Use Of Simulation Training Research Articles

Psychosocial simulation: A novel approach to interprofessional training

Abstract Introduction In health care, teamwork is the foundation for efficient processes and effective outcomes and serves as a cornerstone of quality care. Good teamwork often requires training and practice. The primary aims of this study were to assess the impact of psychosocial simulations on participant knowledge of other professionals’ responsibilities and capabilities and on confidence and competence of psychosocial team members in collaborating and communicating with other psychosocial team members. Secondarily, we assessed participant satisfaction. Methods This single-site study used a pre- and post-survey design of social workers, chaplains, and child life specialists who attended a psychosocial simulation education module. Participants took the Psychosocial Simulation Participant Survey (PSPS), a 19-question survey tool developed by the research team. Pre- and post-simulation responses were summarized and compared using standard statistical analysis methods. Results Participants showed significant improvement in the subscales of Learning and Performance, Benefits of Training, and Cooperation. Two of the three Communication subscale questions showed significant improvements. Previous and current role as participant or observer, past experience with simulation, gender, discipline, age, years at institution, and area of regular assignment were not related to improvement in any of the outcomes. Over 90% of the participants agreed or strongly agreed with the statement “I was satisfied with my simulation experience” and “The post scenario discussion (debriefing) helped me to understand, reflect, and think critically.“ Conclusions The use of simulation training with psychosocial professionals is an effective means of teaching new competencies and of promoting interprofessional collaboration.

Simulation Methods in the Development of Students’ Professional Competence at Higher Medical Educational Institutions

The development of practical skills and abilities is one of the most important tasks of students and teachers of higher medical educational institutions. The ensuring of providing an effective and adequate assistance to the patient in an urgent situation is of particular importance. Various simulation methods exist in educational and medical training centers of higher medical educational institutions to practice the methods of providing medical care in emergency situations. The scientific and practical centers are equipped with training phantoms (for suturing deep wound, reducing dislocations) and allow polishing professional skills during practical classes or after them. Simulation methods give an opportunity to objectively assess the correctness of the actions performed by the student, to teach the technique of cardiac massage and artificial respiration, to correct the position of the mannequin head thereby protecting the person who performs resuscitation procedure from infectious agents. The possibility of simulation training and multiple repetitive resuscitation actions practices the students’ ability to work during an emergency until it becomes automatic. The use of simulation training of medical students allowed bringing the level of national science closer to the world standards.

Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology

Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access. The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient. Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.

Additional simulation training: does it affect students' knowledge acquisition and retention?

Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students' acquisition and retention of knowledge. Two subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students' scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test. Group B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge. Adding a simulation training, before students entered their clinical rotation, improves students' knowledge acquisition and retention compared with those who did not receive the additional simulation training.

Face and construct validity of a novel mechanical ERCP simulator.

Background and study aims Simulation-based training has become an important pillar in competence-based medicine. However, limited data are available on use of simulators in training for endoscopic retrograde cholangiopancreatography (ERCP). We aimed to determine the face and construct validity of the Boškoski-Costamagna mechanical ERCP Trainer, and to assess its didactic value, as judged by experts. Methods Participants were divided into four groups based on ERCP lifetime experience: novices, intermediate, experienced, and experts. Participants performed several standardized assignments on the simulator. Outcome parameters included times to complete the procedure, ability to cannulate both ducts, number of attempts to cannulate the common bile duct and pancreatic duct, number of inadvertent pancreatic duct cannulations, successful stent placement, and successful stone extraction. All experts filled out a questionnaire on the simulator’s realism and didactic value. Results Novices (n = 11) completed the total procedure in 21:09 (min:sec), intermediates (n = 5) in 10:58, experienced (n = 8) in 06:42 and experts (n = 22) in 06:05. Experts were significantly faster than novices (Kruskal-Wallis test P < 0.000). Experts rated the realism of the simulator 7.12 on a 10-point Likert scale. The simulator’s potential as a tool for training novices was rated 3.91 on a four-point Likert scale, and there was a high agreement among experts to include the simulator in the training of novice endoscopists (3.86 on a four-point Likert scale). Conclusions The novel Boškoski-Costamagna ERCP simulator demonstrates good face and construct validity. ERCP experts highly agree on the didactic value and added value of this simulator in the training curriculum for novice endoscopists.

The effect of Cardiac Arrhythmias Simulation Software on the nurses' learning and professional development.

