Simulation-based Training Research Articles

Links between learning goals, learning activities, and learning outcomes in simulation-based clinical skills training: a systematic review of the veterinary literature.

In veterinary education programs it is important to have a balance between providing students with valuable hands-on experience and ensuring the ethical treatment and welfare of the animals involved. In the last years simulation-based veterinary education played an important role helping with the replacement of experimental animals in education and at the same time creating a safe learning environment offering endless options for training in a safe environment. The aim of this systematic review was to discern which type of learning outcomes are used to evaluate specific learning goals of clinical skills training and to grasp the impact of diverse simulator characteristics on the measured learning outcomes in clinical skills training. A systematic search from 1977 until November 2023 has been conducted resulting in 103 included papers. The categories, learning goals, learning activities, and learning outcomes in clinical skills training were used for data extraction of all included studies. This study investigated the interplay between learning goals, learning activities, and learning outcomes. Competence and knowledge were the most frequently described learning outcomes; static and screen-based simulators are the are most frequently used technologies. Static simulators are primarily used to train procedural steps and screen-based simulators are primarily used to train relevant knowledge and clinical reasoning. Notably, none of the reviewed studies made explicit connections between learning goals, learning activities, and learning outcomes. In simulation-based education it is important to provide a structured, constructively aligned process where students gain relevant and effective experience. The results of this study underscore the importance of aligning the learning process in simulation-based clinical skills training, and that alignment in the learning process is not always evident.

The evaluation of video-assisted debriefing for improving performance in simulated medical student resuscitations.

Simulation-based training is commonly used in medical education. However, there is a gap in knowledge regarding best practices in debriefing. We aimed to identify novel solutions to this by adapting video-assisted debriefing (VAD) methodologies used in athletic training. We hypothesized that utilizing VAD would lead to improvements in performance during advanced cardiac life support (ACLS)-based simulations compared to traditional verbal debriefing (VD). The study was conducted at a single medical school. Participants were fourth-year medical students engaging in ACLS simulation-based training as part of their emergency medicine rotation. After completing an ACLS-based simulation, participants received either VD or VAD and then completed a second simulation scenario. Our primary outcome was ACLS performance, graded by blinded reviewers utilizing a previously developed modified checklist. Secondary outcomes included time from cardiac arrest to initiation of cardiopulmonary resuscitation (CPR) and first defibrillation. Measurements were made before and after the interventional debrief, referred to as pre- and postdebrief. A modified Likert-scale survey was used to subjectively assess the student's overall experience. Forty-six groups of 275 students were included in the study. Mean ACLS performance score for VD and VAD postdebrief were 85% and 82%, respectively (p = 0.27). Mean time from arrest to CPR initiation for VD and VAD postdebrief groups were 20 and 24 s, respectively (p = 0.46). Mean time from arrest to defibrillation for VD and VAD postdebrief groups were 50 and 59 s, respectively (p = 0.39). For the Likert surveys, 85% or more of participants in both groups indicated that the session was "very helpful" in all survey categories. VD and VAD both led to improvements in ACLS performance, time to initiation of CPR, and defibrillation among fourth-year medical students. Though postdebrief results were not statistically significantly different by comparison, overall VD led to greater improvement overall across all outcomes.

Challenges in Implementing Competency-based Medical Education in India – Stakeholders’ Perspective: A Mixed-method Analysis

Introduction: Competency-based Medical Education (CBME) was introduced in the year 2019 in India. It has brought about major changes in medical education. The curriculum is learner centric, outcome based, focuses on the development of core competencies and professionalism. However, many institutions have faced challenges during the implementation of the CBME curriculum. This study was aimed at assessing the challenges faced by all the stakeholders (students, faculty, and administrators) of various medical institutions and gather their insights on proposed solutions. Methodology: This cross-sectional study was conducted over a period of 3 months, from October 1, 2023, to December 31, 2023. The study was conducted in 32 medical colleges across India. A total of 60 faculty of various disciplines, 32 administrators of the institutes, and 580 undergraduate medical students were included in the study. Perception of students and faculty was collected using a validated survey form. One-on-one interview was done for all the 32 administrators using a facilitator guide. A mixed-methods approach was used for quantitative and qualitative data collection and analysis. Results: Around 40 (66.6%) faculty opined that that deficiency of trained faculty was a significant challenge in implanting CBME curriculum. Twenty (33.3%) of the faculty felt that there is a lack of adequate infrastructure required for the implementation of CBME curriculum. Among the administrators surveyed, 12 (37.5%) felt that dwindling student attendance was a major challenge, whereas 10 (31.5%) felt that there was the lack of collaboration between universities, colleges, and regulatory authorities. Four hundred and twenty-five (73.2%) of students opined that simulation-based training and 435 (75%) students opined that electives were very good initiatives by CBME curriculum. The students found the inclusion of integrated teaching, Attitude, Ethics, and Communication Module, early clinical exposure, and Family Adoption Programme in the CBME curriculum helpful. Conclusion: CBME curriculum was largely accepted across all the medical colleges. The training of faculty and administrators was considered an important challenge which needs to be considered. Students opined that the newer curricular reforms enhanced their learning.

