Simulation-based Medical Education Research Articles

Transformation and development of simulation-based education and child first aid skills training

Background: Simulation-based medical education is a complex learning methodology in different fields. Exposing children to this teaching method is uncommon as it is designed for adult learning. This study aimed to develop and implement simulation-based education in first aid training of children and investigate the emotions of children in post-simulation scenarios that replicate emergency situations. Methods: This was a phenomenological qualitative research study. The participants attended the modified “Little Doctor” course that aims to train children in first aid and, subsequently, completed simulation scenarios. The children attended focus groups and were asked about their experiences of the course and how they felt during the simulation scenarios. Results: 12 children (Age 8–11 years old) attended the course, and 10 completed the simulation scenarios and focus groups. The major theme derived from was the simulation experience’s effect, which was divided into two subthemes: the emotion caused by—and the behavioral response to—the simulation. The analysis revealed shock and surprise toward the environment of the simulation event and the victim. The behaviors expressed during the simulation scenarios ranged from skill application and empathy to recall and teamwork. Conclusions: Simulation scenarios were successfully implemented during the first-aid training course. Although participants reported mixed feelings regarding the experience, they expressed confidence in their ability to perform real-life skills.

From touch to skill: How tactile feedback is transforming simulation-based medical education?

From touch to skill: How tactile feedback is transforming simulation-based medical education?

Speech recognition technology for assessing team debriefing communication and interaction patterns: An algorithmic toolkit for healthcare simulation educators

BackgroundDebriefings are central to effective learning in simulation-based medical education. However, educators often face challenges when conducting debriefings, which are further compounded by the lack of empirically derived knowledge on optimal debriefing processes. The goal of this study was to explore the technical feasibility of audio-based speaker diarization for automatically, objectively, and reliably measuring debriefing interaction patterns among debriefers and participants. Additionally, it aimed to investigate the ability to automatically create statistical analyses and visualizations, such as sociograms, solely from the audio recordings of debriefings among debriefers and participants.MethodsWe used a microphone to record the audio of debriefings conducted during simulation-based team training with third-year medical students. The debriefings were led by two healthcare simulation instructors. We processed the recorded audio file using speaker diarization machine learning algorithms and validated the results manually to showcase its accuracy. We selected two debriefings to compare the speaker diarization results between different sessions, aiming to demonstrate similarities and differences in interaction patterns.ResultsTen debriefings were analyzed, each lasting about 30 min. After data processing, the recorded data enabled speaker diarization, which in turn facilitated the automatic creation of visualized interaction patterns, such as sociograms. The findings and data visualizations demonstrated the technical feasibility of implementing audio-based visualizations of interaction patterns, with an average accuracy of 97.78%.We further analyzed two different debriefing cases to uncover similarities and differences between the sessions. By quantifying the response rate from participants, we were able to determine and quantify the level of interaction patterns triggered by instructors in each debriefing session. In one session, the debriefers triggered 28% of the feedback from students, while in the other session, this percentage increased to 36%.ConclusionOur results indicate that speaker diarization technology can be applied accurately and automatically to provide visualizations of debriefing interactions. This application can be beneficial for the development of simulation educator faculty. These visualizations can support instructors in facilitating and assessing debriefing sessions, ultimately enhancing learning outcomes in simulation-based healthcare education.

Overcoming Barriers in Simulation-based Medical Education: Challenges and Strategic Solutions

Overcoming Barriers in Simulation-based Medical Education: Challenges and Strategic Solutions

Closing the Trauma Performance Improvement Loop With In-situ Simulation

IntroductionContinuous performance improvement (PI) programs are essential for excellent trauma care. We incorporated PI identified from trauma cases into an in-situ simulation-based medical education curriculum. This is a proof-of-concept study exploring the efficacy of high-fidelity pediatric trauma simulations in improving self-reported provider comfort and knowledge for identified trauma PI issues. MethodsThis study was performed at an American College of Surgeons-verified Level I Pediatric Trauma Center. Several clinical issues were identified during the trauma PI process, including management of elevated intracranial pressure in traumatic brain injury and the use of massive transfusion protocol. These issues were incorporated into a simulation-based medical education curriculum and high-fidelity in-situ trauma mock codes were held. In-depth debriefing sessions were led by a senior faculty member after the simulations. The study participants completed pre- and postsimulation surveys. Univariate statistics are presented. ResultsTwenty three providers completed surveys for the pediatric trauma simulations. Self-reported provider confidence Likert scale improved from pre- to postsimulation (P = 0.02) and trauma experience and knowledge scores improved from 82% presimulation to 93% postsimulation (P = 0.02). ConclusionsHigh-fidelity pediatric trauma simulations enhance provider comfort, knowledge, and experience in trauma scenarios. By integrating high-fidelity trauma simulations to address clinical issues identified in the trauma PI process, provider education can be reinforced and practiced in a controlled environment to improve trauma care. Future studies evaluating the implementation of clinical pathways and patient outcomes are needed to demonstrate the effectiveness of simulations in PI pathways.

