Simulation Training Research Articles

Transforming learning for adult protective services caseworker certification training: program evaluation of simulation training

ABSTRACT This study assesses the first statewide program to provide simulation training conducted via videoconference to all new caseworkers. The simulation training in Illinois was conducted at a mock house. A mock family played by standardized clients is physically present, and trainees participate remotely. The program evaluation team implemented a survey that asks trainees to rate their confidence in different skills at multiple timepoints, to appraise the quality of feedback and debriefing of the training team, and to write text responses to the questions regarding their learning experience. Analysis of quantitative data over the course of the training showed statistically significant linear increases in trainees’ confidence for all the 14 skills. Their text responses indicated that they received feedback they appreciated and felt they gained ability on a range of different skills. The simulation training makes a valued and effective contribution to the certification training.

Exploring metacompetence in child welfare simulation training: toward a holistic model

ABSTRACT Holistic competence involves two distinct constructs: procedural competencies and metacompetencies A framework developed by Tufford and colleagues (2017), suggests four domains of metacompetence: skills in action, deepened perspectives on diversity, managing affective intensity in the moment, and openness to learning. This exploratory evaluation study was guided by the research question, in what ways does Illinois child welfare simulation training address the four domains of metacompetence? Findings indicted that relevant knowledge and skill development for each domain are supported in the training. More nuanced evaluation could better assess procedural and metacompetence and more fully operationalize holistic competence for child welfare professionals.

Non-cadaveric spine surgery simulator training in neurosurgical residency

BackgroundSpine surgical training faces increasing challenges due to restricted working hours and greater subspecialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods. MethodsSixteen residents utilized the Realists RealSpine L4/L5 disc simulator with both microscope and exoscope. A mixed-methods analysis assessed the efficacy and acceptance of the training. Six PGY-1 residents participated in a learning curve study, divided into exoscopic and microscopic cohorts. Each group watched a tutorial in either 3D or 2D, followed by three surgical sessions. Endpoints included surgical progress within 30 minutes and complication rates. Microsurgical skills and mental concepts were evaluated on a numeric Likert Scale. ResultsParticipants rated the simulator training favorably, with a median score of 8/10 across six categories. The learning curve study showed a 30% improvement in microsurgical performance. The completion rate of herniated disc removal increased from 50% at T2 to 100% at T3 and T4. Significant improvement in mental concept was observed (p=0.035), with slightly better consolidation in the exoscope group. Self-assessments revealed significantly improved skills across all participants. ConclusionSpine simulator training was well-received and resulted in improvements in both mental concept and microsurgical performance, with enhanced outcomes in the 3D teaching/exoscope group. This study supports the integration of spine simulators into spine surgical residency, particularly for early-stage training, to improve both cognitive and practical surgical skills.

Enhancing Knowledge and Confidence in Chronic Pelvic Pain Management: The Impact of Simulation Training

Enhancing Knowledge and Confidence in Chronic Pelvic Pain Management: The Impact of Simulation Training

OP002 Topic: AS16–Medical, Nursing and AHP Workforce & Education: Staff Education and Development/Equity, Diversity, Inclusion/Other: INSIGHTS INTO PEDIATRIC MECHANICAL VENTILATION SIMULATION TRAINING: A DATA-DRIVEN ANALYSIS OF LEARNING PATTERNS AND BEHAVIORS OF RESIDENTS

OP002 Topic: AS16–Medical, Nursing and AHP Workforce & Education: Staff Education and Development/Equity, Diversity, Inclusion/Other: INSIGHTS INTO PEDIATRIC MECHANICAL VENTILATION SIMULATION TRAINING: A DATA-DRIVEN ANALYSIS OF LEARNING PATTERNS AND BEHAVIORS OF RESIDENTS

Effect of Interprofessional Crisis Simulation Training in a Non-operating Room Anesthesia Setting on Team Coordination: A Mixed Methods Study: Short title: Effects of interprofessional crisis simulation

Effect of Interprofessional Crisis Simulation Training in a Non-operating Room Anesthesia Setting on Team Coordination: A Mixed Methods Study: Short title: Effects of interprofessional crisis simulation

Implementing an obstetric simulation training protocol in a critical access hospital

BackgroundA high-fidelity (HF) simulation training protocol was implemented to improve nurses' knowledge, skills, and self-confidence to improve patient quality of care and safety, thus ultimately having an impact on decreasing maternal mortality rates. SampleThe sample consisted of 16 participants including nurses, a physician, emergency medical technicians (EMTs), and paramedics. MethodsThis project used a self-confidence and competence assessment prior to and following participation to determine statistical significance. In addition, review of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool data was done to determine the overall success of implementing a HF simulation training protocol. ResultsSuccess of the simulation and content was determined by a reported increase in self-confidence and competence post-simulation. The summative evaluation revealed that participants felt that implementing a HF simulation training protocol, in general, was useful for training. ConclusionWhile this project focused on obstetrics, the premise of the project can be applied to many subject areas to advance practice in rural health. Findings suggest that use of a high-fidelity simulation training protocol is beneficial.

