Simulation-based Medical Training Research Articles

Comparison of simulation and video-based training for acute asthma

BackgroundEmergency medicine is particularly well suited to simulation training. However, evidence for the efficacy of simulation-based medical training remains limited especially to manage high-risk cases such as acute asthma.ObjectiveThe objective of our study was to compare the performance of high-fidelity simulation (HFS) and interactive video-case challenge-based training (IVC) for final-year medical students in the management of acute asthma.MethodsThis was a prospective randomized controlled study conducted at the emergency department (ED) of Monastir University hospital ( Tunisia). 69 final-year medical students were randomized to HFS (n = 34) and IVC (n = 35) training on acute asthma topic. The study was conducted over a 1-week period. Efficacy of each teaching method was compared through the use of multiple-choice questionnaires (MCQ) before (pre-test), after (post-test) training and a simulation scenario test conducted 1 week later. The scenario was based on acute asthma management graded on predefined critical actions using two scores: the checklist clinical score (range 0 to 30), and the team skills score (range 0 to 16). Student satisfaction was also evaluated with the Likert 5 points scale. Two years after the post-test, both groups underwent a third MCQ testing to assess sustainability of knowledge.ResultsThere were no differences in age between groups. There was no statistically significant difference between the HFS and IVC groups pre-test scores (p = 0.07). Both groups demonstrated improvement in MCQ post-test from baseline after training session; the HFS MCQ post-test score increased significantly more than the IVC score (p < 0.001). The HFS group performed better than the IVC group on the acute asthma simulation scenario (p < 0.001). Mean checklist clinical score and mean team skills score were significantly higher in HFS group compared to IVC group (respectively 22.9 ± 4.8 and 11.5 ± 2.5 in HFS group vs 19.1 ± 3 and 8.4 ± 3.1 in IVC group) (p < 0.001). After 2 years, MCQ post-test scores decreased in both groups but the decrease was lower in HFS group compared to the IVC group.ConclusionHigh-fidelity simulation-based training was superior to interactive video-case challenge for teaching final year medical students,and led to more long-term knowledge retention in the management of simulated acute asthma patients.Trial registrationThe study was registered at www.clinicaltrials.gov NCT02776358 on 18/05/2016.

Evaluating the use of role-play simulations in teaching management of medical emergencies in the dental clinic

BackgroundPractical hands-on training is necessary for clinical competence in managing medical emergencies in the dental setting. Therefore, the King Abdulaziz University Faculty of Dentistry developed a role-play simulation-based clinical module for training clinical years (Years 4, 5, and 6) dental students in medical emergency management between 2016 and 2020. This study aimed to assess the knowledge and skills of years 4, 5, and 6 dental students before and after the completion of the role-play simulation-based medical emergency training module.MethodsA mandatory four-hour annual training module was designed consisting of a 45-minute lecture on the medical emergency basic action plan and overview, four hands-on stations, and six role-play simulation-based medical emergency stations. A 16-item multiple choice test was used to assess the knowledge of the students before and after the training module every academic year. An objective structured clinical exam (OSCE) on a medical emergency scenario was administered to the students graduating each year. The difference between the pre- and post-module test scores and the one-time OSCE pass/fail rate were analyzed statistically using appropriate tests.ResultsA total of 846 students participated in the study between 2017 and 2020: 275 once, 483 twice, 87 thrice, and one participated four times; in total, 1,506 assessments were conducted. Overall, the pre-test and post-test mean scores were 9.4 ± 3.0 and 13.5 ± 1.6, respectively. All students showed significant improvements in the post-test scores compared to the pre-test scores. Year 4 students showed the highest improvement, followed by Year 5 and Year 6. There was a statistically significant association between the pass/fail rate of the OSCE station and the number of times the module was taken.ConclusionsThe significant improvement in the scores of clinical year students in this study supports an annual mandate for all dental students to undergo simulation-based competency training in their clinical years. Teaching institutions are recommended to utilize simulation and hands-on instruction to teach medical emergency management.

Application of 3D Printing in Training Health Care Providers; the Development of Diverse Facial Overlays for Simulation-Based Medical Training.

