high-fidelity scenario was successfully constructed and validated for teaching early recognition of sepsis signs and symptoms.

Interprofessional Immersive Virtual Reality Training on Sepsis Recognition

Introduction: The implementation of evidence-based care relies on timely recognition of sepsis. Virtual reality (VR) represents a new simulation modality that can evaluate pediatric sepsis situation awareness. Methods: We evaluated situation awareness through a multiuser immersive VR experience (Fig. 1). A physician/APRN and nurse donned VR headsets to assess and provide initial management for a pediatric patient with sepsis during a team-based clinical simulation scenario. Participants were paused at 3 time points and asked to independently complete open-ended questions, including “what is the most likely cause for the patient’s clinical condition?” We compared experienced providers (nurses with ≥5 years’ experience and critical care or emergency medicine APRNs, fellows, or attendings) and novice providers (nurses with <5 years’ experience and pediatric residents) recognition of sepsis. Odds ratios were calculated for sepsis recognition with group differences assessed via the T test. Results: From January to July of 2021, 144 participants (72 physicians/APRNs and 72 nurses) participated in the experience (Table 1). When assessing for recognition of sepsis at the 2-minute time point, 81% of experienced nurses (N = 48) and 50% of novices (N = 24) recognized sepsis for, on odds ratio (OR) of 4.37 (1.28–14.96), P = 0.019. For physicians/APRNs, 92% of experienced (N = 37) compared to 71% of novices (N = 35) recognized sepsis [OR, 4.61 (0.87–14.97), P = 0.078]. When combined, 85.9% of experienced clinicians (N = 85) and 62.7% of novices (N = 59) recognized sepsis [OR, 3.70 (1.15–9.07), P = 0.004]. Conclusions: These data provide validity evidence for use of this immersive VR experience for assessment and training; potentially addressing a remaining barrier to improving pediatric sepsis outcomes.

CONSULTA DE ENFERMAGEM PARA O USO DE INSULINA: CONSTRUÇÃO E VALIDAÇÃO DE CENÁRIO DE SIMULAÇÃO

ABSTRACT Objective: To build and validate a clinical simulation scenario for teaching students about nursing consultations for people with type 2 Diabetes Mellitus in initial insulin use. Method: A methodological study, carried out in a higher education institution in Minas Gerais, Brazil, between December 2021 and November 2022. The steps taken involved scenario construction, validity by 16 judges and scenario testing by 30 students. The conceptual model proposed by Jeffries and International Nursing Association for Clinical Simulation in Learning guidelines were followed to elaborate the scenario. Results: The scenario was called “Nursing consultation for teaching initial insulin use to people with type 2 Diabetes Mellitus”. The scenario and the checklist for its validity were constructed, then, face and content validity was performed. The final validated version consisted of seven conceptual components (context, background, design, simulated experience, facilitator actions and educational strategy, participants and expected results). The overall value of the Content Validity Index was 0.98. High comprehensibility was noted by the target audience when testing the scenario. Conclusion: The scenario obtained adequate validity and comprehensibility. Using this teaching tool can contribute to the training of future nurses regarding the consultation for patients using insulin.

Clinical simulation scenarios for the planning and management of infusion therapy by nurses.

to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses. methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74. two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.

Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster

BackgroundClinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed.MethodsA multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods.ResultsTwo hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15–0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5–55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02–1.21).ConclusionsThe game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate.Trial registrationClinicalTrials.gov Identifier: NCT02210442. Registered 6 August 2014.

