Simulation-based Training Course Research Articles

A qualitative study of the value of simulation-based training for nursing students in primary care

BackgroundClinical placement is an essential component of nursing education, providing students with the opportunity to apply theoretical knowledge to practice. However, challenges such as lack of supervision and passive involvement in tasks can hinder the learning experience. Supplementing clinical placement with simulation-based training (SBT) has been explored as a potential solution, though this approach has been underexplored within primary care. This study aimed to explore the educational value of a supplemental SBT course for nursing students during primary care placement, as well as the adaption of this approach to a primary care setting.MethodsA qualitative descriptive study was conducted at a medical education and simulation academy in Denmark. Sixth-semester nursing students on placement in primary care were invited to participate. The intervention consisted of a three-day simulation course covering core nursing competencies and common clinical conditions encountered within primary care. Simulation adopted a standardised patient approach. Data was collected using focus group interviews, which was analysed using inductive thematic analysis.ResultsThirty-one nursing students participated in the study. Seven themes emerged from the analysis, including perceptions, educational value, simulation adjustments to primary care, educators’ competencies, learning needs within primary care, challenges of clinical placement and career guidance. Generally, participants perceived the intervention positively, appreciating its relevance to their clinical placement and its educational impact in this context. Participants also provided insights into the adaptation of SBT to a primary care setting, as well as nursing students’ learning needs within this context.ConclusionThe findings indicate that the intervention had a positive impact on participant competencies within this context and enhanced their clinical practice within primary care. Furthermore, the results inform educators on how to effectively employ primary care-related SBT. Overall, this study supports the need for an increased application of SBT within primary care.Trial registrationNot relevant.

Stress responses in surgical trainees during simulation-based training courses in laparoscopy

BackgroundSimulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees’ stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees’ stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting.MethodsWe conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants’ stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored.ResultsTwenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05).ConclusionTrainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees’ stress response during simulation-based skills training courses.

Simulation-based training of endoscopic hemostasis for Japanese pediatric endoscopy learners: a pilot program

Background and AimsEndoscopic hemostasis training, often in emergencies, can be challenging for pediatric endoscopists. This study aimed to establish hands-on seminar sessions using the novel clip hemostasis simulator, and to explore the underlying concerns about endoscopic hemostasis among pediatric endoscopists and the potential of simulator-based training (SBT). MethodsA SBT course was incorporated into seminars by the Japanese Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Surveys with Visual Analog Scale (VAS, 0-100) completed by consenting pediatricians during four seminars from October 2021 to March 2023, were compared with the responses of adult gastrointestinal (GI) residents and junior residents. ResultsFifty-two pediatric endoscopists (median age 31, PGY 7) were enrolled. A median VAS score of 47 (IQR 23.5-65) for understanding endoscopic hemostasis, significantly lower than adult GI residents (median 76, IQR 58-82, P<0.001) and comparable to junior residents (median 54, IQR 50-65). Pediatric endoscopists' confidence in independently performing hemostasis was low, with a median score of 0 (IQR 0-16.5), below adult GI residents (median 67, IQR 49-77, P<0.001) and junior residents (median 11.5, IQR 10-39, P=0.014). Regarding skill enhancement by SBT, a median score of 94.5 showed high and no significant difference from junior residents and adult GI residents. All pediatric endoscopists expressed interest in repeated SBT sessions. Discussion and Future ProspectsPediatric endoscopists were concerned about their competence in endoscopic hemostasis. The simplified SBT programs with the simulator, may potentially improve their skills and confidence.

