Simulation-based Procedural Training Research Articles

Clinical Simulation for Procedural Expertise: State of Education and Application

Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.

Simulation-based procedural training – a pilot programme that delivers training in a novel way

Simulation-based procedural training – a pilot programme that delivers training in a novel way

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BackgroundThe effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.MethodsA prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student’s communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).ResultsFifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].ConclusionSimulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

Improving Pediatric Procedural Skills for EMS Clinicians: A Longitudinal Simulation-Based Curriculum with Novel, Remote, First-Person-View Video-Based Outcome Measurement

Objective Emergency medical services (EMS) clinicians are expected to provide expert care to all patients, but face obstacles in maintaining skillsets required in the care of critically ill or injured children. The objectives of this study were to describe and assess the effectiveness of a pediatric-focused, simulation-based, procedural training program for EMS clinicians, delivered on-site by a pediatric simulation education team. We also describe a novel, remote, asynchronous performance outcome measurement system using first-person-view video review. Methods This was a prospective study of simulation-based training and procedural outcomes. The study population involved EMS clinicians at three fire-based EMS agencies stratified as urban, suburban, and rural sites. The primary outcome was performance of intraosseous catheterization (IO), bag-valve-mask ventilation (BVM), and supraglottic device placement (SGD), measured across three time points. Secondary outcomes were identification of differences across EMS agencies and participant survey responses. Results We obtained video data from 122 clinicians, totaling 561 videos, with survey response rates of 89.0–91.3%. Pre-intervention scores were high: least-square means (95% confident-intervals) 9.5 (8.9, 10.2) for IO; 9.6 (9.3, 9.9) for BVM; and 11.6 (10.9, 12.2) for SGD. There was significant improvement post-intervention: 11.5 (10.7, 12.3) for IO; 11.0 (10.7, 11.4) for BVM; and 13.6 (12.8, 14.4) for SGD. Improvement was maintained at follow-up after a median of 9.5 months: 10.5 (9.8, 11.2) for IO; 10.2 (9.9, 10.6) for BVM; and 12.4 (11.7, 13.1) for SGD. There were no statistical differences between sites. Of survey respondents, half had not cared for a critically ill or injured child in at least a year, the vast majority had not had hands-on pediatric training in over 6 months, and the majority felt that training should occur at least every 6 months. Conclusions Our pediatric-focused, simulation-based procedural training program was associated with improvement and maintenance of high-baseline procedural performance for EMS clinicians over the study period. Findings were consistent across sites. Remote assessment was feasible. Participant surveys emphasized a desire for more pediatric-focused training and highlighted the low frequency of clinical exposure to procedures potentially needed in the care of critically ill or injured pediatric patients.

671 The Effect of Supplementary Simulation-Based Procedural Training: The SIMULATE Randomised Controlled Clinical and Educational Trial

Abstract Aim To evaluate whether surgical trainees undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Methods This international, multicentre randomised controlled superiority trial recruited urology trainees (n=94) who had performed ≤10 ureterorenoscopy (URS) cases, as a selected index procedure, with no prior simulation experience. Recruits were randomised to simulation-based training or non-simulation-based training groups, the latter of which is the current standard of training. Training sessions were conducted for the simulation arm, utilising an expert-developed multi-modality training curriculum. The primary outcome was the number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on an OSATS scale, on 3 consecutive operations, without complications. Inpatient surgical complications were also recorded. All participants were followed up for 25 procedures or over 18 months. Results A total of 1140 cases were performed by 65 participants where proficiency was achieved in 21 simulation and 18 conventional participants over a median of 8 and 9 procedures, respectively (HR: 1.41 [95% CI 0.72–2.75]). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring fewer number of procedures (HR 0.89 [95% CI 0.39–2.02]). Significant differences were observed in overall comparison of OSATS scores between groups (mean difference 1.42 [95% CI 0.91–1.92]; p&amp;lt;0.001), with fewer total complications (15 vs 37; p=0.003) and ureteric injuries (3 vs 9; p&amp;lt;0.001) in the simulation group. Conclusions Simulation-based training demonstrated higher overall proficiency and fewer procedures were required to achieve proficiency in the complex form of the index procedure with surgical complications.

