Use Of Simulation-based Training Research Articles

Simulation-based mathematical learning for higher education students from heterogeneous backgrounds

ABSTRACT This paper explores the use of simulation-based training for mathematical learning in undergraduate and graduate mathematics, science, and engineering courses. Simulation-based training offers the advantages of active learning and inquiry-based learning techniques. Furthermore, it provides extensive flexibility, ranging from user-level usage of simulations to the modification or creation of new possibilities by the student, thus engaging different cognitive levels to achieve the learning objectives. This is particularly interesting in groups consisting of students from diverse backgrounds and levels, due to factors such as their international origin or varying prior education, especially in interdisciplinary Master’s degree programmes. Additionally, in online or blended environments (which have become widespread during the last years), simulation-based learning has the advantage of granting students a certain degree of autonomy, which can, to some extent, compensate for the absence of the instructor’s physical presence.

Exploring the Impact of Simulation on Nursing students' Knowledge and Skills during Basic and Advanced Cardiac Life Support Training in Saudi Arabia

Introduction: Basic life support (BLS) and advanced cardiac life support (ACLS) training is crucial for healthcare providers to respond effectively to cardiac emergencies. Simulation-based training has been shown to improve knowledge and skills in nursing students during BLS and ACLS training. Objective: The objective of this study was to review the literature on the impact of simulation-based training on nurses' and nursing students' knowledge and skills during BLS and ACLS training in Arab countries and internationally. Methods: A literature search was conducted in several databases, including PubMed, CINAHL, and Scopus. The search was limited to articles published, written in English, and conducted in Saudi Arabia. Two articles met the inclusion criteria and were included in the review. Results: The reviewed studies reported significant improvements in knowledge scores, ability to respond to cardiac arrest scenarios, and confidence in skills among nursing students who participated in simulation-based training. However, challenges in implementing simulation-based training were reported, including lack of resources, time constraints, and resistance to change. Conclusion: The findings of the reviewed literature suggest that simulation-based training can be an effective tool for improving nurses' and nursing students' knowledge and skills during BLS and ACLS training in both Arab countries and internationally. The use of simulation-based training in nursing education has several advantages, including providing a safe and controlled environment for practicing skills, promoting critical thinking and decision-making, and allowing for repetitive practice. However, challenges in implementing simulation-based training need to be addressed, and strategies for effectively integrating simulation-based training into nursing education programs need to be explored.

Feasibility of High-Fidelity Simulator Models for Minimally Invasive Spine Surgery in a Resource-Limited Setting: Experience From East Africa.

Spine surgery is a rapidly evolving specialty with a continuous need to learn new skills. In resource-limited settings such as Africa, the need for training is greater. The use of simulation-based training is important in different stages of skill acquisition, especially for high-stake procedures such as spine surgery. Among the available methods of simulation, the use of synthetic models has gained popularity among trainers. Twenty participants of a neurosurgery training course, most of whom (65%) were neurosurgery residents and fellows, were recruited. They had hands-on training sessions using a high-fidelity lumbar degenerative spine simulation model and hands-on theater experience. After this, they completed a survey to compare their experience and assess the effectiveness of the lumbar spine model in stimulating real patient and surgery experiences. The participants were from four African countries, and the majority were neurosurgery residents. There were varying levels of experience among the participants in minimally invasive spine surgery, with the majority either having no experience or having only observed the procedure. All the participants said that the high-fidelity lumbar spine model effectively simulated real minimally invasive spine setup and real bone haptics and was effective in learning new techniques. Most of the participants agreed that the model effectively simulated real dura and nerve roots (95%), real muscle (90%), real bleeding from bones and muscles (95%), and real cerbrospinal fluid in the subarachnoid space. Among them, 95% agreed that the model is effective in lumbar minimally invasive spine training in resource-limited settings. With the development of new and better surgical techniques, the use of high-fidelity models provides a good opportunity for learning and training, especially in resource-poor settings where there is a paucity of training facilities and personnel.

Simulation-based training in cardiac surgery: a systematic review.

