Simulation-based Course Research Articles

Survey of factors influencing learner engagement with simulation debriefing among nursing students.

Simulation-based education has escalated worldwide, yet few studies have rigorously explored predictors of learner engagement with simulation debriefing. The purpose of this cross-sectional, descriptive survey was to identify factors that determine learner engagement with simulation debriefing among nursing students. A convenience sample of 296 Korean nursing students enrolled in the simulation-based course completed the survey. A total of five instruments were used: (i) Characteristics of Debriefing; (ii) Debriefing Assessment for Simulation in Healthcare - Student Version; (iii) The Korean version of the Simulation Design Scale; (iv) Communication Skills Scale; and (v) Clinical-Based Stress Scale. Multiple regression analysis was performed using the variables to investigate the influencing factors. The results indicated that influencing factors of learning engagement with simulation debriefing were simulation design, confidentiality, stress, and number of students. Simulation design was the most important factor. Video-assisted debriefing was not a significant factor affecting learner engagement. Educators should organize and conduct debriefing activities while considering these factors to effectively induce learner engagement. Further study is needed to identify the effects of debriefing sessions targeting learners' needs and considering situational factors on learning outcomes.

Implementation of a novel portfolio of structured, curriculum-aligned, simulation-based, cardiothoracic surgery training courses: Evolving the delivery of surgical education

ObjectiveThe provision of high-quality cardiothoracic surgical training faces many challenges. This has generated an increased interest in simulation-based learning, which can provide a less stressful environment for deliberate practice. We developed a comprehensive, structured program of knowledge and simulation-based learning aligned to the official cardiothoracic surgery curriculum. MethodsA portfolio of 10 curriculum-aligned training courses was designed for cardiothoracic surgical trainees during their 6-year training program. The courses were delivered through a multitude of education methods, including live porcine operating simulation models, and were evaluated through a series of quantitative (5-point Likert-scale) and qualitative assessments. The trainees (n = 15-21 per course) also completed pre- and postsession self-confidence and competency levels for each training episode of knowledge and skill, respectively. In addition, board examination pass rates were assessed in the 3-year periods before and after implementation of the courses. ResultsQuantitative analysis of the trainees' feedback demonstrated an extremely positive view of the portfolio of the simulation-based training courses with excellent satisfaction scores (out of 5) for teaching sessions (4.44 ± 0.07), faculty (4.64 ± 0.07), content and materials (4.63 ± 0.07), and facilities (4.73 ± 0.05). The courses have shown a significant improvement in the post–self-confidence (7.98 ± 0.13 vs 5.62 ± 0.20, P < .01) and perceived self-competency (8.10 ± 0.10 vs 5.67 ± 0.11, P < .01) scores for all courses. Examination pass rates significantly improved in the 3-year period after attendance at the courses (94.82% ± 2.34% vs 76.26% ± 3.23%, P < .005). ConclusionsThis study has described the implementation of the only extensive program of structured simulation-based courses that has been developed to complement clinical training in cardiothoracic surgery.

Early acquisition of non-technical skills using a blended approach to simulation-based medical education

BackgroundNon-technical skills are emerging as an important component of postgraduate medical education. Between 2013 and 2016, a new blended training program incorporating non-technical skills was introduced at an Australian university affiliated hospital. Program participants were medical officers in years 1 and 2 of postgraduate training.MethodsAn interdisciplinary faculty trained in simulation-based education led the program. The blended approach combined open access online resources with multiple opportunities to participate in simulation-based learning. The aim of the study was to examine the value of the program to the participants and the effects on the wider hospital system. The mixed methods evaluation included data from simulation centre records, hospital quality improvement data, and a post-hoc reflective survey of the enrolled participants (n = 68).ResultsOver 30 months, 283 junior doctors were invited to participate in the program. Enrolment in a designated simulation-based course was completed by 169 doctors (59.7%). Supplementary revision sessions were made available to the cohort with a median weekly attendance of five participants. 56/68 (82.4%) of survey respondents reported increased confidence in managing deteriorating patients. During the period of implementation, the overall rate of hospital cardiac arrests declined by 42.3%. Future objectives requested by participants included training in graded assertiveness and neurological emergencies.ConclusionsImplementation of a non-technical skills program was achieved with limited simulation resources and was associated with observable improvements in clinical performance. The participants surveyed reported increased confidence in managing deteriorating patients, and the program introduction coincided with a significant reduction in the rate of in-hospital cardiac arrests.