Evaluating anxiety and self-confidence in nursing students: Adaptation and validation of the NASC-CDM scale for high-fidelity simulation training

BackgroundAnxiety and self-confidence impact performance and decision-making during high-fidelity simulation in nursing education. A validated tool to assess these factors is lacking. MethodsThe Nursing Anxiety and Self-Confidence with Clinical Decision-Making© scale (NASC-CDM) was translated, adapted for high-fidelity simulation and validated using a five-step approach. This included a Content Validity Index review by experts and pilot-testing with first-year nursing students. Construct validity and internal consistency were evaluated using Exploratory Factor Analysis and Cronbach's alpha. ResultsA total of 187 first-year nursing students participated. Exploratory Factor Analysis identified constructs for anxiety (two factors, 60.72% variance) and self-confidence (three factors, 61.22% variance). The tool demonstrated high internal consistency, with Cronbach's alpha values of 0.956 for anxiety and 0.955 for self-confidence. ConclusionThe 19-item Dutch Nursing Anxiety and Self-Confidence with Clinical Decision-Making for High-Fidelity Simulation scale is a valid and reliable instrument measuring anxiety and self-confidence in nursing students during high-fidelity simulation.

A low-cost solution for pressurizing simulation trainer fluid spaces

A low-cost solution for pressurizing simulation trainer fluid spaces

Virtual reality-based simulation improves rotator cuff repair skill: a randomized transfer validity study.

Although virtual reality (VR) simulators have demonstrated their efficiency for basic technical skill training of healthcare professionals, validation for more complex and sequential procedures, especially in arthroscopic surgery, is still warranted. We hypothesized that the VR-based training simulation improves arthroscopic cuff repair skills when transferred to realistic visual and haptic conditions. VR-based training simulation improves arthroscopic cuff repair skills when transferred to realistic visual and haptic conditions. This study is prospective, multicentric and randomized. Thirty orthopedic surgery residents were enrolled in the study and randomized in two groups: VR training (VR+) and no VR training (VR-). Only the VR + group underwent a monthly VR-based training program for rotator cuff repair. The 1 -h VR training sessions were standardized and supervised by the same instructor. After six months, all participants performed a double-row arthroscopic rotator cuff repair procedure on a benchtop shoulder model providing realistic visual and haptic conditions with implants. Two independent surgeons with expertise in shoulder repair and blinded to the randomization rated the participants' performance using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Demographic characteristics and surgical experience were comparable between the two groups. The ASSET global rating score was higher in the VR + group than in the VR- group (34.4 ± 3.1 and 30.5 ± 5.7, respectively; p = 0.046) and the VR+ group performed the procedure faster than the VR- group (27.3 ± 3.6 vs. 31.7 ± 0.4 minutes, respectively; p = 0,003). This study demonstrated that a monthly VR-based program for 6 months was better than standard peer training alone for mastering a complex and sequential rotator cuff repair when using the validated ASSET Score. Overall, nonspecific arthroscopic skills were also higher in the VR + group. II, therapeutic study.

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

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

Analysis of the Effectiveness of Multi-Armed Bandit Algorithms in Crop Pricing

This study explores the application of multi-armed bandit (MAB) algorithms in dynamic pricing of crops, with a focus on evaluating the adaptive upper confidence bound (asUCB) and Thompson Sampling (TS) algorithms. Through simulation experiments on historical data, the study analyzed the performance of these algorithms in fitting actual market price trends and responding to future price fluctuations. The results indicate that the asUCB algorithm performed particularly well in both the training dataset and simulation tests, demonstrating low mean squared error (MSE) and minimal cumulative regret, reflecting its rapid convergence and stable pricing capabilities. In contrast, although the TS algorithm initially performed slightly less effectively, it demonstrated unique advantages in dealing with market volatility due to its strong adaptability. This study demonstrates the potential application of MAB algorithms in dynamic pricing, providing valuable insights for pricing strategies in the agricultural product market.