ASSOCIATIONS BETWEEN ATTITUDES TOWARDS AGING AND CLINICAL DECISIONS AMONGST INTERNAL MEDICINE RESIDENTS

Abstract It has been shown that physicians-in-training can develop negative attitudes towards caring for older patients. Little is known about how these attitudes develop throughout training or if they are associated with ageist clinical decisions. In this pilot study, Internal Medicine (IM) residents completed the Expectations Regarding Aging (ERA-12) survey, a validated instrument that assesses expectations regarding physical health, mental health, and cognitive function in older adults. Residents then completed a survey that included simulated clinical scenarios as part of an educational intervention on Ageism. Of the 72 residents invited to participate, 48 residents (67%) completed the ERA-12 survey. Responses were obtained from all training levels including 24 PGY-1 (50%), 10 PGY-2 (21%), and 14 PGY-3 (29%). When grouped by training year, there were no statistically significant differences found with regards to total ERA-12 scores or expectations regarding physical health, cognitive function, or mental health of older adults. When grouped by responses to clinical scenarios, residents with more biased clinical responses were associated with lower total ERA scores (73 vs. 91, p = 0.015). Those with lower total ERA scores indicated they were inclined to initiate CODE STATUS discussions earlier with older adults and were less inclined to consider coexisting depression. Despite limitations in sample size and the subjective nature of simulated clinical scenarios, this pilot study suggests a possible association between expectations regarding aging and clinical decision-making. More research is needed to assess the strength of this association and if it can be modified through educational initiatives.

Using Simulation to Support Evidence-Based Design of Safer Health Care Environments.

The design of health care environments and the technologies used within them have tremendous influence on the performance of the professionals who care for patients in those spaces. In turn, the performance of those professionals greatly impacts the safety of the care that is delivered to patients. Active and latent safety errors can be greatly reduced by rigorous testing of the patient care environment. · Prior to the approval of final design specifications and actual construction.. · After construction is complete before the first patients move in.. · On an ongoing basis once patient care is in progress.. While there are numerous types of testing that can be conducted, this manuscript will focus on the use of simulated clinical scenarios in realistic/real physical environments to detect and remediate weaknesses in the design of those environments with a focus on their use in perinatal centers. KEY POINTS: · Environmental design influences human performance.. · Realistic clinical simulation can improve the design.. · Simulation should be done on a continuous basis..

EVALUATION OF NEEDLE DRIVER DESIGNS FOR ROBOT-ASSISTED NEEDLE INSERTIONS UNDER MRI GUIDANCE.

This paper presents the evaluation of two detachable MR-Conditional needle driver designs for our 4-degree-of-freedom (DOF) robotic platform for MRI-guided spinal injections. Compared to their predecessor, the new designs open up the possibility of intraoperative needle driver attachment, and in order to evaluate the feasibility of such an approach, force and torque requried during the needle driver attachment process are captured to evaluate which of the two designs are better suited for such purpose. A simulated clinical scenario is also carried out to measure the possible position change of the 4-DOF robot with respect to the patient due to intraoperative tool attachment, thus providing future guidance to the proposed clinical workflow in the framework of body-mounted robotic surgical devices.

Exploring medical students’ understanding of non-technical skills: a thematic analysis

Introduction
 Non-technical skills (NTS) are a developing area of clinical education, partly due to the recognition that poor NTS can contribute to adverse patient events. Simulation is an appropriate teaching environment to consider these skills. Post-scenario discussions often focus on specific NTS, but these may not necessarily be what the participants think of when considering NTS. The aim of this study was therefore to analyse what one group of healthcare professionals, medical students, focused on when observing the NTS of their colleagues in simulated clinical scenarios.
 
 Method
 Medical students from two English universities were asked to observe simulated acute medicine scenarios. They were instructed to document their observations on written worksheets focusing on specific NTS comprising communication, teamwork, task management, decision making, situational awareness and, for the last scenario, a general worksheet asking the students to consider all the NTS discussed so far. These worksheets were then transcribed and analysed using thematic analysis to elicit themes that best outlined the students’ perceptions.
 
 Results 
 Five themes were discovered from analysis of the five NTS from all six worksheets: team dynamics, team communication, awareness of self and events, coping under pressure and misinterpretation of NTS. These themes showed a difference between what the students concentrated on compared to what they were asked to consider. Analysis of these themes gave us an initial understanding of the prior knowledge and assumptions medical students bring with them to discussions on NTS.
 
 Conclusions
 Understanding prior assumptions and interpretations of NTS can better help us understand how to teach the skills effectively and build upon what our students consider important, to help construct new knowledge and skills. As analyses of adverse events in clinical practice often point to errors of NTS as causative factors, improving these skills is an essential aspect of clinical education.