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows.

Effective communication among providers, families, and patients is essential in critical care but is often inadequate in the PICU. To address the lack of communication education pediatric critical care medicine fellows receive, the Children's Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication course. Pediatric critical care medicine trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the Pediatric Critical Care Communication course. Pediatric Critical Care Communication is a 3-day course taken once during fellowship featuring simulation with actors portraying family members. Off-site conference space as part of a pediatric critical care medicine educational curriculum. Pediatric Critical Care Medicine Fellows. Didactic sessions and interactive simulation scenarios. Prior to and after the course, fellows complete an anonymous survey asking about 1) prior instruction in communication, 2) preparedness for difficult conversations, 3) attitudes about end-of-life care, and 4) course satisfaction. We compared pre- and postcourse surveys using paired Student t test. Most of the 38 fellows who participated over 4 years had no prior communication training in conducting a care conference (70%), providing bad news (57%), or discussing end-of-life options (75%). Across all four iterations of the course, fellows after the course reported increased confidence across many topics of communication, including giving bad news, conducting a family conference, eliciting both a family's emotional reaction to their child's illness and their concerns at the end of a child's life, discussing a child's code status, and discussing religious issues. Specifically, fellows in 2014 reported significant increases in self-perceived preparedness to provide empathic communication to families regarding many aspects of discussing critical care, end-of-life care, and religious issues with patients' families (p < 0.05). The majority of fellows (90%) recommended that the course be required in pediatric critical care medicine fellowship. The Pediatric Critical Care Communication course increased fellow confidence in having difficult discussions common in the PICU. Fellows highly recommend it as part of PICU education. Further work should focus on the course's impact on family satisfaction with fellow communication.

Cumulative evaluation data: pediatric airway management simulation courses for pediatric residents

ObjectivesTo utilize cumulative evaluation data of the pediatric airway management simulation-based learning course on knowledge and practical skills of residents in the Saudi Commission for Health Speciality (SCFHS) in order to measure its efficacy and areas for improvement.MethodsThe evaluation is a retrospective cohort study that compares pre- and post-test (knowledge and skills) of a pediatric airway management simulation course. The 2-day course has been conducted four times annually at CRESENT and is comprised of interactive lectures on airway management and crew resource management, a demonstration of fundamentals of intubation, three skill stations, and six case scenarios with debriefing. Our evaluation data includes all pediatric residents who attended the course between January and December 2015.ResultsForty-six residents participated, of whom 30 (65.2%) are male and 16 (34.78%) are female. Overall, there is statistically significant improvement between the pre-test and post-test knowledge and practical skill scores. The pre-test scores are significantly different between the four different resident levels with p values of 0.003 and <0.001 respectively. However, there are no statistically significant differences in the post-test scores among the four different resident levels with p values of 0.372 and 0.133 respectively. The practical skill assessment covers four main domains. Improvements were noted in pharmacology (811%), equipment setup (250%), intubation steps (200%), and patient positioning (130%). The post-test scores are similar in all practical skill categories for the four different residency levels.DiscussionOur outcome-based evaluation strategy demonstrated that residents met the course learning objectives. The pediatric airway management simulation course at CRESENT is effective in improving the knowledge and practical skills of pediatric residents. Although the greatest improvement is noted among junior residents, learners from different residency levels have comparable knowledge and practical skills at the end of the course. Things that can be improved based on our study results include stressing more the type and dosages of the medications used in airway management and mandating the course for all junior pediatric residents. Although residents scored well, specific knowledge and skill elements still led us to targeted areas for course excellence. Similar courses need to be integrated in the pediatric residency curriculum. Further research is needed to study skill retention and more importantly its impact on patients’ care. Although resource-intensive, the use of cumulative evaluation data helped to focus quality improvement in our courses.

A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course: Erratum

A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course: Erratum

The use of a high-fidelity simulation-based course to -prepare for the transition to a medical registrar.