Growing Need for Web-Based Simulation in Low and Middle-Income Countries: A Narrative Review

Web-based simulation programs are poised to offer a productive means of delivering asynchronous training in healthcare professionals’ education. Similarly, web-based simulation programs could also sponsor specialty-specific, web-based fellowships for clinicians of low- and middle-income countries. Web-Based Simulation has been utilized for instruction in critical care fields such as emergency medicine and pediatric anesthesia. Studies have shown that enhanced self-reported knowledge and confidence have been achieved through tele simulation which is in line with in-person simulation. During the COVID-19 pandemic, simulations have helped clinicians hone their use of personal protective equipment and other infection control measures. Additionally, it has helped them in learning new and expanded roles, like processing equipment and assisting infected patients in prone position experiencing respiratory failure. However, web-based simulation programs also have unique challenges that must be satisfied: reliable broadband internet network access, multilingual capability, and programming quality. Studies indicate that cost-effective simulation training can be delivered to learners in remote, low-resource areas worldwide, including South Asia, where access to such education is limited. We aimed to explore the effectiveness, challenges, and strategies for implementing web-based simulation education in low- and middle-income countries, based on a thorough PubMed search focused on web-based simulation programs in medical education.

Development and effect of hybrid simulation program for nursing students: focusing on a case of pediatric cardiac catheterization in Korea: quasi-experimental study.

Hybrid simulation has emerged to increase the practicality of simulation training by combining simulators and standardized patient (SP) that implement realistic clinical environments at a high level. This study aimed to develop a hybrid simulation program focused on case of pediatric cardiac catheterization and to evaluate its effectiveness. The hybrid simulation program was developed according to the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model. And deep learning-based analysis program was used to analyze non-verbal communication with SP and applied it for debriefing sessions. To verify the effect of the program, a quasi-experimental study using a random assignment design was conducted. In total, 48 nursing students (n=24 in the experimental group; n=24 in the control group) participated in the study. Knowledge (F=3.53, p=.038), confidence in clinical performance (F=9.73, p<.001), and communication self-efficacy (F=5.20, p=.007) showed a significant difference in both groups and interaction between time points, and the communication ability of the experimental group increased significantly (t=3.32, p=.003). Hybrid simulation program developed in this study has been proven effective, it can be implemented in child nursing education. Future research should focus on developing and incorporating various hybrid simulation programs using SP into the nursing curriculum and evaluating their effectiveness.

An anthropomorphic phantom for atrial transseptal puncture simulation training

BackgroundTransseptal puncture (TSP) is a critical prerequisite for left-sided cardiac interventions, such as atrial fibrillation (AF) ablation and left atrial appendage closure. Despite its routine nature, TSP can be technically demanding and carries a risk of complications. This study presents a novel, patient-specific, anthropomorphic phantom for TSP simulation training that can be used with X-ray fluoroscopy and ultrasound imaging.MethodsThe TSP phantom was developed using additive manufacturing techniques and features a replaceable fossa ovalis (FO) component to allow for multiple punctures without replacing the entire model. Four cardiologists and one cardiology trainee performed TSP on the simulator, and their performance was assessed using four metrics: global isotropy index, distance from the centroid, time taken to perform TSP, and a set of 5-point Likert scale questions to evaluate the clinicians’ perception of the phantom’s realism and utility.ResultsThe results demonstrate the simulator’s potential as a training tool for interventional cardiology, providing a realistic and controllable environment for clinicians to refine their TSP skills. Experienced cardiologists tended to cluster their puncture points closer to regions of the FO associated with higher global isotropy index scores, indicating a relationship between experience and optimal puncture localization. The questionnaire analysis revealed that participants generally agreed on the phantom’s realistic anatomical representation and ability to accurately visualize the TSP site under fluoroscopic guidance.ConclusionsThe TSP simulator can be incorporated into training programs, offering trainees the opportunity to improve tool handling, spatial coordination, and manual dexterity prior to performing the procedure on patients. Further studies with larger sample sizes and longitudinal assessments are needed to establish the simulator’s impact on TSP performance and patient outcomes.

Looking through the crystal ball feasibility of tele-echocardiography using smart glasses in neonates: a pilot study.