The medical simulation manikins used by healthcare learners provide the training of numerous clinical skills but often lack diversity with respect to race, ethnicity, age, and sex. Having a diverse medical education environment is imperative for exposing learners to the diverse population of patients they may encounter when in practice. In this technical report, the development of diverse and cost-effective facial overlays produced using 3D scanning, 3D printing, and silicone to be used on top of the current medical manikins at Lakeridge Health Hospital (Oshawa, Ontario, Canada) is described. To obtain consistent feedback throughout the development process, an advisory committee was consulted monthly at Lakeridge Health Hospital. The process began by determining that two facial overlays would be developed based on the two groups that represent the highest percentage of visible minorities in the Durham Region (Ontario, Canada). Facial overlays representing the South Asian (31.8%) and Black (29.6%) races were chosen. To prevent the generalizability of the facial features of these two races, volunteers who identified as specific ethnicities (East Indian and Jamaican) within each race were selected. To add variation in age for the facial overlays, the East Indian facial overlay was edited to represent an adolescent teenager (15 to 17 years old) and the Jamaican overlay was edited to represent an elderly citizen (over 60 years old). The facial overlays were developed from the 3D scans of the two volunteers and were used to create the design of 3D printed molds, in which silicone was poured in. Pigments were added to the silicone to match the skin tones of the two volunteers, and these specific tones were used as the base color for each facial overlay. Details, such as wrinkles, eyebrows, and lip color, were painted on top of the base using additional pigmented silicone. Additionally, neck overlays were created to provide continuity of the skin tone of the facial overlay. To retain the functionality of the medical manikins, the eyes of the facial overlays were cut out, and the mouth was cut open to allow for intubation training. For stability purposes, Velcro attachments were added to the facial and neck overlays so that they could be secured onto the medical manikins. Overall, the costs to manufacture both facial overlays resulted in CAD 235.65, including local taxes. Once manufactured, both facial overlays were tested by medical students (n=18) during two separate advanced cardiovascular life support (ACLS) training sessions in the local, hospital-based simulation laboratory at Lakeridge Health Hospital. The feedback obtained suggested a need to improve the functionality of the facial overlays by making the mouths bigger and less stiff for easier intubation. However, the overlays were accepted overall as a means to add diversity to the current medical manikins. In the end, cost-effective and diverse facial overlays were created to be used on top of the medical manikins that are currently being used by healthcare learners at Lakeridge Health Hospital.

Neonatal simulation training decreases the incidence of chest compressions in term newborns

Aim of the studyTo determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters. MethodsThis was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012–2014) and post-training (2015–2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions. ResultsOf 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001). ConclusionAlthough there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome–related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.

Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block.

BackgroundAdvances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block.MethodsFifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire.ResultsThe time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course.ConclusionsA 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.

Augmented Reality, Mixed Reality, and Hybrid Approach in Healthcare Simulation: A Systematic Review

Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients.

Avoiding Fumbles: Online Patient Handoff Training.

The COVID-19 pandemic required rapid curriculum adaptation to online delivery. Given the importance of accurate clinical patient handoffs, we adapted simulation-based medical student training in clinical patient handoffs. We scored the accuracy of the information students presented. We also elicited student feedback to determine their perceptions of the event and their evaluations of the effectiveness of the training. Twenty-six third-year medical students participated online via Zoom. Students participated in groups of three or four students. They sequentially encountered a standardized patient. Clinical information and physical exam findings were handed off from student to student until the encounter was complete. The student group then debriefed with faculty. Students were evaluated based on the proportion of clinical information handed off to the following student. Students also evaluated the training session. The first student handoff included 73.4% of the available information. In subsequent handoffs, the percentage fell to 43%. All students said they felt the training was helpful in practicing patient handoffs and interactions with colleagues. Negative student comments focused on perceived deficiencies in session planning and standardized patient training. This rapidly developed simulation session demonstrated that clinical training in patient handoffs can be adapted to an online environment. In order to ensure success, faculty should carefully consider logistical adjustments required to transition from a patient contact setting to an online environment. Meticulous preparation and attention to detail will ensure that training is successful.

Simulation capacity building in rural Indian hospitals: a 1-year follow-up qualitative analysis

IntroductionThe benefits of simulation-based medical training are well described. The most effective way to plant and scale simulation training in rural locations remains undescribed. We sought to plant simulation training...