The increase in the complexity of operations, the rising quest for improved outcomes and the scrutiny of surgical practice and its associated complications, have led to a decreased educational value of in-patient surgical training within cardiac surgery. Simulation-based training has emerged as an adjunct to the apprenticeship model. In the following review, we aimed to evaluate the currently available evidence regarding simulation-based training in cardiac surgery. A systematic database search was conducted as per PRISMA guidelines, of original articles that explored the use of simulation-based training in adult cardiac surgery programs in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to 2022. Data extraction covered the study characteristics, simulation modality, main methodology and main outcomes. Our search yielded 341 articles, of which 28 studies were included in this review. Three main areas of focus were identified: 1) Validity testing of the models; 2) Impact on surgeons' skills; and 3) Impact on clinical practice. 14 studies reported animal-based models and 14 reported on non-tissue-based models covering a wide spectrum of surgical operations. The results of the included studies suggest that validity assessment is scarce within the field, being carried out for only 4 of the models. Nonetheless, all studies reported improvement in trainees' confidence, clinical knowledge, and surgical skills (including accuracy, speed, dexterity) of trainees both at senior and junior levels. The direct clinical impact included initiation of minimally invasive programmes and improved board exam pass rates, and creating positive behavioural changes to minimise further cardiovascular risk. Surgical simulation has been shown to provide substantial benefits to trainees. Further evidence is needed to explore its direct impact on clinical practice.

Evaluating the Impact of Supervision on Surgical Trainees Stress Response During Simulated Surgical Procedures; A Crossover Randomized Trial

The aim of this study was to evaluate the cumulative impact of supervision on technical skills and surrogate stress markers in surgical trainees. This was a quasi-experimental crossover study to evaluate the impact of attending supervision on orthopedic trainee stress response during a simulated surgical procedure. Enrolled residents performed a proximal femoral nail module with the Precision OS system twice; once independently, and once under direct attending supervision, whilst wearing a heart rate monitor. Mean and maximum heart rates were recorded. Simulated performance was assessed using validated simulator-based metrics. Student's t-test was used to evaluate the impact of supervision on trainee heart rate, and performance ranking. Tertiary trauma center in a Regional Orthopedic Unit PARTICIPANTS: Orthopedic interns and residents within our institution were invited to participate, with 20 participants included for analysis. Both supervised and unsupervised mean heart rate was significantly higher (p = 0.001) than baseline recorded heart rates. Supervised mean and maximum HR were significantly higher than unsupervised HR during module completion (p = 0.015; p = 0.001). Calories burned demonstrated correlation to surrogate stress markers, significantly higher in supervised sessions (p = 0.004). Performance metrics demonstrated superior performance in senior-level participants, with a decrement in performance during supervision, failing to reach significance. The development of accretion of technical and non-technical skills required in surgical training pathways may derive benefit from the use of simulation-based training in surgical residents with both supervised and unsupervised sessions.

Anatomical differences in the abdominal wall between animal species with implications for the transversus abdominis plane block: a systematic review.

With the increased use of simulation-based training using animal models for the education of surgical and anaesthetic techniques, an increased understanding of the anatomy of such models and how they compare to humans is required. The transversus abdominis plane block is a regional anaesthetic technique that requires an understanding of the abdominal wall anatomy along with proficient ultrasound use. The current review aims to compare the anatomy of the abdominal wall across species, particularly focussing on the pertinent differences within the class of mammals, and secondarily, it aims to address the implications of these differences for the use of simulation-based training of the transversus abdominis plane block. To achieve this, the PubMed, Web of Science and Google Scholar databases were searched for relevant literature. Studies pertaining to the musculature, vasculature or innervation of the anterolateral abdominal wall across species were included. The mammalian abdominal wall differs in its musculature, vasculature or innervation from that of amphibians, birds or reptiles; however, among species of mammals, the structure of the abdominal wall follows a similar framework. Particular differences among mammals include the additional muscular layer of the panniculus carnosus found in most mammals other than humans, the variable arterial origins and dominant vascular supply of the abdominal wall and the number of thoracolumbar nerves innervating the abdominal wall. When using animal models for simulation-based training, the pig is recommended for the transversus abdominis plane block given its closely homologous abdominal wall structure, availability and larger comparative size.

Simulation in neonatal care: towards a change in traditional training?