In recent years, the importance of telemedicine has increased significantly. Especially in the field of echocardiography, virtual reality glasses offer the possibility of real-time data transmission without restrictions in the examination process. In particular, the care of critically ill newborns with suspected CHD might be improved by allowing a specialized paediatric cardiologist to remotely guide an echocardiographic examination. The current study aims to prove whether novices, under Google Glass guidance by a paediatric cardiologist, can perform an appropriate neonatal echocardiography. The current study is a prospective monocentric single-blinded pilot study. Participants were supposed to perform two test runs: The first test run was "unguided" and the second test run was instructed via Google Glass. A validated training simulator for neonatal echocardiography "EchocomNeo, Echocom GmbH" was used. The study took place at the Leipzig Heart Center, Department of Pediatric Cardiology from April 2022 to November 2022. A total of 21 medical students were enrolled. In total 252 views (126 views in each test run) were recorded. The overall performance was significantly higher in the Google Glass guided test run compared to "unguided" (structure score: 77.6% vs. 63.2%. p < 0.001 and quality score: 58.7% vs. 47.2%, p < 0.001). Also, the time was significantly lower in the Google Glass guided test run than in the unguided test run, p = 0.014. Google Glass guidance by a paediatric cardiologist could optimize the performance of novices in echocardiography using a standardized neonatal echo-simulator with structural normal cardiac anatomy.

Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 study

Abstract Introduction Interventional cardiology training has a long learning curve and exposes patients and clinicians to undesirable procedural risks. We aim to assess whether mentored simulation-based training with three dimensional (3D) printed models can improve the procedural skills and safety performance of beginners in coronary diagnostic procedures. Methods Twenty-nine final-year medical students from a single centre were lectured in the basic principles of invasive coronary angiography (ICA) for one-hour, and then randomized to conventional training or simulation training. Conventional training (n=15) consisted in watching a 20-minute video demonstrating all ICA steps in a 3D-printed coronary simulator. Simulation training (n=14) offered the same explanations in a hands-on training session with the 3D-printed model, in pairs, for 20 minutes. The co-primary endpoint was efficacy and safety of performing a simulated ICA in the 3D-printed simulator, installed under sterile drapes, in a conventional angiography suite. Efficacy and safety were graded by a blinded investigator using a pre-specified performance checklist, including the identification of procedural "red flags", graded 0-100%. The secondary endpoint was theoretical knowledge, assessed in a 25-question multiple-choice quiz, graded 0-100%. Results All participants completed the training and evaluation phases. Both elements of the co-primary endpoint were superior in the simulation group: efficacy score of 91.5 ± 3.8 vs 64.6 ± 8.3% and safety score 100.0 (100.0-100.0) vs 62.5 (20.8-79.2) %, p&amp;lt;0.001. The median number of "red flags" were 2 (1-4) in conventional and 0 (0-0) in simulation training recipients (p&amp;lt;0.001). Secondary endpoint was higher in simulation training: 85.7 ± 9.0 vs 76.8 ± 12.7% (p=0.039). Conclusion Mentored simulation-based training of medical students in ICA with 3D-printed models resulted in improved performance regarding efficacy, procedural safety, and theoretical knowledge.ResultsSimulation and evaluation setup

Determinants in disaster preparedness of nurses in the Azores

Abstract Background Disasters are situations of complexity and unpredictability, increasingly frequent and more destructive. They require rapid and effective action from different teams from different contexts, with preparation and qualifications for an adequate response to victims, recovering the environment, and restoring living conditions, and nurses play a significant role in these events. Understanding the level of preparedness of nurses for disasters is fundamental for defining the competency framework in the disaster management cycle. Objectives To analyze the preparation of nurses in the Azores for a catastrophe. Methods A cross-sectional study was performed with 160 nurses from the Azores. The questionnaire validated for the Portuguese population “Disaster Preparedness Evaluation Tool (DPET ®): Preparation of nurses in the face of a catastrophe” was applied. It was approved by the Ethics Committee. Results More than half of respondents (n = 137, 71%) indicated that they were not fully prepared to respond to disasters, while 29% (n = 46) acknowledged that they felt adequately prepared. Of the 160 respondents, only 20% (n = 30) participated in the development of emergency plans and only 14% (n = 22) participated in the creation of emergency plans that contribute to improvements at the local level. Training through simulation training was cited as important in disaster preparedness (n = 129, 78%). Discussion The present study identified little involvement of RAA nurses in preparing emergency plans and less than half feel poorly prepared in responding to a catastrophe. This finding is consistent with studies by Baker, Alamri, &amp; Aboshaiqah (2019) and Emaliyawati et al. (2021). Conclusions This study was conducted in a region prone to natural disasters. It is vital to invest in the training of these professionals throughout the disaster cycle so that they can contribute to reducing the impact that the catastrophe will have on the individual/family and community. Key messages • Strengthening capabilities through regular disaster training based on effective information. • Low participation in the development of emergency plans that contribute to improvements at the local level.

