Training and assessment of trauma management: the role of simulation-based medical education

Evaluation of problem-based learning in dental trauma education: An observational cohort study

BACKGROUND/AIM

Problem-based learning (PBL) allows higher thinking among dental students and has improved first-time pass-rates in predoctoral pediatric dentistry education. The aim of this retrospective observational cohort study was to evaluate the impact of PBL-based, traumatic dental injuries case discussions on predoctoral dental trauma education.

MATERIALS AND METHODS

Student performance and perceptions after receiving dental trauma curriculum with or without PBL-based dental trauma case discussions were evaluated. All the students challenged their simulated patient-based assessments. Three recall-based, objective structured clinical examinations, and critical thinking competencies assessed student knowledge about management of traumatic injuries affecting primary or permanent dentition including avulsion. The scores and number of attempts for each competency were compared between the study cohorts using t-tests. Student's self-perceived learning outcomes were measured through a voluntary, five-question survey. Mantel-Haenszel ordinal Chi-square tests were used to assess for differences in rates of agreement on survey responses from the students. Linear regression was used to assess effect of training on scores adjusting for student type (predoctoral or advanced standing). Pearson's correlations were used to assess association between scores. Significance was set at 0.05.

RESULTS

For the PBL cohort, there was a significant (p > 0.05) improvement in the first-time pass-rates and scores in three out of four competencies. A higher proportion of students in the PBL cohort perceived that their dental trauma education improved their radiographic and diagnostic skills compared to the cohort that did not receive PBL (p > 0.05). There was no correlation between recall-memory versus critical thinking competencies (r < 0.5).

CONCLUSION

The PBL-based dental trauma case discussion had a positive impact on predoctoral student learning and perceived benefits while managing simulated traumatic dental injuries. Due to a lack of correlation between recall-memory and critical thinking assessments, evaluation of predoctoral student's dental trauma competencies should involve multi-model assessment.

Training Anesthesiology Residents to Care for the Traumatically Injured in the United States

Training and education for trauma anesthesiology have been predicated on 2 primary pathways: learning through peripheral "complex, massive transfusion cases"-an assumption that is flawed due to the unique demands, skills, and knowledge of trauma anesthesiology-or learning through experiential education, which is also incomplete due to its unpredictable and variable exposure. Residents may receive training from senior physicians who may not maintain a trauma-focused continuing medical education. Further compounding the issue is the lack of fellowship-trained clinicians and standardized curricula. The American Board of Anesthesiology (ABA) provides a section for trauma education in its Initial Certification in Anesthesiology Content Outline. However, many trauma-related topics also fall under other subspecialties, and the outline excludes "nontechnical" skills. This article focuses on the training of anesthesiology residents and proposes a tier-based approach to teaching the ABA outline by including lectures, simulation, problem-based learning discussions, and case-based discussions that are proctored in conducive environments by knowledgeable facilitators.

Creation and application of war trauma treatment simulation software for first aid on the battlefield based on undeformed high-resolution sectional anatomical image (Chinese Visible Human dataset)

BACKGROUND

Effective first aid on the battlefield is vital to minimize deaths caused by war trauma and improve combat effectiveness. However, it is difficult for junior medical students, which have relatively poor human anatomy knowledge and first aid experience. Therefore, we aim to create a treatment simulation software for war trauma, and to explore its application for first aid training. METHODS : This study is a quantitative post-positivist study using a survey for data collection. First, high-resolution, thin-sectional anatomical images (Chinese Visible Human (CVH) dataset) were used to reconstruct three-dimensional (3D) wound models. Then, the simulation system and the corresponding interactive 3D-PDF, including 3D models, graphic explanation, and teaching videos, were built, and used for first aid training in army medical college. Finally, the interface, war trauma modules, and training effects were evaluated using a five-point Likert scale questionnaire. All measurements are represented as mean and standard deviations. Moreover, free text comments from questionnaires were collected and aggregated.

