Simulation Training Program Research Articles

Assessment of simulation training efficacy in improving microsurgical skills: a retrospective analysis.

Microsurgery demands an intensive period of skill acquisition due to its inherent complexity. The development and implementation of innovative training methods are essential for enhancing microsurgical outcomes. This study aimed to evaluate the impact of a simulation training program on the clinical results of fingertip replantation surgeries. A total of 276 replanted digits from 232 patients were included in this study, with a follow-up period of 6 months. Surgeons were identified and divided into trained and control groups, with the trained group receiving the rat tail training program. Primary outcomes included survival rates, replantation duration for each fingertip, degrees of flexion, Semmes-Weinstein monofilament test results, static two-point discrimination scores, Michigan Hand Questionnaire (MHQ) scores, and the incidence rates of complications such as arterial insufficiency and pulp atrophy. Out of 1191 patients screened, 232met the criteria for analysis. The average patient age was 41.3years, predominantly male (87.1%). Trained microsurgeons performing Zone 1A replantation had higher success rates, shorter surgery durations, and fewer arterial complications compared to their untrained counterparts. For Zone 1B, they also showed improved operation times, decreased venous congestion and pulp atrophy, and better sensation outcomes. The results of trained group remained consistent across both single and multiple replantation, while the control group's outcomes varied in multiple replantation with less favorable results. The trained group reported better scores on the MHQ at 6-month follow-ups, particularly regarding work performance, pain levels, aesthetics, and satisfaction. The simulation training program using a rat tail model has proven effective in enhancing the skills necessary for improved fingertip replantation. Participants in the program performed surgeries more efficiently and achieved better clinical outcomes. The structure of the training has demonstrated benefits, which may lead to improvements in various microsurgical procedures, positively impacting trainee surgeons, patient care, and the broader medical community.

Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial.

During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses' clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited. This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings. This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments. After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=-0.30, P=.75; Cohen d=-0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks. This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses' practical skills and pandemic preparedness. Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0.

High-fidelity simulation training for improving nursing professional values acquisition.

Nursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care. To evaluate the impact of high-fidelity simulation training on first-year nursing students' nursing professional values acquisition. Quasi-experimental study using a longitudinal design with a single group pre- and post-intervention evaluation. 202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the "Nurses Professional Values Scale-Revised" (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient. The study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL). Most of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the "professional expertise" and "professional mastery" dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the "ethics" dimension. High-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care.

Advancing surgical education: An evaluation of laparoscopic simulation training for medical students.

To examine the medical students' awareness of laparoscopic surgery as well as assess the perceived importance of laparoscopic simulation training, and its impact on students' confidence, career aspirations, proficiency, spatial skills, and physical tolerance. Descriptive and comparative study using pre- and post-training assessments. Simulation training sessions centred on laparoscopic surgery techniques. Medical students in year three (n = 49) participated in laparoscopic simulation training sessions. Before the simulation training, 85.7% of students were unaware of laparoscopy, with females being less familiar than males (96.3% vs. 72.8%). 85.7% believed mastering laparoscopy was crucial before training, and 81.6% believed simulation training could enhance surgical skills. A disparity existed in this belief between the sexes, with 91% of males and 74.1% of females seeing the value in such training for skill improvement. Pretraining, males (54.5%) were more confident than females (26%) in mastering laparoscopy. Post-training, confidence increased for both groups, and the percentage of students wishing to pursue a surgical career also rose from 50% to 72.7%. Despite initial disparities in the time spent on training modules between males and females, both groups achieved similar proficiency levels by the end of the training. Although females initially lagged in spatial awareness and skills, post-training results showed significant improvement, matching their male counterparts. 26.5% of students experienced physical fatigue post-training, with a higher percentage of females (33.3%) reporting fatigue than males (18.2%). Regarding concentration during simulations, 81.8% of males could maintain focus compared to 48.2% of females. Laparoscopic simulation training effectively improved the understanding, confidence, and surgical skills of medical students, with evident benefits in shaping their career aspirations. While both genders exhibited significant gains, female students faced challenges in terms of physical tolerance and initial spatial awareness. However, their post-training achievements mirrored those of their male peers, highlighting the effectiveness and importance of such simulation training programmes.

