Simulated Encounters Research Articles

Enhancing health care non-technical skills: the TINSELS programme.

Training in 'non-technical skills', i.e. social (communication and teamwork) and cognitive (analytical and personal behaviour) skills, in health care have been of great interest over the last decade. Whereas the majority of publications focus on 'whether' such education can be successful, they overlook 'how' they enhance skills. We designed and piloted a theoretically robust teaching package that addresses non-technical skills in the context of medicine safety through simulation-based interprofessional learning: the Training In Non-technical Skills to Enhance Levels of Medicines Safety (TINSELS) programme. A modified Delphi process was completed to identify learning outcomes, and multi-professional teams were recruited through local publicity. The faculty staff developed a three-session simulation-based intervention: firstly, a simulated ward encounter with multiple medicine-related activities; secondly, an extended debriefing and facilitated discussion; and finally, a 'chamber of horrors', where interprofessional teams identified potential sources of error. Each session was completed in the simulation suite with between six and nine participants, lasted approximately 90 minutes and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Training in 'non-technical skills' in health care have been of great interest over the last decade Feedback was collected on a Likert scale after the course (1, strongly disagree; 5, strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic interprofessional groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety in the workplace. An original, simulation-based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication.

RETRACTED: Simulated Donor Family Encounters at Organ Transplantation Coordinators In-service Training Course: Process and Impact Evaluation

The study was aimed at introducing the modified version of the organ transplantation coordinator course including simulated donor family encounters (SDFEs), communication skills, and evaluating the participants' opinions, achievement levels, and how they implemented what they learned in the course in their work settings. The course was modified using the ADDIE (analysis, design, development, implementation, and evaluation) model and was evaluated in three steps: The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the post-test and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through phone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly use their communication and empathy skills during donor family encounters. The participants' mean post-test score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.

Letter to the Editor: “High-Fidelity Meets Athletic Training Education: An Innovative Collaborative Teaching Project”

Letter to the Editor: “High-Fidelity Meets Athletic Training Education: An Innovative Collaborative Teaching Project”

Simulated Donor Family Encounters at Organ Transplantation Coordinators In-Service Training Course: Process and Impact Evaluation

ObjectiveThis study introduced the modified version of the Organ Transplantation Coordinator course including simulated donor family encounters (SDFEs) and communication skills. It also evaluated participants' opinions and achievement levels, and how they implemented what they learned in the course in their work settings. MethodsThe course used the modified Analysis, Design, Development, Implementation, and Evaluation model and was evaluated in 3 steps. The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the posttest and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through telephone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. ResultsThe participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly utilize their communication and empathy skills during donor family encounters. The participants' mean posttest score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. ConclusionsIt can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.

Learning From Simulation-Based Medication Event Reporting: A Mixed Methods Analysis

BackgroundErrors committed during the course of delivering care represent a significant threat to patient safety. Nurse educators are in a unique position to effect change in patient safety, but more opportunities for learning from and reporting errors are needed to realize this goal. MethodThis study used the convergent parallel design and followed three cohorts of students longitudinally. As part of the simulation program, students were asked to report any adverse events committed or observed during simulation encounters. The reported medication events were analyzed using chi-square analysis and content analysis. ResultsA decreasing trend of reported medication events across courses was found. Chi-square analysis showed statistically significant differences in the categories of wrong dose, wrong patient, failing to ID the patient, communication breakdown, medication handling, knowledge, and personal distraction. Themes identified via content analysis of the open-ended questions included needing to improve communication; double checking orders, dosages, and patient identifiers; needing to gain more medical knowledge; deficiencies in assessment skills; poor focus; distraction; and nervousness. ConclusionThe findings uncover a domain of patient safety that has not been fully explored. The results provide a deeper insight into how students acquire knowledge from making errors and how they incorporate and reflect on lessons learned as they gain knowledge and skills.

Playing doctor: Simulation in medical school as affective practice

Simulated patient encounters, in which a trained layperson role-plays a patient, have become increasingly important in medical education. One such type is the gynecological teaching associate (GTA), who teaches medical students how to perform the pelvic examination using her own body. This paper considers the role that simulation like the GTA session plays in medical students' professional socialization. Drawn from interviews and archival sources gathered from medical students, medical faculty, and GTAs, this paper explores the tensions between artificiality and authenticity in order to understand how, through pedagogical practice, medical students come to embody medical culture through simulation. This paper uses the theoretical framework of the medical habitus to understand the role of emotion in medical student socialization. It argues that simulation is an example of affective practice: any rehearsal of techniques or styles of expressing, experiencing, or managing emotion that reshape the body's capacity to feel.

