Simulation technology for health care professional skills training and assessment

A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city

BACKGROUND

Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components.

METHODS

The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement.

RESULTS

Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups.

CONCLUSION

This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.

Leaders' experiences of embedding a simulation-based education programme in a teaching hospital: an interview study informed by normalisation process theory

There is limited research on the experiences of people in working to embed, integrate and sustain simulation programmes. This interview-based study explored leaders' experiences of normalising a simulation-based education programme in a teaching hospital. Fourteen known simulation leaders across Australia and North America were interviewed. Semi-structured interviews were analysed using reflexive thematic analysis sensitised by normalisation process theory, an implementation science theory which defines 'normal' as something being embedded, integrated and sustained. We used a combined social and experiential constructivist approach. Four themes were generated from the data: (1) Leadership, (2) business startup mindset, (3) poor understanding of simulation undermines normalisation and (4) tension of competing objectives. These themes were interlinked and represented how leaders experienced the process of normalising simulation. There was a focus on the relationships that influence decision-making of simulation leaders and organisational buy-in, such that what started as a discrete programme becomes part of normal hospital operations. The discourse of 'survival' was strong, and this indicated that simulation being normal or embedded and sustained was still more a goal than a reality. The concept of being like a 'business startup' was regarded as significant as was the feature of leadership and how simulation leaders influenced organisational change. Participants spoke of trying to normalise simulation for patient safety, but there was also a strong sense that they needed to be agile and innovative and that this status is implied when simulation is not yet 'normal'. Leadership, change management and entrepreneurship in addition to implementation science may all contribute towards understanding how to embed, integrate and sustain simulation in teaching hospitals without losing responsiveness. Further research on how all stakeholders view simulation as a normal part of a teaching hospital is warranted, including simulation participants, quality and safety teams and hospital executives. This study has highlighted that a shared understanding of the purpose and breadth of simulation is a prerequisite for embedding and sustaining simulation. An approach of marketing simulation beyond simulation-based education as a patient safety and systems improvement mindset, not just a technique nor technology, may assist towards simulation being sustainably embedded within teaching hospitals.

Simulation-guided auscultatory training before graduation is associated with better auscultatory skills in residents

INTRODUCTION

A growing body of scientific evidence shows that simulation-guided auscultatory training can significantly improve the skills of medical students. Nevertheless, it remains to be elucidated if this training has any long-term impact on auscultatory skills. We sought to ascertain whether there were differences in heart and lung auscultation among residents who received simulation-guided auscultatory training before graduation vs. those who did not.

MATERIALS AND METHODS

A total of 43 residents were included in the study; 20 of them entered into Cardiology specialty school (C) and 23 of them entered into Internal and Occupational Medicine specialty schools (M) at the University of Trieste. Based on the history of simulation-guided auscultatory training before graduation (yes = Y; no = N), four groups were formed: CY, CN, MY, and MN. Residents were evaluated in terms of their ability to recognize six heart and five lung sounds, which were reproduced in a random order with the Kyoto-Kagaku patient simulator. Associations between history of simulation training, specialty choice and auscultatory skills were evaluated with Kruskal-Wallis test and logistic regression analysis.

RESULTS

Auscultatory skills of residents were associated with simulation-guided training before graduation, regardless of the specialty chosen. Simulation-guided training had a higher impact on residents in Medicine. Overall, heart and lung sounds were correctly recognized in 41% of cases. Logistic regression analysis showed that simulation-guided training was associated with recognition of aortic stenosis, S2 wide split, fine crackles, and pleural rubs. Specialty choice was associated with recognition of aortic stenosis as well as aortic and mitral regurgitation.

DISCUSSION

History of simulation-guided auscultatory training was associated with better auscultatory performance in residents, regardless of the medical specialty chosen. Choice of Cardiology was associated with better scores in aortic stenosis as well as aortic and mitral regurgitation. Nevertheless, overall auscultatory proficiency was quite poor, which suggests that simulation-guided training may help but is probably still too short.

Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Impact of familiarity with the format of the exam on performance in the OSCE of undergraduate medical students - an interventional study

BACKGROUND

Assessments, such as summative structured examinations, aim to verify whether students have acquired the necessary competencies. It is important to familiarize students with the examination format prior to the assessment to ensure that true competency is measured. However, it is unclear whether students can demonstrate their true potential or possibly perform less effectively due to the unfamiliar examination format. Hence, we questioned whether a 10-min active familiarization in the form of simulation improved medical students´ OSCE performance. Next, we wanted to elucidate whether the effect depends on whether the familiarization procedure is active or passive.

METHODS

We implemented an intervention consisting of a 10-min active simulation to prepare the students for the OSCE setting. We compared the impact of this intervention on performance to no intervention in 5th-year medical students (n = 1284) from 2018 until 2022. Recently, a passive lecture, in which the OSCE setting is explained without active participation of the students, was introduced as a comparator group. Students who participated in neither the intervention nor the passive lecture group formed the control group. The OSCE performance between the groups and the impact of gender was assessed using X2, nonparametric tests and regression analysis (total n = 362).

RESULTS

We found that active familiarization of students (n = 188) yields significantly better performance compared to the passive comparator (Cohen´s d = 0.857, p < 0.001, n = 52) and control group (Cohen´s d = 0.473, p < 0.001, n = 122). In multivariate regression analysis, active intervention remained the only significant variable with a 2.945-fold increase in the probability of passing the exam (p = 0.018).

CONCLUSIONS

A short 10-min active intervention to familiarize students with the OSCE setting significantly improved student performance. We suggest that curricula should include simulations on the exam setting in addition to courses that increase knowledge or skills to mitigate the negative effect of nonfamiliarity with the OSCE exam setting on the students.

Use of Low-Cost Task Trainer for Emergency Department Thoracotomy Training in General Surgery Residency Program

OBJECTIVE

Emergency department thoracotomy (EDT) is an uncommon but potentially lifesaving procedure that warrants familiarity with anatomy, instruments, and indications necessary for completion. To address this need, we developed a low-cost EDT trainer. The primary objective of this study was to compare the effectiveness of a low-cost EDT trainer to teach emergency department thoracotomy with a discussion-based teaching session. Secondary objective was to study the face validity of the low-cost EDT trainer.

DESIGN

A prospective 2-phase randomized control study was conducted. Participants were randomly divided into two groups. In phase one, baseline medical knowledge for both groups was assessed using a multiple-choice question pretest. In Group 1, each participant was taught EDT using a one-on-one discussion with a trauma surgeon, whereas Group 2 used the EDT trainer and debriefing for training. In phase 2 (1 month later), all participants completed a knowledge retention test and performed a videoed EDT using our EDT trainer, the video recordings were later reviewed by content experts blinded to the study participants using a checklist with a maximum score of 22. The participants also completed a reaction survey at the end of phase 2 of the study.

SETTING

OhioHealth Riverside Methodist Hospital, an urban tertiary care academic hospital in Columbus, Ohio.

PARTICIPANTS

Nine senior surgery residents from training years 3 to 5.

RESULTS

The mean score for the performance of the procedure for the simulation-based (Group 2) was significantly higher than that of the discussion-based (Group 1) (Rater 1: 21.2 ± 0.8 vs. 19.0 ± 2.0, p = 0.05, Rater 2: 20.4 ± 1.5 vs. 18.3±1.0, p = 0.04). Group 2 also was quicker than Group 1 in deciding to start the procedure by approximately 56 seconds. When comparing the mean pretest knowledge score to the mean knowledge retention score 30 days after training, the discussion-based group improved from 58.33% to 81.25% (p = 0.01); the simulation-trained group's scores remained at 68.33%. All the participants agreed or strongly agreed that the simulator provided a realistic opportunity to perform EDT and improved their confidence.

