Simulation-based Education Program Research Articles

Effect of simulation-based emergency airway management education on the knowledge, skills and perceived confidence of medical interns.

An effective airway management education program is a crucial part of the undergraduate medical education curriculum. Theoretical instructions and practical demonstrations are the major modalities of medical education in Nepal. Simulation-based education (SBE) programs have not yet been implemented effectively. The authors aimed to determine the effects of an SBE program on the knowledge, skills, and perceived confidence of medical interns regarding emergency airway management. This mixed methods study comprised both quantitative and qualitative components. The study participants were 47 medical interns who had participated in the SBE program. The mean age of the 47 participants was 24.74 years. There were 33 (70.21%) male and 14 (29.79%) female participants. The knowledge, skills, and perceived confidence scores of the participants for airway management preparation, basic airway management, endotracheal intubation, and laryngeal mask airway (LMA) insertion improved significantly following the SBE program (P<0.001). Analysis of the participants' feedback indicated that they largely approved of the SBE program. The majority of students and faculty expressed a willingness to include similar programs in the undergraduate medical education curriculum. This study demonstrated through quantitative and qualitative metrics that SBE can enhance the knowledge, skills, and perceived confidence in performing emergency airway management among medical interns. The authors recommend measures to include and effectively implement SBE in the undergraduate medical education curriculum of Nepal.

"I've yet to meet anyone who's not keen for simulation" - a qualitative study of simulation-based education in the Pacific Islands.

Simulation-based education (SBE) has been increasingly used to train healthcare workers in low-resource settings and has been endorsed by the World Health Organization (WHO). Consideration of the educational and cultural context is important to maximize the effectiveness of SBE. Despite its demonstrable benefits, there have been no studies of the general approach in the Pacific Islands. This study aimed to determine the factors that influence the uptake and success of SBE in the Pacific Islands. In this qualitative study, participants were recruited via professional networks to contribute to focus groups. Questions focused on participants' previous experiences and perspectives on SBE. Data were manually transcribed before thematic analysis. The reporting of the research was guided by the Standards for Reporting Qualitative Research (SRQR). Human Research Ethics Committee approval was obtained. Two focus groups were conducted with 16 participants from six Pacific Island countries. Six themes and 15 subthemes were conceptualized from the data. Uptake of SBE is challenged by resource availability, clinical workloads and geographic remoteness. However, locally-driven solutions and positive attitudes towards SBE facilitate its success. This study reveals the complexity of factors affecting the uptake and success of SBE in the Pacific Islands. These findings can serve to optimize the impact of existing and future SBE programmes and may be considered by educators prior to programme implementation.

Fostering preservice teachers’ mathematical discourse through virtual simulation teaching

Simulation, a new tool in teacher education programmes, requires further evidence as to its effectiveness in supporting the development of preservice teachers’ (PSTs’) mathematical discourse. The study explores the discourse of a group of preservice teachers while teaching the concept of volume in a simulation setting. Specifically, PSTs’ verbal interactions with virtual students (i.e. avatars) are examined using utterances as the basic unit of analysis. By applying mathematics discourse frameworks, the PSTs’ discourse was categorised, identified as different types and analysed both quantitatively and qualitatively. The findings reveal the dynamics of PSTs’ discourse and highlight how simulations provide an authentic classroom-like environment, with the potential to elicit PSTs’ mathematical discourse, including preparation for unexpected situations and fostering inclusive pedagogy. This article makes a contribution to the current literature by exploring the effectiveness of simulation-based teacher education programmes in developing preservice teachers’ (PSTs’) mathematical discourse skills. Specifically, the discussion offers valuable insights into the potential of simulations as a platform for preparing PSTs to become confident and competent educators capable of fostering inclusive learning communities.

Effectiveness of Simulation Based Education on Nurses Knowledge Regarding Paediatric Basic Life Support.