Student Ability, Confidence, and Attitudes Toward Incorporating a Computer into a Patient Interview

To improve pharmacy students' ability to effectively incorporate a computer into a simulated patient encounter and to improve their awareness of barriers and attitudes towards and their confidence in using a computer during simulated patient encounters. Students completed a survey that assessed their awareness of, confidence in, and attitudes towards computer use during simulated patient encounters. Students were evaluated with a rubric on their ability to incorporate a computer into a simulated patient encounter. Students were resurveyed and reevaluated after instruction. Students improved in their ability to effectively incorporate computer usage into a simulated patient encounter. They also became more aware of and improved their attitudes toward barriers regarding such usage and gained more confidence in their ability to use a computer during simulated patient encounters. Instruction can improve pharmacy students' ability to incorporate a computer into simulated patient encounters. This skill is critical to developing efficiency while maintaining rapport with patients.

Assessing Faculty Learning Objectives—a Student Initiative

Faculty regularly review and update learning objectives for student learning activities such as lectures, small group sessions, on-line modules, and standardized patient or simulation encounters. The effectiveness of these learning objectives is linked to faculty evaluations in a general manner. The goal of this project was to assess the student-perceived usefulness of learning objectives, to provide feedback to faculty, and to determine if student-perceived usefulness of objectives was linked to student performance and faculty evaluations. An assessment tool was developed by students, revised, and validated prior to implementation during a 3-month study. Each learning objective was assessed during this period by members of the class (n = 242), and data were analyzed. The results demonstrate that particular types of objectives were identified as being more or less useful for student learning and that student perception of learning objectives varies from faculty intent. Analyses also showed students performed less well on questions linked to objectives considered less useful. However, performance was stratified into two cohorts. Stronger and weaker students performed well or less well, respectively.

Acceptability and usability of a telepresence robot for geriatric primary care: A pilot

The dual challenge of increasing numbers of older adults and overall increases in those with some form of insurance is driving the need to develop and evaluate novel methods of primary care delivery such as telehealth. The goal of this study was to explore the acceptability and usability of a remote presence robot (RPR) in a simulated primary care wellness encounter for older adults. A descriptive exploratory study was used to determine the acceptability and usability of the RPR operated by an APRN 250 miles from 13 older adults residing in a high rise during a simulated primary care visit. The results support previous research that technology such as the RPR can be both acceptable and useful for an older adult and primary care provider but only in certain circumstances.

Developing a physiotherapy clinical simulation assessment tool using the Delphi approach

Purpose: Simulation in physiotherapy education is increasing, but a standardised assessment tool for student performance in simulation has not been developed. The Assessment of Physiotherapy Practice (APP) is a validated tool for student performance in the clinical workplace, and has been used recently for simulation despite its relevance for this context being unknown. The purpose of the study was to gain consensus about which APP items should be included in a tool to assess physiotherapy students’ performance in simulation. The relevance of items was considered for both single patient encounters, and longitudinal (multiple) encounters. Methods: An online Delphi approach used a custom designed survey. A purposive sample of physiotherapists with simulation experience was recruited via email. Two rounds were undertaken with consensus being reached when at least 80% of the panel agreed on inclusion or exclusion of an item. Results: Twenty participants responded in the first round and fourteen in the second (70% retention). For longitudinal simulations, all APP items reached consensus in the first round. For single patient simulation encounters, consensus was not reached in the first round for the following items: commitment to learning (61%), teamwork (76%) and discharge planning (72%). In the second round, consensus for ‘teamwork’ remained the only item below eighty percent agreement (78.6%). Conclusions: The APP was deemed to be an appropriate measure for longitudinal clinical simulations, and with the exclusion of teamwork, for a single patient simulation encounter.

