Use Of High-fidelity Patient Simulation Research Articles

Quantifying Medical Resident Perceptions Regarding the Utility of High‐fidelity Patient Simulation using Q‐methodology

High‐fidelity patient simulation (HFPS) combines sophisticated patient manikins and realistic, immersive environments to safely train physicians at an early stage of their medical careers. However, little is known about the distinct patterns of medical resident perceptions who experienced HFPS during their undergraduate medical education (UME). Q‐methodology obtains first‐person, qualitative viewpoints from participants about a specific topic of interest using a quantitative inverted factor procedure and was used to answer the research question: How do medical residents perceive the utility of, and satisfaction with, HFPS experienced during their UME? Since Q‐methodology is an exploratory, systematic research technique that does not attempt to hypothesize existing relationships, a priori hypotheses were not developed for this research question. Graduates were sampled from Indiana University Bloomington School of Medicine (IUSM‐B) classes of 2015, 2016, and 2017 because HFPS was integrated into their UME. Of the 58 medical residents contacted, 12 were recruited for this study. The residents were asked to electronically sort 37 validated statements relative to each other into a bipolar, inverted quasi‐normal distribution based on their subjective opinions. Two open‐ended questions at the end of the sorting procedure allowed participants to elaborate on their choice of the highest and lowest ranked statements. The final solution consisted of three factors, one unipolar factor (Factor 1) and one bipolar factor (Factor 2a and Factor 2b), that explained 45% of the total variance in the data, with eleven participants (91.7%) mapping onto one of the three factors. Seven residents were grouped into Factor 1 and were labeled ‘Practical Skeptics' given their pattern of finding value in the pragmatic relevance of HFPS, but had difficulty suspending their disbelief of the simulated patient manikin. Three residents were clustered into Factor 2a characterized as ‘Simulation Enthusiasts' and demonstrated a pattern of embracing the HFPS experience, could suspend their disbelief, and found value in interprofessional education simulations with nursing students. Factor 2b included one resident described as an ‘Anxious Supporter’ because this individual embraced the use of HFPS but captured the stress and anxiety that some feel while participating in simulations that was not seen with the other two factors. This study discovered three distinct perceptions regarding HFPS among residents who attended IUSM‐B and may aid in tailoring HFPS strategies to more fully meet the needs and expectations of future physicians.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Nursing Simulation and Transfer of Knowledge in Undergraduate Nursing Programs: A Literature Review.

The purpose of this literature review was to describe what research has been conducted on transfer of knowledge using high-fidelity patient simulation (HFPS) and determine what further research is needed. The use of HFPS has expanded rapidly in recent years. There is research suggesting that HFPS effectively educates nurses for clinical practice. An extensive literature search was conducted and analyzed for themes. Exclusion criteria were studies that focused only on graduate-level nursing education, accelerated programs, medical students, registered nurses, and use of low-fidelity simulation or standardized patients. Themes that emerged included competence, confidence, safety, timing, method and delivery. Study results varied, with only some showing transfer. More research is needed to determine how HFPS influences knowledge transfer to the clinical setting.

Overcoming Reluctance towards High Fidelity Simulation - A Mutual Challenge for Nursing Students’ and Faculty Teachers

BACKGROUND: One strategy to develop nursing students’ clinical judgment are the use of high-fidelity patient simulation (HFS). The aim of the study was twofold. Firstly, the aim of this study was to describe the nursing students’ experiences while participating in HFS, and secondly to describe faculty teachers’ reflections about nursing students’ need in HFS and the related teaching challenges.METHOD: Data was collected in focus group discussions and individual interviews, analyzed using thematic qualitative content analysis.FINDINGS: The nursing students’ experienced HFS as being thrown into an uncertain, exposure situation. This were for some, reason for reluctance. The teachers challenge was motivating and coaching the students throughout a demanding teaching situation. DISCUSSION: Students’ ability to perform in HFS is influenced by self-perceived efficacy, own attitudes and responsibility for one’s learning, which are a challenge for the teachers.CONCLUSION: HFS methodology can be useful to identify gaps and strengths in students’ professional transition towards becoming registered nurses. Overcoming reluctance towards HFS is a mutual challenge for faculty teachers and nursing students. By entering the scenario with a positive mindset, nursing students can improve their ability to perform clinical judgments.