Simulation has traditionally been used in neonatal medicine for educational purposes which include training of novice learners, maintaining competency of health care providers, and training of multidisciplinary teams to handle crisis situations such as neonatal resuscitation. Current guidelines recommend the use of simulation as an education tool in neonatal practice. The place of simulation-based education has gradually expanded, including in limited resource settings, and is starting to show its impact on improving patient outcomes on a global basis. Over the past years, simulation has become a cornerstone in clinical settings with the goal of establishing high quality, safe, reliable systems. The aim of this review is to describe neonatal simulation training as an effective tool to improve quality of care and patient outcomes, and to encourage the use of simulation-based training in the neonatal intensive care unit (NICU) for not only education, but equally for team building, risk management and quality improvement.Conclusion: Simulation is a promising tool to improve patient safety, team performance, and ultimately patient outcomes, but scarcity of data on clinically relevant outcomes makes it difficult to estimate its real impact. The integration of simulation into the clinical reality with a goal of establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes in neonatology must be a priority.What is Known:• Simulation-based education has traditionally focused on procedural and technical skills.• Simulation-based training is effective in teaching non-technical skills such as communication, leadership, and teamwork, and is recommended in neonatal resuscitation.What is New:• There is emerging evidence for the impact of simulation-based training on patient outcomes in neonatal care, but data on clinically relevant outcomes are scarce.• Simulation is a promising tool for establishing high quality, safe, reliable, and robust systems to improve patient safety and patient outcomes.

Ambulance clinicians' attitudes to older patients' self-determination when the patient has impaired decision-making ability: A Delphi study.

The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients' self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care. An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N=31) of prehospital emergency nurses (n=14), registered nurses (n=10) and emergency medical technicians (n=7). Focus group conversations (Round 1) and questionnaires (Rounds 2-4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale. Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n=35), (2) attitudes regarding the patient relationship (n=8), (3) attitudes regarding oneself and one's colleagues (n=45), and (4) attitudes regarding other involved factors (n=20). In Rounds 2-4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus. The findings highlight the complexity of ACs' attitudes towards older patients' self-determination. The respect of older patients' self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs' moral abilities within their professional practice. Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs' abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.

O-050 Virtual reality applications in ultrasound

Abstract text Surgical simulation has been introduced in surgical training since 1920 following the example of airline and military industry. Recently, the Association of American Medical Colleges commented on the increased use of simulation in different medical specialties, recognizing its potential ability to improve patients safety and to enhance healthcare in general. Historically, graduating obstetrics and gynecology residents have been expected to learn following the adage ‘see one, do one, teach one’, which required a high volume experience. Nowadays, as the complexity of procedures increases and surgical volume decreases, in order to acquire surgical skills rapidly there is the need to integrate surgical and ultrasound virtual simulation into modern residency training alongside traditional teaching methods. In addition, recent changes in the field (e.g. workhours restrictions, decreased bedside teaching) have high lightened these necessities. Ultrasonography is a skill that requires a complex interplay of motor skills and visual-cognitive skill. The learning process include two steps: an initial global assessment followed by a focal search for pathology and key landmarks. Recently more attention has been paid to design increasingly sophisticated simulators for ultrasound in obstetrics and gynecology. These are broadly divided into to major categories: physical mannequins and virtual reality simulators. The physical mannequins practically consist in low cost silicon dummies that enable learners to discover basic anatomical and pathological findings using real ultrasound equipment. This type of simulators allows the trainees to learn haw to use the equipment in order to obtain proper scans. However, the case complexity is limited due to the low fidelity of the physical mannequins. In addition there is no automated feedback and a supervisor is always needed during the practice. The virtual reality simulators usually rely on haptic devices or physical mannequins that record probe movements during transabdominal or transvaginal scans and combined them with computer-animated/real ultrasound images. Instructions and automated feedback are provided during the practice. They often contains multiple cases allowing the trainees to be exposed to different clinical scenarios. In the field of Reproductive Endocrinology and Infertility some ultrasound and surgical skills are required for independent practice including transvaginal oocyte pick-up, hysterosalpingocontrastsonography (HyCoSy) and embryo-transfer. Considering advantages and disadvantages of both apprenticeship models (traditional training and simulator-based training), a blended approach which combines simulator-based training with didactic and more traditional training on real patients could be introduced. So far the use of simulation-based training has shown promising results in terms of moderate effects on patient outcomes and large effects on trainee behavior in the clinical setting. It could be useful especially in the initial part of a structured training for novices, enabling them to acquire basic skills and to reach a predefined level of performance in a safe and controlled environment, before applying the procedure to real patients.

