Use Of High-fidelity Simulation Research Articles

Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials

BackgroundSimulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training.MethodsA comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants’ confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software.ResultsAltogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18–0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21–1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20–0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants’ satisfaction and confidence demonstrated no significant benefit for HF simulation.ConclusionsLearners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient’s outcomes.

The Acquired Critical Thinking Skills, Satisfaction, and Self Confidence of Nursing Students and Staff Nurses through High-fidelity Simulation Experience

BackgroundNursing students need to build their self-confidence to cope with complex clinical situations, and practicing nurses must maintain and boost their self-confidence to provide safe, accurate, and high-quality patient care. Exposing nursing students and staff nurses to high-fidelity simulation to can their self-confidence, thus advancing their competencies. MethodsThis study employed a quasi-experimental research design to identify and compare the acquired critical thinking skills, satisfaction, and self-confidence of nursing students and staff nurses based on their use of high-fidelity simulation (HFS) learning. ResultsThe mean difference between the pre- and post-tests of nursing students and staff nurses in HFS sessions 1 and 2 was significant, with p<.0001. Both groups of participants expressed high levels of satisfaction and self-confidence in the HFS experience. Furthermore, participants’ satisfaction with the current learning system had a p-value of .6628 and their self-confidence in learning had a p-value of .9578, which indicates no significant difference. ConclusionBoth groups of participants conveyed high levels of satisfaction and self-confidence following the HFS experience. Furthermore, the use of HFS enhanced their critical thinking skills and boosted their learning retention.

Perception of Satisfaction and Self-Confidence with High Fidelity Simulation Among Nursing Students in Government Universities.

Background : High Fidelity Simulation (HFS) as a Teaching-Learning Methodology is usually implemented by the teaching institutions in the world. Several studies were conducted proving the significance of this method on improving the students’ learning. With the several factors that hinder the students’ clinical learning experiences, it is necessary to determine the students’ viewpoint regarding the use of HFS in increasing their confidence and satisfaction. Research Aim: The aim of this study is to assess the student perceptions regarding Satisfaction and self-confidence toward High Fidelity Simulation as a learning. Research methodology: A cross-sectional correlation descriptive design was used in this study which was conducted at king Saud university (KSU) and princess Nourah university (PUN) in Riyadh. A quota stratified was used to recruit the participant female Saudi and non-Saudi BSN student with HFS experience who were asked to complete the questionnaire on student satisfaction and self-confidence regarding HFS in learning scale and the simulation design scale. Results: This study found out that the fidelity (realism) is the most important factor in learning related to HFS. The students were satisfied and confident in utilizing HFS. Significant correlations between the profile of the participants’ age and student academic level and the key of the simulation features were shown. It was also found out that there were significant correlations between age and marital status with self-confidence in learning through HFS. Conclusion: Simulation as teaching method is as effective tool as a real-life without life-threatening of the patient and promoting students' performance. The fidelity of the simulation is the most important factor to the student and the students were satisfied and confident with current learning related to HFS. Future studies are needed to examine other learning outcomes such as clinical competence, motivation among student using HFS as a learning strategy. Keywords: high fidelity simulation, satisfaction, self-confidence. DOI: 10.7176/JEP/11-12-16 Publication date: April 30th 2020

High fidelity simulation in undergraduate medical curricula: experience of fourth year medical students

Introduction: Application of theoretical knowledge to management of critically ill patients is a challenging task for medical undergraduates where opportunities to learn clinical skills with regard to management of emergencies are few. High fidelity simulation (HFS) is widely used globally to learn clinical skills in a safe environment. However, research in use of HFS in developing countries such as Sri Lanka is minimal. Purpose: The purpose of this study was to explore the response of medical undergraduates to a high fidelity simulator in the context of management of emergencies. Method: A pilot group of 30 fourth year medical students underwent a high fidelity simulator session. They completed a self-administered evaluation, which included both open and close ended questions and participated in a focus group discussion post-simulation. Descriptive statistics were employed to analyze the responses to close-ended questions and the responses to open- ended questions and focus group discussion were analyzed for recurring themes. Result: Students rated the simulation-based learning experience with high positivity. The self-competency of 29 (96.6%) students had increased post-simulation while providing a safe learning environment to all students. Majority (63.3%; n=19) felt it helped put theory into practice. Qualitative data gathered from open-ended questions and focus group discussions further confirmed these findings. Conclusion: The study demonstrates that HFS can be used to provide a safe environment and a satisfying educational experience for students to learn medical emergencies, and as an educational opportunity of translating theory into practice. Although HFSs are costly they appear to be cost effective in terms of educational outcomes.

Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review.

The objective of this review is to evaluate the effectiveness of high fidelity simulation (HFS) versus low fidelity simulation (LFS) on practical/clinical skill development in pre-registration physiotherapy students. Evidence suggests that improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning at clinical placement for health professions students. However, evidence indicates that the clinical environment is most effective for learning. As a result, there has been increased interest in the use of HFS where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified. Experimental and quasi-experimental studies comparing HFS (simulated person, manikin, virtual simulation, video case-studies) to LFS (peer role-play, paper-based case-studies) in pre-registration physiotherapy education were included. Primary outcomes were objective measures of skills performance; secondary outcomes were students' perceptions of the impact of simulation on learning measured using quantitative outcomes. A three-step search strategy was employed. Following an initial search of MEDLINE and CINAHL and analysis of text words, MEDLINE, CINAHL, ERIC, AMED, EThOS and Google Scholar were searched in November 2017. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onwards were included. Title/abstract screening, critical appraisal and data extraction were conducted by two independent reviewers; conflicts were resolved by discussion. Meta-analysis was not possible due to heterogeneity; therefore, results were presented in narrative form. Three randomized controlled trials (RCT) and three quasi-experimental studies (310 participants) were included. They were conducted in the USA and Australia, and evaluated standardized patients (people who take on the role of a real patient), near-peers, computerized manikins and virtual simulation in pre-registration Bachelor of Science (Honors), Master of Science and Doctor of Physiotherapy students. One RCT was considered high quality, with the remainder moderate quality. The findings related to five main areas: i) In terms of motor skills performance, an increased number of safety fails were found with HFS (HFS = 13.5% safety fails, HFS plus video feedback = 15.4% safety fails, control [LFS] = 8.1% safety fails); ii) In terms of clinical performance, the Assessment of Physiotherapy Practice (APP) tool indicated no significant improvement in mean APP scores at week 6 of clinical placement (HFS mean APP score = 60.7 [9.1], control mean APP score = 58.7 [8.4]; P = 0.35); iii) In terms of self-efficacy, only one of two studies showed a statistically significant difference with HFS, as measured by the Acute Care Confidence Survey (P = 0.001); however, became non-significant once students were on clinical placement (P = 0.328); iv) Students did not perceive a significant difference in their communication skills with HFS, as measured on a visual analogue scale (simulation = 9.05 [1.27]; control 8.75 [1.2]; P = 0.482); and v) In terms of general perceptions, students were significantly more positive about HFS for increasing awareness of safety issues (P = 0.002), patients' emotional status (P = 0.002), handling skills (P < 0.0001) and ability to provide instructions to patients (P < 0.0001). Currently, there is no high quality evidence that HFS improves motor skill performance in pre-registration physiotherapy students. There is a small amount of moderate-quality evidence it may improve students' perception of their self-efficacy but no evidence that it improves communication skills. However, a lack of studies and variation in outcome measures meant that meta-analysis was not possible. At present, no recommendations can be made regarding the use of HFS to improve skill performance in this population.

Using high fidelity simulation to increase nursing students' clinical postpartum and newborn assessment proficiency: A mixed-methods research study

ObjectiveThe objective of this study was to explore the benefits of using High Fidelity Simulators (HFS) to teach maternal postpartum and newborn assessment skills to student nurses before they interacted with actual hospital patients. DesignThis descriptive, observational study employed a mixed-method design using a Qualtrics online survey instrument. SettingThe study was set at a Midwestern university. ParticipantsThe study used a convenience sample of third-year BSN nursing students (n = 132). MethodsAfter participating in an HFS experience and completing a maternity clinical rotation, students took an online Qualtrics survey evaluating the benefits and drawbacks of the HFS experience. ResultsStudents valued the HFS experience at an average score of 3.82 on a Likert Scale of 1–5. Open-ended questions identified three themes: psychomotor learning leading to skill acquisition, affective learning, and simulation restructuring to provide more time, better instructor preparation, and smaller groups. ConclusionThis study's data supports the use of HFS to enhance nursing care and education, with special attention given to instructional consistency. Practicing new assessment skills in a non-threatening, safe environment gives students expertise and confidence while promoting the development of critical thinking skills.