A115 EVALUATING THE CONTENT AND FACE VALIDITY OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS

Abstract Background Polypectomy is an essential endoscopic skill involving the removal of potentially premalignant lesions during colonoscopy. The ad hoc nature of polyp encounters is a significant barrier to polypectomy training, as this limits the ability to deliberately practice the skill. Effective and accessible polypectomy simulators may improve global implementation of polypectomy curricula. Aims To determine the face and content validity of a novel low-cost gel polyp simulator for use in endoscopic training programs. Methods A novel gel polyp simulator with multiple polyp morphologies based on the Paris classification was developed and used with a commercially available colonic phantom (Koken Lower GI Endoscopy Simulator Type II LM-107, Koken CO.LTD, Japan) in an endoscopy simulation-based training course (July, 2023). Feedback based on previous prototypes of the simulator were implemented into the simulator utilized in the present study. Novice (ampersand:003C25 procedures) and expert (ampersand:003E1000 procedures) endoscopists performed simulated procedures with the gel polyps. Using a five-point Likert scale (“strongly agree” to “strongly disagree”), a post-training survey based on previously published surveys used to determine the face and content validity of low-cost physical colonic simulators was administered. A section for additional comments was placed at the end of the survey. Results The face and content validity survey was completed by 3 experts and 21 novices. The median score for all face validity questions was 5 (IQR 5-5) from experts and 5 (IQR 5-5) from novices. The median score for all content validity questions was 5 (IQR 5-4) from experts and 5 (IQR 5-5) from novices. In the additional comments section of the survey, one expert commented that future iterations of the gel polyps should be made thicker so that trainees could practice using endoscopic clips. The gel polyp simulator cost $0.61 CAD/polyp including the cost of materials and 3D printed molds. Conclusions The gel polyp simulator appears to be a feasible modality for polypectomy training that is reproducible using accessible and low cost materials. Face and Content Validity Survey (questions and median survey score) Funding Agencies None

All professions can benefit — a mixed-methods study on simulation-based teamwork training for operating room teams

BackgroundOperating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants’ reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace.MethodsIn a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team.Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years.Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis.ResultsAll occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one’s profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration.ConclusionSimulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

Assessing Resident Confidence in Placing a Central Venous Catheter Before and After a Simulation-Based Training Course

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Evaluation of the simulation based training quality assurance tool (SBT-QA10) as a measure of learners’ perceptions during the action phase of simulation

BackgroundIn an earlier interview-based study the authors identified that learners experience one or more of eight explicit perceptual responses during the active phase of simulation-based training (SBT) comprising a sense: of belonging to instructor and group, of being under surveillance, of having autonomy and responsibility for patient management, of realism, of an understanding of the scenario in context, of conscious mental effort, of control of attention, and of engagement with task. These were adapted into a ten-item questionnaire: the Simulation Based Training Quality Assurance Tool (SBT-QA10) to allow monitoring of modifiable factors that may impact upon learners’ experiences. This study assessed the construct validity evidence of the interpretation of the results when using SBT-QAT10.Materials and methodsRecently graduated doctors and nurses participating in a SBT course on the topic of the deteriorating patient completed the SBT-QAT10 immediately following their participation in the scenarios. The primary outcome measure was internal consistency of the questionnaire items and their correlation to learners’ satisfaction scores. A secondary outcome measure compared the impact of allocation to active versus observer role.ResultsA total of 349 questionnaires were returned by 96 course learners. The median of the total score for the ten perception items (TPS) was 39 (out of 50), with no significant difference between the scenarios. We identified fair and positive correlations between nine of the 10 items and the SBT-QA10-TPS, the exception being “mental effort”. Compared to observers, active learners reported significantly more positive perceptions related to belonging to the team and interaction with the instructor, their sense of acting independently, and being focused. The questionnaire items were poorly correlated with the two measures of global satisfaction.ConclusionExcept for the item for mental effort, the QA10-TPS measures learners’ experiences during the active phase of simulation scenarios that are associated with a positive learning experience. The tool may have utility to learners, instructors, and course providers by informing subsequent debriefing and reflection upon practice for learners and faculty. The relationship between these perceptions and commonly used measures of satisfaction remains poorly understood raising questions about the value of the latter.

Challenges for interprofessional simulation-based sedation training courses: Mini review.