An ethnographic study on leadership-as-practice in trauma simulation training

PurposeThis study aims to discover how leadership emerges in a hospital’s trauma team in a simulated trauma care situation. Instead of investigating leadership from a leader-centric perspective, or using a metrics-based approach to reach generalizable results, the study aims to draw from post-heroic theories by applying leadership-as-practice and sociomaterial perspectives that emphasize the cultural-historical context and emergent nature of leadership.Design/methodology/approachThe study was conducted in a Finnish central hospital through ethnographic observations of 14 in situ trauma simulation trainings over a period of 13 months. The data consist of vignettes developed and written from field notes. The analysis was informed by the cultural-historical activity theory.FindingsLeadership in a trauma team during an in situ simulation training emerges from a complex system of agencies taking place simultaneously. Contextual elements contributed to the goal. Clarity of roles and task division, strong execution of leadership at critical points, active communication and maintenance of disciplined communication helped to overcome difficulties. The team developed coordination of the process in conjunction with the care.Originality/valueThe study considers trauma leadership to be a practical phenomenon emerging from the trauma team’s sociomaterial context. The results can be used to develop non-technical skills training within the field of simulation-based medical training.

Lumbar Puncture: Creation and Resident Acceptance of a Low-Cost, Durable, Reusable Fluoroscopic Phantom with a Fluid-Filled Spinal Canal for Training at an Academic Program

Simulation-based medical training provides learners a method to develop technical skills without exposing patients to harm. Although fluoroscopic phantoms are already adopted in some areas of radiology, this has historically not been for lumbar puncture. Commercially available phantoms are expensive. We report a cost-effective, accessible solution by creation of an inexpensive phantom for resident training to perform fluoroscopically guided lumbar puncture, as well as instructions on how to make a phantom for residency education. An anthropomorphic ballistics-gel phantom that contains a plastic lumbar vertebral column and simulated CSF space was created. Radiology residents with minimum or no experience with fluoroscopically guided lumbar punctures were given a brief education and practiced fluoroscopically guided lumbar punctures on the phantom. A survey from the residents was then done. The phantom was qualitatively quite durable and deemed adequate for educational purposes. All the residents surveyed expressed the desire to have this phantom available and it increased comfort, knowledge, and perceived likelihood of success. Few articles have been published that focused on low-cost phantom creation for fluoroscopic-procedure training. This study supports the benefits of using phantoms for fluoroscopic training as well as step-by-step instructions for creation of this phantom. The residents responded positively and felt more confident in their fluoroscopically guided techniques. The ability to make a long-term training device for resident education would be inexpensive and relatively easy to implement in academic programs.

Rapid Preparation of Eye Tracking Data For Debriefing In Medical Training: A Feasibility Study

Simulation-based medical training is an increasingly used method to improve the technical and non-technical performance of clinical staff. An essential part of training is the debriefing of the participants, often using audio, video, or even eye tracking recordings. We conducted a practice-oriented feasibility study to test an eye tracking data preparation procedure, which automatically provided information about the gaze distribution on areas of interest such as the vital sign monitor or the patient simulator. We acquired eye tracking data during three simulation scenarios and provided gaze distribution data for debriefing within 30 minutes. Additionally, we qualitatively evaluated the usefulness of the generated eye tracking data for debriefings. Participating students and debriefers were mostly positive about the data provided; however, future research should improve the technical side of the procedure and investigate best practices regarding how to present and use the data in debriefings.

Simulation-based medical training for paediatric residents in Italy: a nationwide survey

BackgroundA prompt start to an appropriate neonatal and paediatric resuscitation is critical to reduce mortality and morbidity. However, residents are rarely exposed to real emergency situations. Simulation-based medical training (SBMT) offers the opportunity to improve medical and non-technical skills in a controlled setting. This survey describes the availability and current use of SBMT by paediatric residents in Italy with the purpose of understanding residents’ expectations regarding neonatal and paediatric emergency training, and identifying gaps and potential areas for future implementation.MethodsA survey was developed and distributed to Italian residents. SBMT was defined as any kind of training with a mannequin in a contextualised clinically realistic scenario.ResultsThe response rate was 14.4%, covering the 71% of Italian paediatric residency programmes. Among them, 88% stated that Out of the 274 residents, 88% stated that they received less than 5 h of SBMT during the past training year, with 66% not participating in any kind of simulation activity. In 62% of the programmes no simulation training facility was available to residents. Among those who received SBMT, 46% used it for procedures and skills, 30% for clinical scenarios, but only 24% of them reported a regular use for debriefing. Of the overall respondents, 93% were interested in receiving SBMT to improve decision-making abilities in complex medical situations, to improve technical/procedural skills, and to improve overall competency in neonatal and paediatric emergencies, including non-technical skills. The main barriers to the implementation of SBMT programmes in Italian paediatric residencies were: the lack of experts (57%), the lack of support from the school director (56%), the lack of organisation in planning simulation centre courses (42%) and the lack of teaching materials (42%).ConclusionsThis survey shows the scarce use of SBMT during paediatric training programmes in Italy and points out the main limitations to its diffusion. This is a call to action to develop organised SBMT during paediatric residency programs, to train qualified personnel, and to improve the quality of education and care in this field.

