Simulation-based Educational Intervention Research Articles

Birth in the Emergency Department

The use of high-fidelity simulation increases emergency department (ED) staff preparedness in high-risk, low-volume obstetric emergencies. ED staff will be better prepared and more confident in providing appropriate standards of care to the obstetric and newborn populations. A variety of evidence was used, including professional nursing association position statements, evidence-based procedures, nationally recognized care guideline, well-designed case control and cohort studies, and single descriptive studies. Two obstetric/ED simulation scenarios for an unexpected, precipitous birth were developed using high-fidelity simulation manikins. Eighty-five ED staff completed the simulation and debrief session. All survey questions addressing staff confidence and preparedness saw large increases in staff feeling prepared and confident. In addition, for knowledge-based questions, there was an 80% increase in correct answers. The obstetric–newborn population in the ED saw a 90% decrease in incident reports after the simulation sessions. The results suggest that simulation-based educational interventions have a strong effect on nurse confidence, knowledge and preparedness when preparing for the low volume, high risk OB/newborn patient population.

Simulation-based learning for enhanced brachytherapy training among radiation oncology residents

Brachytherapy is a critical and irreplaceable component of treatment for gynecologic malignancies, but its curricula in residency is highly variable, particularly procedural experience. In surgical fields, simulation-based learning has been shown to improve learner's clinical and procedural competence. Thus, we performed, for the first time, a hands-on simulation-based gynecologic brachytherapy education intervention using a custom 3D pelvic phantom to evaluate the benefit of simulation-based learning on resident brachytherapy education.

78. PERFORMANCE UNDER PRESSURE: THE USE OF EPAS TO STANDARDIZE PEDIATRIC MOCK CODE FEEDBACK

Background Pediatric mock code simulation plays a critical role in the development of a trainee's decision making ability for high-stakes, low frequency situations. To ensure trainees receive maximal benefit from these simulations, it is important that they receive optimal, timely feedback. Objective The aim of this study is to characterize the implementation and pilot use of the American Board of Pediatrics’ (ABP) Entrustable Professional Activities (EPAs) for mock code feedback. Methods We designed a simulation-based education intervention study of pediatric trainees at a large pediatric residency program. To ensure consistency and breadth of experience, a standardized mock code curriculum of 13 cases was created. An online assessment tool was created based on the ABP's EPA 10 (resuscitation and initial stabilization) incorporating objective clinical behaviors that the learner must display during the simulation. EPAs and communication were rated based on narrative anchors with seven and five possible levels, respectively. The tool was used to facilitate and record feedback between the instructor and trainee. In addition, other mock code participants evaluated the trainee using the tool in real time. Results 6 months since implementation, 21 residents (45% of PGY-2, PGY-3 classes) have received one-to-one verbal and written feedback using our tool following a mock code. 90 evaluations were completed by faculty and observers. The average EPA rating and communication score of residents was 5.4 (SD 1.27) and 3.66 (SD 0.75), respectively. There were no significant differences observed in the EPA or communication scores between the observers and faculty (P = 0.46 and 0.8, respectively). In the post-simulation survey, 93% (13/14) of trainees indicated the feedback process would improve their future performance. Conclusions An EPA-based, online assessment tool was feasible and easily incorporated into mock code simulations. We found that observers with varying levels of expertise gave similar ratings, suggesting future possibilities of using peers for feedback in mock code settings.

Mastery learning of toxicology life support skills by nurses and doctors, utilizing simulation technology in Nepal

Modern Medicine has been at the forefront in the use of patient simulation for research, training and performance assessment. With simulation, no patients are at risk for exposure to novice caregivers or unproven technologies. It becomes very important in field of toxicological emergencies, due to its acute onset of presentation, rapid progression of symptoms, and early deterioration of vitals and adverse outcomes in morbidity and mortality of patients in extremes of ages. Our observational study suggests that Emergency, Forensic Medicine and Toxicology (FMT) residents and Nurses have limited exposure to critically ill patients of trauma and toxicology and the budding forensic professionals lack the skills to manage them. Simulation has the potential to fill this educational void in managing clinical forensic and toxicological emergencies. The following review will attempt to answer this call by quantifying the effect of simulation-based educational interventions on retention of knowledge and clinical performance, as applied to acute care toxicology.