Sedation for invasive procedures is given for various clinical purposes to patients of all ages worldwide. However, sedation is a continuum to general anesthesia and contains severe inherent risks leading to mortality. Providing a simulation-based sedation training course (SEDTC) to various medical staff could be an effective strategy to improve patient and medical safety associated with sedation. The SEDTC generally includes basic airway management such as upper airway obstruction release or rapid response action toward excessive sedation, utilizing problem-based learning or simulators. However, participation alone in the SEDTC can only achieve Level 1 (reaction) or 2 (learning) in the Kirkpatrick model. A patient safety improvement of Level 3 (transfer) or 4 (result) of the Kirkpatrick model can be achieved when all members related to sedation undergo experiential learning and reach a consensus. Accordingly, in-hospital interprofessional SEDTC focusing on a resilience approach is essential to achieve effective sedation patient safety in Level 3 or 4 of the Kirkpatrick model.

Simulation-based skills training: a qualitative interview study exploring surgical trainees’ experience of stress

IntroductionStress can affect the ability to acquire technical skills. Simulation-based training (SBT) courses allow surgical trainees to train their technical skills away from stressful clinical environments. Trainees’ subjective experiences of stress during SBT courses on laparoscopic surgery remains understudied. Here, we explored the subjective stress experiences of surgical trainees during mandatory laparoscopic SBT courses. We aimed to obtain a broader understanding of which factors of the simulation training the trainees perceived as eliciting stress.MethodsA qualitative study with semistructured individual interviews was undertaken to explore trainees’ subjective experiences of stress. Twenty surgical trainees participated while attending courses at a national training center for advanced laparoscopic surgery. Questions explored trainees’ stress experiences during the SBT courses with a focus on perceived stressors related to laparoscopic simulation training on two box-trainers and one virtual reality simulator. Interview data were analyzed using inductive, qualitative content analysis methods to identify codes, categories, and themes.ResultsFindings indicated that trainees have a variety of stress experiences during laparoscopic SBT. Three main themes were identified to be related to stress experiences: simulation task requirements, psychomotor skill levels and internal pressures, with subcategories such as task difficulty and time requirements, unrealistic haptic feedback and realism of graphics, inconsistent and poor technical performance, and self-imposed pressures and socio-evaluative threats.ConclusionsInsights into surgical trainees’ experience of stress during laparoscopic SBT courses showed that some stress experiences were directly related to simulation training, while others were of psychological nature. The technical and efficiency requirements of simulation tasks elicited stress experiences among trainees with less laparoscopic experience and lower levels of psychomotor skills. Self-imposed pressures played an integral part in how trainees mobilized and performed during the courses, suggesting that levels of stress might enhance laparoscopic simulation performance. For course facilitators aiming at optimizing future laparoscopic SBT courses, attending to the realism, providing clarity about learning objectives, and having awareness of individual differences among trainees’ technical level when designing the simulation tasks, would be beneficial. Equally important to the laparoscopic SBT is to create a psychological safe learning space in order to reduce the internal pressures of trainees.

Effects of a Simulation-Based Training Course on Nurses’ Knowledge and Attitude Towards Covid-19 Vaccine in Sulaimani Health Care Centers

Background: One of the most effective ways to decrease the burden of communicable diseases such as COVID-19 is vaccination but these days despite the availability of vaccine services the hesitancy of the vaccine and the delay of acceptance or rejection of vaccine from most developing countries remain as protection to initiate effective antibody. The aim of this study to assess nurses’ knowledge and attitude regarding COVID-19 vaccination before and after the training course of the health care centers in Sulaimani city. Materials and Methods: we have done a descriptive quantitative design study with a non-probability purposive sample of 74 nurses, The reliability instrument was decided using the internal consistency (Split half) approach. The collection of the data was revealed by using the interview technique, then presenting the training course to the participants and on the last day of the training the post-test was performed. Results: Most of the participants aged between 31-40 years old and were governmental employee’s female which graduated from the institute of nursing, had not been vaccinated yet; and were not trained regarding COVID-19 vaccination (82.4%, 81.1%, 54%, 91.9%, and 97.3%) respectively. (95.9%) of the participant’s knowledge and attitude before the training course regarding COVID-19 vaccination was low level, whereas after the training course the knowledge and attitude of them reach to the highest level 100%. Conclusion: The participant’s level of knowledge before the training course regarding COVID-19 vaccination was low levels, whereas after the training course their knowledge reach the highest level because of that the researchers recommended focusing on more training courses regarding COVID-19 vaccination by the Ministry of health/infection control department to develop their level of knowledge and attitude. Keywords: effect, simulation-based training course, covid-19 vaccine, nurse’s staff, knowledge, attitude

