Simulation Training Course Research Articles

Safe transfer of simulation-based intubation skills to patients in cardiac arrest

Background: Studies investigating the transfer of endotracheal intubation skills from simulation training to out-of-hospital patient scenarios are limited. Aims: The aim was to evaluate the outcome of endotracheal intubation simulation training among paramedics and the safe transfer of skills to out-of-hospital cardiac arrest (OHCA) patients. Methods: Paramedics participated in a 1-day simulation training course including five Airtraq endotracheal intubation attempts using three different types of mannequins (n=15 attempts). Performance and outcome of transfer of intubation skills to patients were monitored for the next 35 months. European Resuscitation Council international advanced cardiopulmonary resuscitation guidelines ( Nolan et al, 2005 ) were followed to ensure patient safety. Findings: Endotracheal intubation was attempted in a total of 417 patients with OHCA by 51 (96%) of the 53 participating paramedics. In 366 (88%) patients, intubation was successfully performed in the first or second attempt. Aspiration, airway secretion, a high modified Cormack Lehane score and insecure verification of tube placement were the most common reasons for failed intubation. Conclusion: Endotracheal intubation with Airtraq in adult patients with OHCA can be performed safely by paramedics after receiving a 1-day simulation-based training course.

Improving the quality of transvaginal ultrasound scan by simulation training for general practice residents

BackgroundUltrasonography (US) is an essential tool for the diagnosis of acute gynecological conditions. General practice (GP) residents are involved in the first-line management of gynecologic emergencies. They are not familiar with US equipment. Initial training on simulators was conducted.The aim of this study was to evaluate the impact of simulation-based training on the quality of the sonographic images achieved by GP residents 2 months after the simulation training versus clinical training alone.MethodsYoung GP residents assigned to emergency gynecology departments were invited to a one-day simulation-based US training session. A prospective controlled trial aiming to assess the impact of such training on TVS (transvaginal ultrasound scan) image quality was conducted. The first group included GP residents who attended the simulation training course. The second group included GP residents who did not attend the course. Written consent to participate was obtained from all participants. Images achieved 2 months after the training were scored using standardized quality criteria and compared in both groups. The stress generated by this examination was also assessed with a simple numeric scale.ResultsA total of 137 residents attended the simulation training, 26 consented to participate in the controlled trial. Sonographic image quality was significantly better in the simulation group for the sagittal view of the uterus (3.6 vs 2.7, p = 0.01), for the longitudinal view of the right ovary (2.8 vs 1.4, p = 0.027), and for the Morrison space (1.7 vs 0.4, p = 0.034), but the difference was not significant for the left ovary (2.9 vs 1.7, p = 0.189). The stress generated by TVS after 2 months was not different between the groups (6.0 vs 4.8, p = 0.4).ConclusionSimulation-based training improved the quality of pelvic US images in GP residents assessed after 2 months of experience in gynecology compared to clinical training alone.

Cupping Therapy Simulation Course; A Pilot Study Assessing Self Reporting of Confidence, Expectations/Satisfaction and Performance

This paper aimed to assess self-reporting of confidence, expectations/satisfaction, and performance of medical students before and after the cupping therapy simulation training course and to validate cupping simulation training evaluation questionnaire (CSTEQ). It was a pilot study to evaluate cupping therapy simulation course provided by National Center for Complementary and Alternative Medicine (NCCAM). The number of participants was 29/41 (70.7%) (20 females and 9 males) before training and 20/41 (48.9%) (9 females and 11 males) after training who returned the (CSTEQ) questionnaire. A significant improvement of performance scale and total score were noted after the cupping simulation training. Significant differences in confidence (P=0.013), expectations/satisfaction (P=0.001), performance (P=0.007) and total scoring (P=0.001) between male and female medical students were noted in favor of males. We can conclude that medical students reported significant improvement in performance and overall scoring after cupping therapy simulation course. Cupping simulation training evaluation questionnaire (CSTEQ) may be a reliable test tool. Cupping therapy simulation course should be encouraged, updated and extended to satisfy the learning needs especially of the female medical student. Future large-scale studies were recommended.

An Emergency Simulation Course in a Postdoctoral General Dentistry Program: The New York Presbyterian/Weill Cornell Medicine Experience.