A Presacral Fixation Simulation Surgical Training Model for Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Sacrocolpopexy

ObjectiveThe number of sacrocolpopexies performed with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasing, and presacral fixation is the most dangerous step. Therefore, the training opportunities for trainees to become competent in performing vNOTES sacrocolpopexy are very important. Simulation-based training is ideal for filling this gap. The objective of this video article is to demonstrate a simulation surgical training model in vNOTES presacral fixation. SettingThe Department of Gynecology at a university hospital. ParticipantsA urogynecological surgeon. Interventions(1) Establish presacral model (Fig. 1) and pelvic model (Fig. 2). (2) Establish vNOTES single-port platform. (3) Steps of vNOTES presacral fixation: (a) Identify the sacral promontory and right hypogastric nerve (rHN), and incise the right pelvic peritoneum. (b) Expose and open the presacral fascia to expose the middle sacral vessels and anterior longitudinal ligament (ALL). (c) Complete mesh fixation. (d) Close the pelvic peritoneum. This study is exempt from IRB approval. Model materials and corresponding costs are given in Table 1. ConclusionWe present a presacral fixation simulation model during vNOTES sacrocolpopexy. A piece of rubber tissue is attached to pelvic model to accurately simulate the vagina, thus achieving the establishment of the vNOTES single-port platform. The presacral model displays the anatomic hierarchy of presacral exposure: pelvic peritoneum, presacral fascia, presacral space, as well as the ALL, rHN, ureter, and presacral vessels, which are embedded in these layers. Presacral slope design enables realistic presacral suture and mesh fixation. In case of nerve, blood vessel, or ureteral injury during dissection, this model simulates the manifestation through the leakage of different colored liquids. This new model allows the next generation of urogynecological surgeons to acquire adequate training to make them more prepared to perform their initial vNOTES sacrocolpopexy on a patient, possibly increasing future safety and effectiveness.

A simulation-based training model to improve percutaneous endoscopic gastrostomy care skills of family caregivers: a randomized controlled study

A simulation-based training model to improve percutaneous endoscopic gastrostomy care skills of family caregivers: a randomized controlled study

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799

L’annonce en oncologie pédiatrique – retour d’expérience sur les formations par méthode de simulation dans le GOCE (Grand Ouest cancer de l’enfant)

The announcement of a cancer diagnosis is a crucial moment in the management of the disease, as it is the starting point for a relationship of trust between patient and caregiver. In 2005, this issue led to the creation of an announcement system as part of the 2003-2007 cancer plan, but its implementation in practice remains uncertain. Pediatric oncology has its own specificities, with a triangular relationship and the need for doctors to adapt to the child's age. These skills require special training, and training opportunities vary from one area to another. To this end, the Angers and Caen centers have developed simulation exercises for training in pediatric oncology announcement. These consist of a theoretical part, followed by an announcement interview with actors, then a debriefing. Evaluation questionnaires are completed by learners before and after the session, and have highlighted the usefulness of this training, particularly in helping them to feel better prepared to face this stressful moment. As simulation has proved its educational value in the healthcare field, GOCE has developed simulation-based training courses for interns/CCAs/assistants in the territory. These courses are much appreciated and are proving extremely useful in clinical practice. This has led the SFCE to extend these courses to all CCAs and young PHs in pediatric oncology in France.

Improving Preceptors’ Self-efficacy for Nutrition-focused Physical Exams and Malnutrition Diagnosis Through a Simulation-based Training Program

Improving Preceptors’ Self-efficacy for Nutrition-focused Physical Exams and Malnutrition Diagnosis Through a Simulation-based Training Program

Is there a Solution to Lengthy Hospital Stays for Nursing Home Residents? Our Nursing Home Liaison Team Are Virtually There