One of the important tasks of nurses in intensive care unit is interpretation of ECG. The use of training simulator is a new paradigm in the age of computers. This study was performed to evaluate the impact of cardiac arrhythmias simulator software on nurses' learning in the subspecialty Vali-Asr Hospital in 2016. This study was conducted by quasi-experimental randomized Salomon four group design with the participation of 120 nurses in subspecialty Vali-Asr Hospital in Tehran, Iran in 2016 that were selected purposefully and allocated in 4 groups. By this design other confounding factors such as the prior information, maturation and the role of sex and age were controlled by Solomon 4 design. The valid and reliable multiple choice test tools were used to gather information; the validity of the test was approved by experts and its reliability was obtained by Cronbach's alpha coefficient 0.89. At first, the knowledge and skills of the participants were assessed by a pre-test; following the educational intervention with cardiac arrhythmias simulator software during 14 days in ICUs, the mentioned factors were measured for the two groups again by a post-test in the four groups. Data were analyzed using the two way ANOVA. The significance level was considered as p<0.05. Based on randomized four-group Solomon designs and our test results, using cardiac arrhythmias simulator software as an intervention was effective in the nurses' learning since a significant difference was found between pre-test and post-test in the first group (p<0.05). Also, other comparisons by ANOVA test showed that there was no interaction between pre-test and intervention in all of the three knowledge areas of cardiac arrhythmias, their treatments and their diagnosis (P>0.05). The use of software-based simulator for cardiac arrhythmias was effective in nurses' learning in light of its attractive components and interactive method. This intervention increased the knowledge of the nurses in cognitive domain of cardiac arrhythmias in addition to their diagnosis and treatment. Also, the package can be used for training in other areas such as continuing medical education.

Initial experience with a novel electrophysiology mapping simulator.

Despite data supporting the use of simulation training in procedural specialties and accreditation requirements, few options exist for electrophysiology (EP) training. We aimed to develop a low-cost, accessible simulator for training in EP mapping, and to test the simulator in a group of novice users. Our mapping simulator is composed of three components: an acrylic case representing torso and thigh; three-dimensional (3D) printed cardiac models; and a commercially available mapping system. Using a proprietary flexible material that mimics the consistency of human heart tissue, we created an anatomically accurate model of a normal right atrium (RA) from computed tomography data. We developed a test protocol consisting of two activities: creation of a RA shell and timed navigation to specific locations within the RA shell. Seventeen participants were randomized to either practice versus no practice on the simulator, and repeated simulator and self-assessment tests were performed after 1week. We measured volume of the RA map and time taken and distance from the target sites for each target location. Both groups showed improvement in generation of geometry, volume, time to target, and self-assessed comfort level after initial exposure to the simulator. Compared with no-practice, the practice group demonstrated an improved sense of confidence in mapping. Focused training in EP mapping using a novel simulator created with 3D printed heart models and a standard mapping system is feasible for use in the training environment. Exposure to the simulator is associated with improved mapping skills and trainee comfort level.

Simulator training for maritime complex tasks: an experimental study

Training simulators are largely deployed to provide operators working within complex systems to instil adequate skills to handle normal and abnormal situations. Improved technology and higher computation power have significantly increased the use of training simulators in the training programs. The goal of this pilot study is to determine the design of training in order to prepare for complex tasks within the maritime domain. In this experimental study, students are trained to perform docking operations when ocean currents with increasing complexity are introduced in the training program. The effect of the training is evaluated by comparing two groups: one trained with homogenous currents and the other with heterogeneous currents. Objective performance measures are used to analyse the participants’ performance. The results indicate that when the participants were exposed to tasks with gradually increasing complexity, they performed better as compared to those who were exposed to complex tasks too early in the training. The results suggest that even though the technology and computational power provide for new possibilities in training simulators, new features that make the tasks more complicated should not be included too early in the training without sufficient investigation. It is also found that increasing functional fidelity of the simulation during training has resulted in the improved performance of the participants during the complex tasks (docking operations), as compared to those training with the highest fidelity from the beginning.

The use of simulation training for robotic-assisted surgery

The use of simulation training for robotic-assisted surgery

To err is human: use of simulation to enhance training and patient safety in anaesthesia

Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improvement techniques and technologies that prioritize high-quality, safe care for patients. This article focuses on one particular domain of patient safety in which anaesthetists have been pre-eminent, the use of simulation in training to improve both professional capabilities and patient safety in anaesthetic practice. This review considers the impact of error in health care; the role of anaesthetists in promoting simulation-based education for the development of clinical skills and improved teamwork; and their role in disseminating human factors and quality improvement science to enhance safety in the clinical workplace. Finally, we consider our position at the vanguard of developments in patient safety and how the profession should continue to pursue a leadership role in the application of simulation-based interventions to training and systems design across health care.