Chimeric Antigen Receptor, Teamwork, Education, Assessment, and Management (CAR-TEAM): A Simulation-Based Inter-professional Education (IPE) Intervention for Management of CAR Toxicities.

Chimeric antigen receptor (CAR) therapies such as tisagenlecleucel, indicated for children and young adults with relapsed and/or refractory CD19+ acute lymphoblastic leukemia (ALL), have been associated with striking treatment outcomes and overall survival. Yet, they are also associated with unique and potentially life-threatening complications. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are generally reversible complications of CAR therapies, but many patients may require critical care support especially if they are not promptly recognized and appropriately managed by frontline healthcare staff. As CAR therapies become more widely available, it is important that inter-professional staff members be aware of general principles regarding diagnosis and management. We hypothesized that an inter-professional education (IPE) simulation-based education intervention (CAR-TEAM) would improve knowledge base and confidence regarding complications of CAR therapies among inter-professional staff. Here, we demonstrate that following CAR-TEAM training, >90% of participants demonstrated knowledge proficiency and confidence in the IPE content area. CAR-TEAM training may serve as an important tool to establish initial and continued competency among sites introducing CAR therapies.

A Simulation-Based Prospective Cohort Study on Teaching Best Practices in Firearms Safety.

Gun violence in the United States is a significant public health concern. The high rate of weapons carriage by Americans places medical providers at risk for exposure to firearms in the workplace and provides an opportunity for patient safety counseling. Few curricular interventions have been published on teaching firearms safety principles to medical providers. Given the risk of encountering firearms in the workplace and the opportunity to engage patients in firearms safety counseling, providers may benefit from dedicated training on safely handling firearms. This was a prospective cohort pilot study of a simulation-based educational intervention for third- and fourth-year medical students enrolled in an emergency medicine subinternship and emergency medicine bootcamp elective. Before undergoing the educational intervention, students completed a preintervention simulation case during which they discovered a model firearm in the patient's belongings and were asked to remove it. Students then received the intervention that included a discussion and demonstration on how to safely remove a firearm in the clinical setting. Two weeks later, the students were presented with a model firearm in a different simulation case, which they needed to remove. During the preintervention and postintervention simulations, students were evaluated on their performance of the critical actions in firearm removal using an 8-item checklist. Students' scores on this checklist were compared. Fifty-three students participated in the study, 25 of whom completed the postintervention assessment. The median number of correctly performed critical actions preintervention was 5 (interquartile range = 4-6) and postintervention was 7 (interquartile range = 6-8, P < 0.001). Students showed particular improvement in 4 steps: holding the firearm by the grip only, pointing the firearm in a safe direction at all times, removing the firearm from the immediate patient care area and placing it in a safe area, and ensuring that the firearm is monitored and untouched until police or security personnel arrive to secure it. This educational intervention is the first to formally teach students about the safe handling of firearms found in the clinical care space. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.

Notes From the Field: Automatic Item Generation, Standard Setting, and Learner Performance in Mastery Multiple-Choice Tests.

Mastery learning assessments have been described in simulation-based educational interventions; however, studies applying mastery learning to multiple-choice tests (MCTs) are lacking. This study investigates an approach to item generation and standard setting for mastery learning MCTs and evaluates the consistency of learner performance across sequential tests. Item models, variables for question stems, and mastery standards were established using a consensus process. Two test forms were created using item models. Tests were administered at two training programs. The primary outcome, the test-retest consistency of pass-fail decisions across versions of the test, was 94% (κ = .54). Decision-consistency classification was .85. Item-level consistency was 90% (κ = .77, SE = .03). These findings support the use of automatic item generation to create mastery MCTs which produce consistent pass-fail decisions. This technique broadens the range of assessment methods available to educators that require serial MCT testing, including mastery learning curricula.

Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention.