RESULTS

The simulation software and interactive 3D-PDF were established. This included pressure hemostasis of the vertex, face, head-shoulder, shoulder-arm, upper forearm, lower limb, foot, and punctures of the cricothyroid membrane, pneumothorax, and marrow cavity. Seventy-eight medical students participated in the training and completed the questionnaire, including 66 junior college students and 12 graduate students. The results indicated that they were highly satisfied with the software (score: 4.64 ± 0.56). The systems were user-friendly (score: 4.40 ± 0.61) and easy to operate (score: 4.49 ± 0.68). The 3D models, knowledge of hemostasis, and puncture were accurate (scores: 4.41 ± 0.67, and 4.53 ± 0.69) and easily adopted (scores: 4.54 ± 0.635, and 4.40 ± 0.648). They provided information about hemostasis and puncture (all scores > 4.40), except for cricothyroid membrane puncture (scores: 4.39 ± 0.61), improved the learning enthusiasm of medical students (score: 4.55 ± 0.549), and increased learning interest (score: 4.54 ± 0.57).

CONCLUSION

Our software can effectively help medical students master first aid skills including hemostasis, cricothyroid membrane and bone marrow puncture, and its anatomy. This may also be used for soldiers and national first aid training.

An innovative and safe way to train novice ear nose and throat residents through simulation: the SimORL experience

Medical simulation enables trainees to learn procedural skills in a tailored, non-threatening, controlled environment that can provide feedback and educational experiences. The goals of this study are to describe the set-up and execution of an educational intervention (SimORL) in Ear Nose and Throat (ENT) simulation, to report confidence in performing basic ENT procedures before and after the event and investigate whether participants would find it useful and educationally effective. SimORL was a two-day formative event held at SIMNOVA - Eastern Piedmont Simulation Centre, Italy. The event was open to ENT trainees from any Italian ENT training program; participants were divided into 5 teams and rotated around 10 different simulation stations over two days. Stations included: high-fidelity, skill trainer, computer based, wet lab and dissection. Stations were: virtual otoscopy (OtoSim^®), simulated clinical cases with high-fidelity mannequin (e.g. epistaxis) or standardised patients (e.g. vestibular neuronitis), robotic surgery (Da Vinci^®), human anatomy (zSPACE AIO^®), surgical tracheostomy (wet model), cadaveric sino-nasal endoscopy (wet model), crisis resource management (team exercise), surgical sutures (Limbs&Things SkinPad^®), surgical set station and team building exercises. Participants were asked to complete a pre- and post-test that queried previous experience and confidence using 10-item unanchored semantic scales. Results are presented as median (25-75 percentile). Satisfaction was assessed by a validated 5-item Likert Simulation Experience Scale (SSES). Twenty-three ENT trainees attended SimORL 2018. Only 3 participants reported limited previous simulation experience. Pre-post confidence significantly improved between before and after the event. Overall satisfaction with Simulation Experience Scale (SSES) was very high with a median of 4.5 of 5. Regarding simulation evaluation, the most appreciated station was nasal endoscopy (10/10), while the least appreciated was otoscopy (6/10). SimORL proved to be a highly rated and useful educational tool to improve junior ENT trainees’ confidence in performing basic ENT procedures.

Developing Neuraxial and Regional Pain Procedural Skills Through Innovative 3-Dimensional Printing Technology

Context

Various forms of simulation-based training, including training models, increase training opportunities and help assess performance of a task. However, commercial training models for lumbar puncture and epidural procedures are costly.

Objective

To assess medical students’ and residents’ perception of 3-dimensional (3D)-printed lumbar, cervical, and pelvic models for mastering joint injection techniques and to determine the utility of ultrasonography-guided needle procedure training.

Methods

Osteopathic medical students and residents used in-house 3D-printed gel joint models during an injection ultrasonography laboratory for mastering lumbar epidural, caudal epidural, sacroiliac, and facet joint injection techniques. After the laboratory, they answered a 17-item survey about their perception of the importance of the models in medical education and future practice. The survey also evaluated comfort levels with performing joint injections after using the models, overall satisfaction with the models, and likelihood of using models in the future.