Informed consent training improves surgery resident performance in simulated encounters with standardized patients

BackgroundAlthough informed consent is vital to patient–physician communication, little training is provided to surgical trainees. We hypothesized that highlighting critical aspects of informed consent would improve resident performance. MethodsEighty (out of 88) surgical postgraduate year 1 surgical residents were randomly assigned to one of the 2 cases (laparoscopic cholecystectomy or ventral herniorrhaphy) and instructed to obtain and document informed consent with a standardized patient (SP) followed by a didactic training session. The residents then obtained and documented informed consent with the other case with the other SP. SPs graded encounters (“Checklist”); trained raters graded notes. Repeated measures multivariate analysis of variance (MANOVA) was used to determine differences between pre- and post-training and Checklist versus “Note” scores. ResultsStatistically significant pre- to post differences for Note (P < .01) and Checklist (P < .01) along with significant differences between Note and Checklist (P < .01) were noted. ConclusionsTraining improved surgery residents’ ability to discuss and document informed consent. Despite this improvement, significant differences between discussion and documentation persisted. Documentation training is a future area for improvement.

A Simulation Curriculum for Management of Trauma and Surgical Critical Care Patients

BackgroundExpectations continue to rise for residency programs to provide integrated simulation training to address clinical competence. How to implement such training sustainably remains a challenge. We developed a compact module for first-year surgery residents integrating theory with practice in high-fidelity simulations, to reinforce the preparedness and confidence of junior residents in their ability to manage common emergent patient care scenarios in trauma and critical care surgery. MethodsThe 3-day module features a combination of simulated patient encounters using standardized patients and electronic manikins, didactic sessions, and hands-on training. Manikin-based scenarios developed in-house were used to teach trauma and critical care management concepts and skills. Separate scenarios in collaboration with the regional organ donation program addressed communication in difficult situations such as brain death. Didactic material based on contemporary evidence, as well as skills stations, was developed to complement the scenarios. Residents were surveyed before and after training on their confidence in meeting the 14 learning objectives of the curriculum on a 5-point Likert scale. ResultsData from 15 residents who underwent this training show an overall improvement in confidence across all learning objectives defined for the module, with confidence scores before to after training improving significantly from 2.8 (σ = 0.85, median = 3) to 3.9 (σ = 0.87, median = 4) of 5, p < 0.001. Although female residents reported higher posttraining confidence scores compared with male residents (average 4.2 female vs 3.8 male, p = 0.002), there were no other significant differences in confidence scores or changes to scores owing to resident sex or program status (categorical or preliminary). ConclusionWe successfully implemented a multimodal simulation-based curriculum that provides skills training integrated with the clinical context of managing trauma and critical care patients, simultaneously addressing a range of clinical competencies. Results to date show consistent improvement in residents’ confidence in meeting learning objectives. Development of the curriculum continues for sustainability, as well as measures to embed objective evaluations of resident competence.

Komentarze do: Medytacje nad treścią fantazmatu schizofrenii. W poszukiwaniu granic destygmatyzacji

Effective communication is the cornerstone of a fruitful patient–physician relationship. Teaching clinical communication has become a pivotal goal in medical education. However, approaches measuring the maintenance of learned skills are needed since a decline in some communication skills during medical school has been reported.Explore medical students’ communication skills in a simulated clinical encounter before and after clerkships.Two-hundred-fifty-five undergraduate students attending the second year of medical course, at the Faculty of Medicine of University of Porto, completed a 1.5-h per week course over 4 months on basic communication skills. The students’ final evaluation consisted in an interview with a simulated patient, assessed by a teacher using a standardized framework. Three years later, while attending clerkships, 68 students from the same population completed a re-evaluation interview following the same procedure.Medical students maintained a communication skill mean level similar to that of the original post-training evaluation, but significant differences in specific communication abilities were detected in this group of students. Empathic attitudes and ability to collect information improved whereas interview structure and non-verbal behavior showed a decline during clerkships expressing a balance between the competencies that improved, those that declined, and those that remained unchanged.Present findings emphasize the importance of patient contact, context and clinical role models on the maintenance of learned skills, underscoring the importance of an integrated approach of clinical communication teaching throughout medical school.

Evolution of mating behavior between two populations adapting to common environmental conditions.

Populations from the same species may be differentiated across contrasting environments, potentially affecting reproductive isolation among them. When such populations meet in a novel common environment, this isolation may be modified by biotic or abiotic factors. Curiously, the latter have been overlooked. We filled this gap by performing experimental evolution of three replicates of two populations of Drosophila subobscura adapting to a common laboratorial environment, and simulated encounters at three time points during this process. Previous studies showed that these populations were highly differentiated for several life-history traits and chromosomal inversions. First, we show initial differentiation for some mating traits, such as assortative mating and male mating rate, but not others (e.g., female mating latency). Mating frequency increased during experimental evolution in both sets of populations. The assortative mating found in one population remained constant throughout the adaptation process, while disassortative mating of the other population diminished across generations. Additionally, differences in male mating rate were sustained across generations. This study shows that mating behavior evolves rapidly in response to adaptation to a common abiotic environment, although with a complex pattern that does not correspond to the quick convergence seen for life-history traits.