Objective: Resuscitation of neonates after birth in the out-of-hospital setting is challenging. Thus, we aimed to assess paramedics' newborn life support knowledge and skills before and after targeted simulation-based training.Methods: Voluntary paramedics were recruited from a single Red Cross division. During a 1-day simulation-based educational intervention, essential aspects of neonatal resuscitation were taught and practiced. Before and after simulation-based training, we assessed (1) knowledge of current European Resuscitation Council (ERC) guidelines using a 20-item-questionnaire and (2) the quality of simulated bag-valve-mask ventilation by measuring face mask leakage, using a respiratory function monitor (Standardized Measurement of Airway Resuscitation Training [SMART], GM Instruments Ltd., United Kingdom).Results: Forty-one paramedics participated in the initial survey and 12 took part in the simulation-based educational intervention. There was a significant increase in the number of correctly answered questions: median 62.1% (IQR 37.5–77.4%) vs. 91.7% (IQR 83.3–100%; p = 0.001). A total of 1,332 inflations were analyzed. The incidence of substantial mask leakage >75% decreased significantly after training (15.8 vs. 6.1%; p < 0.001), while median mask leakage was similar (17.0% [IQR 0.0–55.0%] vs. 18.0% [IQR 6.0–34.0%]; p = 0.414).Conclusions: Among paramedics, theoretical knowledge of current ERC guidelines was moderate in this study. Participation in a targeted simulation-based educational intervention was associated with a significant increase in theoretical knowledge. The initially high incidence of substantial mask leakage >75% was decreased after simulation-based training using respiratory function monitoring.

Design and evaluation protocol for ‘DEALTS 2’: a simulation-based dementia education intervention for acute care settings

There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate 'DEALTS 2', a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England. Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process. Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train. Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.

Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty

Background Uncertainty is ubiquitous in medical practice. The Pediatrics Milestones from the Accreditation Council on Graduate Medical Education state that advanced learners should acknowledge and communicate about clinical uncertainty. If uncertainty is not acknowledged, patient care may suffer. There are no described curricula specifically aimed to improve learners' ability to acknowledge and discuss clinical uncertainty. We describe an educational intervention designed to fill this gap. Methods Second-year pediatric residents engaged in a two-phase simulation-based educational intervention designed to improve their ability to communicate about diagnostic uncertainty with patients and caregivers. In each phase, residents engaged in two simulated cases and debriefs. Performance was assessed after each simulated patient encounter using standardized metrics, along with learner perceptions of the experience. Results Residents' skills in communicating with patients and families about diagnostic uncertainty improved after this intervention (mean score post 3.84 vs. 3.28 pre on a five-point Likert scale, p<0.001). Residents rated the experience as relevant, challenging and positive. Conclusions This prospective study suggests that a simulation-based intervention was effective in improving resident physicians' skills in communicating about diagnostic uncertainty with patients and families. Further study is needed to determine how learners perform in real clinical environments.

An overview of realist evaluation for simulation-based education

This article describes the key features of realist (realistic) evaluation and illustrates their application using, as an example, a simulation-based course for final year medical students. The use of simulation-based education (SBE) is increasing and so too is the evidence supporting its value as a powerful technique which can lead to substantial educational benefits. Accompanying these changes is a call for research into its use to be more theory-driven and to investigate both ‘Did it work?’ and as importantly ‘Why did it work (or not)?’ An evaluation methodology that is capable of answering both questions is realist evaluation.Realist evaluation is an emerging methodology that is suited to evaluating complex interventions such as SBE. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ In seeking to answer this question, realist evaluation sets out to identify three fundamental components of an intervention, namely context, mechanism and outcome. Educational programmes work (successful outcomes) when theory-driven interventions (mechanisms) are applied to groups under appropriate conditions (context). Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation.Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. By investigating and understanding the context, mechanisms and outcomes of SBE interventions, realist evaluation can provide the deeper level of understanding being called for.

Palliative care in the emergency department: an educational investigation and intervention

BackgroundTo investigate the value of a novel simulation-based palliative care educational intervention within an emergency medicine (EM) residency curriculum.MethodsA palliative care scenario was designed and implemented in the simulation program at an urban academic emergency department (ED) with a 3-year EM residency program. EM residents attended one of eight high-fidelity simulation sessions, in groups of 5–6. A standardized participant portrayed the patient’s family member. One resident from each session managed the scenario while the others observed. A 45-min debriefing session and small group discussion followed the scenario, facilitated by an EM simulation faculty member and a resident investigator. Best practices in palliative care were highlighted along with focused learner performance feedback. Participants completed an anonymous pre/post education intervention survey.ResultsForty of 42 EM residents (95%) participated in the study. Confidence in implementing palliative care skills and perceived importance of palliative care improved after this educational intervention. Specifically, residents 1) felt EM physicians had an important role in palliative care, 2) had increased confidence in the ability to determine patient decision-making capacity, 3) had improved confidence in initiating palliative discussions/treatment, 4) believed palliative education was important in residency, and 5) felt simulation was an effective means to learn palliative care. Differences noted between PGY1 and PGY 3 training levels in survey responses disappeared post-intervention. Residents noted being most comfortable with delivering bad news and symptom management and least comfortable with disease prognostication. Residents reported time constraints and implementation logistics in the ED as the most challenging factors for palliative care initiation.ConclusionOur case-based simulation intervention was associated with an increase in both the perceived importance of ED palliative care and self-reported confidence in implementing palliative care skills. Time constraints and implementation logistics were rated as the most challenging factors for palliative care initiation in the ED.

Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study.

The patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes. To evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital. This study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention. The in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia. This study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.

Advancing evidence-based decisions in the management of pancreatic cancer.

506 Background: As a result of updates to pancreatic cancer treatment guidelines, oncologists face a host of escalating treatment challenges that may hinder their abilities to select the most appropriate regimen for patients. A study was conducted to determine if simulation-based educational interventions could improve decisions of oncologists in the management of pancreatic cancer. Methods: A cohort of US-practicing oncologists who participated in a virtual patient simulation (VPS)-based education initiative was evaluated. The VPS consisted of 2 cases presented on a platform that allowed oncologists to assess each patient and make decisions limited only by an extensive database of treatment possibilities matching the scope and depth of actual practice. Clinical decisions made by participants were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided immediately after each decision. Oncologists were allowed a second chance at each decision point; decisions before and after CG were compared using a 2-tailed paired T-test. P values are shown as a measure of significance; P values &lt; .05 are statistically significant. Results: 410 oncologists made clinical decisions within the VPS. Significant improvements were observed in: Selecting the most appropriate first-line regimen in a patient with a PS of 2 (29%, P&lt; 0.001); Ordering an anti-emetic in patients who are receiving chemotherapy (24% , P&lt; 0.001); Evidence-based treatment selection for individuals whose disease progressed on therapy (17%, P= .003); and Ordering adverse event education and counseling (11% and 16%, P= .001). In addition, this study revealed that up to 55% of oncologists would test patients for BRCA mutations while 52% would consider enrolling a patient in a clinical trial if they have progressed on therapy. Conclusions: This study showed improvements in evidence-based practices of oncologists in the management of advanced pancreatic cancer across the continuum of care, thus demonstrating that VPS-based instruction can result in an increase in evidence-based clinical decisions. Therefore, VPS may have a role in improving the quality of care and patient outcomes.

Does simulation-based training increase athletic training students clinical confidence and competence of performing a cardiovascular screening

The incidence of sudden cardiac death (SCD) in athletes is higher than previously estimated. The need for increased screening to detect cardiac diseases in preparticipation physical examinations (PPE) has become a focus in athletic training. The use of simulation-based training in healthcare professionals' education has increased clinical confidence and competence, but research is limited.To examine if a simulation-based educational intervention can increase athletic training students' self-reported confidence and clinical competence in conducting a cardiovascular screening.Pretest-posttest design.25 first-year athletic training students in a professional master's program participated. The intervention consisted of a standardized cardiovascular curriculum consisting of a 45-minute, interactive instructor-led session and a 45-minute audio session which included repetitions of heart murmurs. Learner self-reported confidence scale, multiple-choice knowledge exam, and objective structured clinical examination (OSCE) of cardiovascular assessment skills and auditory recognition of heart murmurs were recorded.Self-reported confidence increased significantly from 4.4±2.1 to 9.2±3.0 post-intervention (F=78.7, p<0.001) with a moderately high effect size (n2=0.789). Knowledge exam scores increased significantly from 11.0±2.5 to 13.6±4.0 post-intervention (F=5.3, p=0.031) with a low effect size (n2=0.191). The history-taking assessment of the OSCE increased significantly from 2.6±1.6 to 5.7±1.7 post-intervention (F=70.1, p<0.001) with a moderately high effect size (n2=0.751). The clinical skills assessment of the OSCE increased significantly from 4.1±2.8 to 15.6±1.6 post-intervention (F=415.4, p<0.001) with a high effect size (n2=0.952).Simulation-based training is an effective tool for increasing athletic training students' self-reported confidence and competence in conducting a cardiovascular screening.