Risk perceptions and risk behavior among children attending a road safety education program in Greece

Abstract Background Road Traffic Injuries (RTI’s) are a significant public health concern for children, placing a considerable burden on their well-being. Greece has consistently recorded high numbers of RTI’s among adolescents. Methods A university lab (LaHeRS, HMU) offers a road safety education program for primary and secondary students in Heraklion, Greece. The program consists of two parallel sessions (practical training using a driving simulator and activity-based risk-perception training) aimed at enhancing competencies in resilience to peer influence, empowering children to engage in informed decision-making and fostering hazard perceptions skills. The current presentation reports on 800 students who attended the program between October 2023 and April 2024. A structured questionnaire was used to collect data on student’s beliefs, attitudes and practices on road safety. Results A total of 800 students attended the program from the broader Crete Region. 50.5% were girls with a mean age of 12.6 (SD = 2.3) years, 60.9% secondary education students, 58% resided in rural areas. 33.9% reported using a motorcycle and 33.8% a car without a driving license. 23.3% reported experiencing a road traffic incident while commuting. 57.1% identified road safety as a problem in their place of residence, only 26.5% felt safe on local streets and only 9.1% considered other road users as watchful. Additionally, 66.8% highly valued helmet use as a precaution in short distances. 71.6% reported always wearing seatbelt in front seats and 68.9% thought seatbelts are important at back seats. 52.1% did not identify themselves as risk takers on the street, and only 22.5% felt competent in avoiding road risks. 32.9% admitted experiencing peer pressure while commuting. Conclusions Risk taking behaviors and low use of protective measures are prevalent among school aged children and need to be addressed through targeted road safety education programs and interventions. Key messages • Promoting safe behaviors and enhancing risk perception is critical among children and young adolescents. • Road safety education should be integrated into school curricula, starting from pre-school education.

Feasibility of novel robot-assisted, remotely-performed echocardiographic examination

Abstract Background Access to echocardiography services outside metropolitan areas is persistently limited. We sought to determine the feasibility and efficiency of performing remotely-controlled, semi-automated robot-assisted echocardiographic examinations (robot-assisted echo) by cardiac sonographers as a potential avenue to provide standard echocardiographic specialist services to remote and rural areas as well as permit expedited diagnoses enabling earlier management of disease. Methods Two accredited cardiac sonographers (Cardiac Investigations Unit) undertook 6 hours virtual training, and 10 hours hands-on robot-assisted echo simulation training; using a novel, semi-automated robotic arm system to remotely manipulate an ultrasound probe to acquire echocardiographic images. Sonographers then performed remotely-performed robot-assisted echo examinations on staff volunteers, and consenting inpatients in whom echocardiography was clinically indicated. Cameras, probe pressure sensors and an ultrasound platform remote console were utilised to support remote operation. Traditional echocardiography (manipulation of probe by hand) was also performed as a reference. Feasibility to obtain a comprehensive robot-assisted echo was compared to traditional echocardiography. Sonographer learning curve and efficiency (image acquisition time and offline measurement time) was also investigated. Results Total cohort was n=78 (age 51±15yrs; 57% male) with 63% patients. All participants had robot-assisted echo and traditional echocardiograms performed within 72hrs. Average feasibility (%) of robot-assisted echo as (a) 11 averaged assessments and (b) 38 averaged measures was 92±9 (a) and 86±11 (b), compared to (a) 99±1 and (b) 97±7 by traditional examination (all respectively). Sonographer learning curve was identified via 1:1 block subcohort analysis, with averaged assessment feasibility (n=33:31) being 86±19 (first block) to 98±3 (last block) and averaged measurement feasibility (n=32:31) being 77±11 (first block) to 92±7 (last block), all respectively. In the staff participant cohort (n=31), average image acquisition efficiency in robot-assisted echo was poorer than that of traditional examination (47+9 minutes compared to 19+2 minutes; p&amp;lt;0.0001), respectively. Average efficiency of offline measurement time was 13+7 minutes by robot-assisted echo; comparable (p=0.33) to traditional examination at 12+6 minutes. There was no learning curve effect on image acquisition efficiency; 42+10 vs 51+7 minutes (1:1; n=16:15; p=0.007). Conclusion Remotely-performed, robot-assisted echo using a commercially-available ultrasound platform performed by briefly-trained, cardiac sonographers is feasible, with reasonable efficiency even though less efficient in image acquisition compared to traditional echocardiograms. Further investigation of performance as a remote service is warranted in larger, clinically-indicated populations.