To create, deliver and evaluate a 1-day medical registrar introductory course, ‘Med Reg Ready’, to CT2s and ST3s, which includes high-fidelity simulations as well as more traditional small-group workshops and lectures, to prepare them for a much more senior role. Participants were asked to fill out a pre-course questionnaire; 67% (n=18) stated that they were not ready to become a medical registrar. Participants were CT2s and ST3s (n=33) from six differing trusts who voluntarily signed up to the course. …

Standardized, Interdepartmental, Simulation-Based Central Line Insertion Course Closes an Educational Gap and Improves Intern Comfort with the Procedure

Central line placement is a common procedure, routinely performed by junior residents in medical and surgical departments. Before this project, no standardized instructional course on the insertion of central lines existed at our institution, and few interns had received formal ultrasound training. Interns from five departments participated in a simulation-based central line insertion course. Intern familiarity with the procedure and with ultrasound, as well as their prior experience with line placement and their level of comfort, was assessed. Of the 99 interns in participating departments, 45 per cent had been trained as of October 2015. Forty-one per cent were female. The majority (59.5%) had no prior formal ultrasound training, and 46.0 per cent had never placed a line as primary operator. Scores increased significantly, from a precourse score mean of 13.7 to a postcourse score mean of 16.1, P < 0.001. All three of the self-reported measures of comfort with ultrasound also improved significantly. All interns reported the course was "very much" helpful, and 100 per cent reported they felt "somewhat" or "much" more comfortable with the procedure after attendance. To our knowledge, this is the first hospital-wide, standardized, simulation-based central line insertion course in the United States. Preliminary results indicate overwhelming satisfaction with the course, better ultrasound preparedness, and improved comfort with central line insertion.

The use of a high-fidelity simulation-based course to ­prepare for the transition to a medical registrar

To create, deliver and evaluate a 1-day medical registrar introductory course, ‘Med Reg Ready’, to CT2s and ST3s, which includes high-fidelity simulations as well as more traditional small-group workshops and lectures, to prepare them for a much more senior role. Participants were asked to fill out a pre-course questionnaire; 67% (n=18) stated that they were not ready to become a medical registrar. Participants were CT2s and ST3s (n=33) from six differing trusts who voluntarily signed up to the course. …

Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation.

The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. The response rate was 84%. Improvements in the participants' self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation.

Preparing medical students for clinical practice: easing the transition.

The transition from medical student to junior doctor is a challenge; the UK General Medical Council has issued guidance emphasizing the importance of adequate preparation of medical students for clinical practice. This study aimed to determine whether a junior doctor-led simulation-based course is an effective way of preparing final year medical students for practice as a junior doctor.We piloted a new ‘preparation for practice’ course for final year medical students prior to beginning as Foundation Year 1 (first year of practice) doctors. The course ran over three days and consisted of four simulated stations: ward round, prescribing, handover, and lessons learnt. Quantitative and qualitative feedback was obtained.A total of 120 students attended (40 on each day) and feedback was collected from 95 of them. Using a scale of 1 (lowest) to 5 (highest), feedback was positive, with 99% and 96% rating 4 or 5 for the overall quality of the program and the relevance of the program content, respectively. A score of 5 was awarded by 67% of students for the ward round station; 58% for the handover station; 71% for the prescribing station, and 35% for the lessons learnt station. Following the prescribing station, students reported increased confidence in their prescribing.Preparation for practice courses and simulation are an effective and enjoyable way of easing the transition from medical student to junior doctor. Together with ‘on-the-job’ shadowing time, such programs can be used to improve students’ confidence, competence, and ultimately patient safety and quality of care.Electronic supplementary materialThe online version of this article (doi: 10.1007/s40037-017-0352-2) contains supplementary material, which is available to authorized users.