Efficacy of Obstetric Simulation in the Learning of Skills Related to Birthing Care in Medical Students, Medellin-Colombia

Introduction: In Colombia, studies regarding the effectiveness of simulation-based medical training programmes are scarce. Objective: To evaluate the effectiveness of a simulationbased obstetric educational intervention in the learning of skills related to birthing care in medical students in Medellin (Colombia). Methods: A randomized experimental study of 28 students who received the intervention and 21 students who did not receive the intervention and served as the control group. A scale was constructed and psychometrically evaluated to measure competencies in three domains, Being, Knowing, and Doing, in birthing care; this scale was applied before and after the intervention, generating a rating between 0 (poorest) and 100 (best). The effectiveness of the educational intervention was evaluated using differences-indifferences and linear regression analysis. Results: The scale showed excellent psychometric properties in the domains of knowing and doing, with Cronbach’s α-value greater than 0.80; furthermore, 100% success in internal consistency, discriminant power, and content validity added to the high explained variance. The intervention did not generate significant changes in the competency in the being domain and was effective in improving competencies in the Knowing and Doing domains, with increases of 23.9 and 27.2 points, respectively. Conclusion: The simulation-based birth-related skills learning programme was effective in increasing the competencies of knowing and doing in medical students.

Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review.

The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the "template for intervention description and replication" checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n=51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.

Advancing evidence-based decisions in the management of EGFR-mutated metastatic NSCLC.

e20663 Background: In patients diagnosed with metastatic NSCLC it is now essential to identify targetable mutations and markers of treatment resistance in order to determine the appropriate therapy. A study was conducted to determine if simulation-based educational interventions to address clinical practice gaps could improve decisions of oncologists in the management of EGFR-mutated metastatic NSCLC. Methods: A cohort of US-oncologists who participated in a virtual patient simulation (VPS)-based education was evaluated. The VPS consisted of 2 cases that allowed oncologists to assess the patient and choose from a database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided after each decision. Oncologists were allowed a second chance at each decision point and decisions before and after CG were compared using a 2-tailed paired T-test to determine differences from pre- to post CG. P values are shown as a measure of significance; with P &lt; .05 statistically significant. Results: 197 oncologists made clinical decisions within the simulation. As a result of CG, significant improvements were observed in: Ordering EGFR mutational testing (16%, P= 0.008) and making an accurate diagnosis (36%) Selecting an EGFR TKI in the first-line setting (24%, P&lt; 0.001) Ordering a PET scan to assess disease progression (10%) and in diagnosing patients with EGFR T790M disease that is resistant (29% , P&lt; 0.001) Evidence-based treatment selection for individuals whose disease progressed on first-line therapy (19%, P= .003) Number of oncologists who ordered adverse event education and counseling (23%, P&lt; .001) Conclusions: This study showed improvements in evidence-based practices of oncologists in the diagnosis and management of EGFR-mutated NSCLC; demonstrating that VPS-based instruction that immerses and engages oncologists for an authentic, practical and16. consequence-free learning experience can result in an increase in appropriate clinical decisions. Therefore, VPS may have a role in improving the quality of patient care.

Simulation: A Tool to Assist Nursing Professional Development Practitioners to Help Nurses to Better Recognize Early Signs of Clinical Deterioration of Patients.

The need to enhance the knowledge and skills of nurses caring for patients exhibiting signs of clinical deterioration has been documented. The literature has further supported the registered nurse as the key individual expected to recognize signs of clinical deterioration in the patient. The use of simulation as an effective teaching strategy has been well documented. The purpose of this project was to use simulation as an educational intervention to increase nurse knowledge, self-confidence, and competency when caring for patients exhibiting signs of clinical deterioration. A significant improvement in nurse knowledge and self-confidence was shown after a simulation-based educational intervention. Competency evaluation during the simulation-based intervention provided information to help nurses when caring for deteriorating patients. Nursing professional development practitioners can use the information from this project in planning educational interventions for staff nurses.

Use of a Simulation-Based Capstone Course to Teach and Assess Entrustable Professional Activities to Graduating Medical Students

A 3-day simulation-based capstone course was developed and pilot tested for a cohort of graduating medical students to assess their readiness for residency. The intervention taught and assessed individual performance on specific components of the 13 core entrustable professional activities (EPAs) that all medical school graduates should perform independently. Two 6-station clinical skills examinations (CSE) were developed to assess performance before and after a simulation-based educational intervention. Graduating medical students could not reliably perform selected EPAs at baseline. However, a focused 3-day simulation-based capstone experience produced significant improvement in core clinical skills.