2052: Simulation-based medical education to learn soft skills in radiation oncology

2052: Simulation-based medical education to learn soft skills in radiation oncology

The evolution of simulation-based medical education research: From traditional to virtual simulations

BackgroundSimulation-based medical education (SBME) is a widely used method in medical education. This study aims to analyze publications on SBME in terms of countries, institutions, journals, authors, and keyword co-occurrence, as well as to identify trends in SBME research. MethodsWe retrieved the Publications on SBME from the Web of Science Core Collection (WoSCC) database from its inception to January 27, 2024. Microsoft Excel 2019, CiteSpace, and VOSviewer were used to identify the distribution of countries, journals, and authors, as well as to determine the research hotspots. ResultsWe retrieved a total of 11272 publications from WoSCC. The number of documents published in 2022 was the highest in the last few decades. The USA, the UK, and Canada were three key contributors to this field. The University of Toronto, Stanford University, and Harvard Medical School were the top major institutions with a larger number of publications. Konge, Lars was the most productive author, while McGaghie, William C was the highest cited author. BMC Medical Education has the highest number of publications among journals. The foundational themes of SBME are “Patient simulation,” “extending reality,” and “surgical skills.” ConclusionsSBME has attracted considerable attention in medical education. The research hotspot is gradually shifting from traditional simulations with real people or mannequins to virtual, digitally-based simulations and online education. Further studies will be conducted to elucidate the mechanisms of SBME. The utilization of SBME will be more rationalized.

Level Up Your Residency: Can a Novel Two-Week Simulation Rotation Really Make a Difference?

This study describes a unique two-week simulation-based medical education (SBME) rotation for transitional year (TY) residents. During the rotation, residents are fully integrated into the simulation team, actively participating in clinically based interprofessional scenarios, procedural techniques, and mixed reality experiences. Residents also created and ran their own simulations while receiving content expert feedback. We evaluated the rotation's effectiveness in preparing TY graduates for their specific advanced residency track. A retrospective survey evaluated the experiences of 11 TY residents who participated in a unique two-week simulation rotation. The survey assessed residents' perceptions of the program's value and skill development, course design, scenario relevance to future practice, and preparedness to develop future scenarios. Residents (11 out of 12 residents, 92% response rate) overwhelmingly endorsed the simulation rotation (100% positive, 45.45% extremely valuable). The program demonstrably improved core clinical skills (100% reported improvement) and fostered self-efficacy for future practice. Scenario relevance was high (81.82% highly relevant). Collaboration and communication skills showed promise (72.73% positive) while highlighting a potential area for future refinement. Residents unanimously agreed on effective time allocation and the program's value for debriefing skills. Notably, 91% strongly supported residency-specific simulation training. The two-week simulation was perceived by prior TY residents as valuable, with a majority finding the experience highly valuable across multiple survey questions. Residents overwhelmingly expressed a preference for residency-specific training, suggesting future development of specialty-tailored modules and enhanced debriefing sessions. The findings highlight the program's effectiveness and successful implementation into a TY residency curriculum.

Simulation-Based Medical Education: 3D Printing and the Seldinger Technique

Three-dimensional (3D)-printed models with high anatomic fidelity are an increasingly viable tool in simulation-based medical education. One advantage of 3D models is they provide enhanced tactile and spatial understanding of complex anatomy to develop technical skills used in minimally invasive procedures. We propose that 3D anatomical models can improve the development of interventional radiology vascular access skills—first described in the 1950s as the Seldinger technique—for pre-clerkship medical students. The early adoption of 3D-printed technology in pre-clinical medical education can lead to improved student engagement and satisfaction when learning procedural techniques. This study involved creating a 3D model of the upper limb vasculature from an anonymized Computed tomography (CT) angiogram, using it as a medical education tool for 31 pre-clinical medical students practicing the Seldinger Technique on a prefabricated venipuncture upper limb, and assessing student satisfaction with this form of learning. Overall, attendees responded positively to the incorporation of the 3D model in medical education to improve their anatomic understanding and application of the Seldinger technique. These results indicate that the use of 3D models in simulation-based medical education can provide benefits in acquiring technical skills and the potential to decrease training costs without harming a patient.

Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort

IntroductionA survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. MethodsWe analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. Results93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (−28.3%, p 0.03). DiscussionOphthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. ConclusionSpain massively adopts the model named by us "surgery for all”, despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Bridging theory and practice: enhancing medical education through simulation-based training methods

ntroduction. With the complexities of contemporary healthcare systems and the paramount importance of high-quality patient care, Simulation-Based Medical Education (SBME) has emerged as a pivotal innovation in the process of training healthcare professionals. This study explores the integration of SBME in undergraduate medical education to bridge the gap between theoretical knowledge and clinical practice, thereby preparing students with the necessary competencies for effective healthcare delivery. Material and methods. Employing a narrative review approach, this study meticulously examined relevant literature from multiple databases, including Google Scholar, PubMed, and MedEdPublish. Following objectives, we chose the sources that were best suited to explore our research questions, focusing on keywords such as „simulation”, „undergraduate medical education”, „simulation-based medical education”, „theoretical frameworks”, „procedural framework” „curriculum design”, „training efficacy”, and „training evaluation” with no restriction for the date of publications. Results. The review identified foundational educational theories underpinning SBME, such as Experiential Learning Theory and Adult Learning Theory, and traced the evolution of simulation methods from simple anatomical models to sophisticated high-fidelity simulators and virtual reality technologies. Various simulation techniques, including task trainers, manikins, and standardized patients, were analyzed for their educational value. Significant benefits of SBME, such as enhanced safety, repeatability, and adaptability, were highlighted alongside challenges like high costs and limited access. Comparative analysis revealed SBME’s advantages over traditional clinical education, particularly in learning efficiency and scalability. Conclusions. SBME represents a transformative approach in undergraduate medical education, offering a dynamic and interactive learning environment that significantly enhances clinical skills, critical thinking, and confidence. Despite its challenges, the integration of simulation-based methodologies into medical curricula is essential for addressing the evolving needs of medical training and improving patient care outcomes. Future research should focus on longitudinal studies to assess the long-term impact of SBME on clinical practice and explore the integration of emerging technologies to enhance the efficacy and accessibility of simulation-based training.

EVALUATING THE IMPACT OF HYBRID SIMULATION IN ENHANCING THE LEARNING DOMAINS OF MEDICAL UNDERGRADUATES: A QUASI-EXPERIMENTAL STUDY

Objectivs: Medical education, crucial for understanding physiological processes and clinical application, faces limitations in traditional methods. Simulation-based training addresses this gap, providing a secure environment for hands-on skill practice. The objectives of the study are to (1) evaluate the impact of simulation on enhancing the learning domains of medical undergraduates and (2) gauge students’ perceptions of simulation based medical education (SBME) through a pre-validated, pre-designed questionnaire. Methods: A quasi-experimental study, involving 60 medical undergraduates, selected by convenient sampling. The study began after obtaining approval from the Institutional Human Ethics Committee and obtaining informed consent from students. A pre-test was conducted for all 60 students followed by a lecture on simulation and then a post-test. The students were then divided into two groups: Group A – SBME using part-task trainers and standardized patients and Group B – (non-SBME) with video lectures on simulation. After 1 month, an assessment of all domains, namely cognitive, affective, and psychomotor, was done by post-test and objective structured clinical examination, respectively. Perception was obtained using the pre-validated questionnaire. Results: The assessment scores of all domains of Group A (SBME) showed significant improvement p<0.05 except cognitive domain. Conclusion: SBME is an effective teaching method for improving the learning domains of medical undergraduates.

Early Clinical Simulation Exposure May Enhances Academic Performance of Medical Students: A Quasi-Experimental Study in Saudi Arabia

