Simulation-based Training Models Research Articles

Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills.

To analyse development of individual nontechnical skills (NTS) domains after undertaking a previously developed simulation-based training model and analyse the relationship between technical skills (TS) and NTS in ophthalmic surgery. The simulation-based training model involved a cataract surgery case complicated by intraoperative posterior capsule rupture. Cataract surgeons underwent the simulation twice, separated by a training intervention. Two blinded independent experts assessed participants' NTS using HUFOES, NOn-Technical Skills for Surgeons (NOTSS), and the OSATS global rating scale for TS. Paired t-tests assessed differences in individual NTS domains, with p < 0.05 indicating significance. The Pearson Product Moment Correlation Coefficient was used to assess the correlation between scores from each scoring system. All NTS domains within HUFOES and NOTSS demonstrated statistically significant improvements secondary to the training intervention. Positive correlations were demonstrated between HUFOES and OSATS scores in the pre- and post-training simulations, r = 0.870 (p < 0.001) and r = 0.861 (p < 0.001), respectively. Positive correlations were also demonstrated between NOTSS and OSATS scores in pre- and post-training simulations, r = 0.849 (p < 0.001) and r = 0.757 (p = 0.001), respectively. Positive correlations were demonstrated between HUFOES and NOTSS scores; r = 0.979 (p < 0.001) (n = 17) and r = 0.959 (p < 0.001) for pre- and post-training simulations, respectively. All NTS domains contained within HUFOES and NOTSS demonstrated significant increases following the completion of the simulation-based training model. Positive correlations exist between an ophthalmic surgeon's TS and NTS. This is the first study to report these findings within ophthalmic surgery.

Interactive training with a novel simulation model for upper gastrointestinal endoscopic hemostasis improves trainee technique and confidence.

Background and study aims Endoscopic hemostasis is a life-saving procedure for gastrointestinal bleeding; however, training for it is often performed on real patients and during urgent situations that put patients at risk. Reports of simulation-based training models for endoscopic hemostasis are scarce. Herein, we developed a novel simulator called "Medical Rising STAR-Ulcer type" to practice endoscopic hemostasis with hemoclips and coagulation graspers. This study aimed to evaluate the reproducibility of the clinical difficulty of this model and the effectiveness of simulation-based training for clipping hemostasis. Patients and methods This was a prospective educational study. Fifty gastroenterology residents from Japan and Canada were recruited to participate in a simulation-based training program. The primary outcome was the success rate for clipping hemostasis. We measured differences in trainee subjective assessment scores and evaluated the co-occurrence network based on comments after training. Results The hemostasis success rate of the trainees significantly increased after instruction (64% vs. 86%, P < 0.05). The success rate for ulcers in the upper body of the stomach (59%), a high-difficulty site, was significantly lower than that for ulcers in the antrum, even after feedback and instruction. Trainee self-perceived proficiency and confidence significantly improved after simulation-based training ( P < 0.05). Co-occurrence network analysis showed that trainees valued a structured learning approach, acknowledged simulator limitations, and recognized the need for continuous skill refinement. Conclusions Our study demonstrates the potential of our simulation-based training model as a valuable tool for improving technical skills and confidence in trainees learning to perform endoscopic hemostasis.

Neurosurgical Education Using Cadaver-Free Brain Models and Augmented Reality: First Experiences from a Hands-On Simulation Course for Medical Students.

Background and Objectives: Neurosurgery has been underrepresented in the medical school curriculum. Advances in augmented reality and 3D printing have opened the way for early practical training through simulations. We assessed the usability of the UpSurgeOn simulation-based training model and report first experiences from a hands-on neurosurgery course for medical students. Materials and Methods: We organized a two-day microneurosurgery simulation course tailored to medical students. On day one, three neurosurgeons demonstrated anatomical explorations with the help of life-like physical simulators (BrainBox, UpSurgeOn). The surgical field was projected onto large high-definition screens by a robotic-assisted exoscope (RoboticScope, BHS Technologies). On day two, the students were equipped with microsurgical instruments to explore the surgical anatomy of the pterional, temporal and endoscopic retrosigmoid approaches. With the help of the RoboticScope, they simulated five clipping procedures using the Aneurysm BrainBox. All medical students filled out a digital Likert-scale-based questionnaire to evaluate their experiences. Results: Sixteen medical students participated in the course. No medical students had previous experience with UpSurgeOn. All participants agreed that the app helped develop anatomical orientation. They unanimously agreed that this model should be part of residency training. Fourteen out of sixteen students felt that the course solidified their decision to pursue neurosurgery. The same fourteen students rated their learning experience as totally positive, and the remaining two rated it as rather positive. Conclusions: The UpSurgeOn educational app and cadaver-free models were perceived as usable and effective tools for the hands-on neuroanatomy and neurosurgery teaching of medical students. Comparative studies may help measure the long-term benefits of UpSurgeOn-assisted teaching over conventional resources.