CONCLUSIONS

The results of this pilot study support our hypothesis that using a low-cost EDT trainer effectively improves general surgery residents' confidence and procedural skills scores in a simulated environment. Further training with low-cost simulators may provide surgical residents with deliberate practice opportunities and improve performance when learning low-frequency procedures.

Evaluation of anesthetic skills acquisition in pre-graduate veterinary students with different grades of anesthetic experience using veterinary simulation exercises

Background

Anesthetic skills are usually learned through continuous supervision by experienced trainers who observe, advise and challenge students. Current educational techniques rely less on live animal training and include the use of simulations and models for teaching and assessment of surgical and anesthetic skills.

Objective

To evaluate the development of anesthetic skills of veterinary students having different levels of previous experience using simulation. An additional aim was to evaluate the impact of the simulation training on students with no anesthesia experience.

Study design

Single group periinterventional and postinterventional study.

Methods

Initial and final anesthesia simulation training recording were obtained from 53 randomly selected veterinary students. Seven faculty members blinded to previous student anesthesia experience reviewed the simulation recording and scored student performance using a rubric, results were recorded and analyzed.

Results

All students participating in an anesthesia and surgery course reached higher proficiency levels on fundamental anesthesia skills regardless of their previous amount of experience with anesthesia. Simulation based learning positively influenced the final score in veterinary students having no previous anesthesia training, suggesting that it is possible for veterinary students to achieve a level of competence in anesthesia skills with simulation-based training.

Main limitations

Sample size, group simulation, multiple reviewers bias.

Conclusion

Students having no experience with clinical anesthesia demonstrated remarkable improvement in their skills, achieving a score that was similar to students having extensive prior clinical anesthesia experience. Despite this clear improvement students having no prior clinical anesthesia experience required more time to complete all anesthesia tasks and may require more training sessions to acquire the speed demonstrated by peers who had significant prior clinical anesthesia experience. Overall, all participants reached a higher proficiency level performing fundamental anesthesia skills at the end of the course.

Exploring the Role of Simulation Training in Improving Surgical Skills Among Residents: A Narrative Review

The role of simulation in medical education is crucial to the development of surgeons' skills. Surgical simulation can be used to improve surgical skills in a secure and risk-free environment. Animal models, simulated patients, virtual reality, and mannequins are some types of surgical simulation. As a result, feedback encourages students to reflect on their strengths and weaknesses, enabling them to focus on improvement. Healthcare simulation is a strong educational instrument, and the main goal of this is to give the students an opportunity to do a practical application of what they have learned through theory. Before taking it to the patients, they will already have certain tools they have previously acquired during the practice. This makes it easier for students to identify the knowledge gaps that they must fill to improve patient outcomes. Moreover, simulation brings a wonderful opportunity for students to acquire skills, gain confidence, and experience success before working with real patients, especially when their clinical exposure is limited. The use of simulation to teach technical skills to surgical trainees has become more prevalent. The cost of setting up a simulation lab ranges from $100,000 to $300,000. There are several ways to evaluate the effectiveness of simulation-based surgical training. Repetitive surgical simulation training can improve speed and fluidity in general surgical skills in comparison to conventional training. Few previous studies compared learners who received structured simulation training to a group of trainees who did not receive any simulation training in single-center randomized control research. Significantly faster and less time-consuming skill proficiency was noticeable in simulated trainees. Despite being anxious in the operating room for the first time, simulated trainees completed the surgery on time, demonstrating the effectiveness of surgical simulation training. Traditional surgical training involves senior-surgeon supervision in the operating room. In simulation-based training, the trainees have full control over clinical scenarios and settings; however, guidance and assessment are also crucial. Simulators allow users to practice tasks under conditions resembling real-life scenarios. Simulators can be compared with traditional surgical training methods for different reasons. For example, intraoperative bleeding may occasionally show up not only visibly on the screen but also by shaking the trocars erratically. Without haptics, training on virtual simulators can cause one's pulling and pushing forces, which are frequently greater than what the tissue needs, to be distorted. A good method of simulation training is using virtual reality simulators with haptics and simulated patients. The availability of these facilities is limited, though, and a typical session might include an exercise involving stacking sugar cubes and box trainers. The degree of expertise or competency is one area that needs clarification as medical education transitions to a competency-based paradigm. The article aims to provide an overview of simulation, methods of simulation training, and the key role and importance of surgical simulation in improving skills in surgical residents.

Virtual versus paper-based PBL in a pulmonology course for medical undergraduates

BACKGROUND

Problem-based learning (PBL) remains a valid and effective tool for small-group medical education. Using Virtual patients (VP) case simulation in PBL is a recognizable educational method that has successfully prepared students to focus learning on core information that uses realistic patient-based cases relating to everyday clinical scenarios. Using other modalities as the virtual patient in PBL instead of the paper-based methods remains debatable. This study aimed to evaluate the effectiveness of using VP case simulation mannequin in PBL versus the PBL in paper-based cases in improving the cognitive skills by comparing the grades of a multiple-choice question test and assess its ability to reach students' satisfaction using questionnaire with Likert survey instrument.

METHODS

The study was conducted on 459 fourth-year medical students studying in the pulmonology module of the internal medicine course, Faculty of Medicine, October 6 University. All students were divided into 16 PBL classes and randomly divided into groups A and B by simple manual randomization. The groups were parallel with a controlled cross-over study between paper-based and virtual patient PBL.

RESULTS

The pre-test showed no significant difference between both, while post-test scores were significantly higher in both VP PBL cases 1 discussing COPD (6.25 ± 0.875) and case 2 discussing pneumonia (6.56 ± 1.396) compared to paper-based PBL (5.29 ± 1.166, 5.57 ± SD1.388, respectively) at p < 0.1 When students in Group A experienced PBL using VP in case 2 after paper-based PBL in case 1, their post-test score improved significantly. (from 5.26 to 6.56, p < .01). Meanwhile, there was a significant regression in the post-test score of the students in Group B when they experienced the paper-based PBL session in case 2 after using PBL using VP in case 1, (from 6.26 to 5.57, p < .01). Most of the students recommended using VP in PBL as they found VP was more engaging and inducing concentration in gathering the information needed to characterize the patient's problem than in a classroom- paper-based cases session. They also enjoyed the teaching of the instructor and found it a suitable learning style for them.

CONCLUSION

Implementing virtual patients in PBL increased knowledge acquisition and understanding in medical students and was more motivating for students than paper based PBL to gather the needed information.

Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms

BACKGROUND

Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery. The aim of this study is to evaluate whether IA biomodels generated by additive manufacturing methods are useful for surgical clip selection in microsurgeries for IA.

METHODS

Three-dimensional (3D) IA biomodels of 10 patients with IA were evaluated using computerized tomography, surgical microscope, and 3D printer. The research was divided into 4 phases as follows: development of the 3D biomodels, evaluation of the biomodel dimensional characteristics, surgical planning evaluation with the biomodel and its clipping effectiveness, and evaluation of the actual surgical simulation process within the models.

RESULTS

Ten 3D biomodels were obtained, made of a malleable and hollow part, formed by the IA and related arteries, and another rigid part, mimicking the skull and other arteries of the skull base. Based on these 3D models, 10 clips were chosen during the surgical planning, and all exactly matched the clip characteristics used during the actual surgeries. The surgical simulation with the biomodels performed by 2 neurosurgeons still in training obtained 100% accuracy in the identification of the clips that were eventually used during the actual surgeries.

CONCLUSIONS

3D biomodels generated by additive manufacturing methods were effective for surgical clip selection in microsurgeries for IA, reducing surgical time, increasing cerebral angioarchitecture understanding, and providing more safety in this type of surgery.

Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills

We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2^™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci^® Skills Simulator^™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2^™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.

Simulation-Based Training on Basic Obstetrics and Gynecology Ultrasound Skills During COVID Pandemic

Background

COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training.

Methods

A cross-sectional study was conducted during 8-day-long workshop to identify the trainees' basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons.

Results

A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals.

Conclusion

The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills.

Frameworks for Integrating Learning Analytics With the Electronic Health Record

The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.

The effectiveness of scenario-based virtual laboratory simulations to improve learning outcomes and scientific report writing skills

The use of virtual laboratory simulations in various disciplines, which provide important educational benefits, has increased. Several studies show that laboratory activities, including scenario-based virtual laboratory simulation (SB-VLS), stimulate cognitive and non-cognitive skills. However, the effects of the SB-VLS when integrated into molecular biology courses, on the development of cognitive skills, such as scientific report writing skills, remain unexplored. A pre-post-test, randomized, quasi-experimental design was used. Thirty-five female students were randomly assigned to experimental or control groups. The control group (n = 17) attended a traditional lecture and video lab demonstration (VLD), while the experimental group (n = 18) participated in SB-VLS on molecular cloning. Findings revealed statistically significant differences, with large effects sizes in the SB-VLS group between pre- and post-test in intrinsic motivation (2.9 vs 3.86, p = 0.042, Cohen’s d = 4.17), self-efficacy (3.31 vs 3.85, p = 0.002, Cohen’s d = 1.071), and knowledge gain scales (50.93 vs 75.93, p = 0.001, Cohen’s d = 1.46). Moreover, between-group effect sizes of the experimental and control groups were also large for intrinsic motivation (dppc2 = 1.441), self-efficacy (dppc2 = 0.766), and knowledge (dppc2 = 1.147), indicating that the effect of the SB-VLS was significant, which may be due to the activities and techniques used in SB-VLS to develop learning outcomes. Additionally, the SB-VLS group had statistically better lab report scores as compared to the control group (3.92 vs. 4.72, p < 0.0001). Collectively, our data show that SB-VLS is an innovative teaching strategy and an effective tool for developing non-cognitive and cognitive skills, especially scientific report writing skills.

Learning Clinical Skills Using Haptic vs. Phantom Head Dental Chair Simulators in Removal of Artificial Caries: Cluster-Randomized Trials with Two Cohorts' Cavity Preparation

Dental task trainer simulators using haptics (virtual touch) offers a cost-effective method of teaching certain clinical skills. The purpose of this study is to evaluate students' performance in removing artificial caries after training with either a haptic dental chair simulator with virtual reality or a traditional dental chair simulator with a mannequin head. Cluster Randomized Controlled Trials in two cohorts, both Year 1 dental students. Students taught using traditional dental chair simulators were compared with students taught using haptic-based simulators on their ability to cut a cavity in a plastic tooth following training. Across both cohorts, there was no difference in the quality of cavity cut, though students' technique differed across the two simulator groups in some respects. No difference was seen across both cohorts in the quality of cavity cut for a simple preparation, though students in the haptic condition performed less well in the more demanding task. Moreover, students in the haptic group were also less likely to be perceived to be 'holding the instrument appropriately'. These findings suggest further investigation is needed into the differences in handling of instruments and level of clinical task difficulty between the simulators.

Specific steps in the operation determine resident speed: Experience with a live tissue simulation model of laparoscopic nephrectomy

INTRODUCTION

It is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation.

MATERIALS AND METHODS

Residents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded.

RESULTS

Seven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1-4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min (p = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, p = 0.03). Significant differences in performance time were not seen in the other steps.

DISCUSSION

The performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

OBJECTIVES

Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies.

METHODS

Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results.

RESULTS

A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training.

CONCLUSIONS

This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.

Care of the dying - medical student confidence and preparedness: mixed-methods simulation study

OBJECTIVES

Of all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.

METHODS

A mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.

RESULTS

Thirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.

CONCLUSION

Using simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

Procedural task trainer gaps in emergency medicine: A rift in the simulation universe

OBJECTIVES

We identified and quantified the gap between emergency medicine (EM) procedures currently taught using simulation versus those that educators would teach if they had better procedural task trainers. Additionally, we endeavored to describe which procedures were taught using homemade models and the barriers to creation and use of additional homemade models.

METHODS

Using a modified Delphi process, we developed a survey and distributed it to a convenience sample of EM simulationists via the Society for Academic Emergency Medicine Simulation Academy listserv. Survey items asked participants to identify procedures they thought should be taught using simulation ("most important"), do teach using simulation ("most frequent"), would teach if a simulator or model were available ("most needed"), and do teach using simulation with "homemade" models ("most frequent homemade").

RESULTS

Thirty-seven surveys were completed. The majority of respondents worked at academic medical centers and were involved in simulation-based education for at least 6 years. Three procedures ranked highly in overall teaching importance and currently taught categories. We identified four procedures that ranked highly as both important techniques to teach and would teach via simulation. Two procedures were selected as the most important procedures that the participants do teach via simulation but would like to teach in an improved way. We found 14 procedures that simulationists would teach if an adequate model was available, four of which are of high importance.

CONCLUSIONS

This study captured data to illuminate the procedural model gap and inform future interventions that may address it and meet the overarching objective to create better and more readily available procedure models for EM simulation educators in the future. It offers an informed way of prioritizing procedures for which additional homemade models should be created and disseminated as well as barriers to be aware of and to work to overcome. Our work has implications for learners, educators, administrators, and industry.

Design of Assessment Judging Model for Physical Education Professional Skills Course Based on Convolutional Neural Network and Few-Shot Learning

In recent years, the promotion of quality education and the development of curriculum and teaching materials reform have put forward higher goals and requirements for professional skills in physical education. However, there are still many shortcomings in the nuclear assessment of physical education professional skills, such as lack of clarity in evaluation objectives, lack of scientific in evaluation indexes, lack of systematization in evaluation contents, lack of diversity in evaluation methods, lack of authority in evaluation results, and lack of timely prediction and analysis of students' mastery of classroom teaching skills, thus not giving good play to all the functions that the nuclear assessment should have, thus to a certain extent fettering the further enhancement of physical education. With the development of information technology, artificial intelligence, as a new technology, can guide the improvement of the assessment and judging mode of physical education professional skills courses, and is also an important guiding idea for physical education majors to meet the development demands of information-based society. Based on the analysis of the connotation and characteristics of deep learning, this paper points out the insufficiency of the assessment and evaluation of traditional physical education professional skills courses and proposes a method of assessment and evaluation of physical education professional skills courses based on convolutional neural networks and small sample learning. In the case of a small amount of data in the course assessment, we use a small number of samples to learn, and only need a small number of samples to learn quickly. Using the improvement measures under the teaching concept of deep learning, physical education personnel are required to truly change in terms of professional skills mastery and evaluation. We effectively implement improvement measures, promote the improvement of physical education professional skills, and realize the migration and innovation of sports knowledge and skills.

Simulation-based Education Improves Military Trainees' Skill Performance and Self- Confidence in Tourniquet Placement: A Randomized Controlled Trial

BACKGROUND

Tactical Combat Casualty Care (TCCC) is the standard of care for stabilization and treatment of military trauma patients. The DoD has mandated that all Service members receive role-based TCCC training and certification. Simulation education can increase procedural skills by providing opportunities for deliberate practice in safe, controlled environments. We developed and evaluated the effectiveness of a simulation-based TCCC training intervention to improve participants' skill performance and self-confidence in tourniquet placement.

