Simulation Workshop Research Articles

State of Gender-Based Microaggressions Among Surgeons and Development of Simulation Workshops for Addressing Microaggressions for Surgical Trainees and Students

Microaggressions are statements or actions taken in a discriminatory manner. Microaggressions can be subtle or explicit, intentional or unintentional, but regardless of the type of microaggressions, it is important to identify and address them, as they are linked to physician burnout and add to levels of depression, anxiety, and stress. In this study, we evaluated the prevalence, quality, and impacts of gender-based microaggressions on surgeons and surgical trainees using simulation-based education. Further, we plan to iteratively develop more simulation sessions based on the findings of this study. We used simulation-based education to develop and implement microaggression scenarios. Those scenarios were performed by standardized patients (trained actors) who demonstrated the different microaggression situations previously seen at the workplace and wards. Published tools to address gender-based microaggressions were outlined in preparation (prebrief) for a discussion of recorded simulations. A debrief of developing potential resolutions as learners and future allies and how similar microaggressions may have been perpetuated in our own careers followed each scenario. Additionally, an 11-item survey was developed based on validated surveys of sexist and Microaggressions Experience and Stress Scale and disseminated through email listservs and social media links. Data collection occurred from November to December2022. When surveyed after the workshop, 100% of participants (n=6) said that they would recommend this session to follow colleagues, and 100% completely agreed the content of the simulation was relevant to their future practice. Further, 100% of participants agreed or completely agreed that their ability to perform these tasks (addressing microaggressions) has improved after this course. Most respondents to the disseminated survey (n=147) were vascular surgeons (95/147; 64.6%) and identified as White (93/147; 63.3%), and as women (142/147; 96.6%). Most were identified as targets of gender-based microaggressions (128/147; 87.1%) and or silent witnesses to such microaggressions (87/147; 59.2%). However, there were reports of having a perpetrator of a microaggression (2/147; 1.4%), a nonsilent witness (3/147; 2.0%), or having no target, witness, or perpetrator (3/147; 2.0%). Of the quality of microaggressions, the most common impacts were when the targeted individual attempted to hide their emotions to not appear too emotional (described in the literature as "leaving gender at the door") (32/147; 21.8%), were told that women no longer experience discrimination (25/147; 17.0%), and were asked when one would have children (24/147; 16.3%). The most stressful types of microaggressions were ones in which male peers were the only ones receiving recognition for work (55/147; 37.4%), targets were told women no longer experience discrimination (49/147; 33.3%), and in which men spoke about women in degrading terms regarding their gender or on topics related to their gender (35/147; 23.8%). Qualitative responses to the survey included comments remarking on the relevancy and prevalence of gender-based microaggressions, reasons for silence, the personal and professional impacts (e.g., pay equity) of microaggressions and gender bias, and future areas of work to address bias in medicine. Given the prevalence of microaggressions seen in surgery, especially among vascular surgeons, future steps include discussion of how techniques can be developed and applied to other types of microaggressions (e.g., due to race/ethnicity, sexuality, disability, religion), implementation of future workshops that address intersectionality in scenarios and potentially virtual sessions to increase accessibility to these types of training options for learners at other institutions.

Integrating Public Health Into Undergraduate Medicine in North America: A Systematic Review.

The coronavirus disease 2019 (COVID-19)pandemic has served as a stark reminder of the importance of foundational public health training for all physicians. However, the most effective way to incorporate these concepts into undergraduate medical education remains unclear. Here, we characterize the literature regarding the effectiveness of public health integration into undergraduate medical education in North America. We systematically searched MEDLINE, Embase, Cochrane Central, and Education Resources Information Center (ERIC) in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for North American peer-reviewed literature, published from 01/01/2000 to 30/08/2021, that described outcomes of integrating public health training within an undergraduate medical curriculum. Results were qualitatively synthesized into key themes. A total of 38 studies, involving interventions across 43 medical schools, were included. Studies reported on a combination of public (n=13), global (n=9), population (n=9), community (n=6), and epidemiological (n=1) health interventions, and either implemented one-off workshops, electives, or international experiences (n=19); a longitudinal theme or long-term enrichment pathway (n=14); or a case-based learning curriculum (n=8). The majority (81.5%, 31/38) of integrations were self-described as successful and, of studies reporting on feasibility, most (94.1%, 16/17) were indicated as feasible. The definition of what constituted such success, however, was unclear. Innovative examples included the use of simulation workshops and mobile-optimized media content. Key challenges were noted, however, in securing adequate funding and buy-in from administrative leadership. Robust community partnerships and iterative cycles of implementation of the intervention were critical factors to success. In summary, foundational public health components can be effectively integrated into medical school curricula and would benefit from adequate resourcing, innovation, community partnerships, and continuous improvement.