An Evaluation of the Role of Simulation Training for Teaching Surgical Skills in Sub-Saharan Africa

BackgroundAn estimated 5 billion people worldwide lack access to any surgical care, whilst surgical conditions account for 11–30% of the global burden of disease. Maximizing the effectiveness of surgical training is imperative to improve access to safe and essential surgical care on a global scale. Innovative methods of surgical training have been used in sub-Saharan Africa to attempt to improve the efficiency of training healthcare workers in surgery. Simulation training may have an important role in up-scaling and improving the efficiency of surgical training and has been widely used in SSA. Though not intended to be a systematic review, the role of simulation for teaching surgical skills in Sub-Saharan Africa was reviewed to assess the evidence for use and outcomes.MethodsA systematic search strategy was used to retrieve relevant studies from electronic databases PubMed, Ovid, Medline for pertinent articles published until August 2016. Studies that reported the use of simulation-based training for surgery in Africa were included.ResultsIn all, 19 articles were included. A variety of innovative surgical training methods using simulation techniques were identified. Few studies reported any outcome data. Compared to the volume of surgical training initiatives that are known to take place in SSA, there is very limited good quality published evidence for the use of simulation training in this context.ConclusionsSimulation training presents an excellent modality to enhance and improve both volume and access to high quality surgical skills training, alongside other learning domains. There is a desperate need to meticulously evaluate the appropriateness and effectiveness of simulation training in SSA, where simulation training could have a large potential beneficial impact. Training programs should attempt to assess and report learner outcomes.

Emergency Airway Response Team Simulation Training: A Nursing Perspective

Simulation-based education is an important tool in the training of professionals in the medical field, especially for low-frequency, high-risk events. An interprofessional simulation-based training program was developed to enhance Emergency Airway Response Team (EART) knowledge, team dynamics, and personnel confidence. This quality improvement study evaluated the EART simulation training results of nurse participants. Twenty-four simulation-based classes of 4-hour sessions were conducted during a 12-week period. Sixty-three nurses from the emergency department (ED) and the intensive care units (ICUs) completed the simulation. Participants were evaluated before and after the simulation program with a knowledge-based test and a team dynamics and confidence questionnaire. Additional comparisons were made between ED and ICU nurses and between nurses with previous EART experience and those without previous EART experience. Comparison of presimulation (presim) and postsimulation (postsim) results indicated a statistically significant gain in both team dynamics and confidence and Knowledge Test scores (P < .01). There were no differences in scores between ED and ICU groups in presim or postsim scores; nurses with previous EART experience demonstrated significantly higher presim scores than nurses without EART experience, but there were no differences between these nurse groups at postsim. This project supports the use of simulation training to increase nurses' knowledge, confidence, and team dynamics in an EART response. Importantly, nurses with no previous experience achieved outcome scores similar to nurses who had experience, suggesting that emergency airway simulation is an effective way to train both new and experienced nurses.

Use of a Novel Airway Kit and Simulation in Resident Training on Emergent Pediatric Airways.

Objective Development of a novel pediatric airway kit and implementation with simulation to improve resident response to emergencies with the goal of improving patient safety. Methods Prospective study with 9 otolaryngology residents (postgraduate years 1-5) from our tertiary care institution. Nine simulated pediatric emergency airway drills were carried out with the existing system and a novel portable airway kit. Response times and time to successful airway control were noted with both the extant airway system and the new handheld kit. Results were analyzed to ensure parametric data and compared with t tests. A Bonferroni adjustment indicated that an alpha of 0.025 was needed for significance. Results Use of the airway kit significantly reduced the mean time of resident arrival by 47% ( P = .013) and mean time of successful intubation by 50% ( P = .007). Survey data indicated 100% improved resident comfort with emergent airway scenarios with use of the kit. Discussion Times to response and meaningful intervention were significantly reduced with implementation of the handheld airway kit. Use of simulation training to implement the new kit improved residents' comfort and airway skills. This study describes an affordable novel mobile airway kit and demonstrates its ability to improve response times. Implications for Practice The low cost of this airway kit makes it a tenable option even for smaller hospitals. Simulation provides a safe and effective way to familiarize oneself with novel equipment, and, when possible, realistic emergent airway simulations should be used to improve provider performance.

Use of simulation training to prepare pharmacy residents for medical emergencies.