METHODS

This study was a single-blinded, randomized trial with waitlist controls. Army ROTC cadets from a single training battalion comprised the study population. After randomization and baseline assessment of all participants, Group A alone received focused, simulation-based TCCC tourniquet application training. Three months later, all participants underwent repeat testing, and after crossover, the waitlist Group B received the same intervention. Two months later, all cadets underwent a third/final assessment. The primary outcome was tourniquet placement proficiency assessed by total score achieved on a standardized 8-item skill checklist. A secondary outcome was self-confidence in tourniquet application skill as judged by participants' Likert scale ratings.

RESULTS

Forty-three Army ROTC cadets completed the study protocol. Participants in both Group A (n = 25) and Group B (n = 18) demonstrated significantly higher performance from baseline to final assessment at five months and two months, respectively, following the intervention. Mean total checklist score of the entire study cohort increased significantly from 5.53 (SD = 2.00) at baseline to 7.56 (SD = 1.08) at Time 3, a gain of 36.7% (p < 0.001). Both groups rated their self-confidence in tourniquet placement significantly higher following the training.

CONCLUSIONS

A simulation-based TCCC curriculum resulted in significant, consistent, and sustained improvement in participants' skill proficiency and self-confidence in tourniquet placement. Participants maintained these gains two to five months after initial training.

LEVEL OF EVIDENCE

Level II - RCT with significant difference and only one negative criterion (<80% follow-up).

Implementation strategies for high-performance health care simulation centres: A multicentre exploratory case study in China

INTRODUCTION

The number of health care simulation centres (HSCs) in mainland China has increased exponentially recently. However, the performance of these centres varies significantly between hospitals. The aim of this study is to address two research questions: (i) what are the critical factors for implementing high-performance HSCs and (ii) how are these critical factors used in the development of implementation strategies to achieve satisfactory performance?

METHODS

Following a literature review on information technology (IT) implementation, we identified a framework comprising four key dimensions for HSCs implementation: technology, organisation, environment and individuals. This TOEI (technology-organisation-environment-individual) framework was then used as a basis for a multicentre case study through which data collection and analysis proceeded. We collected 12 one-to-one in-depth interviews alongside secondary data from six high-performance HSCs in mainland China.

RESULTS

Our study identifies critical TOEI factors that collectively influence HSC implementation performance and major activities at the six high-performance HSCs. Three strategies for implementing high-performance HSCs are also identified: facility management platform, education and training centre and innovation centre.

CONCLUSIONS

HSC implementation is an holistic approach. The critical TOEI factors collectively build a foundation for centre activities. An HSC's implementation strategy highly relies on organisational strategic goals. Additionally, HSCs in mainland China face some common challenges such as faculty retention and future opportunities such as expanding the research scope. Our study also provides insights for hospital leadership, medical associations and policymakers.

Assessment of the learning curve for the novel transanal minimally invasive surgery simulator model

BACKGROUND

Transanal minimally invasive surgery (TAMIS) is technically demanding and requires extensive training. We developed the TAMIS simulator model by remodeling an existing laparoscopic training system to educate trainees and analyzed their learning curves.

METHODS

Between March 2020 and June 2020, 12 trainees performed TAMIS simulator training sessions. The total operative time, including specimen removal and wound closure, was recorded. The wound closure and specimen quality, trainee self-confidence, and supervisor evaluation of technical performance were documented. A moving average was used to analyze the number of training sessions required to stabilize the procedure time, while a cumulative sum analysis was performed to identify that required to reach proficiency with each item.

RESULTS

Each trainee completed 20 TAMIS simulator training sessions. The median total procedure time was 13 min (range, 4-60 min), which stabilized after 15 training sessions. The median times for specimen removal and wound closure were 3 min (range, 1-18 min) and 10 min (range, 2-50 min), respectively, which stabilized after 7 and 15 training sessions, respectively. The mean specimen and wound closure quality scores were 2.9 ± 0.9 (on a scale from 1 to 4) and 2.3 ± 1.1 (on a scale from 1 to 4), respectively, competencies in which were achieved after 16 and 20 training sessions, respectively. The mean trainee self-confidence and supervisor evaluation of technical performance scores were 2.4 ± 1.2 (on a scale from 1 to 5) and 2.7 ± 1.2 (on a scale from 1 to 5), respectively, competencies in which were achieved after 20 and 17 training sessions, respectively.

CONCLUSION

Trainees required 15 training sessions to stabilize the procedure time and 16-20 training sessions to demonstrate competencies with the TAMIS simulator model. We expect this simulator model may help surgeons more rapidly acquire the skills required for TAMIS.

Learning Analytics Applied to Clinical Diagnostic Reasoning Using a Natural Language Processing-Based Virtual Patient Simulator: Case Study

BACKGROUND

Virtual patient simulators (VPSs) log all users' actions, thereby enabling the creation of a multidimensional representation of students' medical knowledge. This representation can be used to create metrics providing teachers with valuable learning information.

OBJECTIVE

The aim of this study is to describe the metrics we developed to analyze the clinical diagnostic reasoning of medical students, provide examples of their application, and preliminarily validate these metrics on a class of undergraduate medical students. The metrics are computed from the data obtained through a novel VPS embedding natural language processing techniques.

METHODS

A total of 2 clinical case simulations (tests) were created to test our metrics. During each simulation, the students' step-by-step actions were logged into the program database for offline analysis. The students' performance was divided into seven dimensions: the identification of relevant information in the given clinical scenario, history taking, physical examination, medical test ordering, diagnostic hypothesis setting, binary analysis fulfillment, and final diagnosis setting. Sensitivity (percentage of relevant information found) and precision (percentage of correct actions performed) metrics were computed for each issue and combined into a harmonic mean (F₁), thereby obtaining a single score evaluating the students' performance. The 7 metrics were further grouped to reflect the students' capability to collect and to analyze information to obtain an overall performance score. A methodological score was computed based on the discordance between the diagnostic pathway followed by students and the reference one previously defined by the teacher. In total, 25 students attending the fifth year of the School of Medicine at Humanitas University underwent test 1, which simulated a patient with dyspnea. Test 2 dealt with abdominal pain and was attended by 36 students on a different day. For validation, we assessed the Spearman rank correlation between the performance on these scores and the score obtained by each student in the hematology curricular examination.

RESULTS

The mean overall scores were consistent between test 1 (mean 0.59, SD 0.05) and test 2 (mean 0.54, SD 0.12). For each student, the overall performance was achieved through a different contribution in collecting and analyzing information. Methodological scores highlighted discordances between the reference diagnostic pattern previously set by the teacher and the one pursued by the student. No significant correlation was found between the VPS scores and hematology examination scores.

CONCLUSIONS

Different components of the students' diagnostic process may be disentangled and quantified by appropriate metrics applied to students' actions recorded while addressing a virtual case. Such an approach may help teachers provide students with individualized feedback aimed at filling competence drawbacks and methodological inconsistencies. There was no correlation between the hematology curricular examination score and any of the proposed scores as these scores address different aspects of students' medical knowledge.

Research Hotspots and Trend Exploration on the Clinical Translational Outcome of Simulation-Based Medical Education: A 10-Year Scientific Bibliometric Analysis From 2011 to 2021

BACKGROUND

In recent decades, an increasing number of studies have focused on the clinical translational effect of simulation-based medical education (SBME). However, few scientific bibliometric studies have analyzed the research hotspots and publication trends. This study aimed to investigate research hotspots and future direction in the clinical translational outcome of SBME via bibliometrics.

METHOD

Relevant publications on the clinical translational outcomes of SBME from 2011 to 2021 were identified and retrieved from the Web of Science Core Collection (WOSCC). Software including VOSviewer (1.6.17) and CiteSpace (5.8R3) and a platform (bibliometric.com) were employed to conduct bibliographic and visualized analysis on the literature.

