Simulation Training Research Articles

Comparative study on the effects of role changes in simulation training among Korean nursing students

BackgroundSimulation education, based on experiential learning, helps nursing students develop coping strategies through reflective problem-solving in a safe environment. This enhances their ability to respond to similar new experiences and improves their caring abilities. Most nursing schools use simulation education, although the applications vary. This study identified a more effective simulation teaching method for nursing students by comparing the effects between two groups: one that performs one role per scenario and another that rotates through multiple roles per scenario. MethodsUsing a randomized control group pre-post design, we equally divided 62 students aged ≥19 years enrolled at a university in Changwon city, South Korea into a single-scenario role rotation group (SRRG) and a multiscenario role fixation group (MRFG). Data were analyzed by performing χ2 tests, independent t-tests, and paired t-tests. ResultsLearning confidence and critical thinking significantly changed in the SRRG; clinical competency significantly changed in the MRFG. ConclusionsExposure to multiple scenario simulations improves clinical competency. Changing roles in a single scenario boost learning confidence and critical thinking disposition.

Health professions students' perspectives of a stigma-reducing simulation including simulated patients with lived experience of addiction and recovery

BackgroundStigma surrounding substance use disorders (SUDs) hinders treatment. This study explores perceptions of health professions students following simulation-based training involving individuals with lived experience of addiction and recovery. MethodsThematic analysis of self-reflection narratives was conducted to identify themes. ResultsThirty-three graduate students from various health disciplines participated. Four themes were identified: humanizing addiction, cultivation of hope, attitude of gratitude, and transformation and growth. Findings highlight contact-based simulations' potential to challenge stereotypes and foster empathy. ConclusionIntegrating stigma reduction interventions into health curricula is crucial. Contact-based simulation training shapes positive attitudes towards individuals with SUDs.

Simulation-based training in robotic surgery education: bibliometric analysis and visualization.

Simulation-based robotic surgery training may help surgeons gain operative skills and experience in the simulation environment. This bibliometric analysis examined the development of simulation-based training for robotic surgical education. Articles pertaining to robotic surgical simulation training that were included in the Web of Science Core Collection up to April 25, 2024, were included. The temporal patterns in published paper numbers were evaluated using Microsoft Excel software, and the data regarding co-authorship and keyword co-occurrence were analyzed and visualized using the VOSviewer and SCImago Graphica tools. A total of 594 papers on simulation-based training for robotic surgical education were evaluated in this study. The United States and United Kingdom were the leading contributors in this field. The most published authors were Professor Ahmed Kamran (23 publications) and Prokar Dasgupta (22 publications). The highest number of papers was published in the journal titled "Surgical Endoscopy and Other Interventional Techniques." The most common keywords were "virtual reality," "curriculum," "robotic surgery simulator," "assessment," and "learning curve." Our study offers a detailed overview of international research on simulation-based training for robotic surgical education, including the publishing countries, institutions, authors, journals, and research hotspots. It also methodically summarizes the state of knowledge in the area, and provides definite directions and concepts for further in-depth analysis.

Beliefs, preferences, and acceptance of personal protective equipment for a shock room team in a tertiary care center.

During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality. The secondary objectives are to describe the expertise and difficulties faced while using PPE in the shock room care. Fifty-four HCW participated in a shock room simulation training at a large urban tertiary care hospital in Germany, utilizing a PPE comprising an FFP2 mask, gloves, goggles, and gown. Subsequently, participants completed an online questionnaire featuring 15 questions presented on a 5-point Likert scale or as multiple-choice questions with predefined answers. Sixty-eight point five percent of our participants voted for an established standard PPE in shock room care. The largest fraction of our participants (40.7%) favors a standard PPE consisting of FFP2 mask, gown, and gloves. Less HCW (31.5%) want to wear PPE in shock room simulation training. Except for goggles we could not detect relevant difficulties faced while using PPE in the shock room environment. Incorrect use of PPE was observed in 14.8%. A majority of our participants favored a standard PPE including a FFP2 respirator in shock room care. In addition, we recommend the use of PPE in shock room simulation training, while further awareness of and training in proper use of PPE seems to be necessary to reduce risk of infectious diseases for HCW.