Dentists can encounter life-threatening medical emergencies during the provision of routine dental care and must therefore be comfortable with the management of these emergencies. High-fidelity simulation has been used routinely in medical and surgical training and is a recognized and effective educational and assessment tool. The aim of this study was to develop and evaluate a new high-fidelity simulation training course in medical emergency management for residents in the General Practice Residency program at New York Presbyterian/Weill Cornell Medicine. In academic years 2014-16, first-year GPR residents were required to take a simulation course covering medical emergency scenarios that are commonly encountered in the dental office. The course involved a team approach to emergency management with active participation by faculty and residents and with each training session followed by feedback and a formal review of the emergencies covered. Evaluation was achieved through completion of questionnaires by the residents following each session. A total of 14 residents (seven in each year) participated, completing 78 questionnaires in the two-year period. They gave the course an overall rating of 4.91 on a scale from 1 to 5, indicating strong agreement with the utility of the course as a learning tool in medical emergency management training. This course is now fully integrated into the GPR educational program at this institution and is a successful component of the emergency medicine curriculum.

Intimal Surface Suture Line (End-Product) Assessment of End-to-Side Microvascular Anastomosis

Summary:Microsurgery simulation courses increasingly use assessment methodologies to evaluate the quality of microvascular anastomosis and to provide constructive feedback in competency-based training. Assessment tools evaluating the “journey” of skill acquisition in anastomosis have evolved, including global rating scores, hand motion analysis, and evaluation of the final outcome, that is, “end-product” assessment. Anastomotic patency is the gold standard end-product in clinical microvascular surgery, and in vivo end-to-side anastomosis, which can be confirmed using the Acland-test. Microsurgery simulation training is moving to include nonliving models, where possible, according to the principles of the replacement, reduction, and refinement of the use of animals in research. While a standardized end-product assessment tool for nonliving end-to-end anastomosis exists, there is no similar tool for end-to-side anastomosis. Intimal surface suture line assessment is an error list-based tool, which involves exposing the intimal surface of a vessel and analysis of the quality of suture placement. Errors in end-to side anastomosis were classified according to the potential clinical significance (high, medium, or low) perceived by the senior authors. Intimal surface suture line assessment provides constructive feedback during microsurgery training, helping to minimize technical errors, which are likely to impact on the final outcome in a clinical environment. Intimal surface suture line assessment lends itself to nonliving simulation training courses as an end-product self-assessment tool, especially during the early learning curve, to demonstrate progression. It has intraoperative relevance by assessment of the intimal surface suture line as the final sutures are placed in an end-to-side anastomosis to provide objective feedback to trainees in relation to likely physiological anastomotic outcome.

Physiological and self-assessed psychological stress induced by a high fidelity simulation course among third year anesthesia and critical care residents: An observational study

IntroductionThe use of high fidelity simulators in Medicine can improve knowledge, behaviour and practice but may be associated with significant stress. Our objective was to measure physiological and psychological self-assessed intensity of stress before and after a planned simulation training session among third year anaesthesia and critical care residents. MethodsA convenience sample of 27 residents participating in a simulation training course was studied. Stress was evaluated by self-assessment using a numerical scale and by salivary amylase concentration before and after the session. Technical and non-technical (using the Aberdeen Anaesthetists’ Non Technical Skills scale) performances were assessed through videotapes analysis. ResultsThe median stress score was 5 (2–8) before and 7 (2–10) after the simulation session (P<0.001). For 48% of residents studied, the stress score after the session was superior or equal to 8/10. Salivary amylase concentration increased significantly after the session compared to before the session, respectively (1,250,440±1,216,667 vs. 727,260±603,787IU/L, P=0.008). There was no significant correlation between stress parameters and non-technical performance. DiscussionSimulation-induced stress, as measured by self-assessment and biological parameter, is high before the session and increases significantly during the course. While this stress did not seem to impact performance negatively, it should be taken into account.

Simulation training in upper tract endourology: myth or reality?

Surgeons training in the twenty-first century are subject to a myriad of pressures, as has always been the case within surgical training. These include reduced hours available for training and increased threat of litigation against their operating practice. The Halstedian approach of "see one, do one, teach one" has been replaced within surgical training and simulation has become established to enable urology trainees to develop technical and non-technical skills away from the operating room. With the primary focus as patient safety and increasing operating skill, "simulation training" encompasses several modalities. These include wet-lab cadaveric and animal models, dry lab, high fidelity, low-fidelity and virtual reality (VR). These can be used to practice generic surgical skills, such as laparoscopic suturing or knot tying on a robotic console. Beyond this there is potential for simulation training courses and full-immersion simulation to address non-technical skills and team aspects within the operating room. To incorporate simulators into training, models must be carefully designed and evaluated according to certain considerations, ensuring that they address parameters such as face, content and construct validity. This review aimed to provide an overview of simulation platforms available within endourology, considering ureterorenoscopy and percutaneous nephrolithotomy and the status of their validation.