Virtual reality simulator metrics cannot be used to assess competence in ureteronephroscopy and stone removal – a validation study

Objective The growing use of simulation-based training makes it necessary to develop efficient training programs in order to ensure optimal use of time and resources. Our aim was to develop and gather validity evidence for a simulation-based test in ureteronephroscopy and set a pass/fail standard for the test that will allow future mastery learning. Design This study is a validation study. A test in ureteronephroscopy and stone removal on the URO Mentor™ virtual reality simulator (3D Systems, USA) was developed by two experienced urologists in order to ensure content. Participants with different experience completed three standardized tasks on the simulator and simulator-generated metrics were used as outcome parameters to minimize bias and ensure a fair response process. Results Twenty novices, 15 intermediates, and 8 experienced urologists were included in the study. Validity evidence for internal structure and relationship to other variables was questionable with weak and mostly insignificant correlations across all four metrics (Cronbach’s alpha = 0.14, p = 0.15) and across the three modules (Cronbach’s alpha = 0.41 (p = 0.02), 0.35 (p = 0.06), 0.10 (p = 0.35), and 0.30 (p = 0.09) for each metric, respectively). It was not possible to establish a pass/fail score for the simulation test with meaningful consequences. Conclusion Our study showed that automatically generated simulator metrics cannot be used as a valid way of assessing competence in ureteronephroscopy. Virtual-reality simulator training could still be a valuable and patient-safe way to practice these skills, but an experienced supervisor is needed to determine when the trainee is ready to continue to supervised practice on patients.

Impact of the COVID-19 pandemic on surgical skills training in pediatric surgery residents.

PurposeTo analyze the initial impact of the SARS-CoV-2 pandemic on surgical skills training and performance of Pediatric Surgery Residents.MethodsRetrospective study considering the modifications on the Pediatric Surgery Residency training from March 1st–May 31st, 2020. Exposure to OR learning opportunities was compared to the same 2018–2019 trimesters. An anonymous survey about self-perception on surgical skills development was also performed.ResultsResidents performed 209 procedures as leading surgeons during the 2020 trimester with a mean number of surgeries per resident of 20.9, representing a reduction of 46% and 56.8% compared to the 2018–2019 averages, respectively. Reduction in both the number and the percentage of total procedures (n: 209, 56.8%) compared to both 2019 (n: 354, 68.7%, p: 0.000272) and 2018 (n: 420, 76.1%, p < 0,00,001) showed statistical correlation with no changes in their complexity pattern.From the survey (response rate: 100%), hours dedicated to simulation-based training were highly increased. More time was spent studying, but only 60% achieved better preparation for surgery and 70% perceived a decrease in surgical confidence.ConclusionsEven though the pandemic promoted new teaching strategies and the use of simulation-based training, it drastically reduced “on-the-job” learning opportunities with potential effects on residents’ performance and self-confidence during surgery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00383-021-04961-8.

Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey.

The aim of this study was to investigate and compare the use of simulation-based technical skills training (SBTST) in the otolaryngology curriculum in different countries, and to explore the needs and opinions about the use of simulation among young otolaryngologists. An e-survey conducted among Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) members. 139 Yo-IFOS members from 51 countries completed the survey. During residency training, 82.7% of respondents have used SBTST on cadavers, 51.8% on physical simulators, and 43.8% on virtual reality simulators. High costs (65.5%), lack of availability (49.2%) and lack of time (25.5%) were the main barriers limiting the practice of SBTST. These barriers also limited teaching using simulation. Sinonasal surgery (72.7%), temporal bone surgery (67.6%), and head/neck surgery (44.6%) were significantly more frequently taught using SBTST than suspension microlaryngoscopy (25.9%) and pediatric surgery (22.3%) (p < 0.001). The procedures rated as the most important to learn through SBTST were tracheotomy (50.4%), emergency cricothyroidotomy (48.9%), and rigid bronchoscopy (47.5%). On an analogic visual scale (0-100) for the question "how important will simulation be for future ENTs in surgical training?", the mean score was 79.5/100 (± 23.3), highlighting the positive attitude toward the use of SBTST in otorhinolaryngology training. SBTST is an attractive learning and teaching method in otorhinolaryngology, but associated costs, lack of access, and lack of time are the main barriers limiting its use. Emergency procedures are key technical skills to be learned using simulation but in some cases, lack relevant simulators for training.