Combining stress inoculation with virtual reality simulation training of malignant hyperthermia

BackgroundLimited research has been conducted on how healthcare simulation can mitigate clinician stress. Stress exposure training (SET) has been shown to decrease stress’s impact on performance. Combining SET with virtual reality (VR) simulation training has not yet been explored in the context of stress inoculation. The primary purpose of this pilot study was to determine if a VR module could induce stress. The secondary purpose was to determine if repeated exposure to stressors could decrease stress response in a simulated environment.MethodsMedical students were recruited to partake in VR simulation modules aimed at treatment of malignant hyperthermia (MH). Those in the SET group were exposed to stressful stimuli during training modules, while those in the Control group were not. Both groups then completed a Test Module with the presence of stressful stimuli. Objective and subjective indicators of stress were measured after each module.ResultsBoth groups indicated increases in perceived stress and module stressfulness after Training Module 1 and decreases after Training Module 2. After the Test Module, the Control group experienced significant elevation in perceived stress (p = .05), and the SET group had a significant decrease in perceived module stressfulness (p < .05). Both groups had a decrease in perceived competence after Training Module 1 (p < .001) and an increase after Training Module 2 (p < .001), with the SET group having significant elevation after the Test Module (p < .01). Both groups found the VR module to be feasible as a teaching tool. Objectively, the SET group showed an upward trend in electrodermal activity (EDA) from the Tutorial to Test Modules (p < .05), with the Control group showing a decrease after Training Module 2 (p = .05) and an increase after the Test Module (p < .01).ConclusionsA VR module targeting treatment of MH successfully induced stress and was regarded favorably by participants. Those in the SET group perceived less stress and more competence after the Test Module than those in the Control. Findings suggest that repeated exposure to stressors through VR may desensitize participants from future stress in a simulated environment.

Colonoscopy Training on Virtual-Reality Simulators or Physical Model Simulators: A Randomized Controlled Trial

This study employed a randomized controlled trial to assess the efficacy of virtual-reality (VR) simulators and physical model simulators on colonoscopy training to explore the optimal and evidence-based simulation training. Forty participants were divided into 2 groups and randomized as dyads: the VR simulator group and the physical model simulator group. All the participants performed a baseline test through porcine colonoscopy. After a 6 h simulation training, each participant underwent a post-test on a pig after bowel preparation, and the procedures were video-recorded. Both the baseline test and the post-test were blindly assessed by 2 experienced assistant director physicians based on the GAGES-C scoring system. Simulation center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai. Forty surgical residents without colonoscopy experience. Both the VR simulator group and the physical model simulator group improved significantly over the baseline test. The VR simulator group performed significantly better than the physical model simulator group, p=0.042. The participants in both groups expressed a high level of simulator satisfaction. Novice residents can benefit from both VR simulators and physical model simulators. The VR simulator was shown to be more effective for colonoscopy training. VR simulators were more recommended for novices conducting basic colonoscopy training.

Simulation techniques in optometric education: Is a model eye for tonometry a valuable instruction tool?

Simulation techniques are used in healthcare education to support the development of clinical skills. The aim of this study was to investigate the perceived value of a tonometry model eye (TME) when used in teaching and learning the clinical skill of Goldmann applanation tonometry (GAT) in optometric education in the UK. A retrospective two-armed cross-sectional study was conducted to investigate the perceived value of using a model eye for teaching and learning GAT in optometric education. Focus group discussion (FGD) was employed to explore the views of academic experts experienced in teaching GAT using a TME. Semi-structured surveys were conducted to elicit the opinions of optometry students following GAT simulation training. Qualitative thematic analysis of the FGD and open-ended survey questions was undertaken. Quantitative data based on rated student responses was assessed using Chi-square analysis to examine differences between year-group responses. The TME was reported to be a useful experiential tool, facilitating a safe learning environment for students to develop the technical skills required to perform GAT before moving on to real-eye experiences. Whilst limitations of the model eye were noted, these did not diminish the value of the model eye as an instructional tool. Students reported improved confidence (86%) and would highly recommend (82%) the TME to other students. The model eye for tonometry was perceived by academic tutors and optometry students to be a valuable instruction tool as part of a scaffolded process for learning GAT. Irrespective of their learning stage, students reported a range of benefits from the model eye, such as being able to make mistakes, taking repeat measurements and getting used to the equipment, all whilst not having to worry about patient safety.

A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus.

Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. III.

Evaluation of Medical Subject Headings assignment in simulated patient articles.