Patient and Caregiver Opinions of Motivational Interviewing Techniques In Role-Played Palliative Care Conversations: A Pilot Study

ContextAlthough many have examined the role of motivational interviewing (MI) in diverse health care encounters, no one has explored whether patients and caregivers facing serious illnesses identify specific MI techniques as helpful. ObjectivesThe aim of this pilot study was to describe how patients and caregivers perceived MI techniques in palliative care role-play encounters. MethodsAbout 21 patients and caregivers participated in a role-play encounter where we asked the participant to act out being ambivalent or reluctant regarding the goals of care decision. The participant met with either an MI-trained physician or a physician who was not trained in MI (usual care). After the simulated encounter, we conducted cognitive interviews (“think-aloud” protocol) asking participants to identify “helpful” or “unhelpful” things physicians said. Participants also completed a perceived empathy instrument as a fidelity test of the MI training of the physician. ResultsQualitative analyses revealed that participants independently identified the following helpful communication elements that are consistent with core MI techniques: reflection and validation of values, support of autonomy and flexibility, and open questions acting as catalysts for discussion. Participants rated the MI-trained physician slightly higher on the perceived empathy scale. ConclusionThis pilot study represents the first exploration of patient and caregiver perceptions of helpful techniques in palliative care conversations. Use of MI techniques shows promise for improving palliative care discussions.

Can medical students identify a potentially serious acetaminophen dosing error in a simulated encounter? a case control study.

BackgroundIn an effort to assess medical students’ abilities to identify a medication administration error in an outpatient setting, we designed and implemented a standardized patient simulation exercise which included a medication overdose.MethodsFourth year medical students completed a standardized patient (SP) simulation of a parent bringing a toddler to an outpatient setting. In this case-control study, the majority of students had completed a patient safety curriculum about pediatric medication errors prior to their SP encounter. If asked about medications, the SP portraying a parent was trained to disclose that she was administering acetaminophen and to produce a package with dosing instructions on the label. The administered dose represented an overdose. Upon completion, students were asked to complete an encounter note.ResultsThree hundred forty students completed this simulation. Two hundred ninety-one students previously completed a formal patient safety curriculum while 49 had not. A total of two hundred thirty-four students (69%) ascertained that the parent had been administering acetaminophen to their child. Thirty-seven students (11%) determined that the dosage exceeded recommended dosages. There was no significant difference in the error detection rates of students who completed the patient safety curriculum and those who had not.ConclusionsDespite a formal patient safety curriculum concerning medication errors, 89% of medical students did not identify an overdose of a commonly used over the counter medication during a standardized patient simulation. Further educational interventions are needed for students to detect medication errors. Additionally, 31% of students did not ask about the administration of over the counter medications suggesting that students may not view such medications as equally important to prescription medications. Simulation may serve as a useful tool to assess students’ competency in identifying medication administration errors.

Mapping galaxy encounters in numerical simulations: the spatial extent of induced star formation

We employ a suite of 75 simulations of galaxies in idealised major mergers (stellar mass ratio ~2.5:1), with a wide range of orbital parameters, to investigate the spatial extent of interaction-induced star formation. Although the total star formation in galaxy encounters is generally elevated relative to isolated galaxies, we find that this elevation is a combination of intense enhancements within the central kpc and moderately suppressed activity at large galacto-centric radii. The radial dependence of the star formation enhancement is stronger in the less massive galaxy than in the primary, and is also more pronounced in mergers of more closely aligned disc spin orientations. Conversely, these trends are almost entirely independent of the encounter's impact parameter and orbital eccentricity. Our predictions of the radial dependence of triggered star formation, and specifically the suppression of star formation beyond kph-scales, will be testable with the next generation of integral-field spectroscopic surveys.

The PrOSTE: identifying key components of effective procedural teaching.

