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Baxendale B, Evans K, Cowley A, Bramley L, Miles G, Ross A, Dring E, Cooper J. GENESISS 1-Generating Standards for In-Situ Simulation project: a scoping review and conceptual model. BMC MEDICAL EDUCATION 2022; 22:479. [PMID: 35725432 PMCID: PMC9208746 DOI: 10.1186/s12909-022-03490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/23/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance. METHODS A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback. RESULTS Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings. CONCLUSIONS ISS presents a promising approach to improve individual and team capabilities and system performance and address the 'practice-theory gap'. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.
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Affiliation(s)
- Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Kerry Evans
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS Trust, Research and Innovation, Nottingham, UK
| | - Louise Bramley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Guilia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Eleanore Dring
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne Cooper
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Hammontree J, Kinderknecht CG. An In Situ Mock Code Program in the Pediatric Intensive Care Unit: A Multimodal Nurse-Led Quality Improvement Initiative. Crit Care Nurse 2022; 42:42-55. [PMID: 35362083 DOI: 10.4037/ccn2022631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lifesaving resuscitation is required for approximately 1 in 100 patients in the pediatric intensive care unit. Certification renewal alone is insufficient to guarantee adequate knowledge, skills, and confidence among staff members involved in infrequent resuscitation events. LOCAL PROBLEM Knowledge and skill gaps were identified in pediatric intensive care unit staff members involved in patient resuscitation events. The primary aim of this quality improvement project was to optimize patient resuscitations through improved staff performance and coordination between interdisciplinary roles. METHODS A multidisciplinary committee was created to develop, implement, and evaluate a mock code program. Surveys were administered before and after the intervention to assess self-perceived resuscitation performance and program effectiveness. Code sheets were analyzed for documentation quality and adherence to pediatric advanced life support guidelines. The committee used a multimodal approach to education, including high-and low-fidelity in situ mock code simulations and supplemental educational events. RESULTS From September 2018 through January 2020, the committee conducted 65 events for almost 500 participants. Nurses' levels of self-reported confidence in initiating pediatric advanced life support interventions and identifying cardiac rhythms increased, as did perceived level of competence and knowledge. Most unit staff members considered the mock code program to be "very to extremely effective" in increasing resuscitation competence, confidence, communication, teamwork, and role clarity. Adherence to recommended resuscitation behaviors improved, as did code sheet documentation quality. CONCLUSION An in situ mock code program using a multimodal approach to education can be a successful educational adjunct to biennial pediatric advanced life support certification.
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Affiliation(s)
- Jennifer Hammontree
- Jennifer Hammontree is a clinical registered nurse and co-chair of the PICU Mock Code Committee, Cook Children's Medical Center, Fort Worth, Texas
| | - Catherine Glenn Kinderknecht
- Catherine Glenn Kinderknecht is a nurse practitioner in the pediatric intensive care unit and manager of advanced practice providers, Cook Children's Medical Center
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Thim S, Henriksen TB, Laursen H, Schram AL, Paltved C, Lindhard MS. Simulation-Based Emergency Team Training in Pediatrics: A Systematic Review. Pediatrics 2022; 149:185292. [PMID: 35237809 DOI: 10.1542/peds.2021-054305] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The rare event of handling critically ill children often challenge the emergency care team. Several studies have investigated effects of simulation-based team training to prepare for such events, but the body of evidence remains to be compiled. We performed a systematic review of the effects of simulation-based team training on clinical performance and patient outcome. METHODS From a search of MEDLINE, Embase, CINAHL, and Cochrane Library, we included studies of team training in emergency pediatric settings with reported clinical performance and patient outcomes. We extracted data using a predefined template and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials 2.0 and the Newcastle Ottawa Quality Assessment Scale. RESULTS We screened 1926 abstracts and included 79 studies. We identified 15 studies reporting clinical health care professional performance or patient outcomes. Four studies reported survival data, 5 reported time-critical clinical events, 5 reported adherence to guidelines, checklists or tasks, and 2 reported on airway management. Randomized studies revealed improved team performance in simulated reevaluations 2 to 6 months after intervention. A meta-analysis was impossible because of heterogeneous interventions and outcomes. Most included studies had significant methodological limitations. CONCLUSIONS Pediatric simulation-based team training improves clinical performance in time-critical tasks and adherence to guidelines. Improved survival was indicated but not concluded because of high risk of bias. Team performance and technical skills improved for at least 2 to 6 months. Future research should include longer-term measures of skill retention and patient outcomes or clinical measures of treatment quality whenever possible.