Abstract Background Research indicates that Nursing Home residents frequently undergo transfers to acute care, leading to adverse events and functional decline (Brucksch et al., 2018). Local data from highlights the significance of this issue, with 447 admissions averaging 11.1 days in 2022 (HIPE, 2023). Hospital at Home is recognised as a cost-effective alternative for older patients (Singh et al., 2022). The proposed solution involves implementing Virtual Wards, remote telemetry, and a Nursing Home Liaison team led by a Consultant Geriatrician. This initiative targets Early Supported Discharge to reduce the hospital length of stay for Nursing Home patients. The study aimed to investigate the feasibility of using the Virtual Ward platform in this service. Methods The study aimed to investigate the feasibility of using the Virtual Ward platform, primarily utilising the Telehealth Usability Questionnaire (TUQ) (Parmanto et al., 2016). A Simulation Lab was also used to test the digital solution before its clinical implementation. Additionally, debriefing sessions were conducted to assess clinicians' perceptions of the technology and identify any potential issues. Results The TUQ scores for clinicians using a Virtual Ward for Nursing Home patients show a notably positive outcome. With an average score of 120.5 out of 147, the system received significant approval. The range of scores, from 111 to 139, demonstrates a consistent positive perception among respondents. After simulation-based training in the Simulation Lab, participants reflected on their experiences with Virtual Ward technology. They found it useful, easy to navigate and committed to future use. However, they also identified areas, such as information retrieval, needing refinement. Increased training was suggested to address these concerns. Conclusion The Virtual Ward system demonstrates significant approval. In light of these promising results, we are proceeding with the plan to launch the Virtual Wards in May 2024 to complement the existing team.

A Study on Designing Cyber Training and Cyber Range to Effectively Respond to Cyber Threats

As cyberattacks become increasingly sophisticated with advancements in information and communication technology, the impact of cyberspace threats is growing in both civilian and defense sectors. The utilization of cyber capabilities in operations is on the rise, prompting major nations to continuously enhance their cyber capabilities. This study aims to establish a systematic approach to cyber operations training and propose a framework for the development of cyber training. A hybrid cyber training system is designed as a plan for temporal and spatial integration to simultaneously combine simulation-based training with real-world target training. To develop this concept, a literature review was conducted, expert consultations were held, and data were collected and analyzed through visits to relevant organizations and units. Additionally, the fundamental components of cyber training were examined from environmental, scenario-based, and operational perspectives, leading to the presentation of a development direction for effective cyber training. This study is anticipated to enhance response capabilities to evolving cyber threats and attacks, improve cyber operational proficiency, and secure cyber power to achieve dominance in cyberspace.

Gerontological Simulation Lab: Process Mapping a New Virtual Ward for the Nursing Home Liaison Service

Abstract Background Simulation-based training is an increasingly accepted way for multidisciplinary teams to learn together. Its use in geriatric departments around Ireland is increasingly visible. The application of simulation to pathway and process development however is less common. We decided therefore to deploy a simulation lab to test a new virtual ward platform for local nursing homes. Methods We developed, in partnership with a digital provider, a piece of software that could enable the efficient and safe operation of a virtual ward. Our simulation was conducted in two phases. Phase 1 involved bench simulation of the platform in order to identify any obvious software issues. Phase 2 involved the development of two simulated patient scenarios that would specifically test the operation of the pathway. Nursing staff from our local nursing homes and specialist MDT members from our own department were invited to the Sim lab in order to work through the developed scenarios. Results Bench simulation of the software during phase 1 identified three significant limitations to the software developed. These were resolved before progressing to phase II testing. The simulated scenarios at our lab worked well and participants shared positive feedback regarding the pathway and technology. They found the software easy to navigate, practical and agreed unanimously to its future use. There were further minor technical issues identified that have been fed back to the software company for resolution. The simulation facilitated training using the “live” system for both the staff at our nursing homes and our own team members. Conclusion The simulation lab proved to be an ideal environment for testing both our new virtual ward pathway and the digital technology developed for its enablement. It facilitated the creation of a comprehensive process map and ensures that all stakeholders had a clear understanding of the new pathway.

Advancing Specialist Geriatric Medicine Training: A Successful Introduction to Simulation-Based Training

Abstract Background Simulation-based education (SBE) has been adopted by various specialties and is used to complement other aspects of education. Geriatric medicine is a diverse specialty, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBE the ideal vehicle to train geriatric medicine trainees. SBE is currently not a formal component of geriatric medicine training in Ireland and trainees experience varying levels of exposure to SBE. To address this, WICOPSIM in collaboration with the Royal College of Physicians (RCPI) facilitated a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBE. Methods A faculty consisting of RCPI Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians coordinated the event. All geriatric medicine trainees were invited to a one-day SBE event hosted by WICOPSIM. Lectures on simulation theory and application preceded a simulation scenario demonstration focusing on the interdisciplinary management of a patient whose capacity was in question; followed by a SBE participant workshop. Results Fifty-two trainees attended the event. Forty-five trainees completed the post-event survey. 98% (n=44) were satisfied with the variety of topics presented and felt more prepared to design and run a scenario. The simulation demonstration, debrief and design workshop met 100% trainees’ expectations. All trainees indicated that SBE should be a routine element of geriatric medicine training. 69% (n=31) intend to run SBE within their own department in the future. Conclusion This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBE. SBE offers trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging scenarios, in a protected environment. The positive feedback generated suggests SBE is a useful tool to enhance the specialist geriatric medicine training experience and warrants further exploration.