전문소생술 시뮬레이션 실습이 간호학생의 학습실재감, 비판적 사고성향, 전문소생술 자기효능감에 미치는 효과

This study aimed to examine the effects of advanced cardiovascular life support simulation practice for nursing students' learning presence, critical thinking disposition and self-efficacy. The research design was single-group pre-post experimental study, and participants were 101 fourth-year nursing students. Data was collected from April 29 to July 7, 2024. A total of 4 teams were formed with 5~6 people per team, The education contents included specialized cardiac compression, airway maintenance device, defibrillator, emergency medication and advanced cardiovascular life support simulation practice. Data were collected using a structured questionnaire, and the collected data was analyzed using SPSS/WIN 25.0 program for descriptive statistics and paired t-test, analyzed with Pearson correlation coefficient. Nursing students experienced greater learning presence, critical thinking disposition, and self-efficacy after practicing advanced life support simulation was statistically significantly improved, and there was a significant positive correlation between variables. The results suggested that advanced cardiovascular life support simulation practice was confirmed as an effective teaching and learning method for nursing students' learning presence, critical thinking disposition and self-efficacy. These findings indicate that advanced cardiovascular life support simulation practice is an effective intervention for improving learning presence, critical thinking disposition and self-efficacy in nursing education. Based on the research results, It is believed that this can be used as basic data for emergency simulation training programs.

Enhancing Emergency Management Skills Through Manikin-Based Basic Life Support Simulations: An Evidence-Based Approach for Nursing Students

Introduction: Effective Basic Life Support (BLS) is crucial in improving survival rates during emergencies. Current nursing education often relies on traditional methods, which may not fully prepare students for the pressure and decision-making required in real-life situations. Objective: This study explores the effectiveness of manikin-based BLS simulation with scenarios in enhancing nursing students' skills in emergency management. Method: This study employed a one-group pre-test post-test design. Thirty nursing students were randomly assigned to participate in a Manikin-Based BLS Simulation training program. Their BLS skills were assessed using a validated and reliable questionnaire based on the American Heart Association (AHA) 2020 guidelines, administered both before and after the training. Data collection occurred in May 2024. The subsequent analysis will compare pre-test and post-test scores to evaluate the effectiveness of the Manikin-Based BLS Simulation in improving students' BLS skills. Result: Post-training, knowledge improved significantly (p &lt; 0.001), with 93.3% of students achieving 'Good' knowledge and 96.7% passing skill assessments. Conclusion: Manikin-based simulations effectively enhance knowledge and skills, supporting their integration into nursing curricula.

Laparoscopic training should be equitable for all: the impact of a mandatory, cost-neutral simulation training programme incorporating a free take-home box trainer

Background: The quality of gynaecological surgical training has faced mounting criticism internationally with multiple countries publishing potential remedies for improvement. Simulation has the indisputable ability to mitigate against training deficiencies, however, access to and the quality of simulation varies across regions, never mind nations. Objectives: To assess the effect on surgical skills by the introduction of a structured and integrated simulation programme with the unique aspect of being completely free of cost with the provision of a take-home laparoscopy box trainer (LBT). Materials and methods: The course was mandatory in attendance and was divided into basic, intermediate and advanced streams. Each stream had a bespoke curriculum based on RCOG training. It was delivered through a combination of lectures and a mixture of dry/wet lab training sessions with the LBT provided for home use. Main outcome measures: All participants completed a pre- and post-course questionnaire with objective laparoscopic skill metrics assessed using the Inovus LapAR system at the beginning and end of the course. Results: 100% of trainees demonstrated a statistically significant (p=&lt;0.05) improvement in smoothness, time and speed. Furthermore, 100% reported the course improved their surgical skills which were further developed by LBT practice. Conclusion: This demonstrated improvement in surgical skills and confidence solidifies the hope that such a programme could be implemented as an international gynaecological standard. If implemented from the initial specialist years of training, a strong foundation can be instilled to ensure that each future gynaecologist has strong surgical skills built from a high level of laparoscopic simulation. What is new? Our study is the first of its kind to describe an equitable and fair approach to laparoscopic surgery training; for the many rather than the select few.