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Affiliation(s)
- Signe Thim
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Laursen
- Medical Library, Regional Hospital Central Jutland, Viborg, Denmark
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Sowan A, Heins J, Dayton C, Scherer E, Tam WS, Saikumar H. Developing and Testing a Protocol for Managing Cardiopulmonary Resuscitation of Patients with Suspected or Confirmed COVID-19: An In-Situ Simulation Study (Preprint). JMIR Nurs 2022; 5:e38044. [PMID: 35675629 PMCID: PMC9205423 DOI: 10.2196/38044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Resuscitating patients with suspected or confirmed COVID-19 imposes unique challenges to organizations and code blue teams. Studies that applied the American Heart Association (AHA) COVID-19–related Interim Resuscitation Guideline and similar European guidelines are scarce. Objective This study aimed to develop and test a cardiopulmonary resuscitation protocol based on the AHA COVID-19–related Interim Resuscitation Guideline. Methods The study was conducted as an in situ simulation in a medical intensive care unit. The COVID-19 cardiopulmonary resuscitation protocol was created and validated by 11 health care team members and tested using 4 simulation sessions where 46 code blue team members participated. During the simulation, we observed role clarity, the effectiveness of communication, team dynamics, infection control measures, and the availability of essential supplies and equipment. Results The main issues identified in each simulation session were debriefed to the code blue teams and used to further revise the protocol. These include the assignment of tasks, availability of equipment and supplies, and failure of communication between the in-room and out-of-room teams. Solutions included changes in the placement of team members and roles and responsibilities; the creation of an isolation code medication package, a respiratory therapy kit, and an isolation code blue bag; and the use of two-way radios and N-95 masks with eye goggles to enhance communication between the teams. Conclusions This study shed light on the challenges to implement the AHA COVID-19–related Interim Resuscitation Guideline. The in situ simulation was an effective approach for rapid training, identifying unreliable equipment and ineffective and inefficient workflow, and managing the complexity of the physical environment.
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Affiliation(s)
- Azizeh Sowan
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Jenny Heins
- Center for Clinical Excellence, University Health, San Antonio, TX, United States
| | - Christopher Dayton
- Division of Pulmonary and Critical Care Medicine, Department of Emergency Medicine, The University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Elizabeth Scherer
- Division of Trauma and Emergency Surgery, Department of Surgery, The University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Wing Sun Tam
- Emergency Department, Audie L Murphy Veterans Affairs Medical Center, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Haritha Saikumar
- Pulmonary and Critical Care, The University of Texas at Austin Dell Medical School, Austin, TX, United States
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Abstract
Plan-Do-Study-Act (PDSA) cycles are nearly universal within various quality improvement (QI) methodologies as a way of testing change prior to implementation. Simulation in health care has traditionally been used to improve teaching, enhance learning, and assess performance; however, it can also be powerful when used in the realm of QI work. Simulation is incredibly versatile and can be incorporated into the different phases of a PDSA cycle. Investigators often encounter situations in which a test of change in the real clinical environment may not be ideal; however, simulation is not considered because many practitioners are not familiar with its use. This article reviews the basics of PDSA cycles and provides examples of how simulation can be used for testing in each phase. Included are clear indications to help practitioners decide when simulation is appropriate to use and how to apply it to a variety of different QI projects. [Pediatr Ann. 2021;50(1):e25-e31.].
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Bican R, Heathcock JC, Jedryszek F, Debarge V, DeJonckheere J, Cybalski MC, Hanssens S. Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:323-328. [DOI: 10.1136/bmjstel-2020-000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022]
Abstract
IntroductionPostpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.MethodsN=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.ResultsMidwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).ConclusionsPhysical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.
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Dias ADO, Bernardes A, Chaves LDP, Sonobe HM, Grion CMC, Haddad MDCFL. Critical incidents as perceived by rapid response teams in emergency services. Rev Esc Enferm USP 2020; 54:e03595. [PMID: 32813801 DOI: 10.1590/s1980-220x2018027903595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/10/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze two hospital emergency services, one in a public institution and another in a philanthropic one, from the perspective of rapid response team professionals in the face of positive and negative critical incidents. METHOD Descriptive, exploratory, qualitative study carried with 62 health professionals. Critical Incident Technique was employed as the theoretical-methodological framework, along with Content Analysis for analyzing data. RESULTS Sixty-two health professionals - including 23 nurses, 20 physiotherapists and 19 doctors - took part in this study. Clusters for 89 critical incidents were obtained; 66 of them were considered positive, whereas 23 were negative. The situations associated to the provided services were discriminated in three categories: recognition of patient clinical deterioration; rapid response team activation in the unit; and time until rapid response team arrival at the ward. CONCLUSION In spite of the difficulties faced by such professionals while providing care to patients who become severely ill in non-critical wards, positive reports were predominant in all categories, what legitimized this service's importance as a contribution to quality and safety of hospitalized patients.