Non-technical skills simulation-based training model for managing intraoperative posterior capsule rupture during cataract surgery.

To develop and implement a simulation-based training model for the management of posterior capsule rupture (PCR) from a non-technical skills (NTS) perspective, and analyse changes in participant's NTS and technical skills (TS). The simulation-based training model consisted of two identical PCR simulations with NTS stressors applied, separated by a predominantly NTS focussed training intervention. Participants' TS and NTS were evaluated by two blinded assessors using the Objective Structured Assessment of Technical Skill (OSATS) global rating scale and the HUman Factors in intraoperative Ophthalmic Emergencies Scoring System (HUFOES) respectively. Paired t-tests were used to establish the difference in mean HUFOES and OSATS scores between initial and repeat simulations; p < 0.05 indicated statistical significance. McGaghie's model of translational outcomes for simulation-based learning was used to establish the simulation model's educational status. Seventeen cataract surgeons of varying training grades participated in the simulation-based training model. NTS improved with statistical significance; mean HUFOES scores increased from 48.7 ± 16.6 to 59.2 ± 14.8 (p < 0.001). Mean OSATS scores increased without statistical significance from 16.0 ± 7.3 to 17.9 ± 8.3 (p = 0.07). This simulation model achieved Level 1 (internal acceptability) and Level 2 (contained effects) according to McGaghie's model. This novel simulation-based training model was designed to improve the NTS required for managing intraoperative PCR, through the provision of an interactive training session. Statistically significant improvements in participants' NTS in combination with statistically insignificant improvements in TS demonstrate that the simulation-based training model has specificity within the NTS domain.

Evaluation of a Simulation-Based Training Program on Childhood Trauma With OT Students

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A simulation-based training model, the Professional ACEs-Informed Training for Health Professionals, was evaluated using a pre–post design. The model emphasizes trauma-informed care and simulation to educate students. The study evaluated students' levels of self-efficacy and knowledge. The results support brief didactics combined with simulation to train OT students on adverse childhood experiences and trauma-informed care, supporting American Occupational Therapy Association research priorities. Primary Author and Speaker: Mary Isaacson Additional Authors and Speakers: Julie Cribbs Contributing Authors: Jedediah E. Bragg, Frances Wen, Kristin Rodriguez, Martina Jelley, and Kim Coon

IMPLEMENTASI MODEL SIMULASI PADA PELATIHAN KEPALA MADRASAH

This study aims to determine the effectiveness of simulation-based training model in terms of improving managerial competence among madrasah heads. The research was intended to the training participants on Substantive Technical Training to Strengthening Madrasah Heads since October 2019 - February 2020 with the cooperation of Bandung Religious Training Center, stakeholders and professional organization. Data collection techniques were conducted by tests (pre and post-test), questionnaire, observation, and structured interview. Data analysis is executed using qualitative approach. The results have shown that the training in the perspective of the process and results carried out effectively, with the average score 85 or competent. The aspect of training process resulted 89.9 or effective, and simulation-based training model application demonstrated score 90.2 which means also effective.Keywords: Simulation Model; Madrasah Head Training; Managerial Competence

Simulation-Based Training Models for Urolithiasis: A Systematic Review.