RESULTS

A total of 1,178 publications were enrolled. An increasing number of publications were observed in the past decades from 48 in 2011 to 175 in 2021. The United States accounted for the largest number of publications (488, 41.4%) and citations (10,432); the University of Toronto and Northwestern University were the leading institutions. Academic Medicine was the most productive journal concerning this field. McGaghie W C and Konge L were the most influential authors in this area. The hot topic of the translational outcome of SBME was divided into 3 stages, laboratory phase, individual skill improvement, and patient outcome involving both technical skills and non-technical skills. Translational research of comprehensive impact and collateral outcomes could be obtained in the future.

CONCLUSION

From the overall trend of 10 years of research, we can see that the research is roughly divided into three phases, from laboratory stage, individual skill improvement to the patient outcomes, and comprehensive impacts such as skill retention and collateral effect as cost-effectiveness is a major trend of future research. More objective evaluation measurement should be designed to assess the diverse impact and further meta-analysis and randomized controlled trials are needed to provide more clinical evidence of SBME as translational science.

An Infant Phantom for Pediatric Pericardial Access and Electrophysiology Training

Background

Cardiac procedures in infants and children require a high level of skill and dexterity owing to small stature and anatomy. Lower incidence of procedure volume in this population results in fewer clinical opportunities for learning. Simulators have grown in popularity for education and training, though most existing simulators are often cost-prohibitive or model adult anatomy.

Objective

Develop a low-cost simulator for practicing the skills to perform percutaneous pericardial access and cardiac ablation procedures in pediatric patients.

Methods

We describe 2 simulators for practicing cardiac procedures in pediatric patients, with a total cost of less than $500. Both simulators are housed within an infant-size doll. The first simulator is composed of an infant-size heart and a skin-like covering to practice percutaneous pericardial access to the heart. Participants obtained sheath access to the heart under direct visualization. The second simulator houses a child-size heart with 7 touch-activated targets to practice manipulating a catheter through a small heart. This can be performed under direct visualization and with 3-dimensional mapping via CARTO. Participants manipulated a catheter to map the heart by touching the 6 positive targets, avoiding the negative target.

Results

Physicians-in-training improved their time to complete the task between the first and second attempts. Physicians experienced with the tools took less time to complete the task than physicians-in-training.

Conclusion

This inexpensive simulator is anatomically realistic and can be used to practice manipulating procedure tools and develop competency for pediatric cardiac procedures.

The role of simulation-based training in healthcare-associated infection (HAI) prevention

Objectives:

To perform a review of the literature on the role of simulation-based training (SBT) in healthcare-associated infection (HAI) prevention and to highlight the importance of SBT as an educational tool in infection prevention.

Methods:

We reviewed English language publications from PubMed to select original articles that utilized SBT as the primary mode of education for infection prevention efforts in acute-care hospitals.

Results:

Overall, 27 publications utilized SBT as primary mode of education for HAI prevention in acute-care hospitals. Training included the following: hand hygiene in 3 studies (11%), standard precaution in 1 study (4%), disaster preparedness in 4 studies (15%), central-line–associated blood stream infection (CLABSI) prevention in 14 studies (52%), catheter-associated urinary tract infection (CAUTI) prevention in 2 studies (7%), surgical site infection prevention in 2 studies (7%), and ventilatory associated pneumonia prevention in 1 study (4%). SBT improved learner’s sense of competence and confidence, increased knowledge and compliance in infection prevention measures, decreased HAI rates, and reduced healthcare costs.

Conclusion:

SBT can function as a teaching tool in day-to-day infection prevention efforts as well as in disaster preparedness. SBT is underutilized in infection prevention but can serve as a crucial educational tool.

Simulation-based clinical education versus early clinical exposure for developing clinical skills in respiratory care students

Background:

Early clinical exposure (ECE) has been shown to improve clinical skills, but several factors limit its implementation.

Objective:

To compare the use of simulation-based education (SCE) and ECE in improving respiratory care students’ clinical skills in laboratory settings.

Methodology:

This experimental prospective study was conducted among respiratory care students at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Students from one batch were allocated to the ECE group, and students from another batch were allocated to the SCE group to concurrently undergo clinical training. On completion of the course, students completed the Clinical Learning Environment Inventory (CLEI), and their clinical practice course grades were evaluated.

Results:

A total of 72 students from the two batches completed the CLEI and clinical performance evaluation; 32 (45%) were female. The mean age was similar across both groups. Between the groups, there was no statistical difference in the mean clinical grade (95% CI) (ECE: 167.29 [164.74–169.84], SCE: 166.88 [164.12–169.65]; P = 0.837) and the CLEI score (ECE: 128.25 ± 3.9, SCE: 123.08 ± 4.2; P = 0.381). Multivariable linear regression analyses revealed no significant difference in the clinical performance grades (β = −0.09; 95% CI: −0.78–0.59; P = 0.788).

Conclusion:

The study found no significant difference in the performance between ECE and SCE in laboratory settings, indicating that SCE is a viable alternative to ECE in RC clinical training. Studies with larger cohorts are required to corroborate this finding.

Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment

Background

The assessment and treatment of pediatric patients in the out-of-hospital environment often presents unique difficulties and stress for EMS practitioners.

Objective

Use a mixed-methods approach to assess the current experience of EMS practitioners caring for critically ill and injured children, and the potential role of a simulation-based curriculum to improve pediatric prehospital skills.

Methods

Data were obtained from three sources in a single, urban EMS system: a retrospective review of local pediatric EMS encounters over one year; survey data of EMS practitioners’ comfort with pediatric skills using a 7-point Likert scale; and qualitative data from focus groups with EMS practitioners assessing their experiences with pediatric patients and their preferred training modalities.

Results

2.1% of pediatric prehospital encounters were considered “critical,” the highest acuity level. A total of 136 of approximately 858 prehospital providers responded to the quantitative survey; 34.4% of all respondents either somewhat disagree (16.4%), disagree (10.2%), or strongly disagree (7.8%) with the statement: “I feel comfortable taking care of a critically ill pediatric patient.” Forty-seven providers participated in focus groups that resulted in twelve major themes under three domains. Specific themes included challenges in medication dosing, communication, and airway management. Participants expressed a desire for more repetition and reinforcement of these skills, and they were receptive to the use of high-fidelity simulation as a training modality.

Conclusions

Critically ill pediatric prehospital encounters are rare. Over one third of EMS practitioners expressed a low comfort level in managing critically ill children. High-fidelity simulation may be an effective means to improve the comfort and skills of prehospital providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-021-00494-4.

Virtual Reality vs. Dry-Lab Models: Comparing automated performance metrics and cognitive workload during robotic simulation training

Background This study compares surgical performance during analogous vesico-urethral anastomosis (VUA) tasks in two robotic training environments, virtual reality (VR) and dry-lab (DL), in order to investigate transferability of skills assessment across the two platforms. Utilizing computer-generated performance metrics and pupillary data we evaluated the two environments' ability to distinguish surgical expertise and ultimately whether performance in the VR simulation correlates to performance on the live robot in the dry-lab. Materials and Methods Experts (≥ 300 cases) and trainees (<300) performed analogous VUAs during VR and dry-lab sessions on a da Vinci robotic console. 22 metrics were generated in each environment (kinematic metrics, tissue metrics, biometrics). The dry-lab included 18 previously validated automated performance metrics (APMs) (kinematics, events metrics) and were captured by an Intuitive systems data recorder. In both settings, Tobii Pro Glasses 2 recorded task-evoked pupillary response (reported as Index of Cognitive Activity [ICA]) to indicate cognitive workload, analyzed by EyeTracking Cognitive Workload Software. Pearson Correlation, Mann-Whitney and Independent t-tests were used for the comparative analyses. Results Our study included 6 experts (median caseload 1300 [interquartile range 400-3000]) and 11 trainees (25 [0-250]). 8/9 metrics directly comparable between VR and DL showed significant positive correlation (r≥0.554, p≤0.032). 5/22 VR metrics distinguished expertise including: task time (p=0.031), clutch usage (p=0.040), unnecessary needle piercings (p=0.026) and suspected injury to endopelvic fascia (p=0.040). This contrasts with 14/22 APMs in dry-lab (p≤0.038) including: linear velocities of all three instruments (p≤0.038) and dominant-hand instrument wrist articulation (p=0.013). Trainees experienced higher cognitive workload (ICA) in both environments when compared to experts (p<0.036). Conclusions A majority of performance metrics between VR and dry-lab exhibited moderate to strong correlations, showing transferability of skills across the platforms. Comparing training environments, APMs during dry-lab tasks are better able to distinguish expertise than VR-generated metrics.