To evaluate human-based Medical Subject Headings (MeSH) allocation in articles about 'patient simulation'-a technique that mimics real-life patient scenarios with controlled patient responses. A validation set of articles indexed before the Medical Text Indexer-Auto implementation (in 2019) was created with 150 combinations potentially referring to 'patient simulation'. Articles were classified into four categories of simulation studies. Allocation of seven MeSH terms (Simulation Training, Patient Simulation, High Fidelity Simulation Training, Computer Simulation, Patient-Specific Modelling, Virtual Reality, and Virtual Reality Exposure Therapy) was investigated. Accuracy metrics (sensitivity, precision, or positive predictive value) were calculated for each category of studies. A set of 7213 articles was obtained from 53 different word combinations, with 2634 excluded as irrelevant. 'Simulated patient' and 'standardized/standardized patient' were the most used terms. The 4579 included articles, published in 1044 different journals, were classified into: 'Machine/Automation' (8.6%), 'Education' (75.9%) and 'Practice audit' (11.4%); 4.1% were 'Unclear'. Articles were indexed with a median of 10 MeSH (IQR 8-13); however, 45.5% were not indexed with any of the seven MeSH terms. Patient Simulation was the most prevalent MeSH (24.0%). Automation articles were more associated with Computer Simulation MeSH (sensitivity = 54.5%; precision = 25.1%), while Education articles were associated with Patient Simulation MeSH (sensitivity = 40.2%; precision = 80.9%). Practice audit articles were also polarized to Patient Simulation MeSH (sensitivity = 34.6%; precision = 10.5%). Inconsistent use of free-text words related to patient simulation was observed, as well as inaccuracies in human-based MeSH assignments. These limitations can compromise relevant literature retrieval to support evidence synthesis exercises.

Pelatihan Five Finger Therapy dalam Meningkatkan Kualitas Tidur Warga Binaan Pemasyarakatan

Introduction: Inmates (hereinafter referred to as WBP) often experience mental health disorders including depression, severe stress, and anxiety. This affects the quality of sleep which will trigger other health problems such as heart failure, coronary heart disease, and heart attacks. Objective: to socialize and train five-finger therapy or hereinafter referred to as Five Finger Therapy in improving sleep quality in Inmates (WBP). Method: th method of this activity uses lectures in socialization and training simulations. The number of participants is 40 people. The activity starts from the preparation, implementation, and evaluation stages. Data was collected through surveys, interviews, and observations before and after the implementation of therapy. Result: the results of the activity showed that out of 40 respondents to WBP in the Class 2B Banjar City male prison, it was found that before Five Finger Therapy was carried out, 30 WBP experienced poor sleep quality (75.0%) and 10 people or 25% had good sleep quality. After Five Finger Therapy was carried out, the category of good sleep quality increased to 32 people (80.0%) and poor quality decreased to 18 people (20.0%). Conclusion: this indicates that Five Finger Therapy has successfully improved the quality of WBP sleep, so that the training is effective in improving the quality of sleep of male WBP in prison. This therapy makes a positive contribution to the mental health of WBP. Recommendations for the continued implementation of five finger therapy and the importance of support from friends and prison officers in facilitating the action

Research on the Impact of Digitalization on Bank Performance Based on BP Neural Network

With the promotion and development of digital finance, the degree of digitalization has an increasingly significant impact on the banking business, which cannot be ignored in the operation of commercial banks. Therefore, establishing a digitalization bank profitability system model is of great significance for the sustainable development of banks and digital finance. This article selects 6 Chinese state-owned banks from 57 listed banks in the A+H stock market as samples, constructs a digital indicator system and evaluation model for banks through the literature review method, and uses simulation training to explore the effectiveness of BP neural network in evaluating the impact of digitalization on bank profitability. The aim is to provide a reference for the evaluation of financial statement information of other banks and other factors affecting bank digitalization. The innovation of the article lies in the innovative use of the entropy weight coefficient of variation method to establish a digital evaluation system model, which utilizes the data itself to objectively establish an evaluation system, incorporate the established digital system into the black box model of the BP neural network model to study the impact of changes in digitalization on banking operations.