Objectives: Urolithiasis is one of the most common presentations in urological practice and it is becoming increasingly important to provide structured, simulation-based training using validated training models. This systematic review aims to identify current simulation-based training models and to evaluate their validity and effectiveness. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was performed on the Medline and EMBASE databases for English language articles published between 2000 and 2018 describing and/or assessing validity of simulation models for urolithiasis procedures. Studies were qualitatively assessed for validity using the Messick validity framework and models were assigned levels of recommendation using the McGaghie model of translational outcomes. Results: A total of 98 studies were included in this study assessing 51 models, with 28 studies concerning models for urethrocystoscopy, 46 studies for ureterorenoscopy, and 39 studies for percutaneous access and/or nephrolithotomy. Only four models demonstrated a level of recommendation of 4. The most validated models were the URO/PERC-Mentor (Simbionix, Lod, Israel) with multiple studies for each across various procedural skills. Conclusion: There is a wide spectrum of simulation-based models currently available for urolithiasis procedures, mostly with limited validity evidence from small studies. Further research is required with higher levels of evidence including randomized controlled trials. In addition, long-term transfer of skills to the operating room should be assessed to establish whether there is genuine skill development and retention using simulation models and whether this helps to reduce surgical complications.

Evaluation of a Simulation-Based Training Program on Childhood Trauma with Occupational Therapy Students

An educational and simulation-based training model, the Professional ACEs-Informed Training for Health Professionals designed for allied health students was evaluated using a pre-and-post design. The training model emphasizes trauma-informed care and uses social simulation to educate and train students with skills to address adverse childhood experiences. This study evaluated occupational therapy students’ (N=70) levels of self-efficacy and knowledge of trauma-informed care at both pre- and post-training. Analysis of variance results indicated a statistically significant improvement in students’ levels of general self-efficacy and knowledge from pre- to post-assessment (p < .01). These results are suggestive of the usefulness of brief didactics combined with simulation to educate occupational therapy students on adverse childhood experiences and trauma-informed care.

Evaluation of a Simulation-Based Training Program on Childhood Trauma With OT Students

Abstract Date Presented 03/27/20 A simulation-based training model, the Professional ACEs-Informed Training for Health Professionals was evaluated using a pre-and-post design. The model emphasizes trauma-informed care and simulation to educate students. The study evaluated students’ levels of self-efficacy and knowledge. The results support brief didactics combined with simulation to train OT students on adverse childhood experiences and trauma-informed care, supporting AOTA research priorities. Primary Author and Speaker: Mary Isaacson Additional Authors and Speakers: Julie Miller-Cribbs Contributing Authors: Jedediah Bragg, Eden Nay, Kristin Rodriguez, Frances Wen, Martina Jelley, Kim Coon

Simulation-Based Training Models for Cleft Palate Repair: A Systematic Review.

Simulation-based training is a relatively new inclusion to surgical training curricula, with promises of achieving increased competency while maximizing patient safety. Cleft palate, which contributes significantly to the global burden of surgically treatable diseases, is a challenging repair to learn due to the high level of skill and dexterity required, delicate oral tissues, and limited space of an infant oral cavity. Simulation training can allow cleft palate education to move from an observational to a competency-based learning. Hence, this systematic review presents the models described in the literature that simulate cleft palate repair. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search of the MEDLINE and Cochrane databases was performed. Qualitative data were extracted, and the models were stratified based on their anatomical fidelity and realism, forming the basis of the curriculum. The database search returned 3261 articles. Twelve articles were considered eligible for inclusion. The anatomical fidelity, human tissue likeness, evidence of improved outcomes, and cost are discussed. Cleft palate is a globally significant birth defect and its repair is a difficult procedure to learn. This review presents the 12 models of cleft palate described in the literature, highlighting the advances and gaps in current cleft palate simulation.

A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery

The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aim to identify the currently available simulators and training courses for neurosurgery, assess their validity, and determine their effectiveness. Both MEDLINE and Embase were searched for English language articles which validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness (LoE) for each simulator or training course. On screening of 6006 articles, 114 were identified to either validate or determine an LoE for 108 simulation-based training models or courses. Achieving the highest rating for each validity domain were 6 models and training courses for content validity, 12 for response processes, 4 for internal structure, 14 for relations to other variables, and none for consequences. For translational outcomes, 6 simulators or training achieved an LoE >2 and thus showed skills transfer beyond the simulation setting. With the advent of increasing neurosurgery simulators and training tools, there is a need for more validity studies. Further attempts to investigate translational outcomes to the operating theater when using these simulators is particularly warranted. More training tools incorporating full-immersion simulation and nontechnical skills training are recommended.