High-Fidelity Patient Simulation Increases Dietetic Students' Self-Efficacy Prior to Clinical Supervised Practice: A Preliminary Study

ObjectiveThis study examined the effect of high-fidelity patient simulation (HPS) on dietetics students' self-efficacy before supervised clinical practice. MethodsThis repeated-measures study was conducted during the 2012–2013 academic year. All students in a masters coordinated program cohort (n = 19) participated in an interprofessional HPS experience before clinical supervised practice. The students completed a 4-point self-efficacy scale in which 0 = not at all confident and 3 = fully confident, at 3 time points: before and after the simulation experience and 2 weeks after beginning clinical supervised practice. ResultsUsing the Wilcoxon signed-rank test, median confidence level differed before and after the simulation (1.5; interquartile range [IQR] 1.2–1.8; and IQR 1.3–2.0, respectively; P = .03) as well as after the simulation vs during the clinical rotation (2.2; IQR 2.0–2.4; P = .002). Conclusions and ImplicationsThis study supports the use of HPS with dietetics students in a coordinated program. High-fidelity patient simulation increases dietetics students' self-efficacy before supervised clinical practice.

Standard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration in paediatric critical care

Identifying and stabilising deterioration in a child with significant clinical compromise is both a challenging and necessary role of the paediatric critical care nurse. Within adult critical care research, high fidelity patient simulation (HFPS) has been shown to positively impact learner outcomes regarding identification and management of a deteriorating patient; however, there is a paucity of evidence examining the use of HFPS in paediatric nursing education. The aim of this study was to investigate the effect of HFPS on nurses' self-efficacy and knowledge for recognising and managing paediatric deterioration. Further, participants' perceptions of the learning experiences specific to the identification and management of a deteriorating child were also explored. Registered nurses working in a tertiary-referral paediatric critical care unit were recruited for this quasi-experimental study. Using a pre-test/post-test control-group design, participants were assigned to one of two learning experiences: HFPS or standard instruction. Following the learning experience, nurses were also invited to participate in semi-structured interviews. 30 nurses participated in the study (control n=15, experiment n=15). Participants in the HFPS intervention were most likely to demonstrate an increase in both perceived self-efficacy (p=<0.01) and knowledge (p=<0.01). No statistically significant change was observed in control group scores. The mean difference in self-efficacy gain score between the two groups was 5.67 score units higher for the experiment group compared to the control. HFPS also yielded higher follow-up knowledge scores (p=0.01) compared to standard instruction. Ten nurses participated in semi-structured interviews. Thematic analysis of the interview data identified four themes: self-awareness, hands-on learning, teamwork, and maximising learning. The results of this study suggest that HFPS can positively influence nurses' self-efficacy and knowledge test scores specific to the recognition and management of paediatric deterioration.

Undergraduate nursing students' experiences when examining nursing skills in clinical simulation laboratories with high-fidelity patient simulators: A phenomenological research study

Simulation has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, the evidence in favour of this pedagogical approach is weak, and more knowledge is needed in support of its use. The aim of this study was (a) to explore the experiences of undergraduate nursing students when examining knowledge, skills and competences in clinical simulation laboratories with high-fidelity patient simulators and (b) to analyse these students' learning experiences during the examination. A phenomenological approach was used, and qualitative interviews were conducted among 23 second-year undergraduate nursing students-17 women and 6 men. The findings revealed that, irrespective of whether they passed or failed the examination, it was experienced as a valuable assessment of the students' knowledge and skills. Even if the students felt that the examination was challenging, they described it as a learning opportunity. In the examination, the students were able to integrate theory with practice, and earlier established knowledge was scrutinised when reflecting on the scenarios. The examination added aspects to the students' learning that prepared them for the real world of nursing in a safe environment without risking patient safety. The study findings suggest that examinations in clinical simulation laboratories can be a useful teaching strategy in nursing education. The use of high-fidelity patient simulators made the examination authentic. The reflections and feedback on the scenario were described as significant for the students' learning. Undergraduate nursing students can improve their knowledge, understanding, competence and skills when such examinations are performed in the manner used in this study.