233 The Use of High-Fidelity Simulation to Identify Potential Protocol Violations and Latent Risk Threats During Standardized Protocol Training in a Large, Multicenter Study

High-fidelity simulation (HF-SIM) has been used extensively in medical education and quality improvement; however, its role in protocol training for large clinical research trials is not well described. We sought to utilize HF-SIM for protocol training for a large multicenter clinical trial in order to standardize training and identify potential protocol violations (PPVs) or study-related latent risk threats (LRTs) prior to enrolling patients in the Hyperbaric Oxygen Brain Injury Treatment (HOBIT) Trial. LRTs are elements of the health care system that make patient care errors more likely. In addition to having over a dozen study sites, the enrollment and treatment protocols for the HOBIT trial are complex, including interdisciplinary critical care transfers between multiple units and patient care areas. This makes a standardized approach to protocol training critical to success. This was a feasibility study of the use of HF-SIM for standardized protocol training in a large, multicenter study. Prior to onboarding individual study sites, 4 HF-SIM patient care scenarios were developed and run in active patient care areas at the primary study site. The scenarios included: 1) a standard, uncomplicated enrollment process with patient transport through all clinical areas, 2) a ventilator circuit kinking during transport requiring troubleshooting, 3) a pneumothorax during HBO therapy requiring urgent decompression, and 4) a ventilator disconnection during HBO therapy, requiring emergent decompression. The scenarios were thought to represent conditions most likely to result in PPVs or LRTs. After each scenario, PPVs and LRTs discovered during the scenario were documented. The primary site’s HF-SIMs were video recorded as examples, and all other participating sites were required to watch the scenarios and reproduce 2 HF-SIM cases at their individual institutions, including one uncomplicated enrollment case and one complication case. Individual sites were required to submit a recorded video of their simulations and a tracking document that listed any PPVs or LRTs discovered, along with potential solutions, in order to determine site readiness for active enrollment of patients. The PPVs and LRTs discovered were coded by 2 independent raters. Items lacking initial agreement were discussed and subsequently agreed upon. Use of HF-SIM was feasible for protocol training at the initial 2 study sites, as both had in-house simulation centers. One center was forced to run a portion of their scenario in the simulation center instead of the ICU due to hospital census, but was able to run the remainder of their HF-SIMs in patient care areas. No other financial or logistical barriers were reported. Aggregate data from these sites reveals that 34 unique PPVs or LRTs were discovered. Themes included: need for additional medical training n=7 (20.6%), protocol clarifications n=4 (11.8%), equipment issues n=8 (23.5%), and systems issues n=15 (44.1%). Some issues were found in multiple care areas, but only included once in the analysis. HF-SIM can be used as part of a standardized protocol training program for clinical trials. The use of HF-SIM identified multiple training and process deficiencies prior to enrolling patients, and could lead to decreased protocol violations as well as decreased patient safety threats during the actual study period.

Comparison of High and Low Fidelity Simulation on Adult Advanced Life Support Skill Attainment and Knowledge Improvement on FMUI Students

Teaching of adult advanced life support (ALS) using low fidelity simulation (LFS) and high fidelity simulation (HFS) gives different results, that can be caused by cultural background difference among students. This study aims to determine the comparison of HFS and LFS in ALS skill attainment and knowledge improvement on FMUI students. An experimental, randomized, single-blinded study with descriptive and analytic data presentation was conducted. Subjects were 39 FMUI students on the 3rd semester. All subjects had written pretest, lecture, and watched video demonstration. In training session, subjects were divided into two groups: LFS and HFS group. LFS group used ResusciAnne® and HFS group used SIMMAN3G®. There were written posttest and skill examination using SIMMAN3G®. Data collected were skill examination and written test scores. Statistical tests used were unpaired T test and Mann Whitney. The skill score in the LFS group was 47.8(39.1–56.5) and in the HFS group was 65.2(39.1–78.2), p = 0.02. The increase of knowledge score in LFS group was 42,75±13,90 (pretest knowledge score 35,25±9,93, posttest knowledge score 78,00±14,73) and HFS group 45.26±10.99 (pretest knowledge score 34.47±7.80, posttest knowledge score 79,74±10,20), p = 0.53. The use of HFS is better than LFS in attaining adult ALS skill on FMUI students and both methods provide equal result in knowledge improvement.