The use of high-fidelity simulation training for preparing pharmacy residents for various high-stress and high-impact medical emergencies and the impact of this training on pharmacy residents' perception of preparedness are described. During the 2015-16 residency year at the University of Kentucky Medical Center, simulation training, in addition to lecture-based orientation training, was chosen as a method to reinforce skills and knowledge learned throughout the orientation, before residents began working on-call shifts. Three different simulation exercises were developed to cover five selected topics over the course of 3 different days: sepsis as its own session, a surgical-themed session combining bleeding reversal and malignant hyperthermia, and a neurologic-themed session combining stroke and status epilepticus. Postgraduate year 2 (PGY2) specialty residents in critical care and emergency medicine helped facilitate the cases. The specialty residents played the role of the physician or nurse for the case and were allowed to answer questions asked of the pharmacy residents, appropriate to their respective roles. Following completion of the simulation exercise, a survey tool was sent to pharmacy residents to rate their perception of preparedness before and after the training for each scenario and again at 6 months after the simulation training to assess sustainability of the training. Participants generally responded that the simulations met their expectations and that the PGY2 residents facilitated the simulations fairly well (scores of 68.5-80 on a scale of 0-100). The resident-reported that beneficial effects of simulation training persisted at 6 months following the simulation exercises. Simulation training increased pharmacy residents' self-reported preparedness for high-stress, high-impact clinical scenarios and medical emergencies.

Identification of Essential Components of Thoracoscopic Lobectomy and Targets for Simulation

Fewer than 50% of lobectomies for lung cancer are performed using thoracoscopic (video-assisted thoracic surgery [VATS]) techniques. This situation could be mitigated through the use of simulation training. Using a Delphi process, this study identified essential components of VATS right upper lobectomy most amenable to focused simulation. Experienced VATS surgeons were randomly selected for participation. A custom Internet interface permitted anonymous voting, commenting, and the ability to modify and propose new components. A component was declared essential when 80% or more of the study participants agreed or strongly agreed on this designation. Participants rated each component for difficulty and then voted for components that were most appropriate for simulation. Thirty-five surgeons initially agreed to participate, and 30 completed the study. Twenty-four components were identified after three votes, and 21 of these components were considered essential. Procedural components that scored the highest for overall difficulty and that were deemed most appropriate for focused simulation included division of the truncus anterior, division of the posterior segmental artery, division of theupper lobe vein, and division of the upper lobe bronchus. A Delphi approach enabled surgeons of disparate training backgrounds and experience to agree on essential components of a VATS lobectomy. There was agreement on the components that are most appropriate for simulation. These findings can be used to design simulation exercises for VATS lobectomy by using targeted anatomy.

An acute interprofessional simulation experience for occupational and physical therapy students: Key findings from a survey study

ABSTRACTDue to the fast pace and high complexity of managing patients in intensive and acute care units (ICUs), healthcare students often feel challenged and unprepared to practice in this environment. Simulations and standardised patients provide “hands-on” learning experiences that are realistic and help students to gain competence and confidence. This study examined the impact of an intensive case simulation laboratory using a patient simulator and standardised patients on students’ perceptions of their confidence and preparedness to work in acute care settings. Second-year Masters of Occupational Therapy (MOT; n = 127) and Doctor of Physical Therapy (DPT; n = 105) students participated in a three-hour intensive care simulation laboratory comprised of four stations that were designed to simulate common ICU patient care scenarios. Data analysed were student pre- and post-simulation surveys and written comments, and clinical instructors’ (CIs; n = 51) ratings on DPT students’ preparedness and confidence within the first two weeks of their acute care internships obtained after the laboratory. There was a significant increase for DPT (p < 0.0001) and MOT (p < 0.10) students in median ratings of how prepared they felt to practice in acute care settings following the ICU simulation compared to before the laboratory. CIs rated the DPT students as either prepared or very prepared for and moderately confident or very confident in the acute care setting. The use of simulation training using standardised patients and patient simulators was beneficial in increasing student confidence and preparing OT and PT students to practice in the acute care setting. Health professional educators should consider using an interprofessional simulation experience to improve their students’ confidence and preparedness to provide appropriate care in the acute setting.