Development of an Anatomical Silicone Model for Simulation-based Medical Training of Obstetric Anal Sphincter Injury Repair in Bangladesh.

Advancing global healthcare in developing countries has traditionally been an area of interest for many North American medical organizations, as they strive to improve patient outcomes by helping to control disease and death-related illnesses. Women’s healthcare in developing countries, in particular, presents a unique set of complexities, revealing high maternal mortality statistics surrounding pregnancy, labor, and childbirth, which is often tied to home births without medically trained attendants. In September 2018, Team Broken Earth, a Canadian-based outreach initiative, hosted a three-day women’s healthcare course in Dhaka, Bangladesh, which included simulation-based training stations, for the purpose of advancing clinical skills and education in regards to local labor and delivery. The training stations included the prevention of shoulder dystocia, helping babies breathe, the application of uterine compression sutures, and the repair of obstetric anal sphincter injuries (OASIS). The OASIS management station provided an opportunity to practice anal sphincter repair on anatomically accurate silicone models, which was a focus of the training course due to the high frequency of such injuries in rural Bangladesh. Evaluation surveys were supplied to workshop participants to capture their feedback about the use of the OASIS models and their efficacy as a training tool in Bangladesh.Overall, the models were considered superior as compared to pre-existing training methods, which traditionally involve textbook education and hands-on learning in emergency birthing scenarios by non-medically trained attendants. Two minor iterative improvements were suggested during the Team Broken Earth workshops in Dhaka, Bangladesh, with regards to improving the models for future use: (a) the ethnicity coloring of the models should be more inclusive, especially when delivering training in international countries, and (b) future silicone models should include the addition of mesh across the bottom layer to ensure participants fingers did not rupture the enclosed vaginal canal while suturing. The purpose of this technical report is to determine the efficacy of a silicone OASIS model, developed for practicing high-risk laceration repair that can occur during childbirth, which presents in higher frequency in developing countries, such as Bangladesh, due to the number of rural at-home deliveries.The original study in this series involved the investigation of silicone perineal repair models focusing on first- and second-degree lacerations, which were used at the Remote and Rural Conference in St. John’s, Newfoundland, in April 2018. The facilitators distributed the first iteration of the models to conference participants and collected participant feedback, which concluded that several improvements were required to enhance the models for medical training purposes. With the iterative revisions complete, the model is now under further validation testing to determine its efficacy within simulation-based medical education (SBME) and clinical skill maintenance. This technical report is the second in the series and includes the most recent third and fourth-degree silicone models as well as all suggested improvements from previous clinical feedback.

The additional ımpact of simulation based medical training to traditional medical training alone in advanced cardiac life support: a scenario based evaluation