A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills

The increasing challenges facing the training of future neurosurgeons have led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and determine their educational effects. In this second part, we aim to identify the available simulators for spine, pediatric neurosurgery, interventional neuroradiology, and nontechnical skills, assess their validity, and determine their effectiveness. Both Medline and Embase were searched for English language articles that validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework, and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness for each simulator or training course. Overall, 114 articles for 108 simulation-based training models or courses were identified. These articles included 24 for spine simulators, 3 for nontechnical skills, 10 for 9 pediatric neurosurgery simulators, and 12 for 11 interventional neuroradiology simulators. Achieving the highest rating for each validity domain were 3 models for content validity; 16 for response processes; 1 for internal structure; 2 for relations to other variables; and only 1 for consequences. For translational outcomes, 2 training courses achieved a level of effectiveness of >2, showing skills transfer beyond the simulator environment. With increasing simulators, there is a need for more validity studies and attempts to investigate translational outcomes to the operating theater when using these simulators. Nontechnical skills training is notably lacking, despite demand within the field.

Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy.

Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training

Current status of simulation training in plastic surgery residency programs: A review

Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors’ opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.

Using a Quality Improvement Approach to Engage Families in Emergency Room Sepsis Huddles

Background:Interdisciplinary team huddles are a key component of the Sepsis Collaborative’s Recognition Bundle in the Emergency Department (ED). Family Engagement (FE) is essential to ensure best outcomes. Working with families as partners we co-produced a simulation-based training model including, clinical scenarios, family-centered competencies, and debriefs. This model engages family advisors who serve as coaches of standardized patients and interdisciplinary teams in an immersive learning experience.Objective:Apply our training model to standardize engagement of families during sepsis huddles in the ED.Methods:Using a quality improvement framework, we developed our key driver diagram (Fig. 1) and focused on development of standardized language as our first intervention to facilitate partnership with families during sepsis huddles. A succession of 6 improvement cycles were implemented (Fig. 2) with unique attending, nurse, and resident learner groups.Results:Based on family and clinician feedback (Fig. 3), the following standardized elements were developed: (1) explanation of sepsis huddle that invites families to partner and share concerns; (2) direct language to explain the term sepsis; (3) explanation of next steps, timeline, and confirmed point of contact. This language guided providers to engage more clearly and consistently.Conclusions:Our co-produced training approach resulted in the development of standardized language as 1 component to support Family Engagement in ED sepsis huddles. Clinicians shared that family feedback was essential in the creation of succinct, meaningful, and mutually engaging language. Though not measured in this intervention, clinicians shared the perception that this training improved efficiency and priority to engage families in huddles.

A Novel Approach to Sexual Assault Nurse Examiner Training: A Pilot Program

BackgroundSexual assault nurse examiners are highly specialized trained nurses. MethodsIn order to meet our institution's need to recruit and train experienced registered nurses as sexual assault nurse examiners, we developed a multimethod, simulation-based training model designed to streamline the educational process and preserve the quality of education. The training program incorporated human manikin-based simulation and specially trained actors. ResultsIn less than one year, this program trained enough registered nurses to provide 24-hour coverage for our institution's five facilities. ConclusionSimulation-based training that incorporates simulated sexual assault victims is an effective model that meets the goals of staffing specially trained sexual assault nurse examiners.

Humeral head intraosseous access: Filling the military training gap

Humeral head intraosseous (HHIO) infusion is the process of injecting fluids directly into the marrow of the humerus, or upper arm bone, to provide a non-collapsible entry point into the circulatory system. This technique provides fluids and medication quickly when intravenous (IV) access is not feasible in emergency situations. As of 2010, Tactical Combat Casualty Care guidelines recommend using intraosseous (IO) infusion in any resuscitation scenario where IV access is not feasible. The US Army Center for Pre-Hospital Medicine (CPHM) provides pre-deployment training to Roles I, II, and III medical providers. In addition, the CPHM provides training for deploying Forward Surgical Teams and en route care via the Critical Care Flight Paramedic Program. The Army’s Program of Instruction currently lacks an adequate simulation-based training model for the HHIO procedure and relies on live tissue training. The US Army Research Laboratory, Human Research and Engineering Directorate, Advanced Training and Simulation Division, developed a capability (i.e., Partial Task Trainer, or PTT) to train this procedure. This study assessed the usability of the PTT device for training on the IO procedure. Specifically, this paper seeks to identify statistically significant differences among the usability ratings of the PTT for paramedics and emergency medicine physicians.