Mixed methods evaluation of simulation-based training for postpartum hemorrhage management in Guatemala

BackgroundTo assess if simulation-based training (SBT) of B-Lynch suture and uterine balloon tamponade (UBT) for the management of postpartum hemorrhage (PPH) impacted provider attitudes, practice patterns, and patient management in Guatemala, using a mixed-methods approach.MethodsWe conducted an in-country SBT course on the management of PPH in a governmental teaching hospital in Guatemala City, Guatemala. Participants were OB/GYN providers (n = 39) who had or had not received SBT before. Surveys and qualitative interviews evaluated provider knowledge and experiences with B-Lynch and UBT to treat PPH.ResultsMultiple-choice surveys indicated that providers who received SBT were more comfortable performing and teaching B-Lynch compared to those who did not (p = 0.003 and 0.005). Qualitative interviews revealed increased provider comfort with B-Lynch compared to UBT and identified multiple barriers to uterine balloon tamponade implementation.ConclusionsSimulation-based training had a stronger impact on provider comfort with B-Lynch compared to uterine balloon tamponade. Qualitative interviews provided insight into the challenges that hinder uptake of uterine balloon tamponade, namely resource limitations and decision-making hierarchies. Capturing data through a mixed-methods approach allowed for more comprehensive program evaluation.

Evaluating the Impact of a Simulation Based Training Course in Intellectual Disability Psychiatry and Autism Co-Delivered by Actors With Intellectual Disability

AimsInequalities in health outcomes, and avoidable deaths, in people with intellectual disability has highlighted the need for improved training and education in Intellectual Disability and Autism. Simulation training facilitated by actors with intellectual disability has been shown to improve connection with people with intellectual disability (Attoe et al 2017). The aim of this project was to develop a simulation-based training course, focused on topics in mental health, intellectual disability and autism, to improve participant confidence in clinical knowledge and skills, as well as support leadership and professionalism training. Here we evaluate the impact of the training on participants’ confidence, and the longer-term effect on attitudes and working practice after attendance.MethodsA novel simulation-based training course, directed at Specialty Trainees, was developed based on the Specialty Training in Learning Disability curriculum. The course was co-delivered by a person with intellectual disability. Participants who attended the simulation training completed general feedback, pre-course and post-course confidence questionnaires and attended a semi-structured group interview at 2 months. Questionnaire data weres analysed using descriptive and inferential statistics. Group interview data were analysed using open &amp; axial coding, and thematic analysis of content. The project was approved by East London NHS Foundation Trust Governance and Ethics Committee for Studies and Evaluations.ResultsEight psychiatrists participated in the training and completed the pre-course and post-course questionnaires. Independent t-test found significant increase in confidence for all scores from pre-course (M = 6.54, SE0.24) to post-course (M = 7.81, SE = 0.36), t= –2.93 p = 0.01. This included ratings of confidence in knowledge in areas such as mental health legislation, and improved confidence in skills such as communication with families of people with intellectual disability and difficult conversations with senior supervisors. In follow-up interviews we elucidated themes of the importance of supported, structured training opportunities with people with intellectual disability, and the value of connection with peers and supervisors.ConclusionSimulation based training in psychiatry, co-delivered with actors with intellectual disability, was reported to be an engaging and enjoyable form of learning. The evaluation suggests such training is effective in increasing trainee confidence in knowledge and skills at the time of training as well as resulting in a lasting change in attitudes after the training. We recommend such training be further developed and delivered at both postgraduate and undergraduate level.