Assessment of an oocyte retrieval simulation training program for residents: From training to clinical practice

AbstractObjectiveTo assess the impact of an oocyte retrieval simulation training program (ORSTP) on the clinical performance of residents.MethodsWe performed a prospective comparative study. The Simulation (S) group included oocyte retrieval (OR) performed by residents who had undergone an ORSTP before performing them on patients (n = 422 OR), and the control (C) group included OR performed by residents who had not received prior simulation training (n = 329 OR). Our main outcome measure was the OR rate (ORR) (number of oocytes collected/number of follicles aspirated) during the first 3 months of the rotation.ResultsIn the S group, six residents aspirated 657 ovaries, while in the C group, five residents aspirated 508 ovaries. The mean ORR during the first 3 months of rotation were comparable between the S and C groups (59% vs. 58%, P = 0.68). ORR during the first and second month, and at the end of the rotation were also comparable between the S and C groups (54% vs. 63% [P = 0.13], 58% vs. 59% [P = 0.82], and 58% vs. 58% [P = 0.90], respectively). There was no significant difference in the rate of failed OR (ORR = 0%) (3.3% vs. 1.8%, P = 0.13) between the S and C groups. Finally, 16% of residents in the S group reported being stressed before their first OR compared to 40% in the C group (P = 0.85), and 83% of residents in the S group felt confident about the results of their retrievals compared to 20% in the C group (P = 0.13).ConclusionThe ORSTP does not improve the residents' clinical performance, but it could decrease their stress and improve their confidence in clinical practice.

Virtual reality simulation and real-life training programs for cataract surgery: a scoping review of the literature

BackgroundCataract surgery requires a high level of dexterity and experience to avoid serious intra- and post-operative complications. Proper surgical training and evaluation during the learning phase are crucial to promote safety in the operating room (OR). This scoping review aims to report cataract surgery training efficacy for patient safety and trainee satisfaction in the OR when using virtual reality simulators (EyeSi [Haag-Streit, Heidelberg, Germany] or HelpMeSee [HelpMeSee foundation, Jersey city, New Jersey, United States]) or supervised surgical training on actual patients programs in residents.MethodsAn online article search in the PubMed database was performed to identify studies proposing OR performance assessment after virtual-reality simulation (EyeSi or HelpMeSee) or supervised surgical training on actual patients programs. Outcome assessment was primarily based on patient safety (i.e., intra- and post- operative complications, OR performance, operating time) and secondarily based on trainee satisfaction (i.e., subjective assessment).ResultsWe reviewed 18 articles, involving 1515 participants. There were 13 using the EyeSi simulator, with 10 studies conducted in high-income countries (59%). One study used the HelpMeSee simulator and was conducted in India. The four remaining studies reported supervised surgical training on actual patients, mostly conducted in low- middle- income countries. Training programs greatly differed between studies and the level of certainty was considered low. Only four studies were randomized clinical trials. There were 17 studies (94%) proposing patient safety assessments, mainly through intraoperative complication reports (67%). Significant safety improvements were found in 80% of comparative virtual reality simulation studies. All three supervised surgery studies were observational and reported a high amount of cataract surgeries performed by trainees. However, intraoperative complication rates appeared to be higher than in virtual reality simulation studies. Trainee satisfaction was rarely assessed (17%) and did not correlate with training outcomes.ConclusionsPatient safety assessment in the OR remains a major concern when evaluating the efficacy of a training program. Virtual reality simulation appears to lead to safer outcomes compared to that of supervised surgical training on actual patients alone, which encourages its use prior to performing real cases. However, actual training programs need to be more consistent, while maintaining a balance between financial, cultural, geographical, and accessibility factors.