Results

Thirty-six medical students and residents participated. Both students and residents agreed that 3D-printed models were easy to use, aided understanding of corresponding procedures, and increased comfort with performing joint injections (all P<.001). Most participants (35 [97.2%]) believed that the models were reasonable alternatives to commercial models. Over half felt capable of successfully performing cervical or pelvic (22 [61.1%]) and lumbar epidural (23 [63.9%]) injections. The majority of participants (34 [94.4%]) would like to use the models in the future for personal training purposes. Overall, 100% believed that the 3D-printed models were a useful tool for injection training.

Conclusions

Results suggest that 3D-printed models provided realistic training experience for injection procedures and seemed to allow participants to quickly master new injection techniques. These models offer a visual representation of human anatomy and could be a cost-saving alternative to commercial trainers.

Cross-sectional study of the educational background and trauma knowledge of trainees in the "China trauma care training" program

BACKGROUND

Since the trauma knowledge of trauma providers correlates with the outcomes of injured patients, this study aims to assess the socio-demographic characteristics and levels of trauma knowledge of trainees in the China trauma care training (CTCT) program in addition to their post-course test results to provide support for the development of trauma care training programs and trauma systems in China.

METHODS

A cross-sectional study was conducted by collecting demographic information, hospital-related information and trauma knowledge of the trainees from 19 regions in China. All participants were assessed by questionnaires collecting the socio-demographic data, the trauma care knowledge levels and the information of the hospitals.

RESULTS

There were 955 males (78.9%) and 256 females (21.1%) enrolled. Among them, 854 were physicians (70.5%), 357 were registered nurses (29.5%). In addition, 64 of them also played an administrative role in the hospitals (5.3%). The score of the trainees who were members of the emergency department staff (72.59 ± 14.13) was the highest among the scores of all the personnel surveyed, followed by those of the trainees from the intensive care unit (ICU) (71.17 ± 12.72), trauma surgery department (67.26 ± 13.81), orthopedics department (70.36 ± 14.48), general surgery department (69.91 ± 14.79) and other departments (69.93 ± 16.91), P = 0.031. The score of the professors (73.09 ± 15.05) was higher than those of the associate professors (72.40 ± 14.71), lecturers (70.07 ± 14.25) and teaching assistants (67.58 ± 15.16), P < 0.0001. The score of the individuals who attended experts' trauma lectures (72.22 ± 14.45) was higher than that of individuals who did not attend the lectures (69.33 ± 15.17), P = 0.001. The mean scores before and after the training were 71.02 ± 14.82 and 84.24 ± 13.77, respectively, P < 0.001. The mean score of trauma knowledge after the training of trainees from different provinces and with different educational backgrounds was higher than that before the training, with a statistically significant difference (P < 0.05).

CONCLUSIONS

The level of trauma knowledge of trauma care providers was associated with their department, professional position and previous participation in related academic conferences. Trauma care experience and participation in academic lectures and training program including CTCT may effectively improve individuals' level of trauma knowledge.

Third-Year Medical Student Impressions of Resident Teaching in Simulated and Clinical Settings

We sought to determine whether simulation-based medical education using Trauma Evaluation and Management® (TEAM®) training module contributes to a positive impression of resident and faculty teaching. Qualitative and quantitative data regarding medical students’ experience of TEAM® training and their interaction with instructors were collected using anonymous surveys after the completion of the training module. A combination of yes or no responses, as well as classification of student confidence and perceptions on the utility of TEAM® training obtained using Likert-type scales, was evaluated. Qualitative data regarding student perceived strengths and weaknesses of this training and their perception of the quality of teaching were collected and analyzed. Most of the students felt the quality of teaching was better when compared with clinical settings, with 91 per cent of the respondents who provided additional feedback stating that residents were better teachers in the simulated setting. The application of TEAM® training in the surgical clerkship curriculum provides an environment to foster high-quality resident-led education.

Prioritization in medical school simulation curriculum development using survey tools and desirability function: a pilot experiment

BACKGROUND

In Italy, there is no framework of procedural skills that all medical students should be able to perform autonomously at graduation. The study aims at identifying (1) a set of essential procedural skills and (2) which abilities could be potentially taught with simulation. Desirability score was calculated for each procedure to determine the most effective manner to proceed with simulation curriculum development.