The Use of Simulation Training to Improve Knowledge, Skills, and Confidence Among Healthcare Students: A Systematic Review

Purpose: The use of simulation has become a routine part of education and training for health professionals in many health education facilities. The increased awareness of patient safety and recent advances in technology are the main incentives to use simulation to teach and evaluate clinical competencies. The primary purpose of this study was to review the best available evidence (level and quality) for the use of simulation training to improve clinical skills, knowledge, and self-confidence among healthcare students. Method: A systematic review of qualitative and quantitative literature published between 2000 and 2016 was undertaken using databases including PubMed, CINAHL®, and PsycINFO® databases as well as three journal collections within ProQuest. In addition to the database search, the literature search for this study included two additional activities: search results were compared against the bibliographies of the reviewed studies, and Google Scholar was used to search the Internet for relevant publications. Data from studies meeting inclusion criteria was extracted and summarized. The level and strength of evidence was rated for each study. Results: Of 1412 studies identified via the search strategy, 30 met the inclusion criteria for this systematic review. A wide variety of study designs, interventions, measurements, and simulation types were represented. Data for study location, health profession, sample size, purpose, simulation type, intervention, and outcome measure are presented via evidence tables by authors. Statistically and/or clinically significant improvements in knowledge, skills, and/or self-confidence following simulation training were reported. Primary and secondary outcomes were identified and summarized. Conclusions: Evidence demonstrates that the use of simulation in student education significantly improves knowledge, skills, and self-confidence. A quality improvement framework of five best practice components for application in simulation research is proposed, generated from the findings of this review. Future research employing high quality research designs focusing on debriefing practices, interprofessional education applications, validation of outcome measures, student satisfaction, and long-term information retention will contribute to the growing body of literature supporting best practices for simulation training in healthcare.

Applications of Discrete-Event Simulation in the Forest Products Sector: A Review

Abstract Decisions in the forest products sector have economic, environmental, and social impacts, and involve multiple stakeholders. The complexities and variations in the sector, such as equipment interactions and seasonalities, make discrete-event simulation an attractive decision-support tool. This article reviews the relevant literature to highlight the extensive applications and benefits of discrete-event simulation in forestry. Discrete-event simulation allows one to perform “what-if” scenarios and assess the impact of changes on processes, overall throughput, and productivity. It has been used to compare harvesting systems, evaluate the impacts of machine interactions in the forest and in mills, conduct bottleneck analyses, determine the feasibility of machine replacements, assess log transportation methods, and analyze biofuel supply chains. No studies considered the combined interactions of workers and machines, which could be considered in the future. Future work could also consider multiple objectives, the combination of optimization and simulation, the combination of different simulation methods, and the use of simulation for training and performance evaluation.

DRIVERS’ READINESS TO USE CAR DRIVING SIMULATOR AS A TOOL TO IMPROVE DRIVING SKILL: A PRELIMINARY STUDY

Driving simulators have existed since the 1960s, but for a long time they remained too expensive to be used widely for training purposes. As IT related technology improved, the cost of driving simulators goes down in the last few years. Today, driving simulators have been used as a training device in the basic driver training. In developed countries the use of simulator in driving education is not new. In Malaysia, however, the use of simulators in training is quite new compared to other Asian countries. This paper presents the results of preliminary study on the readiness of Malaysian driver to use car driving simulator in training and education prior to driver licensing. Survey method was used to get information on drivers’ perception toward the introduction of driving simulator in selected driving institutes. The results of this study showed that all respondents agreed on the importance and usefulness of the driving simulator in improving the driving training process. Based on the result of this study, it is suggested that driving simulator should be implemented in the driving curriculum in order to produce competent driver.

Simulation-based training for burr hole surgery instrument recognition.

BackgroundThe use of simulation training in postgraduate medical education is an area of rapidly growing popularity and research. This study was designed to assess the impact of simulation training for instrument knowledge and recognition among neurosurgery residents.MethodsThis was a randomized control trial of first year residents from neurosurgery residency training programs across Canada. Eighteen neurosurgery trainees were recruited to test two simulation-based applications: PeriopSim™ Instrument Trainer and PeriopSim™ for Burr Hole Surgery. The intervention was game-based simulation training for learning neurosurgical instruments and applying this knowledge to identify correct instruments during a simulated burr hole surgery procedure.ResultsParticipants showed significant overall improvement in total score (p < 0.0005), number of errors (p = 0.019) and time saved (p < 0.0005), over three testing sessions when using the PeriopSim™ Instrument Trainer. Participants demonstrated further performance-trained improvements when using PeriopSim™ Burr Hole Surgery.ConclusionsTraining in the recognition and utilization of simulated surgical instruments by neurosurgery residents improved significantly with repetition when using PeriopSim™ Instrument Trainer and PeriopSim™ for Burr Hole Surgery.