Curated collections for educators: Six key papers on teaching procedural skills.

Competence in teaching procedural skills is required for faculty in all specialties. Regardless of involvement in undergraduate medical education (UME) versus graduate medical education (GME), faculty will likely be involved in teaching procedures to novice learners at some point, with the goal of having the learner achieve graduated independence and technical competence in a skill set. A large body of literature exists addressing the best practices for teaching and maintaining procedural skills. We searched for articles that describe the best practices for teaching procedural skills to all levels of learners. We conducted a literature search for papers on procedural skills training and teaching. We also made a call for papers on social media from members of the online #MedEd and #FOAMed communities. Once a list of the articles was compiled, we conducted a three-round modified Delphi process to identify those illustrating best practices for teaching procedural skills by both junior and senior faculty. We identified 98 relevant articles on the topic of procedural skills training. Six articles were deemed to be highly relevant after three rounds of the modified Delphi. Best practices included using an established educational framework when designing procedural skills teaching sessions, providing positive feedback to learners with opportunities for improvement, and demonstrating the procedure to the learners. Medical educators should employ evidence-based practices when designing and delivering procedural skills sessions. Educational frameworks provide faculty developers and facilitators with an organized approach to teaching these sessions. Maintenance of procedural skills over time is key; faculty can utilize simulation-based procedural training and deliberate practice to prevent decay of learned skills.

Identifying and prioritising technical procedures for simulation-based curriculum in paediatrics: a Delphi-based general needs assessment

ObjectivesTo identify and prioritise technical procedures that should be integrated in a curriculum of simulation-based procedural training in paediatrics using the Delphi method.Study designNational general needs assessment using a Delphi...

Multi-Institutional Regional Otolaryngology Bootcamp.

In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool. To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp. We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed. There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 "very effective" or 5 "most effective." A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.

Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine.

Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation.The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT. The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT. Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT. We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.

Consensus on technical procedures for simulation-based training in anaesthesiology: A Delphi-based general needs assessment.

Anaesthesiologists are expected to master an increasing number of technical procedures. Simulation-based procedural training can supplement and, in some areas, replace the classical apprenticeship approach during patient care. However, simulation-based training is very resource-intensive and must be prioritised and optimised. Developing a curriculum for simulation-based procedural training should follow a systematic approach, eg the Six-Step Approach developed by Kern. The aim of this study was to conduct a national general needs assessment to identify and prioritise technical procedures for simulation-based training in anaesthesiology. A three-round Delphi process was completed with anaesthesiology key opinion leaders. In the first round, the participants suggested technical procedures relevant to simulation-based training. In the second round, a needs assessment formula was used to explore the procedures and produce a preliminary prioritised list. In the third round, participants evaluated the preliminary list by eliminating and re-prioritising the procedures. All teaching departments in Denmark were represented with high response rates in all three rounds: 79%, 77%, and 75%, respectively. The Delphi process produced a prioritised list of 30 procedure groups suitable for simulation-based training from the initial 138 suggestions. Top-5 on the final list was cardiopulmonary resuscitation, direct- and video laryngoscopy, defibrillation, emergency cricothyrotomy, and fibreoptic intubation. The needs assessment formula predicted the final prioritisation to a great extent. The Delphi process produced a prioritised list of 30 procedure groups that could serve as a guide in future curriculum development for the simulation-based training of technical procedures in anaesthesiology.

Effective and Feasible Simulation-Based Procedural Training for Medical Students: Instructional Video-Guided Deliberate Practice Versus Training with Expert Feedback.

Limited opportunity for teaching patient-care skills in clinical settings has increased the need for simulation training in medical education. However, this modality may be hard to sustain because of extensive time requirements and potential scheduling conflicts. The authors conducted a pilot randomized study to compare the immediate and long-term effects of using instructional video with self-directed practice to those of using simulation training with expert feedback. The results are promising for the use of instructional video-guided, self-directed deliberate practice; however, future studies with a larger sample from multiple institutions should replicate this study to confirm these results.

Paracentesis Model for Junior Doctors.

Paracentesis Model for Junior Doctors.