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

Category: Bunion Introduction/Purpose: Minimally Invasive Surgery (MIS) for Hallux Valgus (HV) has become popular with similar results as open surgery with added benefits such as lower post-operative opioid use and improved cosmesis. However, adopting this technique faces challenges due to a pronounced learning curve. This study aims to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. Methods: A training program and a simulation model for HV MIS were designed based on recommendations from three experts. The phantoms were created using computed tomography scans of a patient with mild HV deformity, with iterative refinement through 3D printing and testing. Four experts performed a satisfaction survey of the phantoms. Participants, categorized into two groups based on MIS experience, underwent blind assessments. Evaluation parameters, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and X-ray usage. Four orthopedic surgeons without MIS experience 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 and a program evaluation survey. Four foot and ankle surgeons with vast experience performed the same procedure with one simulated model in order to compare the two groups' initial performance.The desired performance for novices was set at 80% of experts' performance for OSATS score. Results: Expert evaluation of the phantoms 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 23-25) vs. 15.5 (range 12-17) (p=.01), median surgical times of 22.75 minutes (range 12-27) vs. 48.75 minutes (38-60) (p=.02), and median X-ray usage of 70 (range 53-102) vs. 232.5 (range 112-280) (p=.02). Novices exhibited a significant improvement in OSATS scores from the fifth session onward (p = .01), reaching the desired performance of 20 points. Performance at the final training with the phantom did not differ from cadaveric surgery outcomes for all parameters. All trained novices expressed high satisfaction regarding the training program and reported that this program effectively enhanced their surgical skills and confidence. Conclusion: This study validated a simulation phantom model and training program, allowing non-experienced HV MIS orthopedic 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 cadaveric model. [Figure: see text]

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

Efficacy of a new video observational training method (intensive visual simulation) for motor recovery in the upper limb in subacute stroke: a feasibility and proof-of-concept study.

To demonstrate the feasibility and efficacy of a new video-observation training method (intensive visual simulation) to improve upper limb function. Small sample, randomized, evaluator-blind, monocentric study. Seventeen early subacute ischaemic stroke patients with complete hemiplegia were randomly assigned to the therapeutic group (n = 8) or control group (CG, n = 9). Thirty sessions of intensive visual simulation combined with corrected visual feedback (therapeutic group) or uncorrected visual feedback (control group) were performed over 6 weeks on top of a standard rehabilitation programme. 400-point hand assessment test (400p-HA). Box and Blocks (B&B), Purdue Pegboard test, Minnesota. The 400p-HA test improved significantly from T0 to 6 months for both groups, with a significant difference between groups at 3 months (MW-UT p = 0.046) and 4 months (MW-UT p = 0.046) in favour of the therapeutic group. One-phase exponential modelling of 400p-HA showed a greater plateau for the therapeutic group (F test p = 0.0021). There was also faster recovery of the ability to perform the B&B tests for the therapeutic group (log-rank test p = 0.03). This study demonstrated the feasibility and potential efficacy of an intensive visual simulation training programme to improve upper limb function in subacute stroke patients. A larger study is needed to confirm these results.

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation—a before-and-after, non-controlled quality improvement study

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists’ Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants’ individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event “evaluation of plans” (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants’ knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known:• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers’ actual work.• In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.What is New:• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit.• There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

Evaluating FREDeX (Falls Reduction and Empathy Development eXperience) – a novel simulation training program for healthcare workers