Novel approaches for faculty development and assessment of procedural teaching skills are needed to improve the procedural education of trainees. The Objective Structured Teaching Exercise (OSTE) entails a simulated encounter in which faculty are observed teaching a standardized student and has been used to evaluate teaching skills. Use of an OSTE to assess the teaching of central venous catheterization has not been reported. The purpose of this study was to develop a procedural OSTE for subclavian central venous catheter (CVC) insertion and to determine specific aspects of procedural teaching associated with improved skills in novices. Critical care faculty/fellows taught a standardized student to insert a CVC in a simulator. We assessed the instructor's teaching skills using rating scales to generate a procedural teaching score. After this encounter, the instructor taught novice medical students to place CVCs in simulators. Novices then independently placed catheters in simulators and were evaluated by trained observers using a checklist. Generalized estimating equations were used to examine the correlation between specific teaching behaviors and the novices' skills in CVC placement. We recruited 10 participants to serve as teachers and 30 preclinical medical students to serve as novice learners. The overall mean procedural teaching score was 85.5 (±15.4). Improved student performance was directly related to the degree to which the teacher "provided positive feedback" (β = 1.53, SE = 0.44, P = 0.001), "offered learner suggestions for improvement" (β = 1.40, SE = 0.35, P < 0.001), and "demonstrated the procedure in a step-by-step manner" (β = 2.50, SE = 0.45, P < 0.001). There was no significant correlation between total scores and student skills (β = 0.06, SE = 0.46, P = 0.18). The OSTE is a standardized method to assess procedural teaching skills. Our findings suggest that specific aspects of procedural teaching should be emphasized to ensure effective transfer of psychomotor skills to trainees.

Information-gathering for self-medication via Eastern Indonesian community pharmacies: a cross-sectional study.

BackgroundGathering sufficient information when handling self-medication requests in community pharmacies is an important factor in assisting patients to obtain appropriate health outcomes. Common types of information usually gathered include patient identity, signs and symptoms, action taken, medical history, and current medications being used. The aims of the study were (1) to describe the types and amount of information gathered by Eastern Indonesian community pharmacy staff when handling self-medication requests, and (2) to identify factors associated with the reported amount of information gathered.MethodsPatient simulation and pharmacy staff interviews were used. First, patient simulation was conducted using 2 cough scenarios and 1 diarrhoea scenario. Second, a structured interview was administered to eligible pharmacy staff in the setting. The types and amount of information gathered during patient simulation encounters and reported during pharmacy staff interviews were noted. A regression analysis was performed to identify factors associated with the amount of information gathered from the interview data.ResultsThe most frequent types of information gathered in patient simulation encounters were the nature of symptoms (88% in one of the cough scenarios) and patient identity (96% in the diarrhoea scenario). Other types of information were gathered in <40% of encounters in each scenario. From the pharmacy staff interviews, >90% of the 173 interviewees reported that they gathered information on patient identity, nature of symptoms, and associated symptoms. Information on medical history and medication used was gathered by 20% and 26% respectively of the 173 interviewees. The majority of pharmacy staff asked 0 to 2 questions in the patient simulation encounters compared to 5 questions pharmacy staff reported as their usual practice during the interviews. Being qualified as a pharmacist or a pharmacy technician was one of the factors positively associated with the reported amount of information gathered.ConclusionThere were deficits in the types of information gathered when pharmacy staff handling self-medication requests. Having a pharmacy educational background and additional work experience in the pharmacy was positively associated with the reported amount of information gathered. There could be other factors contributing to shortcomings in the actual practice which need to be explored.

Teens as Teachers: Improving Recruitment and Training of Adolescent Standardized Patients in a Simulated Patient Encounter

Background: Studies in medical education have reliably established the importance of utilizing adolescents as standardized patients. Their realistic portrayals offer authentic learning experiences. Additionally, the curricula can offer the adolescent participants a meaningful educational opportunity. Methods: The “Teens as Teachers” program was developed at the University of Connecticut, School of Medicine, to prepare second year medical students to interview, elicit a history and address issues related to risk behaviors in adolescent standardized patients. In addition, the program offers educational and mentoring opportunities for the teenaged participants. Results: The twenty-four adolescents trained as standardized patients have worked with 359 second year medical students. Results reveal that the adolescents felt the training adequately prepared them for their cases, found the overall experience rewarding and 100% of the adolescents would return to participate if possible. 88.6% of medical students rated the cases authentic, 98.8% found then valuable, 94.2% were able to practice the skills learned during lecture and 96.8% received feedback from the adolescent standardized patients. Conclusion: Utilizing adolescent standardized patients to teach interviewing skills to medical students can prepare them to elicit comprehensive histories and can be a beneficial learning experience for the teenaged participants.