Adaptation of non-technical skills behavioural markers for delivery room simulation

BackgroundSimulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room).MethodsThe MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected.ResultsThe mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories.ConclusionThe MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.

Abstract TP281: Reducing Door-to-Needle Times in Acute Ischemic Stroke : Multidisciplinary Team-based Approach at a Single Center

Background: The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time dependent, and national guidelines recommend door-to-needle (DTN) time within 60 minutes. Several strategies have been reported to be associated with reducing DTN times. However, effectiveness of such strategies has not been fully evaluated. Methods: In 2014, we assembled a multidisciplinary team called ‘Acute Stroke Team (AST)’ aiming for improving outcomes of patients with acute ischemic stroke, especially by reducing onset-to-treatment time. A new protocol was implemented to minimize delays: AST staff prenotification, parallel process workflow, and rapid acquisition of laboratory testing and brain imaging. AST reviewed all intravenous tPA cases and discussed the points of improvement. AST also organized both public and in-hospital lectures, and simulation training course. We compared patients received intravenous tPA within 4.5 hours from the symptom onset at our institute in the pre AST (April 2011 - August 2014) and post AST (September 2014 - July 2016) period. Using univariate methods and multivariable logistic regression, we assessed the associated factors with favorable outcomes. Results: In the pre and post AST period, 46 and 36 patients were treated with intravenous tPA, respectively. Compared with pre AST period, the median (interquartile range) DTN times was reduced from 71 (63-95) minutes to 55 (49-71) minutes (p&lt;0.01), and the percentage of patients with DTN times within 60 minutes were improved from 22% to 64% (P&lt;0.001) in the post AST period. By multivariable analysis, shorter DTN times (OR 0.98, 95% CI 0.95-0.99, p=0.025), lower age (OR 0.90, 95% CI 0.85-0.96, p=0.001) and lower NIHSS on admission (OR 0.88, 95% CI 0.82-0.95, p=0.001) were independently associated with independent ambulation at hospital discharge. Conclusions: Multidisciplinary team-based approach reduced DTN times. Reducing DTN times was associated with improving patient outcomes. Future efforts should focus on sustainability and safety of this approach.

Development of the simulation center oriented to residents competence enhancement

The study is an insight into the construction concept, curriculum set-up, faculty, facilities and management of the simulation center for standardized residency training base, with in-depth elaboration of the approach to build a simulation training center oriented to residency competency enhancement.The authors proposed to equip soft and hard ware to meet the needs of residents, build up faculty team and develop standardized simulation training courses, for enhanced residence competence. Key words: Resident; Competence; Simulation training center; Development

Simulation and Web-based learning increases utilization of Bier block for forearm fracture reduction in the pediatric emergency department.

Bier block (BB) is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet remains infrequently used in the pediatric emergency department (PED). No standardized methods of BB training have previously been described. The objective of this study was to determine whether a multimodal instructional course increases comfort with BB and translates to increased use of this technique. A novel interdisciplinary simulation and Web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED. Participants were surveyed pre-/post-training, and at 2 and 6 months regarding their comfort with BB. In parallel, we prospectively assessed the clinical use of BB for children ages 6 to 18 years requiring closed reduction of forearm fractures during the 24-month post-course period. Course participation included 26 physicians and 12 nurses. Survey response rate was 100%. Course participation increased both comfort (10% pre-training v. 89% post-training, p<0.001) and the willingness to use BB (51% pre-training v. 95% post-training, p<0.001), an effect sustained at 6 months post-course (66% and 92%, respectively, p<0.001 for both). In clinical practice, there were no BBs performed prior to course administration. We observed a consistent and sustained increase in clinical use among the BB-trained physicians, with 37% of all forearm reductions performed using BB at 24 months post-course completion. A novel combined simulation and Web-based training course increased comfort and willingness to use BB and was associated with increased use of this technique for forearm fracture reduction in the PED.