'Food for thought' in devising aging-simulation experience.

Aging simulation (experiencing age-related functional decline), an educational tool commonly used in geriatrics education, is widely recognised for being able to drive positive attitudinal change toward older patient care. However, scholars1 warned that, given its focus on age-related limitations and disabilities, the method may lead junior medical students to take age-related barriers as impending and irrevocable, thereby reinforcing myths and negative assumptions on ‘growing old’. Prior research reported that, in aging simulation, interest in geriatric care (driven by empathy) might be achieved at the expense of worsening self-views on personal aging. To mitigate this unintended-side effect, a recommendation made was to integrate learning strategies of ‘demystifying myths’ and ‘experiencing aging’. Dysphagia is a health condition common in old age and often associated with malnutrition, pneumonia and dehydration. It can also be part of normal aging, given how the aetiologies also grow with age. Internationally, prevalence of dysphagia in aged care facilities has been estimated to be up to 40%. Yet, awareness and recognition of its impacts on one's lived experience are lacking among medical officers. While other age-related physiological changes such as walking difficulties, visual and hearing impairments are often covered in traditional aging simulation, dysphagia remains an unaddressed topic. In collaboration with a Hong Kong-based social enterpirse “The Project Futurus”, we piloted a 2.5-hour aging simulation workshop centred around dysphagia in old age. At a teaching kitchen, second-year MBBS students could personally relate to the mealtime experience of dysphagic older persons. The activity was part of a Medical Humanities Curriculum at HKU. Quota was capped at 20 owing to COVID restrictions. Instead of a focus on age-related difficulties and feelings of frustrations that usually characterize traditional aging simulation, our workshop, titled ‘Dignified meal and sparks for life’, exposes students to the realities of aging while shedding a positive light on wellbeing in old age: Before class, students were invited to experience food similar to porridge being served to dysphagic patients in the past. In class, students received (i) a mini-lecture demystifying dysphagia diet, and (ii) a live demonstration on using Japanese Engay (easy-to-swallow) cooking techniques to create more uplifting dysphagia diet with aesthetic appeal and texture. Then, students (iii) worked in groups to prepare and mould texture-modified meals, followed by (iv) tasting and debriefing on how the lived experience of dysphagic older persons could be transformed through person-centred care. We administered the validated UCLA Geriatrics Attitudes Scale (UCLA-GAS) to assess student attitudes toward older patient care, and Reactions to Ageing Questionnaire (RAQ) to assess attitudes toward personal aging. All participants (n = 20) completed pre- and post-questionnaires. Mean age was 19.5. Contrary to an earlier study,1 our workshop had improved attitudes toward geriatric patient care (p = 0.02) and personal aging (p = 0.042) in second-year undergraduate medical students. Cohen's d was 0.492 and 0.406, respectively, indicating moderate effect size in both measures. Despite a small sample, we have developed a new form of aging simulation pertaining to the human experience of dysphagia in old age. By integrating elements of ‘demystifying myths’ and re-orienting the activity's focal point from age-related difficulties to enablers of wellbeing, our pilot throws light on how aging simulation's unintended negative side-effect could be avoided.

Digital Delivery of a Global Critical Care Education Program.

CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) education program was developed to accelerate the global dissemination of a standardized, systemic, structured approach to critical care delivery. The coronavirus disease (COVID-19) pandemic prompted the evolution of this program from a live in-person course to a blended synchronous and asynchronous learning experience, including virtual simulation. We describe our experience and insights gained through this digital program transformation and highlight areas in need of further research to advance the delivery of high-quality online education offerings to global interprofessional audiences. The CERTAIN education program was delivered to a broad international audience first in person (2016-2019) and then virtually during the COVID-19 global pandemic (2020-present). During this transition, we adopted a flipped classroom model to deliver the core content asynchronously using an online learning management system, supplemented by a novel synchronous online experience to provide learners with the opportunity to apply these concepts using a series of simulated clinical cases. A total of 400 participants attended 11 CERTAIN courses. We transitioned our 10-hour live course to a 3-hour virtual workshop. The duration of simulation activities (admission, rounding, and shared decision-making) remained constant. Didactic lectures were eliminated from the synchronous online course and presented as recorded videos in precourse materials. We collected 306 postcourse surveys (response rate, 76.5%). The majority of the overall course ratings were excellent (147 [49.5%]) and very good (97 [32.7%]), and learner responses were similar to live and online courses. Simulation activities were consistently the most popular elements of our program. Access to digital learning platforms and language barriers during simulation activities proved to be the greatest challenges during our transition. Delivering mobile-friendly online content and close coordination between dedicated bilingual faculty and local champions helped overcome these challenges. Critical care education and case-based simulation workshops can be delivered to international interprofessional audiences with similar, high degrees of learner satisfaction to in-person offerings.

Simulation Based Peer-Assisted Learning: Peripheral Venous Catheterization and Blood Sampling

Background
 Peripheral venous catheterization (PVC) and blood sampling (BS) represent some of the first basic techniques that a medical student learns when starting clinical practice. As they are invasive maneuvers, there is a level of self-doubt that can be overcome through practice in a simulated setting.
 Peer-assisted medical simulation learning is an innovative educational technique that allows students to gain confidence in conducting clinical maneuvers in a safe environment. Simulation based learning focuses on trial and error, participants being able to approach the technique multiple times, without the risk of hurting a real patient. Additionally, the fact that the workshop is conducted by fellow students, creates a more comfortable learning setting.
 
 Aim of study
 Our aim is to determine the effectiveness of medical simulation in learning to perform PVC and BS and in increasing the level of confidence of the participants.
 
 Materials and methods
 Our study was conducted at the Department of Medical Simulation of the Center for Innovation and e-Health (CIeH), part of the University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania, between March and December 2021. During this period, 2186 first year students took part in a peer-conducted simulation workshop, conducted by undergraduate medical students in all years of studies, who had previously undergone extensive training and evaluation. The aim of the workshop was to learn the basics in PVC and BS in a controlled environment.
 Through a questionnaire, we collected data regarding knowledge acquisition and auto-evaluation of the students’ skill and knowledge prior and after the training on a five-point scale. At the beginning of the questionnaire we obtained informed consent from the study participants.
 
 Results
 The response rate to the questionnaire was 66,10%. The participants obtained an average score of 60%. There were few participants that did not acquire enough information in order to answer correctly to the questionnaire. 80% of the respondents answered accurately on 2 out of 3 questions.
 We observed a 48,35% increase in the confidence level of participants regarding clinical knowledge and skill acquisition after the workshop. Prior to the workshop, only 10% of participants self-evaluated with a score of 4 or 5, compared to 85% of respondents after the workshop.
 
 Conclusions
 The medical simulation training led to a significant rise in students’ confidence and a high impact on the development of skill and knowledge. Through our basic workshops we want to familiarize the participants with the clinical environment, additional knowledge and skills being acquired once throughout their studies. The workshop's objective of increasing participants’ comfort regarding basic clinical techniques, such as blood sampling and peripheral venous catheterization, was accomplished. The outcome of the study enables us to adapt the curriculum and testing procedures to better meet the needs of the participants.