Health professions education scholarship: The emergence, current status, and future of a discipline in its own right

Medical education, as a domain of scholarly pursuit, has enjoyed a remarkably rapid development in the past 70 years and is now more commonly known as health professions education (HPE) scholarship. Evidenced by a solid increase of publications, numbers of specialized journals, professional associations, national and international conferences, academies for medical educators, masters and doctoral courses, and the establishment of many units of HPE scholarship, the domain of HPE education scholarship has matured into a scholarly discipline in its own right. In this contribution, the author reviews the developments of the field from Boyer's four criteria that determine scholarship: discovery, integration, application, and teaching. Born mid-20th century, and in the first decades developed in the predominant area of physician education, HPE scholarship has matured, with increasing breadth, depth, and volume of scholars, publications, conferences, and dedicated centers for research and development. The author concludes that, given the infrastructure that has emerged, HPE can arguably be considered a discipline in its own right. This academic question may not matter hugely for practices of scholarly work in this domain, and any stance in this academic debate inevitably reflects a personal view, but the author would support the view of health professions scholarship as being a unique niche, with inherent dependence on both medical and other health professional sciences, on the one hand, and social sciences, including educational sciences, on the other hand.

Deliberate Practice in Simulation-Based Surgical Skills Training: A Scoping Review

BACKGROUND

In recent years there has been a shift from traditional Halstedian methods toward more simulation-based medical education (SBME) for developing surgical skills. Questions remain about the role and value of SBME, although feedback and engagement in repetitive practice have been associated with positive learning outcomes. Regardless of approach, the principles of deliberate practice align with both the Halstedian traditions and ways of implementing SBME. Whilst deliberate practice is well described in the wider literature, the extent to which it is an effective instructional approach in surgical training remains unknown.

OBJECTIVE

To explore the effectiveness of deliberate practice as an instructional design for developing surgical skills through SBME interventions, as assessed by improvements in trainee performance and/or patient outcomes.

METHODS

A combined search was conducted in PUBMED, CINAHL, EMBASE, MEDLINE, PSYCHINFO, and Google Scholar. Three hundred one articles were screened and 17 met the inclusion criteria for analysis.

RESULTS

There was heterogeneity of study methods with 6 randomized control trials, 7 pretest/post-test design, 2 nonrandomized comparisons and 2 observational studies. All articles demonstrated positive learner outcomes following SBME with deliberate practice, although there was no direct comparison to another instructional method. Two studies demonstrated skill transfer to the clinical environment and 1 demonstrated improved patient outcomes.

CONCLUSION

Deliberate practice informed SBME interventions appeared effective for developing surgical skills among trainee surgeons, however the reliability of these conclusions was limited by the modest quality of the research studies and the design elements of deliberate practice were inconsistently applied. There was little evidence that deliberate practice led to skills retention beyond 30 days, although participant numbers were low and the quality of studies was modest.

Decisions and Consequences: Validation of High-Stakes Simulation-Based Assessments in Gynecologic Surgery

STUDY OBJECTIVE

Simulation-based assessment is poised for application in educational promotion and credentialing in gynecologic surgery. With high-stakes assessment, validation necessitates evidence, not just about the trustworthiness of decisions but of beneficial consequences to education and healthcare as well. In this paper, we unpack the modern conceptualization of validity as it pertains to surgical simulation and high-stakes competency assessment.

DESIGN

N/A SETTING: N/A PATIENTS: N/A INTERVENTIONS: N/A MEASUREMENTS AND MAIN RESULTS: N/A CONCLUSION: Validity in high-stakes simulation-based assessment necessitates evidence, not just about the trustworthiness of score-based decisions but of beneficial consequences to education and healthcare as well.

Deliberate practice and self-recorded demonstration of skill proficiency: One baccalaureate nursing school's response to the COVID-19 pandemic

AIM

The purpose of this study was to determine whether using self-video recording of the skill competency assessment would promote deliberate practice of nursing skills, clinical skill proficiency, limit virtual high stakes testing anxiety and facilitate progression of first semester baccalaureate nursing students during the global COVID-19 pandemic.

DESIGN

A cross-sectional study was conducted during the Spring 2020 semester using self-reported student data from an end of course survey.

METHODS

A 16 item instructor-designed survey of student's perceptions of critical thinking, preparation, availability of materials, practice, video recording skill demonstrations, self-reported levels of anxiety related to the virtual testing environment and type of skill assessment exam was provided to all first semester baccalaureate nursing students enrolled in the basic nursing skills course.

RESULTS

Approximately half of the cohort (N = 33) voluntarily responded to the instructor designed survey. The greatest relationship was observed between 'adequate information for each version' of the test and 'adequate time to prepare' (rho (32) = 0.729 p = 0.000). Although 54.6% (n = 18) of the respondents believed performing the demonstration in the home environment caused them to 'think harder' about the tasks, 78.8% (n = 26) reported feeling less anxiety than while performing previous demonstrations in the lab. A Wilcoxon test examined the results of the anxiety for demonstration on campus and anxiety for demonstration at home and a significant difference was found (p = 0.000, 95% CI) indicating anxiety levels were significantly less when demonstrating in the home environment. A moderate positive correlation was identified between opportunity to repeat with less stress at home (rho (32) = 0.61, p = 0.000), while moderate negative correlations were found between opportunity to repeat and anxiety levels related to recording (rho (32) = -0.60, p = 0.000), opportunity to repeat and anxiety related to demonstration at home (rho (32) = -0.53, p = 0.002) and concern about recording and opportunity to repeat (rho (32) = -0.49, p = 0.004).

CONCLUSIONS

Student success using remote assessment strategies during the Spring 2020 semester was similar to the success rate using traditional skill assessment methods in Fall 2019. Although the need for prompt feedback was identified as an area of improvement to promote deliberate practice, student video recording of skill proficiency was a viable solution for comprehensive remote assessment during the COVID-19 pandemic and campus closure. Although further study is recommended, findings have international implications for virtual teaching and learning in nursing education.

Development of a novel global rating scale for objective structured assessment of technical skills in an emergency medical simulation training

BACKGROUND

Medical simulation trainings lead to an improvement in patient care by increasing technical and non-technical skills, procedural confidence and medical knowledge. For structured simulation-based trainings, objective assessment tools are needed to evaluate the performance during simulation and the learning progress. In surgical education, objective structured assessment of technical skills (OSATS) are widely used and validated. However, in emergency medicine and anesthesia there is a lack of validated assessment tools for technical skills. Thus, the aim of the present study was to develop and validate a novel Global Rating Scale (GRS) for emergency medical simulation trainings.

METHODS

Following the development of the GRS, 12 teams of different experience in emergency medicine (4th year medical students, paramedics, emergency physicians) were involved in a pre-hospital emergency medicine simulation scenario and assessed by four independent raters. Subsequently, interrater reliability and construct validity of the GRS were analyzed. Moreover, the results of the GRS were cross-checked with a task specific check list. Data are presented as median (minimum; maximum).