High-fidelity patient simulators to expose undergraduate students to the clinical relevance of physiology concepts.

PHYSIOLOGY EDUCATORS are often faced with the difficulty of showing students the clinical relevance of the science they are learning. This occurs at the healthcare professional level before clinical rotations with direct patient encounters. This challenge is likely even more prevalent during undergraduate training as students are years away from exposure to an actual healthcare setting. Physiology, which is arguably the foundation of clinical medicine, is a difficult subject for students of all levels to learn for various reasons, including the fact that it is conceptual and highly integrated (8). Therefore, finding avenues for undergraduate students, especially those in healthcare career tracks, to experience the clinical relevance of physiology “in action” may help student engagement, enthusiasm, and learning of physiology as well as help guide career choices. The use of high-fidelity patient simulators (HFPSs) has expanded throughout medical, nursing, and allied health professions education in the last decades. These manikins can be programmed to represent pathological states and are used to teach clinical skills as well as clinical reasoning. First, the students are typically oriented either to the manikin or prebriefed about the specific case or scenario. This is followed by the 15- to 30-min simulation itself with a subsequent debrief about the experience (9). These HFPS experiences have been shown to improve learning and retention of physiology concepts in medical students (2, 5, 6). Interestingly, the use of HFPSs has also expanded into high school, college, and graduate schools in an effort to add problem-solving and critical thinking components to science classes (9). Gordon and Oriol (4) from the Harvard Summer Preclinical Institute have shown that student reflection reveals a deep satisfaction with the experience. Participation in these classes helped to improve confidence and reinforce humanism as well as providing clarity for future career choices (4). Although the idea of incorporating HFPSs within undergraduate courses appears beneficial on multiple levels, there are limited data regarding implementation and learning outcomes of the experience. The purpose of this report is to share the data and reflections from a HFPS experience for biomedical students in our undergraduate program. The 2-h HFPS experience was part of an upper-level undergraduate course titled “Laboratory Virtual Simulations in Physiology,” which is a mixed-mode class consisting of laboratory modules and limited face-to-face lecture time. The HFPS experience was developed and facilitated by faculty members from the University Central Florida College of Medicine and School of Biomedical Sciences. The goals of this study were to determine the feasibility of the simulation activity, whether learning occurred in the activity, and whether students were engaged during the activity. A pretest and posttest were designed and given to participants to test knowledge and perceptions of teamwork and communication skills. This study was reviewed and exempted by the Institutional Review Board of the University of Central Florida, and students participated with informed consent.

The use of high-fidelity simulation to teach cultural competence in the nursing curriculum.

The United States population is undergoing a major demographic shift, by the year 2050, it is predicted that minority populations will constitute half of the general population. This evolving population change is significant due to the overwhelming burden of disease that minorities face in the nation. Cultural competence training is currently being used to prepare practitioners to provide care to a diverse population in an effort to eliminate health disparities. With the increasing demands of the nursing curriculum and the limited time frame to prepare competent clinicians, the search continues for innovative strategies that will produce culturally competent providers. Patient simulation is a technique that replicates real-world scenarios in a controlled and nonthreatening environment. However, despite the legal and moral obligations that nurses have to provide culturally competent care, a lack of evidence exists regarding how to properly integrate simulation methods for cultural competence training into the nursing curriculum. In the nursing curriculum, patient simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental context. The potential exists for the use of high-fidelity patient simulation as an effective teaching strategy for cultural competence training.