Education in Transition: Adapting and Thriving in a Post-COVID World

The COVID-19 pandemic profoundly disrupted traditional education systems worldwide, prompting a rapid shift to online platforms and the emergence of innovative teaching strategies. This paper critically reviews the extensive body of research on post-COVID-19 education, focusing on the practical and feasible solutions proposed to maintain and enhance educational continuity. The review categorizes and examines studies on various approaches, including simulation-based training, project-based learning, and hybrid models, highlighting their effectiveness during and after the pandemic. Special attention is given to the role of information technology, the challenges faced by educators and students, and the importance of mental health support in the new educational landscape. The findings suggest that while digital tools such as virtual reality and 3D environments show promise, their implementation remains limited, particularly in resource-constrained settings. The study also identifies a significant gap in empirical research on these innovations in the post-pandemic era. Furthermore, the paper highlights the need for systemic changes in curriculum design, educator training, and policy development to address the long-term impacts of the pandemic on education. This review provides a comprehensive overview of the lessons learned from the COVID-19 pandemic, offering insights into how educational institutions can better prepare for future crises.

The effect of simulation-based training on problem-solving skills, critical thinking skills, and self-efficacy among nursing students in Vietnam: a before-and-after study.

This study investigated the effect of simulation-based training on nursing students’ problem-solving skills, critical thinking skills, and self-efficacy. A single-group pretest and posttest study was conducted among 173 second-year nursing students at a public university in Vietnam from May 2021 to July 2022. Each student participated in the adult nursing preclinical practice course, which utilized a moderate-fidelity simulation teaching approach. Instruments including the Personal Problem-Solving Inventory Scale, Critical Thinking Skills Questionnaire, and General Self-Efficacy Questionnaire were employed to measure participants’ problem-solving skills, critical thinking skills, and self-efficacy. Data were analyzed using descriptive statistics and the paired-sample t-test with the significance level set at P<0.05. The mean score of the Personal Problem-Solving Inventory posttest (127.24±12.11) was lower than the pretest score (131.42±16.95), suggesting an improvement in the problem-solving skills of the participants (t172 =2.55, P=0.011). There was no statistically significant difference in critical thinking skills between the pretest and posttest (P=0.854). Self-efficacy among nursing students showed a substantial increase from the pretest (27.91±5.26) to the posttest (28.71±3.81), with t172 =-2.26 and P=0.025. The results suggest that simulation-based training can improve problem-solving skills and increase self-efficacy among nursing students. Therefore, the integration of simulation-based training in nursing education is recommended.

Awareness and Knowledge of Adverse Drug Reactions and Pharmacovigilance Among Medical and Nursing Students and Staff in a Tertiary Care Hospital.

Background Pharmacovigilance is defined as the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or other drug-related problems. Underreporting of adverse drug reactions (ADRs) is a global issue, and adequate knowledge among healthcare professionals is essential. Engaging young doctors and nursing professionals in pharmacovigilance is crucial for promoting ADR reporting. Objectives The objective of this study is to evaluate the knowledge and awareness of ADRs and pharmacovigilance among medical and nursing students and staff in a tertiary care hospital in Vijayapura, India. Methods A cross-sectional, observational, questionnaire-based study was carried out using a validated questionnaire that included a total of 19 questions related to knowledge and awareness aspects. This was distributed electronically using Google Forms. By using the convenience sampling method, a sample size of 96 participants was calculated for each group (medical and nursing), and this was rounded to 100 participants per group to account for potential dropouts and to ensure the strength of this study. All the questions were peer-reviewed by expert faculties from the Department of Pharmacology. Results The data analysis showed that medical students and staff had superior knowledge of ADRs and pharmacovigilance. Nursing students and staff exhibited greater awareness of the nearest pharmacovigilance center and ADR monitoring centers in India. Nursing students and staff were more active in ADR and pharmacovigilance awareness programs. Conclusions This study clearly shows the importance of flexible attitudes and robust education in pharmacovigilance and ADR reporting among healthcare professionals. Executing simulation-based training can strengthen the skills and confidence of both medical and nursing professionals in ADR reporting and pharmacovigilance.