Objectives. The principal aim of medical education is to provide medical student with the fundamental knowledge and re-quired skills that can be specifically used in real-life conditions such as high-quality cardiopulmonary resuscitation (CPR). Traditional medical training (TMT) is an effective method in Advanced cardiac life support (ACLS) training. Simulation-based medical training (SBMT), with the advancements in technology, is a relatively new, but a preferred ACLS training method since it implements a safe educational en-vironment. We planned a scenario-based study to evaluate the additional impact of SBMT to TMT alone in ACLS training. Methods. This before-after type,&nbsp;com-parative,&nbsp;cohort study was performed in a simulation center. One hundred thirty-six 6th grade medical students who took ACLS training with TMT on their emer-gency medicine clerkship were enrolled in 34 teams. All students managed a specific ACLS scenario before and after SBMT with a high-fidelity manikin. All data regarding chest compression, airway management, defibrillation and drug administration were recorded by the sensors of the high-fidelity manikin.Results. Median age was 23 and 51.5% were male. After SBMT, we found significant increases in the successful CPR cycle rate and&nbsp;successful scenario completion rate (60.3%; 61.8%, respectively). Median time to chest compression (Tcc) and defibrillation&nbsp;(Tdef) were&nbsp;significantly decreased after SBMT (1 sec., 1 sec., respectively). For the adequacy of chest compressions, compression depth, recoil, and frequency are all significantly increased after SBMT, 7.0 mm, 6.0 mm and 8.5/min, respectively.&nbsp;Conclusion. SBMT in combination with TMT is a promising ACLS training meth-od when compared to TMT alone.

Efficacy of Obstetric Simulation in the Learning of Skills Related to Birthing Care in Medical Students, Medellin-Colombia

Introduction: In Colombia, studies regarding the effectiveness of simulation-based medical training programmes are scarce. Objective: To evaluate the effectiveness of a simulationbased obstetric educational intervention in the learning of skills related to birthing care in medical students in Medellin (Colombia). Methods: A randomized experimental study of 28 students who received the intervention and 21 students who did not receive the intervention and served as the control group. A scale was constructed and psychometrically evaluated to measure competencies in three domains, Being, Knowing, and Doing, in birthing care; this scale was applied before and after the intervention, generating a rating between 0 (poorest) and 100 (best). The effectiveness of the educational intervention was evaluated using differences-indifferences and linear regression analysis. Results: The scale showed excellent psychometric properties in the domains of knowing and doing, with Cronbach’s α-value greater than 0.80; furthermore, 100% success in internal consistency, discriminant power, and content validity added to the high explained variance. The intervention did not generate significant changes in the competency in the being domain and was effective in improving competencies in the Knowing and Doing domains, with increases of 23.9 and 27.2 points, respectively. Conclusion: The simulation-based birth-related skills learning programme was effective in increasing the competencies of knowing and doing in medical students.

Use of simulation-based medical training in Swiss pediatric hospitals: a national survey

BackgroundSimulation-based medical training (SBMT) is a powerful tool for continuing medical education. In contrast to the Anglo-Saxon medical education community, up until recently, SBMT was scarce in continental Europe’s pediatric health care education: In 2009, only 3 Swiss pediatric health care institutions used SBMT. The Swiss catalogue of objectives in Pediatrics does not acknowledge SBMT. The aim of this survey is to describe and analyze the current state of SBMT in Swiss pediatric hospitals and health care departments.MethodsA survey was carried out with medical education representatives of every institution. SBMT was defined as any kind of training with a mannequin excluding national and/or international standardized courses. The survey reference day was May 31st 2015.ResultsThirty Swiss pediatric hospitals and health care departments answered our survey (response rate 96.8%) with 66.6% (20 out of 30) offering SBMT. Four of the 20 hospitals offering SMBT had two independently operating training simulation units, resulting in 24 educational units as the basis for our SBMT analysis. More than 90% of the educational units offering SBMT (22 out of 24 units) were conducting in-situ training and 62.5% (15 out of 24) were using high-technology mannequins. Technical skills, communication and leadership ranked among the top training priorities. All institutions catered to inter-professional participants. The vast majority conducted training that was neither embedded within a larger educational curriculum (19 out of 24: 79.2%) nor evaluated (16 out of 24: 66.6%) by its participants. Only 5 institutions (20.8%) extended their training to at least two thirds of their hospital staff.ConclusionsTwo thirds of the Swiss pediatric hospitals and health care departments are offering SBMT. Swiss pediatric SBMT is inter-professional, mainly in-situ based, covering technical as well as non-technical skills, and often employing high-technology mannequins. The absence of a systematic approach and reaching only a small number of healthcare employees were identified as shortcomings that need to be addressed.

Assessment of Simulated Emergency Scenarios: Are Trained Observers Necessary?