Psychosocial interprofessional perinatal education: Design and evaluation of an interprofessional learning experience to improve students’ collaboration skills in perinatal mental health

BackgroundPerinatal mental health disorders are one of the leading causes of maternal illness and suffering and care and services need to be well coordinated by an interprofessional team who are skilled in working collaboratively. AimThe aim of this paper is to describe the design and evaluation of an innovative interprofessional education initiative to increase midwives and other health professional students’ knowledge and skills in caring collaboratively for women with psychosocial issues in the perinatal period, including women experiencing domestic and family violence. MethodsThe Psychosocial Interprofessional Perinatal Education workshop was designed for midwifery, psychology, social work and medical students. It provided a simulated learning experience with case studies based on real life situations. Students undertook pre and post surveys to measure changes in students’ perceptions of interprofessional collaboration and their experiences of participating in the interprofessional simulation-based learning activity. Quantitative survey data were analysed using paired t-tests and a qualitative content analysis was undertaken on the open-ended questions in the survey. FindingsComparison of pre and post surveys found students from all disciplines reported feeling more confident working interprofessionally following the workshop. The following categories were generated from analysis of the open ended survey data: Greater understanding of each others’ roles; Recognising benefits of interprofessional collaboration; Building on sense of professional identity; Respecting each other and creating a level playing field; and Filling a pedagogical gap. ConclusionThrough this innovative, simulated interprofessional education workshop students developed skills essential for future collaborative practice to support women and families experiencing psychosocial distress.

Enteral Nutrition Simulation Workshop Enhances Knowledge and Skills of Graduate Nutrition Students

Registered dietitian nutritionists are integral to the health care team, especially in delivering and managing parenteral or enteral nutrition (EN). 1 Corrigan ML Bobo E Rollins C Mogensen KM. Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support. Nutr Clin Pract. 2021; 36: 1126-1143 Google Scholar The training and education of future registered dietitian nutritionists are necessary to promote and advance the skill set of the practitioner. The Accreditation Council for Education in Nutrition and Dietetics (ACEND) is the accrediting agency for nutrition and dietetics education programs which provides the required standards and learning elements that train students to become dietitians. 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar The ACEND standards require learning activities in the curriculum to ensure the full scope of the competencies is met. 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar In 2022, ACEND added required elements and learning experiences for all nutrition and dietetics programs. The ACEND Accreditation Standards for Nutrition and Dietetics Graduate Degree Programs (Future Education Model) 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar specify faculty must prepare students to become competent in this skill: “Element 3.2e-3: Explain the steps involved and observe the placement of nasogastric (NG) or nasoenteric feeding tubes; if available, assist in the process of placing NG or nasoenteric feeding tubes.” 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar

1342 DO NOT ATTEMPT CONVERSATIONS PRE-REHEARSAL: TEACHING MEDICAL STUDENTS TO HAVE DNACPR CONVERSATIONS

Abstract Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK. Method Students' confidence levels were measured pre and post session using a Likhert scale questionnaire. Results 90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session. Conclusion DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.

Validity of the Rezum Simulator for Trainees.

Simulations have revolutionized surgical training and are an invaluable adjunct tool for augmenting the proficiency of surgeon and patient safety. Before being included in a practical assessment process, simulators need to be using various validity inference frameworks. We examine the construct validity and reliability of the Rezum simulator. Seventeen candidates of different professions voluntarily participated in the Rezum simulation workshop. The simulator provides a variety of variable metrics and challenges. Each candidate performed three cases of different difficulty levels with three trials of each case. Validity was measured statistically through a one-way analysis of variance (ANOVA) test, and a p-value of < 0.05 was considered significant. Additional reliability tests were provided, including intraclass correlation coefficients, a Cronbach test (0.7 is considered acceptable), and standard error of measurement. The ANOVA of total scores among candidates was significant (p = 0.029). Senior registrars and consultants had the highest total scores. Procedure times did not differ significantly among candidates (p = 0.169). The reliability test for the total score was 0.899 (0.831-0.942), with a standard error value of 2.75, a standard deviation of 8.67, and a Cronbach alpha value of 0.915. We confer the primer evidence of Rezum simulation as a valid, reliable simulator of most of its metrics.