Validation of the Informant Quick Dementia Rating System (QDRS) among Older Adults in Singapore.

The Quick Dementia Rating System (QDRS) is a brief and rapid tool that can be administered by an informant without the need for a trained assessor. Our objective was to examine the validity, reliability, and cost-effectiveness of the informant QDRS in a Singapore memory clinic sample. We assessed a total of 177 older adults, among whom, 32 had no cognitive impairment (NCI), 61 had mild cognitive impairment (MCI), and 84 had dementia. Elderly underwent 1) the informant QDRS, 2) the Clinical Dementia Rating (CDR) as the gold standard diagnosis, 3) the Mini-Mental State Examination (MMSE), and 4) the Ascertain Dementia 8 (AD8) as comparisons to the QDRS. The extent to which the QDRS may reduce the recruitment cost (time) of clinical trials was also calculated. The QDRS had excellent internal consistency (Cronbach alpha = 0.939). It correlated highly with the CDR-global (R = 0.897), CDR Sum-of-Boxes (R = 0.915), MMSE (R = -0.848), and the AD8 (R = 0.747), showing good concurrent validity. With an optimal cut-off of 1.5 for MCI (sensitivity 85.2%, specificity 96.3%) and 6 for dementia (sensitivity 90.1%, specificity 89.2%), the QDRS achieved a higher overall accuracy of 85.0%, as compared to MMSE (71.2%) and AD8 (73.4%). A simulated clinical trial recruitment scenario demonstrated that pre-screening with the QDRS followed by a confirmatory CDR would reduce the time needed to identify NCI subjects by 23.3% and MCI subjects by 75.3%. The QDRS is a reliable cognitive impairment screening tool which is suitable for informant-administration, especially for identification of MCI.

Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial.

Background: In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario. Methods: A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received. Results: Significant differences were observed for the statements “I felt more confident in donning after receiving this training” (p = 0.029) and “I felt more confident in doffing after receiving this training” (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004). Conclusions: Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.

Deep neural networks allow expert-level brain meningioma segmentation and present potential for improvement of clinical practice

Accurate brain meningioma segmentation and volumetric assessment are critical for serial patient follow-up, surgical planning and monitoring response to treatment. Current gold standard of manual labeling is a time-consuming process, subject to inter-user variability. Fully-automated algorithms for meningioma segmentation have the potential to bring volumetric analysis into clinical and research workflows by increasing accuracy and efficiency, reducing inter-user variability and saving time. Previous research has focused solely on segmentation tasks without assessment of impact and usability of deep learning solutions in clinical practice. Herein, we demonstrate a three-dimensional convolutional neural network (3D-CNN) that performs expert-level, automated meningioma segmentation and volume estimation on MRI scans. A 3D-CNN was initially trained by segmenting entire brain volumes using a dataset of 10,099 healthy brain MRIs. Using transfer learning, the network was then specifically trained on meningioma segmentation using 806 expert-labeled MRIs. The final model achieved a median performance of 88.2% reaching the spectrum of current inter-expert variability (82.6–91.6%). We demonstrate in a simulated clinical scenario that a deep learning approach to meningioma segmentation is feasible, highly accurate and has the potential to improve current clinical practice.

Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework.

Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework.

The effect of two simulations on students' knowledge and skills regarding physical health problems of psychiatric patients: A mixed-method study

BackgroundSimulation-based training can help nursing students improve their mental and physical healthcare knowledge and skills. ObjectivesThis study focused on two different simulation modalities and investigated whether they helped nursing students acquire knowledge and develop skills necessary to address the physical health problems of people with mental disorders. DesignThis is a mixed-method study. SettingsThis study was conducted in Turkey. ParticipantsThe sample consisted of 61 students divided into two experimental groups and one control group. MethodsOne experimental group participated in a clinical simulation scenario involving a standardized patient modality, while the other participated in a hybrid simulation modality (standardized patient and high-fidelity model simulator). The control group participated in conventional training. The researchers evaluate the effect of the modalities and conventional training on clinical practice one month after the interventions. Focus group interviews were conducted with all participants one month after the evaluation. Knowledge test was administered to all participants before the intervention, after the intervention, at the third and sixth months after the intervention. Results and conclusionThe clinical simulation was statistically effective for students' skill development about physical health problems of psychiatric patients. Also, in the qualitative findings, the clinical simulation increased the knowledge level of the students and improved their physical health assessment skills. Standardized patient simulation and hybrid simulation modalities should be used to help nursing students develop their assessment skills regarding the physical health problems of psychiatric patients.