The Perceptions of Nurse Educators regarding the use of High Fidelity Simulation in Nursing Education

Although nurse educators are aware of the advantages of simulation-based training, some still feel uncomfortable to use technology or lack the motivation to learn how to use the technology. The aging population of nurse educators causes frustration and anxiety. They struggle with how to include these tools particularly in the light of faculty shortages. Nursing education programmes are increasingly adopting simulation in both undergraduate and graduate curricula. The aim of this study was to determine the perceptions of nurse educators regarding the use of high fidelity simulation (HFS) in nursing education at a South African private nursing college. A national survey of nurse educators and clinical training specialists was completed with 118 participants; however, only 79 completed the survey. The findings indicate that everyone is at the same level as far as technology readiness is concerned, however, it does not play a significant role in the use of HFS. These findings support the educators’ need for training to adequately prepare them to use simulation equipment. There is a need for further research to determine what other factors play a role in the use of HFS; and if the benefits of HFS are superior to other teaching strategies warranting the time and financial commitment. The findings of this study can be used as guidelines for other institutions to prepare their teaching staff in the use of HFS.

High Fidelity Simulation Use in Asia—a Perception Study

High-fidelity simulation (HFS) has taken a strong hold in healthcare education with its ability to allow for continuous practice, to present a wide range of clinical complexity, and to encourage multiple learning strategies. We speculate that within Asia, there are challenges that exist in setting up the simulation journey, with cost and cultural factors playing a role in the utilisation of HFS in the region. In the present study, we surveyed the use of HFS in Asia. A qualitative study was performed assessing simulation educators’ perception of HFS use. Thirty-four simulation educators from 12 countries in Asia completed the survey, with an average of 5.8 years experience of using HFS. The survey included five open-ended questions on HFS use which were derived from the current literature on healthcare simulation. Thirty-four simulation educators from 12 countries in Asia completed the survey: Saudi Arabia, Brunei, China, Hong Kong, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, and Thailand with an average of 5.8 years experience using HFS. Typically, the adoption of HFS at each institution started with a few core faculty using scenarios in emergency training, and, gradually, training courses and scenario topics were developed. Concerns allied to HFS were in keeping with well-recognised challenges and limitations, with a need to encourage higher stakeholders to consider its merit. HFS has proven its value in Asian healthcare education. Whilst challenges do exist, ensuring appropriate collaboration and educating fellow educators in the region of the potential of this platform will help to further enhance its application.

Practise on plastic: the impact of high fidelity simulation on learning and teaching

The integration of high fidelity simulation (HFS) as an adjunct resource into healthcare curricula is not a new phenomenon. Healthcare assistants (HCAs) are increasingly likely to be expected either to partake in high fidelity simulation training, or to work in the context of a multidisciplinary team (MDT) where this is commonplace activity in training or continuing professional development. HFS is regularly used in the context of medical, nursing and the allied healthcare professions to provide realistic scenarios where students can practise their clinical skills and interventions in an ethos of support and constructive feedback. Over the past five years particularly, the use of simulated practice as a teaching and learning tool within healthcare has increased in importance; it is seen as the major teaching method for practising and assessing developing skills, knowledge, attitudes and meaningful decision-making within the field of healthcare ( Humphreys, 2013 ). The use of HFS offers a safe, non-threatening environment, creating opportunities for learners to develop cognitive, psychomotor and affective competencies away from the patient's bedside ( Murray et al, 2008 ). This article provides an insight into the educational significance of HFS, alongside issues of implementation and educational focus.

High-Fidelity Simulation: A Tool for Occupational Therapy Education

High-fidelity simulation (HFS) is an educational tool commonly used by professional education programs of medicine and nursing for student training and assessment. Although its use in occupational therapy (OT) education is emerging, implementation of simulation in OT education varies broadly across programs, and, in general, the tool remains underused. This paper describes how the OT education program at Samuel Merritt University (SMU) has systematically expanded the use of HFS in various formats throughout the curriculum. The specific processes and procedures of using HFS in facilitating student critical thinking and clinical skills are explained to emphasize the potential educational value of HFS. Although student responses to simulation have been positive, methodical studies are needed to validate the use of this teaching and learning tool in OT education. The paper also suggests additional ideas for implementing aspects of HFS based on various levels of resources available to an OT education program.