Insights into virtual reality-based training for unexplained disease outbreaks: A qualitative exploration of Chinese standardized training nurses' experiences

BackgroundAn unexplained disease outbreak refers to a scenario wherein a group of individuals encounters similar health issues within a short timeframe, yet healthcare professionals find it challenging to promptly identify the specific cause or pathogenic factors triggering the outbreak. Emerging as a vital force in China, standardized training nurses can significantly mitigate the impact of unforeseen events. ObjectiveThis study aims to illuminate the experiences of Chinese standardized training nurses engaged in training for unexplained disease outbreaks utilizing virtual reality (VR) technology. DesignA qualitative descriptive research design was employed. ParticipantsThirty Chinese standardized training nurses participated in semi-structured interviews. MethodsData were collected through semi-structured interviews conducted from April 2023 to June 2023. Braun and Clark's thematic analysis method was applied for data analysis. ResultsThe study revealed five prominent themes: Surpassing Expectations, Enjoyable Learning, Self-challenge, Reflective Learning, and Promotion-Worthy. In essence, Chinese standardized training nurses perceived VR training as effective, meaningful, and conducive to reflective opportunities. Nevertheless, they expressed challenges in composing epidemiological reports, particularly when lacking expertise in epidemiology and having limited exposure to simulated training. ConclusionVirtual Reality (VR) technology plays a crucial role in continuing education after graduation (standardized training for nurses) in China, contributing to the enhancement of clinical practice standards and the promotion of teamwork collaboration. Its broader application is considered worthy of promotion.

Large-eddy simulation of shock train in convergent-divergent nozzles with isothermal walls

ABSTRACT High-order accurate Large-eddy simulations (LES) have been carried out for compressible, turbulent flow through two bell-shaped convergent-divergent nozzles- one with a short divergent portion and the other with a longer one. An explicit filtering approach based on approximate deconvolution method is used for the LES. The nozzles have isothermal walls and circular cross-sections. The incoming flow is a turbulent, subsonic fully developed pipe flow at centreline Mach number of around 0.4 and friction Reynolds number 216. An adaptive filter is used to capture the shocks appearing in the divergent portion of the nozzles. The complicated behaviour of the mean flow, Reynolds stresses, production and pressure-strain terms of the axial Reynolds stress budget in the shock train region is shown. The broadband nature of the shock train oscillations having multiple dominant frequencies in these nozzles is observed in the present LES.

Simulation training in mammography with AI-generated images: a multireader study.

The interpretation of mammograms requires many years of training and experience. Currently, training in mammography, like the rest of diagnostic radiology, is through institutional libraries, books, and experience accumulated over time. We explore whether artificial Intelligence (AI)-generated images can help in simulation education and result in measurable improvement in performance of residents in training. We developed a generative adversarial network (GAN) that was capable of generating mammography images with varying characteristics, such as size and density, and created a tool with which a user could control these characteristics. The tool allowed the user (a radiology resident) to realistically insert cancers within different regions of the mammogram. We then provided this tool to residents in training. Residents were randomized into a practice group and a non-practice group, and the difference in performance before and after practice with such a tool (in comparison to no intervention in the non-practice group) was assessed. Fifty residents participated in the study, 27 underwent simulation training, and 23 did not. There was a significant improvement in the sensitivity (7.43 percent, significant at p-value = 0.03), negative predictive value (5.05 percent, significant at p-value = 0.008) and accuracy (6.49 percent, significant at p-value = 0.01) among residents in the detection of cancer on mammograms after simulation training. Our study shows the value of simulation training in diagnostic radiology and explores the potential of generative AI to enable such simulation training. Using generative artificial intelligence, simulation training modules can be developed that can help residents in training by providing them with a visual impression of a variety of different cases. Generative networks can produce diagnostic imaging with specific characteristics, potentially useful for training residents. Training with generating images improved residents' mammographic diagnostic abilities. Development of a game-like interface that exploits these networks can result in improvement in performance over a short training period.

Shaping the future of healthcare: improving quality and safety through integrating simulation into Public Health education.

This perspective focuses on the role of healthcare simulation in training and implementing processes aimed at improving the quality of care and patient safety. Evidence of the effectiveness of simulation in improving clinical performance, reducing healthcare costs and raising professional education standards is presented. In light of this evidence, we propose to consider simulation-based education as an integrative training modality in the preparation of health professionals in the field of Public Health. A pilot project is presented with the aim of training professionals capable of further contributing to improving the quality and safety of patients through an interdisciplinary and innovative approach.