RESULTS

The GRS consists of ten items each scored on a 5-point Likert scale yielding a maximum of 50 points. The median score achieved by novice teams was 22.75 points (17;30), while experts scored 39.00 points (32;47). The GRS overall scores significantly discriminated between student-guided teams and expert teams of emergency physicians (p = 0.005). Interrater reliability for the GRS was high with a Kendall's coefficient of concordance W ranging from 0.64 to 0.90 in 9 of 10 items and 0.88 in the overall score.

CONCLUSION

The GRS represents a promising novel tool to objectively assess technical skills in simulation training with high construct validity and interrater reliability in this pilot study.

Curriculum setting and students' feedback of pre-clinical training in different dental schools in China-A national-wide survey

INTRODUCTION

Adequate time and effective training facilities are essential for undergraduate dental students participating in pre-clinical dental practice to ensure them providing safe treatment for patients in the future. The study aimed to explore the current status of pre-clinical dental training in China in relation to the curriculum setting and students' feedback of pre-clinical training in different dental schools and thus provide information for further standardise curricula.

MATERIALS AND METHOD

An online questionnaire was distributed electronically to undergraduates in 44 Chinese dental schools of different levels according to China Discipline Ranking (CDR). The questionnaire collected information in relation to the training hour and student to facility ratio of four main dental courses (cariology and endodontics, periodontology, prosthodontics and oral surgery), as well as the application and effect of virtual reality (VR) simulator in pre-clinical dental practice in different schools. Students' feedback was also collected.

RESULTS

A total of 565 valid questionnaires were recruited. Results of this cross-sectional survey show that training hour of periodontology course was the lowest, and oral surgery course showed most prominent shortage of facilities. The application of VR simulator amongst schools is uneven. Students from A and A+ level schools showed higher satisfaction with their pre-clinical courses and reported a more positive attitude towards the use of VR simulator than other students. (p < .05).

CONCLUSION

Pre-clinical dental training in China remained imperfect in insufficient training time, training facility and students did not have access to standard pre-clinical training and quality assurance. VR technique has potential values in pre-clinical dental practice in China.

A hemodialysis curriculum for nephrology fellows using a blended learning approach: best of both worlds?

A comprehensive, hands-on hemodialysis curriculum during nephrology training is necessary for effective learning and optimal patient care. Traditional instructive approaches are unable to fully meet the needs of the digitally inclined learner and are limited by time constraints and increasing clinical workload. Internet based learning (E-learning) is becoming increasingly popular in medical education and nephrology and gaining even greater relevance in the COVID era. However, it presents technical challenges and may create an environment of social isolation. A ‘blended learning approach’ combines E-learning with traditional methods of teaching and offers advantages over either approach alone. We have designed and implemented a formalized hemodialysis curriculum at our institution that is based on blended learning, utilizing faculty-created E-learning tools combined with traditional pedagogical methods (bed-side and classroom). The web-based tools discuss hemodialysis adequacy, principles of urea transport, hemodialysis access examination and access complications. These tools are open access and structured around the science of cognitive learning using animation, interactivity, self-assessment and immediate feedback features. They have been viewed by a wide audience of nephrologists, dialysis nurses as well as medicine house-staff and have received strong validation in a post-test survey. The online tools have supported a ‘flipped classroom’ instructive model and our blended curriculum has been successfully used for nephrology fellow training at our institution. Incorporating faculty designed/approved E-learning tools to create a ‘blended’ nephrology curriculum for trainees at various levels of medical education, can help streamline active and time-efficient learning, with the goal of improving learner engagement, knowledge acquisition and academic curiosity in the field.

Simulation Training for Community Emergency Preparedness

Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].

How personality affects teamwork: a study in multidisciplinary obstetrical simulation

BACKGROUND

Multidisciplinary simulation has been shown to improve teamwork in the obstetrical literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members' personality traits on how the team performs during an obstetrical emergency has not been studied in medicine.

OBJECTIVE

Our objective was to evaluate teamwork and communication of simulation participants in association with personality traits within a multidisciplinary obstetrical simulation program.

STUDY DESIGN

This was a prospective observational study of postpartum hemorrhage simulations involving participants from Obstetrics, Nursing, Midwifery, and Anesthesia. Before simulation, individual personality testing was performed on participants using the Big Five Inventory. Each team was scored using the Clinical Teamwork Scale after simulation. Communication and teamwork scores were evaluated for association, and personality traits were analyzed for association with teamwork and communication. For each personality trait, an interaction model was tested for 3 of the team scores: teamwork, communication, and situational awareness. Analysis of variance with 2 level interactions was used in this effort.

RESULTS

From July 2018 to June 2019, 22 obstetrical simulations were performed with a total of 270 staff. Overall, teamwork was significantly associated with communication for each team. When examining individual personality scores, neuroticism was negatively associated with teamwork when coupled with communication. That is, increased neuroticism was significantly associated with increased communication that was detrimental to the overall teamwork. Other personality traits were not significantly associated with teamwork and communication (P=.03).

CONCLUSION

In a multidisciplinary simulation, communication was positively associated with teamwork, and specific personality traits negatively affected team performance.

Attitudes and experience of urology trainees in interpreting prostate magnetic resonance imaging

INTRODUCTION

Multiparametric magnetic resonance imaging (mpMRI) has resulted in accurate prostate cancer localization and image-guided targeted sampling for biopsy. Despite its more recent uptake, knowledge gaps in interpretation and reporting exist. Our objective was to determine the need for an educational intervention among urology residents working with mpMRIs.

METHODS

We administered an anonymous, cross-sectional, self-report questionnaire to a convenience sample of urology residents in U.S. and Canadian training programs. The survey included both open- and closed-ended questions employing a five-point Likert scale. It was designed to assess familiarity, exposure, experience, and comfort with interpretation of mpMRI.

RESULTS

Fifty-three surveys were completed by residents in postgraduate years (PGY) 1-5 and of these, only 12 (23%) reported any formal training in mpMRI interpretation. Most residents' responses demonstrated significant experience with prostate biopsies, as well as familiarity with reviewing mpMRI for these patients. However, mean (± standard deviation [SD]) Likert responses suggested a relatively poor understanding of the components of Prostate Imaging-Reporting and Data System (PI-RADS) v2 scoring for T2-weighted films (2.45±1.01), diffusion-weighted imaging (DWI) films (2.26±0.90), and dynamic contrast-enhanced (DCE) films (2.21±0.99). Similar disagreement scores were observed for questions around interpretation of the different functional techniques of MRI images. Residents reported strong interest (4.21±0.91) in learning opportunities to enhance their ability to interpret mpMRI.

CONCLUSIONS

While mpMRI of the prostate is a tool frequently used by care teams in teaching centers to identify suspicious prostate cancer lesions, there remain knowledge gaps in the ability of trainees to interpret images and understand PI-RADS v2 scoring. Online modules were suggested to balance the needs of trainee education with the residency workflow.

The Utility of Virtual Reality Simulation in Cataract Surgery Training: A Systematic Review

Introduction Cataract surgery is a fundamental intraocular procedure with a steep learning curve. Virtual reality simulation offers opportunity to streamline this aspect of ophthalmic education by exposing trainees to operative techniques in a controlled setting.

Materials and Methods A systematic review of the PubMed database was conducted through December 2019 for English language studies reporting on use of virtual reality simulation in cataract surgery training to assess usefulness. Studies meeting inclusion criteria were examined for pertinent data: study design, number of subjects and live cases, simulator model, training regimen, surgical skills assessed, and overall outcomes.