Effectiveness of Simulation- Versus Didactic Video-Based Learning to Teach Advanced Lung Isolation Techniques

Mastery of lung isolation is crucial for optimal cardiothoracic anesthesia education. The authors tested the hypothesis that simulation- is more effective than didactic video-based learning (cognitive, affective, and psychomotor) to teach anesthesiology fellows advanced lung isolation techniques. A prospective randomized study. At a single academic heart center, simulation laboratory. Thirty anesthesiology fellows with equivalent prior experience in basic lung isolation techniques. Randomized participants received 1 of 2 structured educational interventions of equivalent duration designed to teach advanced lung isolation skills, a simulation workshop, or a video-based didactic session. To assess Bloom's taxonomy domains, performance measurements included pre- and postintervention cognitive tests and affective surveys and a postintervention psychomotor task (time to complete lung isolation). Changes in test and survey scores and time to completion were compared using the Mann-Whitney U test; p values < 0.05 were considered significant. Improvements in lung isolation learning assessments were greater in the simulation group, but significant differences only existed in the affective domain. Specifically, affective survey score increases were greater in the simulation group (simulation- versus video-based didactic: +19.0 v +4.0; p ≤ 0.001), whereas there was no significant difference in cognitive pre- to posttest scores (simulation- versus video-based: +28.6 v +19.1, p=0.23), and time to achieve lung isolation (simulation- versus video-based: 32 v 36 seconds, p=0.46). Although greater affective learning of advanced lung isolation skills occurred with simulation-based compared to didactic video-based education, the authors found no differences between the teaching approaches in cognitive and psychomotor learning among anesthesiology fellows.

Right heart catherisation – a virtual reality

Abstract Introduction Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors. Method We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed. The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system. We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis. Results The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion. Conclusion A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals

Difficult airway in intensive care unit

Airway management in critically ill patients is often difficult and is associated with complications. Knowledge of airway anatomy, its change during laryngoscopy and physiology of oxygen transport is essential for predicting difficult airway and in planning the management. Optimal assessment of the airway anatomy to predict difficulty, formulating a plan of action, and an alternate plan, assembling the required equipment and personnel, keeping the difficult airway trolley ready, preparation of the patient by preoxygenation and proper positioning are some of the measures to decrease complications. Adequate training to develop cognitive and procedural skill for managing difficult airway is very important. All physicians involved in airway management should update their skills by involving in simulation excercises and workshops

Are Technical Skills Assessed Using Medical Knowledge Associated with Non-technical Skill Knowledge in Anaesthesia Resident Training?

Objective: We examined the association between midterm examinations and anaesthetists’ non-technical skills (ANTS) knowledge using multiple choice questions (MCQs) for anaesthesia training.&#x0D; Materials and Methods: A prospective cross-sectional study was implemented based on two cohort studies conducted in November 2017 and November 2019 at the university hospital in southern Thailand. Each cohort consisted of MCQs, short answer questions (SAQs), objective structured clinical examinations (OSCEs), and MCQs after ANTS simulation workshops during the midterm examinations. The main exposure variable was the midterm examination (MCQs/ SAQs/ OSCEs) whereas the ANTS MCQs were the outcome. The potential predictors were the residents’ role, sex, PGY (1-3), and competency. Associations between midterm examinations and ANTS MCQ scores were analysed using Pearson’s correlation coefficients (r) and multivariate linear regression analysis, and presented as beta coefficient (β) and 95% confidence limit (CL).&#x0D; Results: Forty-eight anaesthesia residents were recruited for the study. After adjusting for PGY, knowledge score, and attitude evaluated by the staff, OSCE was found to be significantly associated with the pretest ANTS scores (β [95% CL]= 1.02 (0.06, 1.98)) and MCQ scores were significantly associated with the posttest ANTS scores (β [95% CL]= 0.14 (0.04, 0.24)). SAQ scores had negative associations with the pretest (β [95% CL]=-0.11 (-0.21, -0.01)) and posttest (β [95% CL]=-0.16 (-0.27, -0.05)) ANTS scores. It was found that there was a significant relationship between midterm examinations and posttest ANTS scores (r=0.52).&#x0D; Conclusion: Technical skills using OSCE and midterm MCQ examination scores were associated with non-technical skill knowledge in anaesthesia training.

Evaluation of online interprofessional simulation workshops for obstetric and neonatal emergencies.

To explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops. This qualitative study was conducted at Monash University, Australia. Data were obtained from six separate online Obstetric Neonatal Emergency Simulation workshops held between May 2020 and August 2021. A total of 385 students attended and were invited to participate in the study by completing an online survey two-three weeks later. Of the attendees, 144 students completed the survey (95 medical, 45 midwifery), equating to a response rate of 37%. Survey responses were downloaded from online survey platform and separated into medical and midwifery responses. Thematic analysis of data was performed using a coding framework, resulting in development of themes and subthemes. Main themes were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. Consistent with existing literature evaluating similar in-person programs, midwifery students were most interested in interprofessional interaction (predominant theme: dynamics of online interaction), whilst medical students were more concerned with developing clinical skills (predominant themes: learning through modelling, experiential learning). Online learning may be a useful and convenient way of delivering interprofessional simulation-based education during the pandemic, in remote areas and as an adjunct to in-person teaching. Future studies should evaluate the impact of online learning with a mixed methods study and in comparison, to in-person programs.

Checklist: A Useful and Safe Tool for the Initiation of Care for Eutocical Vaginal Delivery.

The aim of this study is to present and analyze the vaginal delivery checklist as a safe and useful learning tool for first-year residents in the gynecology and obstetrics and midwifery specialties at different hospitals and to analyze the items that comprise it and the progress of the residents during the first 30 normal deliveries attended in a supervised manner. We present a descriptive, observational and prospective study in which 18 participants from different hospitals in Spain completed a checklist of skills in the first 30 births attended autonomously after learning its use in a simulation workshop. We collected a total of 329 of 330 checklists completed by 11 participants. In addition, the mean responses for each item contained on the checklist and the mean global progression of the participants were subsequently analyzed, detecting statistically significant differences using Student’s t-test for paired data. During the data collection period between September 2020 and August 2021, a total of 329 checklists were analyzed. The global average of positive responses for the 30 questions contained on the checklist was 25.36 out of 30 points. The fulfillment of the different items was variable, with the lowest fulfillment of 2.18 points, although 73% of the items obtained a score greater than 25. A statistically significant difference in the mean compliance of the first five childbirths compared to the last five deliveries using the proposed checklist was obtained, with p < 0.01. In conclusion, knowing the importance of using a checklist to anticipate risk situations and reduce the number of adverse perinatal outcomes, we can say that, for first-year residents in gynecology and obstetrics attending a clinical simulation workshop in eutocic vaginal delivery, it may be interesting to have a tool, such as the checklist proposed in this study, that facilitates the learning process and the suitable progress of the participants.

Right heart catherisation – a virtual reality

Abstract Introduction Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors. Method We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed. The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system. We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis. Results The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion. Conclusion A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals

Impact of pre-registration extended immersive ward-based simulation on student learning in preparation for clinical placement

BackgroundGraduate nurses commonly experience significant challenges in transitioning to professional practice. The practice readiness of graduate nurses continues to be a concern for nurse educators and industry partners. Introduction of pre-registration extended immersive ward-based simulation can provide opportunities for students to practice the role of registered nurse before graduation. It is not clear if participation in simulation-based learning transfers to increased preparedness for dealing with real-life situations following entry into the workforce. ObjectiveTo report on student views on how ward-based immersive simulation assisted in preparing for clinical placement and graduate practice. DesignA qualitative, descriptive design was used to conduct a series of face-to-face focus groups. SettingSchool of Nursing and Midwifery metropolitan Western Australian university. ParticipantsFinal year baccalaureate nursing students who had participated in six four-hour simulation workshops between February and April 2021 were selected through purposive sampling. MethodsFocus group and interview data was transcribed from audio recordings. A six-phase approach was used to analyse data into themes and sub-themes. The study adhered to the consolidated criteria for reporting of qualitative research. ResultsThree focus groups and one interview were conducted. Eight themes emerged. Student learning was identified as occurring in a variety of ways, such as how to work as a team and was influenced by a number of factors, such as the capacity for students to self-reflect. ConclusionsLearning opportunities for students to practice how to think and work independently as a registered nurse is something that can be supported by pre-registration extended immersive ward-based simulation. Understanding of what will be expected of them once qualified can make students more prepared for professional practice enabling them to apply knowledge gained from simulated experiences to a similar situation as a graduate nurse.