Telesimulation for Training in Infant Feeding: A Randomized Controlled Trial.

Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., "telesimulation", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding.

Individualized Design Application of 3-Dimensional Printing Navigational Template for Pedicle Screw Installation: A Training Case Report.

BACKGROUND The proper installation for pedicle screws by the traditional method of surgeons dependent on experience is not guaranteed, and educational solutions have progressed from chalkboards to electronic teaching platforms. We designed a case of 3-dimensional printing drill guide template as a surgical application, which can accurately navigate implantation of pedicle screws, and assessed its effect for simulative training. MATERIAL AND METHODS We randomly selected a set of computed tomography data for spondylolisthesis. A navigational template of pedicles and screws was designed by software Mimics and Pro-E, where trajectories of directions and angles guiding the nail way were manipulated for screwing based on anatomy, and its solid model was fabricated by a BT600 3D printer. The screws were integrated and installed to observe their stability. RESULTS The navigational model and custom spine implants were examined to be compatibly immobilized, because they are tolerant to radiation and stable against hydrolysis. The screw size and template were fit accurately to the vertebrae intraosseously, because the pilot holes were drilled and the trajectories were guided by cannulas with visible routes. During the surgical workflow, the patient reported appreciation and showed substantial compliance, while having few complications with this approach. Compared with fluoroscopy-assisted or free-hand techniques, the effect of simulative training during processing was excellent. CONCLUSIONS The surgical biomodel is practical for the procedural accuracy of surgical guides or as an educational drill. This fostering a style of "practice substituting for teaching" sets a paragon of keeping up with time and is worthy of recommendation.

Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students – a prospective evaluation study

BackgroundEmpathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students.MethodsThe prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale.Results146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy.ConclusionThe results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student’s further course of study.

Assessing the Efficacy of Medium- and High-Reality Simulators in Normal Labor Management: A Randomized Controlled Trial

IntroductionIn recent years, the use of simulation has become integral to midwifery education. This study systematically examined the effectiveness of high- and medium-reality simulators in the management of normal labor, focusing on their impact on normal delivery skills, student satisfaction, and self-confidence in learning. The evaluation encompassed both laboratory and hospital settings, providing a comprehensive assessment of the simulators' efficacy in enhancing key aspects of midwifery education. Material and methodIn this experimental randomized controlled study, the sample group comprised 102 students enrolled in the midwifery department of a university in Türkiye. These students were randomly assigned to three groups utilizing Research Randomizer (https://www.randomizer.org). The students consisted of a control group (d1 = slide and video presentation, 30 people) and two experimental groups (d2 = medium-reality simulator, 32 people; d3 = high-reality simulator, 33 people). Data were collected by a single observer using various tools, including the Introductory Information Form, the Student Satisfaction and Self-Confidence in Learning Scale, and the Normal Birth Evaluation Form. Pre- and post-test applications were conducted in both laboratory and hospital settings. This study is registered on ClinicalTrials.org with the registration number NCT05999409. FindingsSimulation-based learning did not lead to a significant difference between the groups in terms of students' satisfaction and self-confidence in learning (p > .05). However, it was observed that the utilization of both medium- and high-reality simulations significantly impacted students' normal delivery skills, leading to a statistically significant difference between the groups (p < .05). ConclusionMedium- and high-reality simulation training proved effective in enhancing the normal delivery skills of midwifery students, with a notable positive impact. However, this training did not have a significant influence on student satisfaction and confidence. The findings suggest that incorporating medium- and high-reality simulation training is crucial for midwifery students to be able to improve their skills in hospital practice.

The “scenario” as a key educational tool in the simulation centre

ABSTRACT Using simulations is considered an effective tool in training and instructional processes. At the core of the process is the ‘scenario’. The objective of the current research was to shed light on the elements that affect the development of the scenario topic and all that relate to its operation during a simulation. With a mixed method based on grounded theory, we analysed the characteristics of 74 simulation workshops and 150 scenarios between the years 2019–2020 carried out in our college’s simulation centre. Findings point to a need to construct clear criteria and rules for preparing scenarios for simulation training. Issues such as the active simulation participants’ selection process, the scenario writer’s identity, the time of exposure to the scenario before arriving at the simulation centre, and how the scenario is mediated may also contribute to the simulation’s effectiveness.