Background: Pediatric basic life support (BLS) involves administering cardiopulmonary resuscitation (CPR) to children experiencing cardiac arrest without the use of equipment, relying on bag-mask ventilation or barrier devices until advanced life support (ALS) is available. Objective: The purpose of this study was to determine the effect of simulation-based education on nurses’ knowledge in Pediatric Basic Life Support (PBLS). . Method: A quasi-experimental pretest-posttest study was carried out with 50 nurses from pediatric wards of two general hospitals in Al_Najaf City, Iraq, fromSeptember16,2023,toJanuary20,2024. Study subject: A convenience sample of 50 nurses was randomly assigned to two groups of 25, to be treated as intervention or control groups. The intervention group received simulation-based educational program while the control group received no intervention. Descriptive and inferential statistics were calculated. Data collection tools: A structured self-administered questionnaire with two parts related to socio-demographic characteristics and nurses' knowledge of paediatric basic life support. The education passed through 3 phases e, pre-test, implementation and post-test phase. Results: The study's findings showed that the implementation of a simulation education program led to an improvement in the knowledge of the study group . Conclusions: The study concluded that simulation based education improved nurses' knowledge related pediatric basic life support and the study provides aline to enhance the simulation integration as active education strategies to develop nurses' knowledge in applying clinical skills. Recommendations: Further studies are recommended to evaluate the impact of simulation on nurses' education outcomes, providing more evidence that simulation would be beneficial for nurses' improvement. The researcher also suggests encouraging nurses to improve their knowledge and performances through increased participation in Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) courses, at least every six months.

Effectiveness of a Simulation-Based Education Program to Improve Novice Nurses' Clinical Judgment Skills.

We assessed the effectiveness of a simulation-based education program to improve novice nurses' clinical judgment skills. A simulation education program was implemented for 21 novice nurses. Surveys were conducted on program satisfaction, learning, and clinical judgment skills before, immediately after, and two months after the program. Novice nurses were highly satisfied with the simulation education program. The following nine categories were identified as learnings: provide psychological care for patients, conduct sufficient observation, conduct assessment and make judgment based on observational findings, consult and report appropriately to senior nurses, take response action calmly, collect necessary information, acquire knowledge, predict patients' conditions, and make environmental arrangements. The subscale score for theoretical and practical reasoning was significantly higher immediately after and two months after the program than before it. In addition, the subscale for grasping the condition by observation was significantly higher two months after the program than before and immediately after it. The novice nurses learned to sufficiently observe, obtain necessary information, and prospectively assess patients' conditions by taking part in the simulation education program. The subscale score for grasping the condition by observation was significantly higher two months after the program than before and immediately after it. After the simulation program, novicenurses were likely actively practicing nursing; therefore, this program may not be directly responsible for the improvement of these new nurses' clinical judgment. Nevertheless, we found that the completion of the simulation program was correlated with enhanced clinical judgment.

Effectiveness of simulation-based interprofessional education on teamwork and communication skills in neonatal resuscitation

BackgroundThe role of effective interprofessional teamwork is especially vital in the Neonatal Intensive Care Unit (NICU) where infants facing emergency situations are admitted. Proper neonatal resuscitation, facilitated by comprehensive resuscitation training, can significantly decrease the mortality rates associated with neonatal asphyxia and respiratory failure. This study aimed to develop a simulation-based interprofessional education (IPE) programme for medical staff working in a nursery and NICU and to assess its effectiveness on teamwork, communication skills, clinical performance, clinical judgement, interprofessional attitudes, and education satisfaction.MethodsThrough a demand survey, neonatal resuscitation was selected as the theme, and an IPE team comprised of one doctor and two nurses was formed. The education programme consisted of three sessions lasting a total of 140 min: two simulation exercises and one theoretical education session. Data were collected from 18 nurses working in the nursery and NICU and 9 doctors working in the paediatrics department.ResultsA comparison of the metrics before and after applying simulation-based IPE programmes revealed teamwork (Z=-2.67, p = .008), communication skills (Z=-2.68, p = .007), clinical performance (Z=-2.52, p = .012), clinical judgement (Z=-4.52, p < .001), and interprofessional attitude (Z=-3.64, p < .001) to have significantly improved. Education satisfaction scores were 4.73 points on average out of a maximum of 5. The simulation-based IPE programme was effective in improving the teamwork, communication, and clinical performance of resuscitation teams, individual clinical judgement, and interprofessional attitude.ConclusionsSimulation-based IPE is effective for enhancing teamwork, team communication, clinical judgement skills, and clinical performance in neonatal resuscitation. This programme has the potential to contribute to the improvement of patient safety and the quality of neonatal care. Additional studies are needed to longitudinally examine the effects of the programme on patient safety and quality of neonatal care.