Purpose: The traditional medical curriculum in Saudi Arabia needs to undergo major reforms to make it more student-centric, relevant, interesting and contemporary. This unmet need can be fulfilled by the use of “Early Clinical Exposure “(ECE) techniques, employed via simulation based medical education (SBME) courses, integrated into the medical curriculum. This study delivered ECE via SBME, to third year pre-clinical students, and assessed its impact on their fourth-year academic scores. Materials and Methods: SBME modules designed by expert faculty members were delivered through a peer-assisted learning model, spread over a three-week period, at a well-equipped medical simulation laboratory at our teaching hospital, in Jeddah, Saudi Arabia. Students who attended this SBME intervention were tracked for their performance in their fourth year, versus the control group. Result: Of the 401 third year students included in the study, only 30.2% consented to attend the SBME course, while 69.8% comprised the control group. The overall study population obtained a mean score of 40.27 in the fourth-year final examination. The male and female students who attended the SBME module obtained a statistically significantly higher mean score versus the non-attendees (p=0.0018). Among the SBME course attendees, no statistically significant difference was noted between the scores of males and females (p=0.187). Conclusion: SBME exposure during the pre-clinical years has a significantly positive impact on the performance of students, in the core clinical years at medical college. It holds promise in reducing redundancies in medical education, making medical studies more interesting, relevant, contemporary and practical. It facilitates seamless transition of students from pre-clinical to clinical years in medical college. Implementation of early SBME courses at the pre-clinical level, mandated and supported by government initiatives, would be a huge step forward in the medical education in Saudi Arabia.

High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education.

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

A Modified Delphi Study for Curricular Content of Simulation-Based Medical Education for Pediatric Residency Programs

ObjectiveWe sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME). MethodsWe conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥70% rated the item as extremely important and exclusion as ≥70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of three rounds. ResultsA total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least one content item that experts considered important to teach through simulation as compared to other modalities. ConclusionsUsing consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content.

Using Mixed Reality Simulation to Improve Junior Medical Trainees’ Preparedness to Manage High-Acuity Trauma

High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This...

Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey.

Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs. We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020. The survey consisted of questions pertaining to the characteristics of the simulation centres, their faculty, learners, curriculum, and assessment processes. All 17 residency training programs participated in the survey and reported large variability in the number and formal training of simulation faculty and in content delivery. Five programs (29%) did not provide faculty recognition for curriculum design and running simulation sessions. Most programs offered one to four simulation sessions per academic year for each year of residency. All programs offered mannequin-based and part-task trainers for teaching technical and nontechnical skills. Fourteen programs (82%) offered interprofessional and interdisciplinary simulation sessions, and ten programs (59%) did not include in situ simulation training. Commonly reported barriers to faculty involvement were lack of protected time (12 programs, 71%), lack of financial compensation (ten programs, 59%), and lack of appreciation for SBME (seven programs, 41%). Large variability exists in the delivery of SBME in Canadian anesthesiology residency simulation programs, in part because of differences in financial/human resources and educational content. Future studies should explore whether training and patient outcomes differ between SBME programs and, if so, whether additional standardization is warranted.

Feasibility and evaluation of high-fidelity simulation education for acute clinical toxicology.

To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.

Current Use of Simulation in Canadian Cardiology Residency Programs: Painting the Landscape to Better Visualise the Future

Simulation-based medical education (SBME) has been proposed as a method to expose cardiology residents to common and uncommon clinical scenarios. This approach aims to develop the core clinical competencies required for practice amidst many constraints, such as reduced training hours, limited patient encounters, and increased healthcare complexity. SBME fits particularly well in the Canadian Competency-by-Design framework, where the emphasis is on measurable competencies and achievement of milestones. This survey-based study aims to outline the current uses of SBME in Canadian cardiology residency programs, explore opportunities for SBME to enhance current approaches and identify barriers to its integration into the curriculum.

Efficacy of an Antimicrobial Reality Simulator (AMRSim) as an Educational Tool for Teaching Antimicrobial Stewardship to Veterinary Medicine Undergraduates

Purpose: Simulation-based medical education has changed the teaching of clinical practice skills, with scenario-based simulations being particularly effective in supporting learning in veterinary medicine. In this study, we explore the efficacy of simulation education to teach infection prevention and control (IPC) as part of Antimicrobial Stewardship (AMS) teaching for early years clinical veterinary medicine undergraduates. Methods: The intervention was designed as a 30-minute workshop with a simulation and script delivered online for 130 students as a part of hybrid teaching within the undergraduate curriculum. Learning outcome measures were compared between an intervention group and waitlist-control group using one-way between-groups analysis of covariance tests. Results: Significant differences between groups were found for outcomes measures related to short-term knowledge gain and confidence in IPC and AMS in small animal clinical practice. However, lateral knowledge transfer to large animal species clinical practice showed no significant differences. Student feedback indicated that the intervention was an enjoyable and engaging way to learn AMS. Conclusions: The intervention provided short-term knowledge gain in IPC protocols and enhanced procedural skills via active learning and motivation to learn in large groups of students. Future improvements would be to include large animal clinical scenario discussions and evaluate longer-term knowledge gain.