Surgical Simulation in East, Central, and Southern Africa: A Multinational Survey

High-income countries have increased the use of simulation-based training and assessment for surgical education. Learners in low- and middle-income countries may have different educational needs and levels of autonomy but they and their patients could equally benefit from the procedural training simulation provides. We sought to characterize the current state of surgical skills simulation in East, Central, and Southern Africa and determine residents' perception and future interest in such activities. A survey was created via collaboration and revision between trainees and educators with experiences spanning high-income countries and low- and middle-income countries. The survey was administered on paper to 76 trainees (PGY2-3) who were completing the College of Surgeons of East, Central, and Southern Africa (COSECSA) Membership of the College of Surgeons examination in Kampala, Uganda in December 2019. Data from paper responses were summarized using descriptive statistics and frequencies. We received responses from 43 trainees (57%) from 11 countries in sub-Saharan Africa who participated in the examination. Fifty-eight percent of respondents reported having dedicated space for surgical skills simulation training, and most (91%) had participated in some form of simulation activity at some point in their training. However, just 16% used simulation as a regular part of training. The majority of trainees (90%) felt that surgical skills learned in simulation were transferrable to the operating room and agreed it should be a required part of training. Seventy-one percent of trainees felt that simulation could objectively measure technical skills, and 73% percent of respondents agreed that simulation should be integrated into formal assessment. However, residents split on whether proficiency in simulation should be achieved prior to operative experience (54%) and if nontechnical skills could be measured (51%). The most common cited barriers to the integration of surgical simulation into residents' education were lack of suitable tools and models (85%), funding (73%), and maintenance of facilities (49%). Residents from East, Central, and Southern Africa strongly agree that simulation is a valuable educational tool and ought to be required during their surgical residency. Barriers to achieving this goal include availability of affordable tools, adequate funding and confidence in the value of the educational experience. Trainees affirm further efforts are necessary to make simulation more widely available in these contexts.

Training Thoracic Ultrasound Skills: A Randomized Controlled Trial of Simulation-Based Training versus Training on Healthy Volunteers

Introduction: As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. Objectives: The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. Method: A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. Results: Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups’ performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; p = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (p = 0.009). Conclusions: The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients.

Simulation-based teaching and models for caesarean sections: a systematic review to evaluate the tools for the 'See One, Practice Many, Do One' slogan.

Caesarean sections are the most commonly performed procedure globally. Simulation-based training for caesarean sections can provide healthcare practitioners a safe and controlled environment to develop this life-saving skill. We systematically reviewed the use of simulation-based training for caesarean section and its effectiveness. Embase, Pubmed, Scopus and Web of Science were searched from inception to June 2019, without language restriction, for studies that included methods of simulation for caesarean section. Studies were selected and data extracted in duplicate. Synthesis analysed common themes on simulation-based training strategies. There were 19 relevant studies including the following simulation-based methods: simulators (high and low fidelity), scenario-based drills training, e-learning and combinations. A common theme was simulation for rare events such as perimortem caesarean, impacted foetal head and uterine rupture. Combination studies appeared to provide a more comprehensive training experience. Studies rarely adequately assessed the educational or clinical effectiveness of the simulation methods. There are different types of simulator models and manikins available for caesarean section training. Simulation-based training may improve technical skills and nontechnical skills, in a risk-free environment. More research is needed into simulation training effectiveness and its efficient incorporation into practice for improving outcomes.

Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician's Performance.