Use of a novel "Split" ventilation system in bench and porcine modeling of acute respiratory distress syndrome.

Split ventilation (using a single ventilator to ventilate multiple patients) is technically feasible. However, connecting two patients with acute respiratory distress syndrome (ARDS) and differing lung mechanics to a single ventilator is concerning. This study aimed to: (1) determine functionality of a split ventilation system in benchtop tests, (2) determine whether standard ventilation would be superior to split ventilation in a porcine model of ARDS and (3) assess usability of a split ventilation system with minimal specific training. The functionality of a split ventilation system was assessed using test lungs. The usability of the system was assessed in simulated clinical scenarios. The feasibility of the system to provide modified lung protective ventilation was assessed in a porcine model of ARDS (n = 30). In bench testing a split ventilation system independently ventilated two test lungs under conditions of varying compliance and resistance. In usability tests, a high proportion of naïve operators could assemble and use the system. In the porcine model, modified lung protective ventilation was feasible with split ventilation and produced similar respiratory mechanics, gas exchange and biomarkers of lung injury when compared to standard ventilation. Split ventilation can provide some elements of lung protective ventilation and is feasible in bench testing and an in vivo model of ARDS.

P48 - Perinatal mental health: using interactive videos and simulation to develop skills in midwifery practice

The aim of this project was to support midwifery students to develop woman centred skills and confidence in communicating with women and birthing people in the context of their perinatal mental health. Simulated activities supported by audio visual resources and assessments which simulate real-world clinical encounters aimed to strengthen teaching and learning objectives. A new Objective Structured Clinical Examination (OSCE) was piloted in 2021 in undergraduate and postgraduate pre-registration midwifery subjects ‘Perinatal mental health’ (PMH). The OSCE was designed and instituted to facilitate an authentic PMH consultation in the antenatal clinic setting. 3 rd year students volunteered to act as pregnant women, in a range of simulated clinical scenarios. Midwifery academics assessed the interaction and after the OSCE, students documented their findings in written progress notes that were also assessed. After the OSCEs, feedback was sought from assessors (midwifery staff), actors (3rd year B Mid students) and students who underwent the OSCE. The feedback was synthesised to inform the production of three interactive videos, aiming to help students prepare for their PMH OSCE and for clinical practice. Current and former students and teaching staff were involved in co-design endeavours to ensure the videos met their needs. One of the videos will be showcased as part of this presentation. Although assessment, support, and referral of women suffering from mental ill health is a core midwifery skill, there is limited opportunity for students to gain clinical placement experiences that are specific to PMH. Prior to this project there were no accessible audio-visual materials available that demonstrate how midwives in Australia work with women in relation to their mental health. Implications for practice include improving the standard of PMH screening, support and care provided by students and graduating midwives to women and birthing people in Australia.

CONSTRUCTION AND VALIDATION OF A CLINICAL SIMULATION ON HIV TESTING AND COUNSELING IN PREGNANT WOMEN

Objective: to construct and validate a clinical simulation scenario on rapid HIV testing and counseling in pregnant women. Method: methodological study, of appearance and content validation, developed between June and October 2020 through the Delphi technique. For validation, the judges who obtained five or more points according to the adapted Fehring criteria were included. The data were analyzed by calculating the Content Validity Index (CVI). Results: After the first Delphi round, two items (5.7%) did not reach the I-CVI required for validation in all the criteria evaluated, which were: behavioral, objectivity, simplicity, clarity, relevance, accuracy, variety, modality, typicality, and credibility. At the end of the second Delphi round, all items (100%) reached the I-CVI required for validation. Conclusion: the script proved to be valid, contributing to subsidize the teaching of HIV testing and counseling of pregnant women.