From Information to Simulation: Improving Competency in ECT Training Using High-Fidelity Simulation.

This study was intended to develop a new educational model that supplements ECT didactics with simulation-based procedural training and to evaluate the learning gains conferred by such a curriculum. Two types of curricula were evaluated for educational efficacy in this prospective randomized controlled trial. Psychiatry residents (n = 35) completed surveys to ascertain their baseline experience, knowledge, and proficiency with the ECT procedure. They were then block-randomized to receive either a didactic ECT curriculum (non-SIM) or one augmented by simulation training (SIM). Three months post-completion of the two types of instruction, all residents were re-administered the surveys and a procedural post-assessment. The median number of ECTs performed prior to the study was similar between the two groups (SIM group = 3, non-SIM group = 4.) The SIM group showed significant improvement on pre- and post- survey theoretical knowledge scores: 51% (95% CI = 41 to 61%) and 69% (95% CI = 64 to 74%), respectively, p = .02; this difference was not significant in the non-SIM group, p = .2. Improvement between pre- and post- proficiency scores were seen in the SIM group: 22% (95% CI = 13 to 32%) and 51% (95% CI = 53 to 59%), p < .001 while the effect was less pronounced in the non-SIM group. Inter-rater agreement for the proficiency assessment was excellent: k, = .9. Residents showed significant improvement in knowledge, comfort, and skills following ECT simulation training. With the proposed curriculum, residents would receive comprehensive education not only in the theory behind ECT but also in procedural skills. This curriculum can be modeled in other programs that do not have extensive ECT facilities.

Simulation-Based Procedural Skills Training in Pediatric Emergency Medicine

Procedural skills are integral to the practice of pediatric emergency medicine, but provider experience is limited by case rarity. Simulation-based medical education allows for the practice of rare procedures without compromising patient safety. Simulation-based procedural training improves provider confidence, knowledge, and performance, and may translate to better patient outcomes. However, optimal instructional designs for simulation-based training remain unclear, and educators have a plethora of didactic approaches and simulator characteristics to consider. This article reviews how simulation can be used for pediatric procedural skills training and maintenance, focusing on instructional design features, simulation modalities, and the use of simulation as an assessment tool in the era of competency-based medical education.

Multiple Modality Simulation Chest Tube Insertion - Is More Learning Always Better?