METHODS

A web poll was conducted at the School of Medicine in Novara, looking at the level of expected and self-perceived competency for common medical procedures. Three groups were enrolled: (1) faculty, (2) junior doctors in their first years of practice, and (3) recently graduated medical students. Level of importance of procedural skills for independent practice expressed by teachers, level of mastery self-perceived by learners (students and junior doctors) and suitability of simulation training for the given technical skills were measured. Desirability function was used to set priorities for future learning.

RESULTS

The overall mean expected level of competency for the procedural skills was 7.9/9. Mean level of self reported competency was 4.7/9 for junior doctors and 4.4/9 for recently graduated students. The highest priority skills according to the desirability function were urinary catheter placement, nasogastric tube insertion, and incision and drainage of superficial abscesses.

CONCLUSIONS

This study identifies those technical competencies thought by faculty to be important and assessed the junior doctors and recent graduates level of self-perceived confidence in performing these skills. The study also identifies the perceived utility of teaching these skills by simulation. The study prioritizes those skills that have a gap between expected and observed competency and are also thought to be amenable to teaching by simulation. This allows immediate priorities for simulation curriculum development in the most effective manner. This methodology may be useful to researchers in other centers to prioritize simulation training.

Anesthesiology Resident Induction Month: a pilot study showing an effective and safe way to train novice residents through simulation

BACKGROUND

The transition of new residents from medical school to the post-graduate clinical environment remains challenging. We hypothesized that an introductory simulation course could improve new residents' performance in anesthesiology.

METHODS

The Anesthesiology Residents Induction Month (ARIM) program was designed as a non-clinical simulation training program aiming at providing the theoretical and practical skills to safely approach, as junior anesthesiologists, the operating rooms. For each participant, specific knowledge, procedural skills and non-technical performance were assessed with a pre and post-test approach, before and immediately after the participation in the study.

RESULTS

Fifteen first-month residents participated in the study. As compared to pre-test, residents significantly improved in all three evaluated areas. Pre-test knowledge assessment mean improved from 56% to 73% in the post-test (P<0.001). In the procedural skills assessment, pre-test mean improved from 43% to 77% (P<0.001) and non-technical skills assessment improved from 3.17 to 4.61 (in a scale out of seven points) in the post-test (P<0.001).

CONCLUSIONS

Data suggest that an intensive simulation-based program can be an effective way for first-year residents to rapidly acquire and develop basic skills specific to anesthesiology. There might be benefits to begin residency with a training program aiming at developing and standardizing technical and non-technical skills.

Mobile in Situ Simulation as a Tool for Evaluation and Improvement of Trauma Treatment in the Emergency Department

BACKGROUND

Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully.

METHODS

The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention.

RESULTS

The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005).

CONCLUSION

The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment.

Efficacy of simulation-based trauma team training of non-technical skills. A systematic review

Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulation-based trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome.

Patientensicherheit in der Endoskopie: Prävention und Management von kritischen Ereignissen bei der Sedierung