Objectives: Simulation-based medical training is associated with superior educational outcomes and improved cost efficiency. Self- and peer-assessment may be a cost-effective and flexible alternative to expert-led assessment. We compared accuracy of self- and peer-assessment of untrained raters using basic evaluation tools to expert assessment using advanced validation tools including validated questionnaires and post hoc video-based analysis. Methods: Twenty-eight simulated emergency airway management scenarios were observed and video-recorded for further assessment. Participants consisted of 28 emergency physicians who were involved in four different airway management scenarios with different roles: One scenario as a team leader, one as an assisting team member, and two as an observer. Non-technical skills (NTS) and technical skills (TS) were analyzed by three independent groups: 1) the performing team (PT) consisted of the two emergency physicians acting either in the role of team leader or team member (self-assessment); 2) the observing team (OT), consisted of two of the participating emergency physicians not involved in the current clinical scenario (peer-assessment) and assessment occurred during (OT) or directly after (PT) the simulation without prior specific interpretational training but using standardized questionnaires; and 3) the expert team (ET) consisted of two specifically trained external observers (one psychologist and one emergency physician) using video-assisted objective assessment combined with standardized questionnaires. Results: Intragroup reliability demonstrated by intra-class correlation (ICC) was moderate to good for TS (ICC 0.42*) and NTS (ICC 0.55*) in PT and moderate to good for TS (ICC 0.41*) or poor for NTS (ICC 0.27) in OT. ET showed an excellent intragroup reliability for both TS (ICC 0.78*) and NTS (ICC 0.81*). Interrater reliability was significantly different between ET and PT and between ET and OT for both TS and NTS. There was no difference between OT and PT for neither TS nor NTS; *p < 0.05. Conclusions: Expert assessment of simulation-based medical training scenarios using validated checklists and performance of post hoc video-based analysis was superior to self- or peer-assessment of untrained observers for both TS and NTS.

Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study.

Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. Before and after intervention study. University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P < 0.001 for comparison with pretraining scores) and 26.5 (±5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (±1.0) points before training, 5.0 (±1.04) after training (P < 0.001 for comparison with pretraining scores) and 3.7 (±1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (±2.3) before training, 19.9 (±1.06) after training (P < 0.001 for comparison with pretraining scores) and 17.4 (±1.41) (P = 0.002 for comparison with pretraining scores). The percentage of correct answers in the multiple-choice questionnaire increased from 76.0% (±7.9) before training to 87.7% (±4.4) after training (P < 0.001). Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.

Validity of Cognitive Load Measures in Simulation-Based Training: A Systematic Review.

Cognitive load theory (CLT) provides a rich framework to inform instructional design. Despite the applicability of CLT to simulation-based medical training, findings from multimedia learning have not been consistently replicated in this context. This lack of transferability may be related to issues in measuring cognitive load (CL) during simulation. The authors conducted a review of CLT studies across simulation training contexts to assess the validity evidence for different CL measures. PRISMA standards were followed. For 48 studies selected from a search of MEDLINE, EMBASE, PsycInfo, CINAHL, and ERIC databases, information was extracted about study aims, methods, validity evidence of measures, and findings. Studies were categorized on the basis of findings and prevalence of validity evidence collected, and statistical comparisons between measurement types and research domains were pursued. CL during simulation training has been measured in diverse populations including medical trainees, pilots, and university students. Most studies (71%; 34) used self-report measures; others included secondary task performance, physiological indices, and observer ratings. Correlations between CL and learning varied from positive to negative. Overall validity evidence for CL measures was low (mean score 1.55/5). Studies reporting greater validity evidence were more likely to report that high CL impaired learning. The authors found evidence that inconsistent correlations between CL and learning may be related to issues of validity in CL measures. Further research would benefit from rigorous documentation of validity and from triangulating measures of CL. This can better inform CLT instructional design for simulation-based medical training.

Virtual reality for medical training: the state-of-the-art

Virtual reality (VR) medical simulations deliver a tailored learning experience that can be standardized, and can cater to different learning styles in ways that cannot be matched by traditional teaching. These simulations also facilitate self-directed learning, allow trainees to develop skills at their own pace and allow unlimited repetition of specific scenarios that enable them to remedy skills deficiencies in a safe environment. A number of simulators have been validated and have shown clear benefits to medical training. However, while graphical realism is high, realistic haptic feedback and interactive tissues are limited for many simulators. This paper reviews the current status and benefits of haptic VR simulation-based medical training for bone and dental surgery, intubation procedures, eye surgery, and minimally invasive and endoscopic surgery.