Board 404 - Research Abstract Evaluation of Simulation Education using Anesthesia Information System (Submission #99)

Introduction/Background The use of high-fidelity patient simulation is a validated educational tool for anesthesiology resident training, especially for novice residents.1 Simulation has the advantage of teaching students clinically applicable skills and judgment without risking patient harm. Documentation of improved speed with acquisition of technical skills, such as fiberoptic intubation2 and central line placement,3 has been published but very few studies have been able to demonstrate a correlation between high-fidelity simulation education and improvement in patient outcomes. Wayne et al4 have demonstrated that simulation-based education of internal medicine residents in ACLS and code blue training resulted in an improved adherence to ACLS protocols during actual hospital code blue events. Barsuk et al5 showed that resident simulation-based training can reduce catheter related blood stream infections. Aside from these few small studies, there is little data to substantiate the belief that simulation-based education Results in improved patient outcomes. This study examines the effect of simulation on the treatment of emergence of hypertension through the examination of EMR records. Methods IRB was obtained through UC Irvine Simulation Center. Participants were anesthesiology resident volunteers. Each resident participated in a simulation which contained a patient with hypertension at emergence. The simulation session included a 20 minute scenario participation followed by a 40 minute debriefing. Pharmacologic treatment of hypertension was reviewed during the debriefing. The simulation scenario was the same for each participant. Surgical Information Systems (SIS) is the Anesthesia Information Management System (AIMS) or electronic anesthesia medical record at UC Irvine Medical Center. The electronic anesthesia records of each participant were then searched for the cases one month prior to the simulation education sessions to evaluate whether or not hypertension at emergence was treated pharmacologically. Emergence was defined as within 30 minutes of extubation and hypertension was defined as mean arterial pressure (MAP) 20% greater than baseline. The month following the simulation was later searched in UC Irvine AIMS to determine whether hypertension at emergence was treated by participants or not. We used the Related-Samples Wilcoxon Signed Rank test to compare the median proportion treated before and after simulation. Results Eleven residents participated in the study. One participant was excluded because they went onto outside rotations and data could not be evaluated. During the month prior to the simulation, a total of 53 patients had a MAP greater than 20% baseline and in 26 (43%) of these cases the hypertension was treated pharmacologically by the participant. The median percentage of cases per participant treated pre-simulation was 50% [10.7, 67.6]. In the month following the simulation, a total of 53 cases had a MAP greater than 20% baseline and in 35 (66%) of these cases the hypertension was treated pharmacologically. The calculated median percentage of cases per participant treated post-simulation 65.7% [48.6, 81.2], which is statistically significant (p = 0.037). Conclusion Following the simulation session, participants did show an increase in the percentage of cases of emergence hypertension treated pharmacologically. More participants are needed to draw conclusive Results. AIMS can be a used as a tool when evaluating the impact of simulation on clinical outcomes.

Faculty Development for the Use of High-Fidelity Patient Simulation: A Systematic Review

Faculty Development for the Use of High-Fidelity Patient Simulation: A Systematic Review

Using high-fidelity simulation to bridge clinical and classroom learning in undergraduate pediatric nursing

In Patricia Benner's book, Educating Nurses: A Call for Radical Transformation, she recommends essential changes in policy, curriculum, and in the way nursing programs approach student learning. This study explored how two of Benner's key recommendations, (1) integrating the theoretical component and the clinical component and (2) moving education from an emphasis on critical thinking to an emphasis on clinical reasoning, could be achieved by integrating the use of high-fidelity patient simulation in a pediatric curriculum. Qualitative and quantitative data were collected from the group of traditional and nontraditional baccalaureate students (n=131). The quantitative data revealed learning objectives were met over 80% of the time in simulation exercises and the qualitative themes revealed a positive experience with the simulation exercises with a large proportion of students offering the sentiments that these scenarios become requirement prior to the start of clinical rotations.