Simulation training to support healthcare professionals to meet the health needs of people with intellectual disabilities

Purpose The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented. Design/methodology/approach This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions. Findings Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities. Practical implications Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities. Originality/value The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

LO055: Increased utilization of Bier block for pediatric forearm fracture reduction following simulation and web-based training

Introduction: Bier block (BB) regional intravenous anesthesia is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet BB remains infrequently utilized in the Pediatric Emergency Department (PED). No standardized methods of BB training have previously been described. The objectives of this study were to evaluate comfort and level of experience with BB in the PED, and to determine if a multimodal instructional course increases these from baseline and translates to increased utilization of this technique. Methods: A novel interdisciplinary simulation and web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED. Participants were surveyed pre/post training, and at 2- and 6-months regarding their comfort with and willingness to use BB. In parallel, we prospectively assessed the clinical utilization of BB in the PED during the 24-month period immediately following course completion. Results: Course participation included 38 members of the PED (N = 26 physicians, 12 nurses), and survey response rate was 100% at all time points. Respondents reported that course participation increased both their comfort (10% pre vs. 89% post-training, p&lt;0.001) and willingness (51% pre vs. 95% post-training, p&lt;0.001) to use BB for forearm fracture reduction, an effect that was sustained at 6-months following course completion (66% and 92%, respectively, p&lt;0.001 for both). Before course attendance, only 6% of respondents indicated that they had ever used BB in a PED setting, and all participants indicated that the course addressed their learning objectives. In clinical practice, there were no BB performed prior to course administration. We observed a consistent and sustained increase in the clinical utilization of BB, with 39% of all PED forearm reductions performed using BB at 24-months post-course completion (114 BB, 17 unique physicians). Conclusion: A combined simulation and web-based training course increased comfort and willingness to use BB and was associated with increased utilization of this technique for forearm fracture reduction in the PED.

Identification tags and learners' situational awareness during high-fidelity simulation.

Simulation-based medical education is an integral part of the curriculum of many specialties. Simulation allows participants to develop and practice technical skills useful to the management of rare and urgent clinical situations in a safe and supportive learning environment.1 Several points are deemed essential to the promotion of optimal learning during simulation. One, which was emphasized by Issenberg and associates, stated that acquiring experience in medicine was governed by the learners’ commitment to a simulation’s realistic environment.2 Obtaining and maintaining the commitment of participants in a high-fidelity simulation scenario is then essential for a better learning experience. One way to foster a learner’s commitment toward a simulated environment is to help the learner gain a greater awareness of the environment’s characteristics. With better situational awareness, participants can more easily understand the various elements and the complexity of the environment, and then anticipate the human and material resources that might be needed. This could allow students to engage in better clinical decision making. Situational awareness has been measured by quantitative scales in studies conducted in the aviation and maritime fields, but additional adjustment and validation of these scales are still required.3,4 Moreover, specific factors affecting the situational awareness remain unstudied. Here, we undertook this research to assess whether wearing badges or name tags stating each participant’s function and posting a sign to clearly inform students of the scenario’s location during the high-fidelity simulation could lead to greater awareness of each learner’s role and contribute to their commitment. We hypothesized that using badges and formally identifying the location of the scenario would enable participants to feel more committed and to better identify everyone’s role and where the action was taking place. Evaluating the importance of the name tags and place identification We used a pretest-posttest design to achieve our study goals. Our study took place within a planned simulation training course for 25 anesthesiology residents on the management of critical anesthesia situations from April 30, 2014, to June 11, 2014. Study coordinators assigned 4 to 5 participants to each of the 6 overall simulation sessions scheduled. Each session was 4 hours long and included an introduction, followed by two high-fidelity simulated scenarios with debriefing. The high-fidelity simulation was operationalized through high equipment fidelity (functionality and responsiveness of patients, manikins, and medical instruments), high environment fidelity (real world overload demands), and high psychologic fidelity (maintaining the natural ‘‘flow’’ of a clinical scenario and participant’s immersion within the scenario).5 One scenario was about a patient who had a massive amniotic fluid embolism that occurred after a complicated delivery and leading to a maternal cardiac arrest, and the alternative scenario was of a patient with postoperative malignant hyperthermia. The order of the two scenarios was randomized for each session. During the first scenario of the session, participants did not wear badges, and no sign that formally identified the mock location was allowed. In the second scenario, name badges and identifying signs were used systematically. At the end of each scenario, all residents completed, using an audience response system (Turning Point, Ontario, Canada, Turning Technologies), a 7-question survey (7-point Likert scale) to evaluate their situational awareness and their level of commitment. An evaluator, blinded to the randomization sequence, listened to the soundtrack only of the audio-video recording of the simulated scenarios in search of indicators suggesting a lack of situational awareness. We noted no differences between the groups regarding their consciousness of the location, or of the various roles played by the participants. We found that the resident’s engagement was also similar in both groups. The number of indicators of poor situational awareness, noted by the blinded evaluator during audio review of the scenario’s video recording was not significantly different between groups.