A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course

Background and Purpose: There is demand for physical therapists to practice in intensive care units (ICUs); however, many physical therapists lack the specialized knowledge and skills to provide these services. Immersive simulation is an ideal instructional design strategy for learning ICU rehabilitation skills because simulation provides safe, low-risk environments to master high-risk interventions. This case report describes an elective hybrid pre-professional physical therapist course that incorporates simulation-based learning experiences (SBLEs) with clinical mentoring to prepare students for formal ICU internships. Case Description: Eight final-year physical therapist students participated in this course. The goal of this course was to facilitate the development of students interested in specializing in ICU practice. Course objectives included acquiring the knowledge, communication skills, and clinical skills essential for participating in mentored clinical ICU internships. Educational strategies included lectures, SBLEs, and clinical ICU experiences. Outcomes: All students successfully completed the course, earned the American Heart Association Advance Cardiac Life Support certification, and were identified by ICU physical therapist clinical instructors as ready for formal ICU internships. Stakeholders positively reviewed the course. One year following the course, 4 of 8 students were employed in acute care and/or ICU settings. Discussion: This elective course used a combination of lectures, SBLEs, and clinical experiences to successfully prepare physical therapist students for mentored ICU internships and employment in acute and critical care practice settings. More research is required to evaluate the simulation pedagogy (structure, types of cases, and time in simulation) and criteria for determining student competence level for ICU practice.

Residents’ perceptions of simulation as a clinical learning approach

Simulation is increasingly being integrated into medical education; however, there is little research into trainees' perceptions of this learning modality. We elicited trainees' perceptions of simulation-based learning, to inform how simulation is developed and applied to support training. We conducted an instrumental qualitative case study entailing 36 semi-structured one-hour interviews with 12 residents enrolled in an introductory simulation-based course. Trainees were interviewed at three time points: pre-course, post-course, and 4-6 weeks later. Interview transcripts were analyzed using a qualitative descriptive analytic approach. Residents' perceptions of simulation included: 1) simulation serves pragmatic purposes; 2) simulation provides a safe space; 3) simulation presents perils and pitfalls; and 4) optimal design for simulation: integration and tension. Key findings included residents' markedly narrow perception of simulation's capacity to support non-technical skills development or its use beyond introductory learning. Trainees' learning expectations of simulation were restricted. Educators should critically attend to the way they present simulation to learners as, based on theories of problem-framing, trainees' a priori perceptions may delimit the focus of their learning experiences. If they view simulation as merely a replica of real cases for the purpose of practicing basic skills, they may fail to benefit from the full scope of learning opportunities afforded by simulation.

EU Simulations and Engagement: Motivating Greater Interest in European Union Politics

ABSTRACTWhile the effects of simulation-based courses on the knowledge of participating students may be marginal in relation to standard lecture and discussion-based courses, this article argues that the greatest leverage is gained by increasing participating students’ level of interest in the subject of study and in politics more broadly. Participants tend to become increasingly absorbed in their roles and in the politics of the institutions at the center of the simulation. To better consider this possibility, we conducted a survey of students participating in the 2015 Mid-Atlantic European Union Simulation and of appropriate control populations. The survey results indeed suggest that, much more than simply acquiring knowledge about the EU, the simulation experience serves to generate more robust interest in the subject of study.

Sharing simulation-based training courses between institutions: opportunities and challenges

BackgroundSharing simulation-based training (SBT) courses between institutions could reduce time to develop new content but also presents challenges. We evaluate the process of sharing SBT courses across institutions in a mixed method study estimating the time required and identifying barriers and potential solutions.MethodsTwo US academic medical institutions explored instructor experiences with the process of sharing four courses (two at each site) using personal interviews and a written survey and estimated the time needed to develop new content vs implement existing SBT courses.ResultsThe project team spent approximately 618 h creating a collaboration infrastructure to support course sharing. Sharing two SBT courses was estimated to save 391 h compared with developing two new courses. In the qualitative analysis, participants noted the primary benefit of course sharing was time savings. Barriers included difficulty finding information and understanding overall course flow. Suggestions for improvement included establishing a standardized template, clearly identifying the target audience, providing a course overview, communicating with someone familiar with the original SBT course, employing an intuitive file-sharing platform, and considering local culture, context, and needs.ConclusionsSharing SBT courses between institutions is feasible but not without challenges. An initial investment in a sharing infrastructure may facilitate downstream time savings compared with developing content de novo.

Implementation of clinical practice changes by experienced anesthesiologists after simulation-based ultrasound-guided regional anesthesia training.

BackgroundAnesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop.MethodsPracticing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA.ResultsSurvey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure.ConclusionsParticipation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.

Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care.

Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management. Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM) educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM. Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings. Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance.

Perceptions of simulation-assisted teaching among baccalaureate nursing students in Chinese context: Benefits, process and barriers.

To explore the subjective learning experiences of baccalaureate nursing students participating in simulation sessions in a Chinese nursing school. This was a qualitative descriptive study. We used semi-structured interviews to explore students' perception about simulation-assisted learning. Each interview was audio-taped and transcribed verbatim. Thematic analysis was used to identify the major themes or categories from the transcript and the field notes. Only 10 students were needed to achieve theoretical saturation, due to high group homogeneity. Three main themes which were found from the study included 1. Students' positive views of the new educational experience of simulation; 2. Factors currently making simulation less attractive to students; and 3. The teacher's role in insuring a positive learning experience. Simulation-assisted teaching has been a positive experience for majority nursing students. Further efforts are needed in developing quality simulation-based course curriculum as well as planning and structuring its teaching process. The pedagogy approach requires close collaboration between faculty and students.

Using Simulation in Clinical Education: Psoriasis Area and Severity Index (PASI) Score Assessment.

The use of simulation-based learning in the medical field has many benefits, including patient safety, health care professional confidence, accelerating diagnostic and therapeutic procedures, meeting the unfulfilled demand for medical personnel, and lowering of medical errors. Developing of interactive learning tools for teaching a simulated clinical case studies program, is highly needed to improve specialist nurses and middle grade health care professionals skills and competency. Assess the outcomes of a simulated problem-based learning educational activity for scoring the Psoriasis Area and Severity Index (PASI). 33 training health care professionals took part in the simulation activity. Before commencing the teaching program, every participant answered a pre-simulation activity confidence and competence levels questionnaire. The simulation activity was carried out in 3 phases: Phase 1: interactive instructor-learner format; Phase 2: Peer-led tutorial; Phase 3: completely independent student led learning adopting a "Problem solving" approach. At the end, every participant completed a questionnaire for post-simulation activity confidence and competence levels. The percentage of agreement with the reference PASI score was progressively improving which reflects improvement of the learners' skills after adopting the repetitive learner engagement approach. All participants expressed positive attitudes toward the simulation-based course. The overall mean for the student satisfaction subscale was 4.33/5, whereas the overall mean for the selfconfidence subscale was 4.15/5. Simulation-based teaching is an effective way to teach health care professionals. This approach led to improving attitudes, behaviors, interaction, confidence and overall performance leading to potential increased patient safety and better clinical outcomes. The next step is to implement simulation-based training effectively and efficiently in standard teaching.

Effectiveness of a Critical Care Ultrasonography Course

Widespread use of critical care ultrasonography (CCUS) for the management of patients in the ICU requires an effective training program. The effectiveness of national and regional CCUS training courses is not known. This study describes a national-level, simulation-based, 3-day CCUS training program and evaluates its effectiveness. Five consecutive CCUS courses, with a total of 363 people, were studied. The 3-day CCUS training program consisted of didactic lectures, ultrasonography interpretation sessions, and hands-on modules with live models. Thoracic, vascular, and abdominal ultrasonography were taught in addition to goal-directed echocardiography. Learners rotated between hands-on training and interpretation sessions. The teacher-to-learner ratio was 1:3 during hands-on training. Interpretation sessions were composed of interactive small groups that reviewed normal and abnormal ultrasonography images. Learners completed a video-based examination before and after completion of the courses. Hands-on image acquisition skills were tested at the completion of the course. Average scores on the pretest and posttest were 57%and 90%, respectively (P<.001). The average score on the hands-on test was 86%. Learners aged 20 to 39 years compared with learners≥ 40 years old scored better on the pretest (64%vs51%; P< 0.001), posttest (91%vs88%; P< .010), and hands-on test (90%vs82%; P< .001). Learners demonstrated a significant improvement in written test scores that assessed cognitive and image interpretation abilities. In addition, they demonstrated acquisition of practical skills as evidenced by high scores during hands-on testing. Further studies are needed to determine if a simulation-based CCUS course will translate into effective clinical practice and to measure the durability of training. This 3-day course is an effective method to train large groups of critical care clinicians in the skills requisite for CCUS (image acquisition and image interpretation).