High-Fidelity Patient Simulation in Nursing Education:An Integrative Review

An integrative review was undertaken to analyze studies published since 1998 on the use of high-fidelity patient simulation (HFPS) in undergraduate nursing education. This review found that HFPS benefits nursing students in terms of knowledge, value, realism, and learner satisfaction;findings were mixed in the areas of student confidence, knowledge transfer, and stress. Further research in these and other areas will determine whether its increased use is warranted.

Simulating Rapid Response in Undergraduate Critical Care Education

This article describes use of high-fidelity patient simulators to simulate patient emergencies in an undergraduate critical care course. Our rapid response scenarios integrate the nursing process, teamwork, communication, and delegation principles to assist students in recognizing and intervening with patients who are physiologically deteriorating and require urgent nursing care. The scenarios were developed to provide students an understanding of who is involved in rapid response situations, how participants behave, and the roles of the registered nurse and an opportunity to practice those roles. Each senior student participates in 8 to 9 patient scenarios, either in the role of the primary nurse, nursing student, nurse associate, or as an observer during the last semester of their senior year.

Integrating Simulation Across the Curriculum

The authors describe the process used to implement simulation in a small baccalaureate nursing program and provide examples of how simulation can be used to facilitate the development of key curricular concepts such as critical thinking, therapeutic interventions, and communication. The primary focus is on the use of high-fidelity patient simulators and human "standardized patients."

U.S. Boards of Nursing and the Use of High-Fidelity Patient Simulators in Nursing Education

High-fidelity patient simulation is becoming an essential component of prelicensure nursing education. A survey was mailed to the boards of nursing in all states, the District of Columbia, and Puerto Rico to ascertain the use of high-fidelity patient simulators for clinical time in current regulations. Participants were asked if high-fidelity patient simulation could be substituted for clinical time in the regulations and, if so, for what percentage. If not, they were asked whether they gave approval to nursing programs to substitute clinical time with high-fidelity patient simulators and, if so, for what percentage. Finally, the participants were asked whether they felt that the regulations would be changed in the future to allow the use of high-fidelity patient simulators to substitute for clinical time. Five states and Puerto Rico have made regulation changes to allow for such substitution, but only Florida has indicated a percentage of time. Sixteen states currently give approval for simulation substitution, and 17 states may consider regulation changes concerning high-fidelity patient simulation in the future. Such findings have implications for alterations in the prelicensure nursing curriculum that could examine patient safety and quality concerns addressed by the public and leading health and nursing organizations.

Preparing ward nursing staff for more effective team involvement in a code blue (BLS/ALS) utilising high fidelity patient simulation (HFPS)

Purpose of the study: Knowledge, skills and confidence decay have been identified as significant factors impacting on the effectiveness of emergency calls in the general ward environment. Ward nurses indicate they do not feel confident in interacting with the Resuscitation Team and feel underprepared in dealing with resuscitation equipment. This paper describes the development of and participants’ perceptions of a cardiac arrest in a Ward Nurses Study Day that focuses on knowledge needed, clinical practice required and how the nurse can be an effective team player, using focused simulation technology and application of acute crisis resource management principles. Materials and methods: The education preparation includes preparatory tutorials, followed by interactive clinical skills stations; orientation to the simulation environment and culminating in a scenario-based, team focused interactive HFPS. This construct has been developed to encourage a more effective retention of the ward nurses’ knowledge, skills and confidence levels for subsequent involvement in a resuscitation emergency. Participants completed a 13 item standardised course evaluation at the end of the course to examine their perceptions of the education provided. Results: Participants (n = 88) indicated that the study days were purpose constructed, the information provided relevant, pitched appropriately while the skills stations helped increase knowledge and skills about and handling of resuscitation equipment. The simulation sessions were powerful, dynamic activities that facilitated experiential learning, team activity acquisition, behaviour modification and positive self-perceptions. Conclusions: The use of HFPS during a resuscitation study day has the potential to encourage confidence in clinical practice, improve team activities, thus facilitating increased positive patient outcomes during a subsequent emergency.