Results Of the 41 analyzed studies, 15 investigated the impact of virtual reality simulation-based training on performance in live surgery or wet laboratories; 20 used simulation as a device for direct assessment of operative proficiency; 6 explored simulation-based training's effect on performance in simulated surgery. Thirty-seven studies employed an iteration of the Eyesi simulator, though methodologies varied widely with a few randomized trials available. The literature endorsed validity of simulator-based assessment and benefits of structured training on live complication rates, operative times, and self- and faculty-perceived competency, particularly in novice surgeons.

Discussion The literature surrounding simulation in cataract surgery training is characterized by significant heterogeneity in design. However, most works describe advantages that may outweigh the costs of implementation into training curricula. Collaborative efforts at establishing a structured, proficiency-based cataract surgery curriculum built around virtual reality and wet laboratory simulation have the potential to improve outcomes and enhance future surgical training.

Moving From Organ Donation to Knowledge Donation: A Novel Opportunity for Surgical Education Following Organ Donation

The objective of this article is to share how our institution implemented the use of organ donors for surgical education following organ recovery. Despite technological advances, realistic surgical simulation models are lacking, leaving little opportunity to practice a procedure prior to performance on a living patient. Utilization of organ donors following organ donation offers an opportunity for life-like surgical simulation. We developed a pathway to use organ donor tissue in the post-recovery period for robotic simulation. We obtained support from our local Institutional Review Board, Ethics Committee, and organ procurement organization to create a "knowledge donor" program. Our knowledge donation program provided learners hands-on experience with a novel procedure and also provided organ donors another opportunity to express their altruism. We found that the process was well accepted by donor families and learners. We implemented a knowledge donation program at our hospital that provides valuable surgical experience. We discuss future directions for knowledge donation at our institution.

Haptic exploration improves performance of a laparoscopic training task

BACKGROUND

Laparoscopy has reduced tactile and visual feedback compared to open surgery. There is increasing evidence that visual and haptic information converge to form a more robust mental representation of an object. We investigated whether tactile exploration of an object prior to executing a laparoscopic action on it improves performance.

METHODS

A prospective cohort study with 20 medical students randomized in two different groups was conducted. A silicone ileocecal model, on which a laparoscopic action had to be performed, was used inside an outside a ForceSense box trainer. During the pre-test, students either did a combined manual and visual exploration or only visual exploration of the caecum model. To track performance during the trials of the study we used force, motion and time parameters as representatives of technical skills development. The final trial data were used for statistical comparison between groups.

RESULTS

All included time and motion parameters did not show any clear differences between groups. However, the force parameters Mean force non-zero (p = 004), Maximal force (p = 0.01) Maximal impulse (p = 0.02), Force volume (p = 0.02) and SD force (p = 0.01) showed significant lower values in favour of the tactile exploration group for the final trials.

CONCLUSIONS

By adding haptic sensation to the existing visual information during training of laparoscopic tasks on life-like models, tissue manipulation skills improve during training.

Consensus on technical procedures in radiology to include in simulation-based training for residents: a European-wide needs assessment

OBJECTIVES

To identify and prioritize technical procedures for simulation-based training that should be part of the education of residents in radiology.

METHODS

This European-wide needs assessment study used a modified Delphi technique to gather consensus from different key education stakeholders in the field. The first round was a brainstorming phase to identify all procedures that a newly specialized radiologist should potentially be able to do. In the second round, each procedure was explored for the need for simulation training; the participants determined frequency, number of radiologists performing the procedure, impact on patient comfort and safety, and feasibility of simulation. The result of this round was sent back to the participants for final evaluation and prioritization.

RESULTS

Seventy-one key education stakeholders from 27 European countries agreed to participate and were actively involved in the Delphi process: response rates were 72% and 82% in the second and third round, respectively. From 831 suggested procedures in the first round, these were grouped and categorized into 34 procedures that were pre-prioritized in the second round according to the need for simulation-based training. In the third round, 8 procedures were eliminated resulting in final inclusion of 26 procedures. Ultrasound procedures were highly ranked including basic skills such as probe handling; abdominal ultrasound; and ultrasound of kidneys, retroperitoneum, intestines, and scrotum.

CONCLUSION

The prioritized list of procedures represents a consensus document decided upon by educational stakeholders in radiology across Europe. These procedures are suitable for simulation and should be an integral part of the education of radiologists.

KEY POINTS

• The 26 identified procedures are listed according to priority and should be included as an integral part of simulation-based training curricula of radiologists across Europe. • This needs assessment is only the first step towards developing standardized simulation-based training programs that support the harmonization of education and training across Europe.

Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation

BACKGROUND

Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses.

OBJECTIVES

To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions.

METHODS

An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression.

RESULTS

Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, -3.0; 95% CI, -5.3 to -0.8; P = .01).

CONCLUSIONS

Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.

Initial testing of a computer-based simulation training module to support clinicians' acquisition of CBT skills for substance use disorder treatment

Cognitive behavioral therapy (CBT) is one of the most common and effective treatments for substance use disorders (SUD); however, effective delivery of CBT depends on a wide variety of nuanced skills that require practice to master. We created a computer-based simulation training system to support the development of necessary skills for student trainees to be able to apply CBT effectively for clients with SUDs. CBT: Introducing Cognitive Behavioral Therapy is an interactive, role-play simulation that provides opportunities for clinician trainees to hone their skills through repeated practice and real-time feedback before application in a clinical setting. This is the first study that tests whether such a simulation improves trainee skills for the treatment of clients with SUDs. Graduate students (N = 65; social work, clinical psychology) completed standardized patient (SP) interviews, were randomized to the simulation training program or manual comparison condition (Project MATCH manual), and completed SP interviews three months post-baseline. Using general linear models, results indicated a significant time x group effect, with students assigned to the simulation training program showing greater improvement in "extensiveness" and "skillfulness" ratings across three skill categories: general agenda setting (p = .03), explaining CBT concepts (p = .007), and understanding of CBT concepts (p = .001). However, manual comparison participants showed greater improvement than simulation trainees in "assessing primary drug use" (p_range = .013-.024). No changes in extensiveness or skillfulness of motivational interviewing (MI) style were observed. This pilot test of CBT: Introducing Cognitive Behavioral Therapy offers support for use of this novel technology as a potential approach to scale up CBT training for students, and perhaps clinicians, counseling people with SUDs.

Designing authentic simulations in ROSE and EBUS for undergraduate laboratory medicine students

Introduction

Simulation-based education (SBE) has successfully been implemented in several healthcare professions, more so in the fields of medicine and nursing. Laboratory medicine courses prepare medical scientists for employment in pathology laboratories typically via a staged training regime. Laboratory techniques related to the diagnostic disciplines are introduced to students in a graduated fashion over time for the development of professional skills and technical competencies. For students specialising in diagnostic cytology, there are continual changes to the scope of practice of scientists in industry that require advanced training at undergraduate level to meet expectations of contemporary laboratory testing.

Methods

The National Health Education and Training in Simulation (NHET-Sim) framework was applied to create and deliver bespoke simulations for laboratory medicine students. This paper outlines the steps taken, including working with actors and industry partners, to create simulations which contextualise the pressures and team interactions during diagnostic procedures.

Findings

Supported by a range of expertise and personnel, five laboratory medicine simulations were developed and delivered to final year students. Details of the steps taken and range of scenarios are included for sharing and discussion.

Discussion

SBE can contribute positively to student confidence in communication at interdisciplinary and interprofessional levels in ways that can be essential to successful patient management. Understanding that cytology has now evolved to become part of a multidisciplinary approach to patient-centred care will improve the overall patient outcome and experience to personalised medicine.

Conclusion

This paper demonstrates how a high-fidelity SBE scenario can test students’ decision-making around technical, clinical and diagnostic competencies in a complex investigation that they would likely experience in industry.