<b><i>Hintergrund: </i></b>Die Verbesserung der Patientensicherheit in der Endoskopie ist nicht einfach und nicht von heute auf morgen zu realisieren. Der größte Anteil an schwerwiegenden Zwischenfällen bei der Endoskopie ist auf die Sedierung zurückzuführen. <b><i>Methode: </i></b>Anwendung der Inhalte der S3-Leitlinie sowie aktueller Kenntnisse zur Erhöhung der Patientensicherheit. <b><i>Ergebnisse: </i></b>Es ist selbstverständlich, dass die gemäß der aktuellen S3-Leitlinie geforderten Personal-, Struktur- und Prozessvoraussetzungen bei einer Sedierung in der Endoskopie auch bei Personalknappheit kompromisslos eingehalten werden. Risikopatienten müssen zuverlässig identifiziert und dann von entsprechend (intensivmedizinisch) erfahrenem Personal während endoskopischer Eingriffe betreut werden. Dennoch gilt: Fehler sind in komplexen Systemen zu erwarten und insofern «normal». Aber wir müssen aus Fehlern lernen. Hierfür bieten moderne softwarebasierte «Critical Incident Reporting»-Systeme (CIRS) gute Voraussetzungen. 70% der medizinischen Fehler beruhen nicht auf mangelndem Fachwissen, sondern auf Problemen im Bereich der Human Factors (HFs). Crisis Resource Management (CRM) ist ein effektives Tool gegen HF-bedingte Fehler und sollte in Zukunft von allen beherrscht werden. <b><i>Schlussfolgerungen: </i></b>Der aktuelle Goldstandard für HF/CRM-Training ist der Einsatz von realitätsnahen und modernen Simulationsteamtrainings, die von speziell geschulten Instruktoren durchgeführt werden. Um die Patientensicherheit nachhaltig zu erhöhen, sind die Autoren der Auffassung, dass Simulationstrainings zu Sedierungen und Zwischenfällen in der Endoskopie mindestens zweimal pro Jahr für jeden medizinischen Mitarbeiter bei Sedierungen in der Endoskopie durchgeführt werden sollten.

Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students

OBJECTIVES

To examine the effectiveness of an asynchronous learning tool consisting of web-based lectures for trainees covering major topics pertinent to pediatric emergency medicine (PEM) and to assess resident and student evaluation of this mode of education.

METHODS

PEM faculty and fellows created a 21-lecture, web-based curriculum. These 20-minute online lectures used Microsoft PowerPoint with the voice-over feature. A 75-question test was created to assess the effectiveness of the web-based learning model, administered online before and after the rotation in the pediatric emergency department (PED). All fourth-year medical students and residents (across all specialties) rotating through the PED were required to complete 10 of the 21 lectures during their 1-month rotation. The main outcome variable was difference in score between pre- and post-rotation tests of participants who viewed no lectures and those who viewed at least one lecture. Evaluation of the program was assessed by anonymous survey using 5-point discrete visual analog scales. Responses of 4 or 5 were considered positive for analysis.

RESULTS

One hundred eleven residents and fourth-year medical students participated in the program. An initial 32 completed testing before implementation of the on-line lectures (March 2007-August 2007), and another five did not complete the on-line lectures after implementation (September 2007-February 2008). Seventy-one completed testing and on-line lectures, and all but three completed at least 10 on-line lectures during their rotation. Fourteen of 111 trainees did not complete the pre- or post-test (including two who viewed the lectures). The mean change in score was a 1% improvement from pre-test to post-test for trainees who viewed no lectures and a 6.2% improvement for those who viewed the lectures (mean difference = 5.2%, 95% confidence interval = 2.5% to 7.9%). In the linear regression model, the estimate of the coefficient was 0.43 (p < 0.001), meaning that, for each lecture viewed, post-test score rose by 0.43%. Sixty-nine of 75 test items (92%) had a point biserial correlation greater than 0.15. Thirty of the 72 trainees who completed the online lectures and testing (42%) returned surveys. All were comfortable using the Internet, and 87% (26/30) found the web-site easy to use. All felt that their educational goals were met, and 100% felt that the format would be useful in other areas of education.

CONCLUSIONS

Although not a replacement for traditional bedside teaching, the use of web-based lectures as an asynchronous learning tool has a positive effect on medical knowledge test scores. Trainees were able to view online lectures on their own schedules, in the location of their choice. This is helpful in a field with shift work, in which trainees rarely work together, making it difficult to synchronously provide lectures to all trainees.