SESSION TITLE: Education and SimulationSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PMPURPOSE: Procedural skills training for medical learners can be challenging. Often relegated to occur during postgraduate training, there is often a long lag time between when these skills are taught and when they are called upon in an acute situation. This study attempts to determine if multiple-modality teaching, compared to traditional teaching, improves short and long-term retention of clinical procedures, specifically chest tube insertion. Multiple-modality simulation for procedural skills, need not be more time-consuming than didactic teaching, even though it may cover the subject material in more depth. Initial learning through various modalities - videos, lectures, and interactive sessions - as well as procedural learning itself, should increase students' retrieval of a particular clinical skill and related pathophysiology.METHODS: The participants of this study were twenty undergraduate students. The students were randomized into two groups: a control group that was given a 15- minute lecture prior to a 45-minute laboratory demonstration on chest drain insertion. The multiple modality group was given the same 15-minute lecture but in addition to this, they were given additional teaching (designed to maximize Mayer's Cognitive Theory of Multimedia Learning) with an instructional video, a radiology teaching session and further interactive explanation of the pathophysiology. The group then had 30 minutes for the lab-session component. Both groups were administered both an immediate and delayed written assessment to test knowledge retention.RESULTS: We performed a mixed ANOVA statistical analysis on the groups. The multi-modality group scored higher by approximately 13% on the delayed assessment and 15% lower at immediate assessment. Effect size for the MML learning was 0.298 or ~ 0.3.CONCLUSIONS: Compared to other simulation-based procedural training systematic reviews, the effect size from this study was smaller. Systematic reviews show improved knowledge, but small/moderate patient benefits. Other studies looked at more common procedural skills (arterial line insertion and central venous catheter insertion) rather than rarer, hard to teach procedures like chest tube insertion.CLINICAL IMPLICATIONS: The results suggest that multiple-modality teaching is associated with improved knowledge retention with chest tube insertion. In a high-stakes environment such as the ICU - we may have to accept smaller effect sizes when it comes to interventions that involve SBME = something is better than nothing.DISCLOSURE: The following authors have nothing to disclose: Soraya Nazerali-Lorenzon, Alasdair Nazerali-MaitlandNo Product/Research Disclosure Information SESSION TITLE: Education and Simulation SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Procedural skills training for medical learners can be challenging. Often relegated to occur during postgraduate training, there is often a long lag time between when these skills are taught and when they are called upon in an acute situation. This study attempts to determine if multiple-modality teaching, compared to traditional teaching, improves short and long-term retention of clinical procedures, specifically chest tube insertion. Multiple-modality simulation for procedural skills, need not be more time-consuming than didactic teaching, even though it may cover the subject material in more depth. Initial learning through various modalities - videos, lectures, and interactive sessions - as well as procedural learning itself, should increase students' retrieval of a particular clinical skill and related pathophysiology. METHODS: The participants of this study were twenty undergraduate students. The students were randomized into two groups: a control group that was given a 15- minute lecture prior to a 45-minute laboratory demonstration on chest drain insertion. The multiple modality group was given the same 15-minute lecture but in addition to this, they were given additional teaching (designed to maximize Mayer's Cognitive Theory of Multimedia Learning) with an instructional video, a radiology teaching session and further interactive explanation of the pathophysiology. The group then had 30 minutes for the lab-session component. Both groups were administered both an immediate and delayed written assessment to test knowledge retention. RESULTS: We performed a mixed ANOVA statistical analysis on the groups. The multi-modality group scored higher by approximately 13% on the delayed assessment and 15% lower at immediate assessment. Effect size for the MML learning was 0.298 or ~ 0.3. CONCLUSIONS: Compared to other simulation-based procedural training systematic reviews, the effect size from this study was smaller. Systematic reviews show improved knowledge, but small/moderate patient benefits. Other studies looked at more common procedural skills (arterial line insertion and central venous catheter insertion) rather than rarer, hard to teach procedures like chest tube insertion. CLINICAL IMPLICATIONS: The results suggest that multiple-modality teaching is associated with improved knowledge retention with chest tube insertion. In a high-stakes environment such as the ICU - we may have to accept smaller effect sizes when it comes to interventions that involve SBME = something is better than nothing. DISCLOSURE: The following authors have nothing to disclose: Soraya Nazerali-Lorenzon, Alasdair Nazerali-Maitland No Product/Research Disclosure Information

Simulation-Based Procedural Training for Pediatric Residents

Simulation-Based Procedural Training for Pediatric Residents

Teaching and Assessing Procedural Skills Using Simulation: Metrics and Methodology

Simulation allows educators to develop learner-focused training and outcomes-based assessments. However, the effectiveness and validity of simulation-based training in emergency medicine (EM) requires further investigation. Teaching and testing technical skills require methods and assessment instruments that are somewhat different than those used for cognitive or team skills. Drawing from work published by other medical disciplines as well as educational, behavioral, and human factors research, the authors developed six research themes: measurement of procedural skills; development of performance standards; assessment and validation of training methods, simulator models, and assessment tools; optimization of training methods; transfer of skills learned on simulator models to patients; and prevention of skill decay over time. The article reviews relevant and established educational research methodologies and identifies gaps in our knowledge of how physicians learn procedures. The authors present questions requiring further research that, once answered, will advance understanding of simulation-based procedural training and assessment in EM.

Quick reference guides for pediatric trauma care.

Procedural skills are integral to the practice of pediatric emergency medicine, but provider experience is limited by case rarity. Simulation-based medical education allows for the practice of rare procedures without compromising patient safety. Simulation-based procedural training improves provider confidence, knowledge, and performance, and may translate to better patient outcomes. However, optimal instructional designs for simulation-based training remain unclear, and educators have a plethora of didactic approaches and simulator characteristics to consider. This article reviews how simulation can be used for pediatric procedural skills training and maintenance, focusing on instructional design features, simulation modalities, and the use of simulation as an assessment tool in the era of competency-based medical education.