Evaluation of Simulation-Based Training Model on Vascular Anastomotic Skills for Surgical Residents

Reduced work hours and concerns over patient safety have encouraged surgical educators to find methods to advance resident skills more efficiently. Simulation provides the opportunity to improve technical surgical skills outside the operating room. We hypothesized that practice on surgical task simulators would improve residents' technical performance of vascular anastomotic technique. Senior general surgery residents at an academic medical center completed pretests and posttests on 3 vascular surgery simulators: femoral-popliteal bypass, carotid endarterectomy, and abdominal aortic aneurysm repair. The initial training sessions began with a 15-minute instructional video on how to perform the procedures, followed by supervised sessions in anastomotic technique with attending vascular surgeons. Initial individual sessions were videotaped as a pretest, and the final attempt was videotaped as the posttest. Each test was evaluated by a single experienced attending vascular surgeon blinded to the examinees. Anastomoses were graded using a performance rating and a modified objective structured assessment of technical skill rating. Results were analyzed using mixed model P values. The residents showed statistically significant improvement between the pretest and the posttest in both their performance rating (1.9 vs. 2.4, P = 0.02) and the objective structured assessment of technical skill (2.6 vs. 3.1, P = 0.01), as well as in most subsets of each assessment scale. We conclude that practice using simulated anastomotic models leads to measurable improvement in vascular anastomotic technique in senior general surgery residents.

Simulation-based Training in Ultrasound Assisted Central Venous Catheterization.

BACKGROUND: More than 5 million central venous catheters (CVCs) are inserted in the USA each year, and although these catheters can be life saving, they are also associated with significant risks; 75% of complications arising from procedures like CVC occur in the first 30 cases of a physician’s career. A structured CVC training program9 and the use of ultrasound guidance for CVC placement, 7, 10, 11 increased patient safety by reducing complication rates. 8, 10–14 Simulation-based procedural trainers have demonstrated validity in transferring skills to applied clinical environments,1–6 and the use of simulators for CVC training is valuable because skills can be honed before attempting to perform the procedure on a live patient, thereby increasing patient safety. METHODS: Fifty-four Internal Medicine Interns received training and were assessed through didactic and one-on-one instruction in Ultrasound-guided CVC procedures using Blue Phantom? vascular access simulation models. After individual instruction, subjects independently practiced placement procedures using Ultrasound machines and standard catheter kits using one or more of 4 types of models: leg, arm, and head/neck anatomical models and a simple block model. Six-point Likert scales were used to assess pre- and post-test procedural self-efficacy, CVC performance on head/neck models, perceived value of simulation-based training, and an open response for subjects to write down what they learned. RESULTS: Mean subject score on the knowledge-based quiz was 91.68 / 100.00 (SD = 11.99). Subjects performed in the good to very good range for CVC performance (M=4.74, SD = .44). The small standard of deviation suggests that the training results were uniformly consistent. There were no significant differences between the type of practice model and CVC performance. There were no significant differences in CVC performance based on the number of previously placed CVCs, although prior placement ranged from zero to 35 (M = 4.33, SD = 4.97). This suggests that the instruction was effective independent of the experience level of the learner. Subjects indicated that after simulation-based training they were more confident in helping with CVC (t = -9.25, p =.000) and in performing CVC on their own (t = -13.52, p =.000). Subjects ranked the overall quality of instruction as very good (M = 5.25, SD = 0.17). More than half (57.4%) of the subjects made specific comments about what they learned during the training session, including specific mechanical techniques (83.87%), how to operate the equipment (67.74%), infection control techniques (38.71%), safety measures and contraindications (35.49%), associated complications (22.58%), specific anatomy (25.8%), and the advantages of practice (19.35%). CONCLUSION: The simulation-based training model that we employed using Ultrasound guidance and Blue Phantom? models for procedural training demonstrates that the integration of these components provides trainees with the tools they need to successfully demonstrate understanding and techniques associated with placing a CVC, and that the students perceived the training as effective. The logical next step is to assess the trainings effectiveness on the transfer of knowledge and skills to the clinical setting.