Leaders’ experiences of embedding a simulation-based education programme in a teaching hospital: an interview study informed by normalisation process theory

There is limited research on the experiences of people in working to embed, integrate and sustain simulation programmes. This interview-based study explored leaders’ experiences of normalising a simulation-based education programme in a teaching hospital. Fourteen known simulation leaders across Australia and North America were interviewed. Semi-structured interviews were analysed using reflexive thematic analysis sensitised by normalisation process theory, an implementation science theory which defines ‘normal’ as something being embedded, integrated and sustained. We used a combined social and experiential constructivist approach. Four themes were generated from the data: (1) Leadership, (2) business startup mindset, (3) poor understanding of simulation undermines normalisation and (4) tension of competing objectives. These themes were interlinked and represented how leaders experienced the process of normalising simulation. There was a focus on the relationships that influence decision-making of simulation leaders and organisational buy-in, such that what started as a discrete programme becomes part of normal hospital operations. The discourse of ‘survival’ was strong, and this indicated that simulation being normal or embedded and sustained was still more a goal than a reality. The concept of being like a ‘business startup’ was regarded as significant as was the feature of leadership and how simulation leaders influenced organisational change. Participants spoke of trying to normalise simulation for patient safety, but there was also a strong sense that they needed to be agile and innovative and that this status is implied when simulation is not yet ‘normal’. Leadership, change management and entrepreneurship in addition to implementation science may all contribute towards understanding how to embed, integrate and sustain simulation in teaching hospitals without losing responsiveness. Further research on how all stakeholders view simulation as a normal part of a teaching hospital is warranted, including simulation participants, quality and safety teams and hospital executives. This study has highlighted that a shared understanding of the purpose and breadth of simulation is a prerequisite for embedding and sustaining simulation. An approach of marketing simulation beyond simulation-based education as a patient safety and systems improvement mindset, not just a technique nor technology, may assist towards simulation being sustainably embedded within teaching hospitals.

Efficacy of a virtual nursing simulation-based education to provide psychological support for patients affected by infectious disease disasters: a randomized controlled trial.

Virtual simulation-based education for healthcare professionals has emerged as a strategy for dealing with infectious disease disasters, particularly when training at clinical sites is restricted due to the risk of infection and a lack of personal protective equipment. This research evaluated a virtual simulation-based education program intended to increase nurses' perceived competence in providing psychological support to patients affected by infectious disease disasters. The efficacy of the program was evaluated via a randomized controlled trial. We recruited 104 nurses for participation in the study and allocated them randomly and evenly to an experimental group and a control group. The experimental group was given a web address through which they could access the program, whereas the control group was provided with a web address that directed them to text-based education materials. Data were then collected through an online survey of competence in addressing disaster mental health, after which the data were analyzed using the Statistical Package for the Social Sciences(version 23.0). The analysis showed that the experimental group's disaster mental health competence (F = 5.149, p =.026), problem solving process (t = 3.024, p =.003), self-leadership (t = 2.063, p =.042), learning self-efficacy (t = 3.450, p =.001), and transfer motivation (t = 2.095, p =.039) significantly statistically differed from those of the control group. A virtual nursing simulation-based education program for psychological support can overcome limitations of time and space. The program would also be an effective learning resource during infectious disease outbreaks. This Korean clinical trial was retrospectively registered (21/11/2023) in the Clinical Research Information Service ( https://cris.nih.go.kr ) with trial registration number KCT0008965.