La Machine: Obstetric Phantoms of Madame Du Coudray … Back to the Roots.

For 300 years now, obstetrics has drawn on the concept of simulation training to not only teach anatomy and physiology theoretically, but to literally infuse it practically. In an 18th century scientific culture, which was predominantly patriarchal, the French royal midwife Angelique Marguerite Le Boursier du Coudray excelled in this field. Using La Machine, one of the first obstetric phantoms, she taught thousands of midwives and even physicians. The exponential increase in publications on obstetric simulations in recent years continues to underline their current relevance, and Madame du Coudray was once at the forefront with her mannequin, probably the most sophisticated phantom of its time, a symbiosis of practical-robust architecture and anatomical-theoretical accuracy. In retrospect, it is therefore worthwhile to take a closer look at this pioneer and her obstetric phantoms, applied in the first national simulation-based training course, and to evaluate them in the overall picture of the development of anatomically correct replicas for practice-oriented training with detailed, flexible exercise – back to the roots.

100 ACUTE MEDICINE MEETS ‘KNIGHTMARE’: ‘CHOOSE YOUR OWN ADVENTURE’ FORMAT FOR REGISTRAR COURSE DELIVERY

Ongoing social distancing restrictions have greatly limited opportunities for registrars to attend regional acute medicine teaching. Basing the project on previous work within the trust running simulation via Microsoft Teams (using a one-to-one method of delivery) this project set about opening this up to a much larger group using a ‘choose your own adventure’ (‘CYOA’) format depicted in the children’s television show ‘Knightmare’.The aim of the study was to deliver a simulation-based training course for a large number of participants simultaneously using an online platform.Scenarios were as follows: Patient with an exacerbation of COPDPatient with a life-threatening overdosePatient presenting with undifferentiated unconsciousnessThe clinical room featured an audio-visual set-up for debrief with three cameras and patient observations from Laerdal Learning Application (LLEAP) combined with an audio mix shared via video-stream to VLC media player; then from the host laptop via Teams. Teams used audio mixer input from room via USB. This included phone audio allowing calls to relatives, other specialists, etc. to be heard. Teams accessed from the following locations: Host (control room)Faculty (control room)Faculty (clinical room)Faculty (debrief room)Participants (remote) × 14Teams host laptop was pre-loaded with all scenario information which allowed ECGs, CTs, Toxicology reports to be shared as requested throughout the scenarios. The multi-screen set-up allowed for monitoring of chat from a control room and clinical space meaning all users could access key information shared on screen. Faculty had radio communication to control room for prompts and questions. Scenarios would be led by a member of faculty playing the role of a clinician in the scenario. The scenario would progress with input from the participants via that Teams chat. At key points, the scenario would pause and a question would be put to the group and an option would be voted on to continue. After each scenario, using Teams break-out rooms for debrief allowed the large group of participants to have a more focussed debrief session led by one of the medical faculty.Using the structure of ‘CYOA’ encouraged users to take part in key interventions, whilst chat function within teams allowed for continuous dialogue. Participant feedback stated that the discussion format and expertise within the group was very useful in their training and would have a positive impact on working practice. Faculty found virtual simulation more demanding to facilitate than face-to-face simulation, but feasible to run the session annually.

Impact of a large interprofessional simulation-based training course on communication, teamwork, and safety culture in the operating theatre: A mixed-methods interventional study