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.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Empowering medical students: bridging gaps with high-fidelity simulations; a mixed-methods study on self-efficacy

BackgroundHigh-fidelity simulations play a crucial role in preparing for high-mortality events like cardiopulmonary arrest, emphasizing the need for rapid and accurate intervention. Proficiency in cardiopulmonary resuscitation(CPR) requires a strong self-efficacy(SE); training for both is crucial. This study assesses the impact of Advanced Life Support(ALS) simulation on SE changes in final-year medical students.MethodsThis mixed-methods prospective simulation study involved medical students in emergency medicine internships, examining self-efficacy perceptions regarding ALS technical skills(ALS-SEP). A comparison was made between students who underwent scenario-based ALS simulation training and those who did not. Competencies in chest compression skills were assessed, and the concordance between ALS-SEP scores and observed CPR performances were evaluated. Focus group interviews were conducted and analyzed using content analysis techniques.ResultsThe study involved 80 students, with 53 in the experimental group(EG) and 27 in the control group(CG). The EG, underwent simulation training, showed a significantly higher ALS-SEP change than the CG(p < 0.05). However, there was low concordance between pre-simulation SEP and actual performance. Compression skills success rates were inadequate. Qualitative analysis revealed main themes as"learning“(32.6%), “self-efficacy“(29%), “simulation method“(21.3%), and “development“(16.5%).DiscussionPost-simulation, students reported improved SEP and increased readiness for future interventions. The findings and qualitative statements support the effectiveness of simulation practices in bridging the gap between SEP and performance. Utilizing simulation-based ALS training enhances learners’ belief in their capabilities, raises awareness of their competencies, and encourages reflective thinking. Given the importance of high SEP for ALS, simulation trainings correlating self-efficacy perception and performance may significantly reduce potential medical errors stemming from a disparity between perceived capability and actual performance.

Using simulation scenarios and a debriefing structure to promote feedback skills among interprofessional team members in clinical practice

BackgroundTeam reflexivity and peer feedback in daily clinical work can improve patient safety. However, teams do not always engage in reflection after patient care. A reason could be that team members may lack skills in engaging in team reflection. This study explores the use of interprofessional team-based simulations to encourage and equip teams for reflective conversations in the real-world clinical practice.MethodsThis was a prospective, explorative study of team members’ perceptions of the use of in situ simulation-based scenarios with critically ill patient cases to train team-based reflections and peer feedback. The study took place in two neurological wards. Prior to the intervention, a 1-day observation in each ward and semi-structured short interviews with physicians and nurses were conducted.ResultsA total of 94 staff members, 57 nurses, 8 nurse assistants and 29 physicians participated in the in situ simulation scenarios. All team members showed appreciation of the safe learning environment. The authors found that the simulations and the debriefing structure provided an opportunity for training of team reflexivity and feedback. The team members evaluated the simulation-based training very positively, and their initial reaction indicated that they found peer feedback useful for the individual and the team. This approach allowed them to reflect on their own clinical practice.ConclusionThe simulation-based training scenarios and the debriefing structure promoted team members’ team reflexivity and peer feedback skills. The method is feasible and could be used in other specialties and situations.The team members’ reactions to feedback were positive, and based on their reflections, there is a potential to increase both individual and team skills as well as improve patient treatment.

Ecological and Cost Advantage from the Implementation of Flight Simulation Training Devices for Pilot Training

The paper discusses a case study of obtaining an airline pilot license in integrated training—the so-called “from zero to Airline Transport Pilot License”. The environmental implications of simulator-based training were examined across multiple dimensions. Key areas of research include the reduction of harmful exhaust gases pollution associated with traditional flight training activities. Based on our analysis, it can be stated that increasing the use of Flight Simulation Training Devices in pilot training should be significant consideration. This approach brings many benefits, especially ecological ones. Changing the training program and increasing the use of flight simulators can result in a reduction of CO2 emissions by up to 70%. Based on country specific electricity factors, CO2 emissions during flight training in each EU country were calculated. Using Levelized Cost of Electricity average value to calculate training costs in EU countries depends on the mix of energy sources (wind, photovoltaics, carbon and gas). The findings highlight the significant ecological advantages of simulator-based training methods in mitigating the environmental footprint of aviation operations. By seeking to minimize environmental disruption and increase training efficiency, the adoption of simulators is a sustainable approach to pilot training that is consistent with global efforts to mitigate climate change and protect natural ecosystems.