A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries.

Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation. This review provides a framework for conducting outcome evaluation of simulation-based education programmes in low and middle-income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation-based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower-middle-income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed-methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low-resource settings to evaluate their own activities.

Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training.

There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.

Bridging the gap: a simulation-based education programme to improve the management of postoperative neck haematomas

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box. This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios. 50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes. The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.

Simulation-based Bone Marrow Aspiration and Trephine Biopsy Education for Medical Students: A Non-randomized Controlled Trial.

Introduction Despite the critical role of bone marrow aspiration and a trephine biopsy (BMAT) in the diagnosis and management of hematological diseases, research on effective teaching methods is limited. Medical students traditionally learn to perform BMAT through observation and replication, which poses a risk to patient safety. Therefore, we developed a novel BMAT simulator for undergraduate medical students using a simulation-based education program. Methods This program, designed for fourth- and fifth-year medical students at Okayama University Medical School, included pre-study materials and one hour of simulation training. Internists practicing hematology served as the controls. Before and after the simulation training, the students completed questionnaires regarding self-confidence, self-evaluation, interest, and knowledge. The procedures were evaluated objectively using a checklist at the end of the program. Results There were significant improvements in self-evaluation, self-confidence, interest, and knowledge acquisition after the simulation program (p≤0.001). The checklist revealed that the mean overall proficiency level of the students was 76.9%, which was significantly higher than that of internists (63.5%) (p≤0.01). Conclusion Our simulation-based education program using the novel BMAT simulator improved medical students' BMAT knowledge and skills.

Development and Effectiveness of a Basic Epidemiological Investigation Simulation Program of Emerging Respiratory Infectious Diseases for Nursing Students: Application of Standardized Patients

Purpose: This study aimed to develop a simulation-based education program of emerging respiratory infectious diseases using standardized patients for nursing students, and to test the effects on basic epidemiological investigation performed while wearing Level D Personal Protective Equipment (PPE).Methods: A total of 64 senior nursing students were recruited and assigned to either the experimental group (n=33) or a control group (n=31) in May 2022. This program was developed based on the analysis, design, development, implementation, and evaluation model. The analysis phase consisted of a literature review and target group survey. In addition, learning objectives and a structure were designed, and a scenario was developed with expert consulting. In the implementation phase, the program was conducted the course of 3 hours. The evaluation phase involved verification of the effects on clinical performance, self-efficacy, and anxiety related to basic epidemiological investigation, as well as an assessment of satisfaction with the program.Results: There were significant differences between the experimental and control groups in clinical performance (Z=-2.15, &lt;i&gt;p&lt;/i&gt;=.010) and anxiety related to basic epidemiological investigation (Z=-4.02, &lt;i&gt;p&lt;/i&gt;&lt;.001). However, there was no significant difference in self-efficacy related to basic epidemiological investigation.Conclusion: The results indicate that this simulation-based education program was effective in improving clinical performance and reducing anxiety related to basic epidemiological investigation of nursing students. In addition, this program is expected to be widely used as an epidemiological investigation education for the initial prevention of infectious diseases.

A Train-the-Trainer Simulation Program Implemented Between Two International Partners.

With the expansion of global health initiatives focused on healthcare professional training, it is important to ensure that such training is scalable and sustainable. Simulation-based education (SBE) is a highly effective means to achieve these goals. Although SBE is widely used in the United States, its integration globally is limited, which can impact the potential of SBE in many countries. The purpose of this perspective piece is to demonstrate how a train-the-trainer program can help in the development of an international SBE program and specifically what unique issues must be considered in operationalizing this strategy.

Effectiveness of Lung Ultrasound Training Utilizing a High-Fidelity Simulator.