BackgroundCommunication and teamwork are critical non-technical skills in the operating theatre. However, prevention of events associated with communication failures by large simulation-based programs remains to be evaluated. The objective was to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. MethodsWe aimed to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. We conducted a before-and-after interventional study based on a mixed-methods approach combining qualitative and quantitative evaluation criteria. The study was performed in a University Hospital with 39 operating theatres operated by 300 providers before (period 1) and after (period 2) an interprofessional simulation-based training course. Surgical procedures were observed, and the primary outcome measure was the rate of procedures with at least one communication failure associated with adverse event. Additional outcomes measured included the rate of other communication failures, checklist adherence, while teamwork and safety culture were assessed by questionnaires. ResultsIn total, 46 970 communication episodes were analysed during 131 (period 1) and 122 (period 2) surgical procedures. One hundred sixty-four professionals attended 40 simulation-based sessions. The rate of procedures with at least one communication failure associated with adverse events was not significantly different between the 2 periods (38% in period 1 and 43% in period 2; P = 0.47). Nevertheless, the rate of communication failures reduced between period 1 and 2 (8117/28 303 (29%) vs. 3868/18 667 (21%), respectively; P < 0.01). Teamwork scores and checklist adherence increased significantly after the intervention (8.1 (7.2–8.7) in period 1 vs. 8.6 (8.0–9.2) in period 2; P < 0.01 and 17% (0–35 %) in period 1 vs. 44% (26–57 %) in period 2; P < 0.01). Safety culture ratings did not change significantly. ConclusionThis study shows that although the rate of procedures with at least one communication failure associated with adverse event (primary endpoint) was not significantly different, a large interprofessional simulation-based training course has a positive effect on communication failures, teamwork, and checklist adherence.

Pediatric Simulation-Based Prehospital Training Course in Botswana

Author(s): Glomb, Nicolaus; Rus, Marideth; Kosoko, Adeola; Saha, Sharmistha; Murphy, Kristen; Doughty, Cara; Galapi, Cafen; Laba, Bushe; Shah, Manish

Pediatric Simulation-Based Prehospital Training Course in Botswana.

This simulation-based training focuses on the most common and high risk pediatric prehospital scenarios in low- and middle-income countries (LMIC). The curriculum was developed based on a needs assessment to train Ministry of Health and Wellness (MOHW) prehospital providers in Botswana specifically for pediatric resuscitation and could be used for emergency medical services (EMS) providers in other LMIC. After participating in this curriculum, providers should enhance their assessment and interventions in acutely ill pediatric prehospital patients. The entire course was designed to be presented over two days with 6-8 hours of instruction each day. In recent years, prehospital medicine has shown continued growth in LMICs, specifically in Sub-Saharan Africa. As these programs develop focused training for the pediatric population, equipping the workforce with pediatric resuscitation skills is essential. A few years after its inception, the Botswana MOHW identified deficiencies in their current training program and sought external expertise and educational training. We partnered with the MOHW to create and implement a novel, prehospital simulation curriculum to teach pediatric resuscitation to prehospital providers. Our aim was to create a curriculum based on the needs of the community that could also be implemented in other similar resource-limited settings. This course included didactic sessions, five simulation scenarios using low fidelity mannequins and three pediatric-focused skill sessions. This program was found to be effective based on statistically significant improvement in written and simulation post-test scores. The objective of this educational project was to design, implement, and evaluate a curriculum relevant to an EMS system based in a LMIC, so that it could be a basis for curricula for use in similar contexts. The educational goal is to improve prehospital providers performance in common pediatric resuscitations. The educational methods used in this curriculum included simulation using rapid cycle deliberate practice (RCDP), didactic lectures, and hands on skills training for common pediatric scenarios. Outcomes were measured by comparing performance on written and simulation-based pre-and post-tests. Participants completed written and simulation-based pre- and post-tests covering the concepts taught in the curriculum. Continuous variables (written and simulation test scores) were compared between two dependent groups (pre- and post-trainings) using paired t-tests. Mean written test scores increased by 11%, from 75% to 86% (p<0.0001), while mean simulated test scores increased by 22% (from 56% to 78 % (p<0.0001). The curriculum we developed focused on high-yield pediatric skills based on the needs of the Botswana MOHW EMS program. We believe simulation training was an excellent and effective method for this type of training. We specifically designed RCDP scenarios for the training, due to the limited experience of the prehospital providers at that time. RCDP offers ample opportunities for feedback with immediate practice and improvement. Trainees demonstrated retention of knowledge and improved performance in simulation-based testing. The overall satisfaction level of the trainees was high and suggests additional training would be beneficial and desired. Additionally, as the results of our needs assessment mirrored common chief complaints in other LMIC countries in Sub-Saharan Africa1,2 we feel that this curriculum can be utilized and adopted with minor modifications in other LMIC settings, particularly where EMS programs are developing and in circumstances where few EMS providers have had extensive field experience. Respiratory distress, asthma, dehydration, hypovolemic shock, hypoglycemia, seizure, toxic ingestion, newborn resuscitation, precipitous delivery, traumatic injury, EMS, Botswana, global health, collaboration, rapid cycle deliberate practice (RCDP), medical simulation.