Is There Any Difference Between Maneuver Simulation and Scenario Workshop Learning about Radiation Triage?

Background: Very little information on maneuver simulations (MS) effectiveness in radiation triage (RT) training is currently available. Objectives: The present study aimed to compare the effect of MS and scenario workshops (SW) on rescuers' learning of RT. Methods: This quasi-experimental study was conducted on rescuers in July 2020. For this purpose, two military medical centers were randomized into two groups, intervention (MS) and control (SW). The main tool was the researcher-made Radiation Triage Knowledge Questionnaire (RTKQ). In this respect, the pre-test was performed using the RTKQ questionnaire. The first post-test, two weeks following the intervention, was also done through the RTKQ and the objective structured clinical examination (OSCE), and the second post-test was conducted four weeks after the intervention, only via the RTKQ. Results: In total, 30 rescuers with a mean age of 22 participated in this study. During the pre-test, the difference in knowledge between the two study groups (intervention and control) was not significant. In the first post-test, no significant difference was also observed in the levels of knowledge between MS and SW groups respectively (80.0 ± 8.9 vs. 79.3 ± 0.8), but the difference in skills between the study groups was significant (89.3 ± 10.3 vs. 61.3 ± 16.0). In the second post-test, there was a significant difference between the mean value of the levels of knowledge (76.0 ± 9.1 vs. 64.7 ± 10.9) and skills (written scenarios) (71.3 ± 9.9 vs. 54.0 ± 0.14) in two study groups. Conclusions: Both training methods improved RT knowledge and skills, but MT was more effective than SW in boosting and maintaining knowledge and skills up to one month after the intervention. The utilization of MS in RT training was also accompanied by greater effectiveness.

Community of Inquiry framework to evaluate an online obstetric and neonatal emergency simulation workshop for health professional students in India

BackgroundWe transitioned our obstetric neonatal emergency simulation (ONE-Sim) workshops to an online format during the COVID-19 pandemic. In this study, we evaluated key learning acquired by undergraduate medical and nursing students attending the online ONE-Sim workshops from a low- and middle-income country (LMIC).MethodsStudent perception of online workshops was collected using electronic questionnaires. Data was analysed using thematic analysis by employing the Community of Inquiry (CoI) framework.ResultsOne hundred sixty medical and nursing students who attended the online ONE-Sim workshops completed the questionnaires. There was evidence in the data to support all three aspects of the CoI framework—social, cognitive and teacher presence.ConclusionsThe use of the CoI framework helped to describe key learning from online interprofessional simulation workshops conducted for a LMIC.

44 Empowering Surgical Foundation Year 1s (F1s) in the Management of High-Risk Post-Op Patients

Abstract Aim To improve the confidence of a cohort of surgical F1s in the management of high-risk post-op patients. Patients due to have an emergency laparotomy can be risk stratified using the National Emergency Laparotomy Audit (NELA) score. This score gives a percentage risk of mortality within 30 days of the emergency-laparotomy. Patients with a NELA score &amp;gt;5% are classified as high-risk. A proportion of patients will go to the Surgical high dependency unit (SHDU) post-op. The primary doctor presence in the SHDU is a single surgical F1. This leads to the surgical F1s having exposure to the management of high-risk post-op patients1. Method Data was collected on every patient to have an emergency laparotomy in the emergency theatre of a tertiary hospital. Over the course of 15 weeks in 2020–21, 36% of post-emergency –laparotomy patients in a tertiary hospital with a NELA score of &amp;gt;10% went to the SHDU post-op. Results A combined teaching and simulation workshop on common post-op complications was delivered for a cohort of surgical F1s. The feedback from this showed that all attendees felt that they were now more confident in managing common post-op complications. Conclusion Surgical F1s are exposed to the management of high-risk post-op patients. Feedback has shown that a combined teaching and simulation workshop on common post-op complications can increase the F1s’ confidence in managing these conditions. 1. NELA - National Emergency Laparotomy Audit [Internet]. Nela.org.uk. 2021 [cited 26 October 2021]. Available from: https://www.nela.org.uk/