The usefulness of lung ultrasound (LUS) has been demonstrated. However, it is unclear whether diagnostic techniques using LUS are accepted by all physicians. A simple simulation-based educational program may improve the LUS skills of beginners, but it has not been fully assessed. This prospective study was conducted to assess the educational outcomes of LUS training using a high-fidelity simulator. A simulator-based program for LUS was conducted. All clerkship students at the Department of Respirology at Chiba University Hospital participated in the program from December 2022 to April 2023. The participants watched a 30 minute teaching video on demand before a hands-on session lasting for 1 hour during the first week of the clinical clerkship. The readiness of the participants to learn LUS and the usefulness of the program were assessed using questionnaires administered before and after the program. The LUS skills were assessed using simulator-based tests during Weeks 1 and 4. Data on the accuracy and time required to answer the questions were collected during the tests. Forty clerkship students participated in this study. Thirty-three (82.5%) had received other ultrasound education; however, only two (5.0%) had experience with LUS. Based on the questionnaire responses, the participants perceived LUS as useful (preprogram: 4.6 vs. postprogram: 4.8; P = 0.010; a 5-point Likert scale was used [1: not useful to 5: useful]). The simulator-based tests showed comparable accuracies at Weeks 1 and 4 for pneumothorax (Week 1: 47.5% vs. Week 4: 52.5%; P = 0.623), pulmonary edema (Week 1: 100% vs. Week 4: 100%; P = 1.000), and pleural effusion (Week 1: 37.5% vs. Week 4: 40.0%; P = 0.800). The time required for scanning was the same for each question. In addition, the test results did not differ with prior learning, previous knowledge, or experience during clinical clerkships on LUS. A short educational program consisting of on-demand learning and hands-on sessions with a high-fidelity simulator would be effective in equipping clerkship students with basic LUS skills. However, to increase its educational effectiveness to a practical degree, the program should be improved, and more opportunities for training using simulators should be provided.

비보건계열 대학생 대상 시뮬레이션 기반 심폐소생술 교육 프로그램의 효과

Objectives The purpose of this study is to develop simulation-based cardiopulmonary resuscitation education and apply it to non-health related college students to understand its effect.&#x0D; Methods This study was conducted on 54 non-health college students (27 in the experimental group and 27 in the control group). The control group received the general cardiopulmonary resuscitation (CPR) education, and the experimental group received the shortened version of the CPR education provided to the control group and the simulation-based CPR education developed in this study.&#x0D; Results Simulation-based CPR education was developed and applied in five stages: analysis, design, development, implement, and evaluation. The experimental group's cardiopulmonary resuscitation performance was 41.22±3.91 points, and the control group's cardiopulmonary resuscitation performance was 28.15±4.05 points, indicating a significant difference in cardiopulmonary resuscitation performance (Z=-6.32, p=&lt;.001). There were no significant differences in knowledge of CPR (Z=-0.04, p=.972), confidence in performing CPR (Z=1.00, p=.922), education satisfaction (Z=-0.28, p=.782), and immersion (Z=-0.08, p=.935).&#x0D; Conclusions Simulation-based CPR education programs was found to be effective in improving CPR performance. Therefore, the simulation-based CPR program can be used as an effective educational method for non-health college students, and it is necessary to consider ways that can be applied not only to college students but also to the general public.

Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment

Endovascular aortic repair (EVAR) is being used increasingly for the treatment of infrarenal abdominal aortic aneurysms. Improvement in educational strategies is required to teach future vascular surgeons EVAR skills, but a comprehensive, pre-defined e-learning and simulation curriculum remains to be developed and tested. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), an assessment tool for simulation based education (SBE) in EVAR, has previously been designed to assess EVAR skills, and a pass limit defining mastery level has been set. However, EVARATE was developed for anonymous video ratings in a research setting, and its feasibility for real time ratings in a standardised SBE programme in EVAR is unproven. This study aimed to test the effect of a newly developed simulation based modular course in EVAR. In addition, the applicability of EVARATE for real time performance assessments was investigated. The European Society of Vascular Surgery (ESVS) and Copenhagen Certification Programme in EVAR (ENHANCE-EVAR) was tested in a prospective cohort study. ENHANCE-EVAR is a modular SBE programme in EVAR consisting of e-learning and hands-on SBE. Participants were rated with the EVARATE tool by experienced EVAR surgeons. Twenty-four physicians completed the study. The mean improvement in EVARATE score during the course was+11.8 (95% confidence interval 9.8 - 13.7) points (p < .001). Twenty-two participants (92%) passed with a mean number of 2.8 ± 0.7 test attempts to reach the pass limit. Cronbach's alpha coefficient was 0.91, corresponding to excellent reliability of the EVARATE scale. Differences between instructors' EVARATE ratings were insignificant (p= .16), with a maximum variation between instructors of ± 1.3 points. ENHANCE-EVAR, a comprehensive certifying EVAR course, was proven to be effective. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE) is a trustworthy tool for assessing performance within an authentic educational setting, enabling real time feedback.

A Quality Improvement Project to Improve the Utilization of an Intraoperative Rapid Response System

Introduction: Rapid response teams (RRTs) improve morbidity by reducing the incidence of cardiac arrests. Although providers commonly activate RRTs on acute care wards, they are infrequently used perioperatively. At our institution, two intraoperative calls for help exist: staff assists (SAs) and code blues (CBs). The SA functions analogously to an RRT, and the CB indicates cardiopulmonary arrest. Given the success of RRTs, this project aimed to increase the use of the SA system. Our primary goal was to increase the ratio of SA to CB alerts by 50% within 6 months. Methods: A quality improvement team led this project at an academic pediatric hospital in Northern California. The team analyzed the current state and identified an achievable goal. After developing key drivers, they implemented monthly simulations to teach providers the signs of clinical deterioration and to practice activating the SA system. In addition to measuring the ratio of SA to CB alerts, the team surveyed the etiologies of SA and measured process satisfaction. Results: Before the introduction of this initiative, the ratio of SA to CB alerts were 1:13.3. These improvements efforts led to an increase of SA to CB alerts to 1.5:1 (P = 0.0003). Twenty-three anesthesiologists provided etiologies for SA, reporting laryngospasm as the most common reason (30.4%). Nineteen nurses completed the SA survey and reported high satisfaction. Conclusion: This project successfully increased the utilization of a rapid response protocol in a pediatric perioperative setting using improvement methodologies and a simulation-based educational program.

A24Calculating the cost of simulation based education. What to include?

The cost of developing simulation-based education (SBE) facilities is high. However, the cost of sustaining SBE activities is often not considered in the initial outlay and facilities and centres can find themselves in financial difficulty early on. In addition to the cost of the initial capital and technology costs, there are many other costs incurred when running and sustaining SBE programmes. These are often not apparent or considered by simulationists when establishing new programmes. Research to date has focused on cost effectiveness and a return on investment [1]. However, the sustainability of a SBE programme is related to the ability to meet these costs. The aim of this work is to develop a simulation cost calculator that considered all costs incurred in skills programme development. Following consultation with experienced simulation faculty, the finance office, human resources and buildings office and equipment providers, a cost calculator template was devised to categorize the items required for SBE. The template allows for the calculation of the cost of teaching a procedural skill per person based on the total cost of all of the items in the template plus the number of attempts required for teaching and/or assessment. The cost calculator categories for procedural skills teaching in a simulated environment included recurrent costs such as heating, light and cleaning of the simulation space/facility, consumables, single use simulators, fixed equipment/initial outlay, waste disposal, depreciation costs and staff costs. To illustrate, the calculated cost for a bowel anastomosis workshop using biological materials is approx. €235 per person while the equipment cost for a basic skill such as venepuncture is €161.17. Adequate resourcing is critical to establish, run and sustain SBE programmes. A cost calculator template will help new facilities to project their budget requirements and to decide what skills education they can support and sustain long term. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A63The use of simulation based education (SBE) to improve recognition and management of patients in the transition from acute to end of life care

Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3]. To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients. Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario. Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning. SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.