Abstract Purpose: Care after falls constitutes a substantial cost to the Australian health system. The Falls Reduction and Empathy Development Experience (FREDeX), a hybrid simulation training program, was designed in rural NSW. This paper initiates a multi-pronged evaluation of FREDeX. Methodology: Pre- and post-training survey data was collected from voluntary FREDeX trainees. Surveys included validated empathy, compassion, and person-centred-care assessment tools, as well as questions about workshop quality and open-ended response questions. Findings: There was significant improvement in trainees' empathy, compassion, and person-centred care scores. Trainees expressed positivity about FREDeX, noting facilitators and challenges of the program, and implications for professional practice. FREDeX enhanced empathy, aiding better patient understanding, communication, and personalised care. Implications: Significant evidence has emerged demonstrating the efficacy of virtual reality and other simulation training for empathy and compassion in clinical contexts. FREDeX enhances soft skills through a hybrid simulation training approach, proving to be engaging and educational. It is valuable for the delivery of person-centred care, and a compelling program based on effectiveness and ease of implementation. Originality and value: FREDeX has demonstrated implications for improving empathy and compassion in rural and urban healthcare professionals and enables more person-centred care. The positive outcomes from FREDeX suggest broader adoption of hybrid simulation training may enhance soft skills and healthcare quality, emphasising the potential of technology-driven learning for health workforce capacity. Limitations: While this evaluation demonstrates the value of FREDeX, further evaluation will seek to bridge the gap between demonstrated improvements in assessed metrics of care ability and direct improvements to patient care, by assessing fall rates, harm assessments, and clinical notes for participating facilities. This will endeavour to determine changes in fall prevalence and improvement in management and care for falls.

Building Frontline Capability for Shared Decision-Making (SDM) in a Major Academic Oncology Center Caring for People With Non-Small Cell Lung Cancer: Performance Outcomes of a SDM Simulation Training Program.

There is a growing body of evidence on shared decision-making (SDM) training programs worldwide. However, there is wide variation in program design, duration, effectiveness, and evaluation in both academia (ie, medical school) and the practice setting. SDM training has been slow to integrate in practice settings. A pilot study of 6 multidisciplinary clinicians was conducted using quantitative and qualitative methods to evaluate changes in participant understanding and implementation of SDM in the practice setting. A 2-rater criterion-based evaluation method was used to assess a simulation-based case study role-play program using 7 domains of SDM pre and post training. The authors assessed whether clinicians addressed each of the 7 domains or what fraction of each domain was addressed as part of their simulation case study role-play performance. Focus groups were conducted pre- and postintervention to provide feedback to participants and to understand the clinician experience in greater detail. The increase in improvement in SDM ranged from 17% to 37%, and 7 of 8 domains for which participants were rated showed significant improvement. The areas of greatest improvement were seen in determining a patient's goals/preferences, including risk tolerance regarding treatments (+37%) and values and self-efficacy (+37%). The results of this study reveal a significant shift in clinician awareness of a patient's goals, preferences, and values. Postintervention, clinicians began to understand the value of building a partnership with their patients whereby the patient becomes an active participant in their clinical care.

Assessing Team Performance in a Longitudinal Neonatal Resuscitation Simulation Training Program: Comparing Validity Evidence to Select the Best Tool.