Critical Care Education and Skills Validation Course for Internal Medicine Physicians in the Military.

Military internist and internal medicine (IM) subspecialist physicians must be prepared to function in both traditional inpatient and outpatient settings, as well as manage critically ill patients within a deployed austere environment. As many critical care procedures are not performed on a routine basis in general IM practice, many active duty IM physicians experience skills degradation and lack confidence in performing these procedures. In order to address this perceived deficiency, the U.S. Army and Air Force Internal Medicine Education and Skills Validation Course was developed to provide essential training in critical care procedures for active duty military IM physicians and subspecialists. Staff internist and subspecialist physicians at multiple military treatment facilities participated in a 2-day simulation-based training course in critical care procedures included in the Army Individual Critical Task Lists and the Air Force Comprehensive Medical Readiness Program. Educational content included high-yield didactic lectures, multi-disciplinary Advanced Cardiac Life Support/Advanced Trauma Life Support high-fidelity simulation scenarios, and competency training/validation in various bedside procedures, including central venous and arterial line placement, trauma-focused ultrasound exam, airway management and endotracheal intubation, chest tube thoracotomy, and mechanical ventilation, among others. A total of 87 staff IM physicians participated in the course with an average of 2-4 years of experience following completion of graduate medical education. Upon course completion, all participants successfully achieved rigorous, checklist-based, standardized validation in all the required procedures. Survey data indicated a significant improvement in overall skills confidence, with 100% of participants indicating improvement in their ability to function independently as deployed medical officers. Broad implementation of this program at military hospitals would improve pre-deployment critical care procedural readiness in military IM physicians.

Multidisciplinary, simulation-based training to improve review of seclusion

Purpose Seclusion is the supervised containment of a patient, away from others, when immediately necessary to manage safety on a psychiatric inpatient ward. When seclusion is necessary, it should be used for the shortest time possible, with a regular multidisciplinary review of the patient’s mental and physical health, medication and risk guiding decisions around continuation or ending of this restrictive measure. However, many medical and nursing staff can be anxious about taking part in such reviews. Simulation has been used in many areas of medicine to help people to develop competence and confidence, in a safe setting where their own needs can be paramount. This paper aims to describe the use of a blended learning approach, including simulation, to build confidence and competence amongst healthcare professionals in the safe review of seclusion. Design/methodology/approach A multidisciplinary group, including input from individuals with lived experience of use of seclusion, put together a one-day training course, which included group debate exploring the relationship between seclusion and the Human Rights Act, guided discussion of videos exploring some aspects of practice and a half-day of simulation where multidisciplinary teams could act as the team reviewing a patient who had been secluded. Findings This paper found that the course’s blended learning approach helped participants to feel more confident in their understanding of several aspects of seclusion, including what their team discussions should include before and after seeing a patient and in knowing when to end a period of seclusion. Originality/value While simulation is slowly becoming a more familiar component of the undergraduate and postgraduate education offer in psychiatry, the authors are unaware of any evaluation of a dedicated simulation-based training course around reviews of seclusion.

Simulation-based surgical education for glaucoma versus conventional training alone: the GLAucoma Simulated Surgery (GLASS) trial. A multicentre, multicountry, randomised controlled, investigator-masked educational intervention efficacy trial in Kenya, South Africa, Tanzania, Uganda and Zimbabwe

Background/AimGlaucoma accounts for 8% of global blindness and surgery remains an important treatment. We aimed to determine the impact of adding simulation-based surgical education for glaucoma.MethodsWe designed a randomised controlled,...