ABSTRACTBackgroundSimulation is to imitate or replicate real-life scenarios in order to improve cognitive, diagnostic and therapeutic skills. An ideal model should be good enough to output realistic clinical scenarios and respond to interventions done by trainees in real time. Use of simulation-based training has been tried in various fields of medicine. The aim of our study was to prospectively evaluate the effectiveness of simulation model “CRITICA”™ (MEDUPLAY systems) in training critical care physicians.Materials and methodsThe advanced intensive care unit (ICU) simulator “CRITICA”™ (MEDUPLAY systems) was developed as a joint collaboration between the Indian Institute of Science, Bengaluru and St John’s Medical College, Bengaluru. Two-day workshop was conducted. Intensive didactic and case-based scenarios were simulated to formally teach principles of advanced ICU scenarios. The physicians were tested on clinical scenarios in hemodynamic monitoring and mechanical ventilation displayed on the simulator. Assessment of the analytical thinking and pattern recognition ability was carried out before and after the display of the scenarios. Pre- and posttest scores were collected.ResultsThe postsimulation test scores were higher than pretest scores and were statistically significant in hemodynamic monitoring and mechanical ventilation module. [Hemodynamic monitoring pre- and posttest scores 4.41 (2.06) vs 5.23 (2.22) p < 0.001] [Mechanical ventilation pre- and posttest scores 4 (2–5.5) vs 7.5 (6.5–8.5) p < 0.001]. A greater increase in posttest scores was seen in the mechanical ventilation module as compared to hemodynamic module. There was no effect of specialty or designation of a trainee on difference in pre- and posttest scores.ConclusionSimulator-based training in hemodynamic monitoring and mechanical ventilation was effective. Comparison of routine classroom teaching and simulator-based training needs to be evaluated prospectively.How to cite this articleHavaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician’s Performance. Indian J Crit Care Med 2020;24(6):423–428.

Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department.

Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.

Nursing students\u2019 transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study

BackgroundSimulation-based training is used to develop nursing students’ clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students’ experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice.MethodsEight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis.ResultsThree major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration.ConclusionsThis study revealed students’ transfer of learning outcomes from simulation-based training to clinical practice. The students’ experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students’ experiences of the transfer of knowledge to clinical practice.

Using Reentry Simulations to Promote Changes in Attitude toward Offenders: Experiential Learning to Promote Successful Reentry

This research examines the viability of using reentry simulations as a tool for influencing changes in participants’ perspectives about the realities of coming back in the community after a period of incarceration. Using both quantitative and qualitative methodologies, we investigated changes in attitudes toward offenders after participants completed a reentry simulation designed to replicate the experience of the first four weeks in the life of a person attempting to reenter society after incarceration. Participants were 27 students enrolled in a community corrections course that was cross listed and co-taught between criminal justice and social work. Participants completed a quantitative pre- and post-test that assessed attitudes toward prisoners as well as a reflection assignment about the simulation experience. Wilcoxon Signed Rank Test was used to analyze scores from pre- and post-tests. Qualitative analysis of the reflection papers identified and analyzed themes. Both quantitative and qualitative analysis indicate that simulations humanize perspectives toward former offenders and develop a better understanding of their situation. This understanding creates empathetic feelings that can reduce discrimination and stigma, thereby creating an environment more conducive to successful reintegration. Based on the results of this study, use of simulation-based training is recommended with audiences including criminal justice personnel, service providers, court practitioners, judges, and legislators as a way to more clearly articulate the realities faced by this vulnerable population.

Operationalising resilience for disaster medicine practitioners: capability development through training, simulation and reflection

Resilience has in recent decades been introduced as a term describing a new perspective within the domains of disaster management and safety management. Several theoretical interpretations and definitions of the essence of resilience have been proposed, but less work has described how to operationalise resilience and implement the concept within organisations. This case study describes the implementation of a set of general resilience management guidelines for critical infrastructure within a Swedish Regional Medical Command and Control Team. The case study demonstrates how domain-independent guidelines can be contextualised and introduced at an operational level, through a comprehensive capability development programme. It also demonstrates how a set of conceptual and reflective tools consisting of educational, training and exercise sessions of increasing complexity and realism can be used to move from high-level guidelines to practice. The experience from the case study demonstrates the value of combining (1) developmental learning of practitioners’ cognitive skills through resilience-oriented reflection and interaction with dynamic complex open-ended problems; (2) contextualisation of generic guidelines as a basis for operational methodological support in the operational environment; and (3) the use of simulation-based training as part of a capability development programme with increasing complexity and realism across mixed educational, training and exercise sessions. As an actual example of a resilience implementation effort in a disaster medicine management organisation, the study contributes to the body of knowledge regarding how to implement the concept of resilience in operational practice.