See One, Do One, Teach One: Advanced Technology in Medical Education

The concept of "learning by doing" has become less acceptable, particularly when invasive procedures and high-risk care are required. Restrictions on medical educators have prompted them to seek alternative methods to teach medical knowledge and gain procedural experience. Fortunately, the last decade has seen an explosion of the number of tools available to enhance medical education: web-based education, virtual reality, and high fidelity patient simulation. This paper presents some of the consensus statements in regard to these tools agreed upon by members of the Educational Technology Section of the 2004 AEM Consensus Conference for Informatics and Technology in Emergency Department Health Care, held in Orlando, Florida. Web-based teaching: 1) Every ED should have access to medical educational materials via the Internet, computer-based training, and other effective education methods for point-of-service information, continuing medical education, and training. 2) Real-time automated tools should be integrated into Emergency Department Information Systems [EDIS] for contemporaneous education. Virtual reality [VR]: 1) Emergency physicians and emergency medicine societies should become more involved in VR development and assessment. 2) Nationally accepted protocols for the proper assessment of VR applications should be adopted and large multi-center groups should be formed to perform these studies. High-fidelity simulation: Emergency medicine residency programs should consider the use of high-fidelity patient simulators to enhance the teaching and evaluation of core competencies among trainees. Across specialties, patient simulation, virtual reality, and the Web will soon enable medical students and residents to... see one, simulate many, do one competently, and teach everyone.

Identification of gaps in the achievement of undergraduate anesthesia educational objectives using high-fidelity patient simulation.

In this study we sought to identify educational gaps in medical students' knowledge using human patient simulation. The Undergraduate Committee developed 10 scenarios based on anesthesia curriculum objectives. Checklists were designed by asking 15 faculty members involved in undergraduate education to propose expected performance items at a level appropriate for medical students. These items consisted of essential performance items as well as critical management omissions. Checklists were used to score students' videotaped performances. Checklist items common to more than one scenario were grouped for data analysis and identification of gaps in achievement of educational objectives. Eighteen groupings of expected performance criteria and 8 groupings of critical management omissions were established. Performance data of 165 students were analyzed. Common management omissions were lack of adequate airway management, failure to check blood pressure, and failure to stop the anesthetic. Students reliably performed defibrillation, notation of vital signs, auscultation of lung fields, and administration of IV fluids. The most common critical omissions were failing to a). call for help, b). take a history/do physical examination, and c). prepare airway equipment. Management and critical omissions noted during performance assessments provide information regarding students' educational needs, enabling faculty to focus attention on demonstrated areas of weakness. This study involved the use of high-fidelity patient simulation that offers standardized clinical experiences that can detect gaps in medical students' knowledge base and clinical performance. This information can be used by faculty to focus their teaching efforts to ensure competency in important educational areas.

22 Use of High-fidelity Patient Simulation Combined with Flat-screen Simulation for Biochemical Weapons Response Training

22 Use of High-fidelity Patient Simulation Combined with Flat-screen Simulation for Biochemical Weapons Response Training

Anaesthetic simulators: training for the broader health-care profession.

The use of high-fidelity patient simulators for training health-care professionals has increased rapidly in recent years. Approximately 150 simulation training centres operate internationally. Australasia has acquired four centres since 1997. A large component of simulator-based training is experiential. Participants manage clinical scenarios on lifelike computer-controlled mannikins within realistic clinical environments. Afterwards they actively reflect upon the experience, an exercise that is facilitated by observation of a video replay of the event. This approach to training promotes a consideration of broader issues which can influence clinical practice and patient outcomes. This has particular relevance to emergencies. Here, events that are by nature infrequent and unscheduled can be addressed in a controlled fashion, in an environment that is supportive and separated from actual patients. A broad range of skills can be addressed with this resource. Of key importance are situational management and team effectiveness skills. Deficiencies with respect to these 'non-clinical' skills are being increasingly identified for their contribution to preventable adverse events within the health-care environment. Multidisciplinary operation-room team training has the potential to address these issues as they relate to the perioperative environment.