Simulation as a tool to improve the safety of pre-hospital anaesthesia--a pilot study

We conducted a pilot study of the effects of simulation as a tool for teaching doctor-paramedic teams to deliver pre-hospital anaesthesia safely. Participants undertook a course including 43 full immersion, high-fidelity simulations. Twenty videos taken from day 4 and days 9/10 of the course were reviewed by a panel of experienced pre-hospital practitioners. Participants' performance at the beginning and the end of the course was compared. The total time from arrival to inflation of the tracheal tube cuff was longer on days 9/10 than on day 4 (mean (SD) 14 min 52 s (2 min 6 s) vs 11 min 28 s (1 min 54 s), respectively; p = 0.005), while the number of safety critical events per simulation were fewer (median (IQR [range]) 1.0 (0-1.8 [0-2]) vs 3.5 (1.5-4.8 [0-8], respectively; p = 0.011). Crew resource management behaviours also improved in later simulations. On a personal training needs analysis, participants reported increased confidence after the course.

Hybrid simulation combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills

OBJECTIVES

In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills.

METHODS

A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings.

RESULTS

Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (Delta VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (Delta VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (Delta VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (Delta VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053).

CONCLUSIONS

Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents.

Current concepts in simulation-based trauma education

The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. The integration of simulators into medical student curriculum, residency training, and continuing medical education has been strongly recommended by the American College of Surgeons as an innovative means of enhancing patient safety, reducing medical errors, and performing a systematic evaluation of various competencies. Advanced human patient simulators are increasingly being used in trauma as an evaluation tool to assess clinical performance and to teach and reinforce essential knowledge, skills, and abilities. A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.

Simulation in a disaster drill: comparison of high-fidelity simulators versus trained actors

OBJECTIVES

High-fidelity patient simulation provides lifelike medical scenarios with real-time stressors. Mass casualty drills must construct a realistic incident in which providers care for multiple injured patients while simultaneously coping with numerous stressors designed to tax an institution's resources. This study compared the value of high-fidelity simulated patients with live actor-patients.

METHODS

A prospective cohort study was conducted during two mass casualty drills in December 2006 and March 2007. The providers' completion of critical actions was tested in live actor-patients and simulators. A posttest survey compared the participants' perception of "reality" between the simulators and live actor victims.

RESULTS

The victims (n = 130) of the mass casualty drill all had burn-, blast-, or inhalation-related injuries. The participants consisted of physicians, residents, medical students, clerks, and paramedics. The authors compared the team's execution of the 136 critical actions (17 critical actions x 8 scenarios) between the simulators and the live actor-patients. Only one critical action was missed in the simulator group and one in the live actor group, resulting in a miss rate of 0.74% (95% confidence interval [CI] = 0.01% to 4.5%). All questionnaires were returned and analyzed. The vast majority of participants disagreed or strongly disagreed that the simulators were a distraction from the disaster drill. More than 96% agreed or strongly agreed that they would recommend the simulator as a training tool. The mean survey scores for all participants demonstrated agreement that the simulators closely mimicked real-life scenarios, accurately represented disease states, and heightened the realism of patient assessment and treatment options during the drill with the exception of nurse participants, who agreed slightly less strongly.

CONCLUSIONS

This study demonstrated that simulators compared to live actor-patients have equivalent results in prompting critical actions in mass casualty drills and increase the perceived reality of such exercises.

Summative assessment in medicine: the promise of simulation for high-stakes evaluation

Throughout their careers, physicians are exposed to a wide array of assessments, including those aimed at evaluating knowledge, clinical skills, and clinical decision-making. While many of these assessments are used as part of formative evaluation activities, others are employed to establish competence and, as a byproduct, to promote patient safety. In the past 10 years, simulations have been successfully incorporated in a number of high-stakes physician certification and licensure exams. In developing these simulation-based assessments, testing organizations were able to promote novel test administration protocols, build enhanced assessment rubrics, advance sophisticated scoring and equating algorithms, and promote innovative standard-setting methods. Moreover, numerous studies have been conducted to identify potential threats to the validity of test score interpretations. As simulation technology expands and new simulators are invented, this groundbreaking work can serve as a basis for organizations to build or expand their summative assessment activities. Although there will continue to be logistical and psychometric problems, many of which will be specialty- or simulator-specific, past experience with performance-based assessments suggests that most challenges can be addressed through focused research. Simulation, whether it involves standardized patients (SPs), computerized case management scenarios, part-task trainers, electromechanical mannequins, or a combination of these methods, holds great promise for high-stakes assessment.