Introduction Neonatal resuscitation is a high-acuity, low-occurrence event that requires ongoing practice by interprofessional teams to maintain proficiency.Simulation provides an ideal platform for team training and evaluation of team performance. Our simulation center supports a longitudinal in situ simulation training program for delivery room teams. In addition to adherence to the Neonatal Resuscitation Program standards, team performance assessment is an essential component of program evaluation and participant feedback. Multiple published teamwork assessment tools exist. Our objective was to select the tool with the best validity evidence for our program's needs. Methods We used Messick's framework to assess the validity of evidence for potential teamwork assessment tools. Four possible tools were identified from the literature: the Mayo High Performance Teamwork Scale (Mayo), Team Performance Observation Tool (TPOT), Clinical Teamwork Scale (CTS), and Team Emergency Assessment Measure (TEAM). Relevant context included team versus individual focus, external evaluator versus self-evaluation, and ease of use (which included efficiency, clarity of interpretation, and overall assessment). Three simulation experts identified consensus anchors for each tool and independently reviewed and scored 10 pre-recorded neonatal resuscitation simulations. Raters assigned each tool a rating according to efficiency, ease of interpretation, and completeness of teamwork assessment. Interrater reliability (IRR) was calculated using intraclass correlation for each tool across the three raters. Average team performance scores for each tool were correlated with neonatal resuscitation adherence scores for each video using Spearman's rank coefficient. Results There was a range of IRR between the tools, with Mayo having the best (single 0.55 and multi 0.78). Each of the three raters ranked Mayo optimally in terms of efficiency (mean 4.66 + 0.577) and ease of use (4+1). However, TPOT and CTS scored highest (mean 4.66 ± 0.577) for overall completeness of teamwork assessment. There was no significant correlation to NRP adherence scores for any teamwork tool. Conclusion Of the four tools assessed, Mayo demonstrated moderate IRR and scored highest for its ease of use and efficiency, though not completeness of assessment. The remaining three tools had poor IRR, which is not an uncommon problem with teamwork assessment tools. Our process emphasizes the fact that assessment tool validity is contextual. Factors such as a relatively narrow (and high) performance distribution and clinical context may have contributed to reliability challenges for tools that offered a more complete teamwork assessment.

Survey of Current Simulation Based Training in the US Military Health System.

Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system. A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue. Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%). The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.

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.

Comparing Male and Female Resident Physicians in Central Venous Catheter Insertion Self-confidence and Competency: A Retrospective Cohort Study.

Female physicians often report lower self-confidence in their procedural and clinical competency compared to male physicians. There is limited data regarding self-reported confidence of female versus male trainees and any relation to objective competency in central venous catheter insertion. To analyze differences between male and female trainees in self-confidence and skill-based outcomes in placing central venous catheters. Using data from a central venous catheter simulation training program at a large tertiary medical center, we performed linear regressions to analyze confidence difference pre- and post-training, number of restarts, and number of cannulation attempts while controlling for baseline demographic characteristics of the sample. PGY-1 physician residents in all residency specialties who insert central venous catheters in the clinical setting at a tertiary academic center with a sample size of 281 residents. Confidence difference pre- and post-training measured on a Likert scale 1-5, number of restarts (novel global assessment variable), and number of cannulation attempts during the competency evaluation. Female trainees had both lower pre-program confidence (1.35 versus 1.74 out of 5, p < 0.001) and lower post-program confidence (3.77 versus 4.12 out of 5, p = 0.0021) as compared to male trainees. There was no statistically significant difference in number of restarts (95% CI - 0.073 to 0.368, p = 0.185) or cannulation attempts (95% CI - 0.039 to 0.342, p = 0.117) between sexes in linear regressions controlled for age, specialty designation, prior central venous catheter training, prior ultrasound guided vessel cannulation training, and pre-training confidence level. Female trainees rated their confidence significantly lower than their male counterparts both before and after the training program, despite no significant difference in skill-based outcomes. We discuss potential implications for trainees acquiring procedural skills during residency and for physician educators as they design training programs and delegate procedural opportunities.

시뮬레이션 기반 응급상황 대처에 대한 교육요구도 조사 학령전기 아동어머니를 대상으로

This study aimed to understand the need for simulation-based emergency response education among mothers with pre-school-aged children. According to the survey, the most common emergency situations at home in the past year were bleeding (30.8%), falls and drops (9.6%), poisoning (3.8%), burns (21.2%), choking (5.8%), fractures (7.7%), high fever (38.5%), vomiting (26.9%), CPR (3.8%), being bitten by bugs or humans (48.1%), and entrapment or constriction (9.6%). 84.6% expressed interest in participating if a child emergency care simulation training program were developed. The results indicate that simulation-based emergency care training could be effective for mothers of pre-school children. Based on these results, we suggest an experimental study to develop a simulation-based emergency care program for these mothers and verify its intervention effect.