Developing simulated training in old age psychiatry to recognise and assess medical problems in a psychiatric setting (RAMPPS)

IntroductionOlder people with mental ill health are more likely to receive lower quality of health care, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality [1–3]. There is increase focus on supporting people with multiple long-term physical and mental health conditions, particularly by embracing opportunities created by technology [4] (references are not available for this abstract).ObjectivesTo identify the common medical comorbidities on the Old Age Psychiatry Wards.AimsTo develop simulation training from the medical scenarios.MethodWe audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds, which consists of 4 Old Age Psychiatry wards. Data was collected in October 2015 and included referral date, patients’ age and sex, number of referrals, reason for referral and the outcome.ResultsWe assessed 339 (142 F, 197 M) patients with a mean age of 77 (range: 56-94). The cardiovascular problems constituted the majority (34%) of the referrals, central nervous system (11%), respiratory (8%), gastrointestinal (8%), infection (8%), musculoskeletal (7%), renal (3%), others (19%) and the reasons were unknown in (2%) of the 440 referrals. Some unusual problems were diagnosed including a spontaneous pneumothorax, primary biliary cirrhosis.ConclusionThe audit highlights the essence for more training in recognising and assessing medical problems in psychiatric settings - the simulation programme (RAMPPS) in Old Age Psychiatry. As a result of the service model, we are developing a simulation-training course tailored to the mental and physical health needs of the elderly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract TP313: Virtual Stroke Patient Simulation Training for Residents and Medical Students Improves Knowledge, Skill Sets and Confidence in Acute Stroke Care

Introduction: At most teaching hospitals, first- and second-year residents respond to a “Stroke Alert” where “Time is Brain.” Interpreting neurologic signs and symptoms and acute management of stroke is complex. In many medical specialties, simulated instruction improves performance and addresses patient safety needs without harm to, or practice upon, a real-live patient. Thus, we designed a virtual stroke patient simulation training course: to boost knowledge, skill sets, and confidence in managing hyperacute stroke scenarios with this new first-responder audience in mind. Hypothesis: We hypothesize that performance outcomes, as measured by Declarative and Procedural (Skill Sets) Knowledge and Confidence will improve over the 1.5-day period of a virtual stroke patient simulated training course. Methodology: Incoming Neurology residents and medical students with minimal exposure to stroke care underwent the aforementioned stroke simulation course at the Center for Advance Medical Learning and Simulation (CAMLS) in Tampa, Florida, USA. It included 3 lectures on acute stroke care by USF faculty and 10 simulated scenarios of “Stroke Alerts” using standardized actors and electronic patient simulators. After each scenario, debriefing reviewed participants’ performance in Declarative and Procedural (Skill Set) Knowledge and Confidence. Results were analyzed using Likert scale on data collected prior to, and after, the course. Results: A repeated measures ANOVA demonstrated that, compared to pre-testing, post-testing data for Declarative and Procedural (Skill Set) Knowledge (F=14.05, p=.002) and Confidence (F=33.37, p&lt;.001) of Acute Stroke management improved significantly for both residents and medical students alike. Conclusion: In conclusion, simulation training for acute stroke management is statistically and significantly effective for neurology residents and medical students. Simulation training addresses patient safety needs without harm to, or practice upon, real-live patients. Neurology residency programs across the country should consider designing similar programs or utilizing ours at CAMLS for optimal stroke care among beginning residents at the front line of stroke patient care.

S.T.A.R.T.T. plus: addition of prehospital personnel to a national multidisciplinary crisis resource management trauma team training course.

The Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course is a unique multidisciplinary trauma team training course deliberately designed to address the common crisis resource management (CRM) skills of trauma team members. Moreover, the curriculum has been updated to also target the specific learning needs of individual participating professionals: physicians, nurses and respiratory therapists. This commentary outlines further modifications to the course curriculum in order to address the needs of a relatively undertargeted group: prehospital personnel (i.e., emergency medical services). Maintenance of high participant satisfaction, regardless of profession, suggests that the S.T.A.R.T.T. course can be readily modified to incorporate prehospital personnel without losing its utility or popularity.

Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course)

The survival of patients after the sudden circulatory arrest (SCA) depends not only on immediate onset of resuscitative measures, but also on their quality. The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course. Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR) and chest compression (CC) technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video); CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor) and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest). The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR), minimum and maximum values. The difference was considered significant at P<0.05. Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18). When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000). While only one provider was able to perform the target CC without the sensor and the tips (4%), 12 providers were able to do it with the sensor (48%) (P=0.0000). In all resuscitation teams, there was a lack in compliance with the ECR 2015 guidelines for expanded CPR, as well as ineffective team work was revealed. Chest compressions did not comply with recommended parameters; pauses before and after defibrillator discharge were too long. In most cases, there was hyperventilation during the artificial lung ventilation. The safety principle was not followed by one of resuscitation teams during the defibrillation procedure. Conclusion. The obtained data demonstrate that healthcare providers have poor skills in basic and expanded CPR. Therefore, it is important to train and retrain healthcare providers in basic and expanded CPR within the frames of simulation training courses on a regular basis (in accordance with European Resuscitation Council Guidelines for Resuscitation 2015 and National Resuscitation Council). During training, the use of technical means of monitoring of the chest compression quality control in CPR should be warranted. It is important to arrange regular retraining in order to keep the skills uptodate, as well as regular debriefings on the CPR quality after each case of resuscitation measures in a hospital.

Efficacy of Eyesi® surgical simulator training in improving high-tension capsules capsulorhexis performance

Objetivos: Avaliar se o realizado com o simulador cirurgico de catarata Eyesi e o seu curriculo de exercicios padrao sao efetivos em melhorar o desempenho de cirurgioes de catarata em formacao na confeccao de capsulorrexe em capsulas de alta tensao realizadas no simulador. Metodos: Analisamos retrospectivamente relatorios de de residentes de 2o e 3o ano e fellows de catarata que realizaram o curso versao 2.1 de com o simulador cirurgico de catarata Eyesi no periodo de maio de 2012 a agosto de 2013 no Instituto de Diagnostico e Terapia Ocular, Rio de Janeiro, Brasil. Comparamos o escore medio (de 0 a 100 pontos) atribuido na confeccao de capsulorrexe em capsula de alta tensao no simulador antes do treinamento (durante inicio do curso) e depois do treinamento (nos estagios finais do curso). Resultados: Trinta e sete relatorios de cirurgioes em foram analisados. O escore medio e desvio padrao da capsulorrexe em capsula de alta tensao antes do treinamento foi de 41,73 ± 27,08 pontos e depois do treinamento de 72,55 ± 16,40 pontos, uma diferenca de +30,82 pontos (p <0.001 no teste t pareado), representando uma melhora de 73% no desempenho. Conclusao: O realizado com o simulador cirurgico de catarata Eyesi seguindo o curriculo do curso versao 2.1 foi eficaz em melhorar o desempenho de cirurgioes em na confeccao de capsulorrexe em capsulas de alta tensao.

Simulated Trauma and Resuscitation Team Training course—evolution of a multidisciplinary trauma crisis resource management simulation course

BackgroundWe previously reported on a pilot trauma multidisciplinary crisis resource course titled S.T.A.R.T.T. (Simulated Trauma and Resuscitative Team Training). Here, we study the course's evolution. MethodsSatisfaction was evaluated by postcourse survey. Trauma teams were evaluated using the Ottawa global rating scale and an Advanced Trauma Life Support primary survey checklist. ResultsEleven “trauma teams,” consisting of physicians, nurses, and respiratory therapists, each completed 4 crisis simulations over 3 courses. Satisfaction remained high among participants with overall mean satisfaction being 4.39 on a 5-point Likert scale. As participants progressed through scenarios, improvements in global rating scale scores were seen between the 1st and 4th (29.8 vs 36.1 of 42, P = .022), 2nd and 3rd (28.2 vs 34.6, P = .017), and 2nd and 4th (28.2 vs 36.1, P = .003) scenarios. There were no differences in Advanced Trauma Life Support checklist with mean scores for each scenario ranging 11.3 to 13.2 of 17. ConclusionsThe evolved Simulated Trauma and Resuscitative Team Training curriculum has maintained high participant satisfaction and is associated with improvement in team crisis resource management skills over the duration of the course.