Faculty Development in High Fidelity Clinical Simulation

High fidelity simulation (HFS) is an educational format that demonstrates a realistic situational approach to learning. The purpose of this study was to evaluate the effect of a HFS educational action plan on faculty members’ perceived comfort levels with utilization of HFS as an integrative teaching methodology.A sample of 42 educators from an accredited RN nursing school in the northeast was used. Data was collected using the Jones Faculty Comfort Assessment Tool.Results were presented using percentages, frequencies, and t -test. The findings revealed a statistically significant pre and post comfort level in the utilization of HFS with a p<0.001 following the educational component of the study; along with the reporting from faculty of the need for a simulation specialist, p<0.001; demonstration practice, p<0.001; the provision of a simulation committee, p=0.008; and a simulation workshop, p<0.001. Faculty did not demonstrate statistically significant results pre and post comparisons in the amount of time needed to plan, p=0.664; implement, p=0.083; and evaluate, p=1.00; the utilization of HFS; or the need for release time, p=1.00; or colleague collaboration, p=0.103. The results suggested that while nursing faculty feel the use of HFS is a viable teaching strategy, there is significant trepidation on their part in the comfort of its use. There is significant need for nursing programs to provide faculty with formal educational programs and support, to facilitate the use of HFS as a teaching strategy.

High Fidelity Simulation Effectiveness in Nursing Students’ Transfer of Learning

Members of nursing faculty are utilizing interactive teaching tools to improve nursing student's clinical judgment; one method that has been found to be potentially effective is high fidelity simulation (HFS). The purpose of this time series design study was to determine whether undergraduate nursing students were able to transfer knowledge and skills learned from classroom lecture and a HFS clinical to the traditional clinical setting. Students (n=42) were observed and rated on their ability to perform a respiratory assessment. The observations and ratings took place at the bedside, prior to a respiratory lecture, following the respiratory lecture, and following simulation clinical. The findings indicated that there was a significant difference (p=0.000) in transfer of learning demonstrated over time. Transfer of learning was demonstrated and the use of HFS was found to be an effective learning and teaching method. Implications of results are discussed.

Challenges in High Fidelity Simulation: Risk Sensitization and Outcome Measurement

As the use of high fidelity simulation (HFS) in nursing education increases, evidence of its impact on learner self-confidence continues to grow. However, evidence to demonstrate an actual, positive influence on learner competence remains inconsistent. This lack of clear evidence supporting increased clinical competence challenges faculty seeking effective teaching strategies related to HFS. The purpose of this article is to discuss two key challenges in the integration and use of HFS in nursing curricula. The authors review the use of HFS in nursing education and provide a critical discussion of two challenges to incorporating HFS into the nursing curricula: the dangers of risk sensitization and the need for a standardized framework. They conclude that simulation experiences that encompass the element of longitudinal care and patient response, along with further research identifying best practices are needed to provide a sound basis for supporting the use of HFS in nursing education.

Advancing interprofessional education through the use of high fidelity human patient simulators

Modern medical care increasingly requires coordinated teamwork and communication between healthcare professionals of different disciplines. Unfortunately, healthcare professional students are rarely afforded the opportunity to learn effective methods of interprofessional (IP) communication and teamwork strategies during their education. The question of how to best incorporate IP interactions in the curricula of the schools of health professions remains unanswered. We aim to solve the lack of IP education in the pharmacy curricula through the use of high fidelity simulation (HFS) to allow teams of medical, pharmacy, nursing, physician assistant, and social work students to work together in a controlled environment to solve cases of complex medical and social issues. Once weekly for a 4-week time period, students worked together to complete complex simulation scenarios in small IP teams consisting of pharmacy, medical, nursing, social work, and physician assistant students. Student perception of the use of HFS was evaluated by a survey given at the conclusion of the HFS sessions. Team communication was evaluated through the use of Communication and Teamwork Skills (CATS) Assessment by 2 independent evaluators external to the project. The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01), 2 to 3 (p = 0.035), and overall from 1 to 4 (p = 0.001). The inter-rater reliability between evaluators was high (0.85, 95% CI 0.71, 0.99). Students perceived the HFS improved: their ability to communicate with other professionals (median =4); confidence in patient care in an IP team (median=4). It also stimulated student interest in IP work (median=4.5), and was an efficient use of student time (median=4.5). The use of HFS improved student teamwork and communication and was an accepted teaching modality. This method of exposing students of the health sciences to IP care should be incorporated throughout the curricula.