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Affiliation(s)
- Alexsandro de Oliveira Dias
- Programa de Pós-Graduação em Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Andrea Bernardes
- Programa de Pós-Graduação em Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Lucieli Dias Pedreschi Chaves
- Programa de Pós-Graduação em Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Helena Megumi Sonobe
- Programa de Pós-Graduação em Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Dharamsi A, Hayman K, Yi S, Chow R, Yee C, Gaylord E, Tawadrous D, Chartier LB, Landes M. Enhancing departmental preparedness for COVID-19 using rapid-cycle in-situ simulation. J Hosp Infect 2020; 105:604-607. [PMID: 32540462 PMCID: PMC7292952 DOI: 10.1016/j.jhin.2020.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/10/2020] [Indexed: 01/25/2023]
Abstract
In response to coronavirus disease 2019 (COVID-19), a rapid-cycle in-situ simulation (ISS) programme was developed to facilitate identification and resolution of systems-based latent safety threats. The simulation involved a possible COVID-19 case in respiratory failure, using a mannequin modified to aerosolize phosphorescent secretions. Thirty-six individuals participated in five ISS sessions over 6 weeks, and a further 20 individuals observed these sessions. Debriefing identified latent safety threats from four domains: personnel, personal protective equipment, supply/environment and communication. These threats were addressed and resolved in later iterations. Ninety-four percent of participants felt more prepared to care for a potential case of COVID-19 after the ISS.
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Affiliation(s)
- A Dharamsi
- Emergency Department, University Health Network, Toronto, Canada; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada.
| | - K Hayman
- Emergency Department, University Health Network, Toronto, Canada; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | - S Yi
- Emergency Department, University Health Network, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - R Chow
- The Michener Institute of Education at University Health Network, Toronto, Canada
| | - C Yee
- Emergency Department, University Health Network, Toronto, Canada
| | - E Gaylord
- Emergency Department, University Health Network, Toronto, Canada
| | - D Tawadrous
- Emergency Department, University Health Network, Toronto, Canada; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | - L B Chartier
- Emergency Department, University Health Network, Toronto, Canada; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Canada
| | - M Landes
- Emergency Department, University Health Network, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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Using Standardized Checklists Increase the Completion Rate of Critical Actions in an Evacuation from the Operating Room: A Randomized Controlled Simulation Study. Prehosp Disaster Med 2020; 34:393-400. [PMID: 31389323 DOI: 10.1017/s1049023x19004576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Hospital evacuations of patients with special needs are extremely challenging, and it is difficult to train hospital workers for this rare event.Hypothesis/Problem:Researchers developed an in-situ simulation study investigating the effect of standardized checklists on the evacuation of a patient under general anesthesia from the operating room (OR) and hypothesized that checklists would improve the completion rate of critical actions and decrease evacuation time. METHODS A vertical evacuation of the high-fidelity manikin (SimMan3G; Laerdal Inc.; Norway) was performed and participants were asked to lead the team and evacuate the manikin to the ground floor after a mock fire alarm. Participants were randomized to two groups: one was given an evacuation checklist (checklist group [CG]) and the other was not (non-checklist group [NCG]). A total of 19 scenarios were run with 28 participants. RESULTS Mean scenario time, preparation phase of evacuation, and time to transport the manikin down the stairs did not differ significantly between groups (P = .369, .462, and .935, respectively). The CG group showed significantly better performance of critical actions, including securing the airway, taking additional drug supplies, and taking additional equipment supplies (P = .047, .001, and .001, respectively). In the post-evacuation surveys, 27 out of 28 participants agreed that checklists would improve the evacuation process in a real event. CONCLUSION Standardized checklists increase the completion rate of pre-defined critical actions in evacuations out of the OR, which likely improves patient safety. Checklist use did not have a significant effect on total evacuation time.
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Goldshtein D, Krensky C, Doshi S, Perelman VS. In situ simulation and its effects on patient outcomes: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 6:3-9. [DOI: 10.1136/bmjstel-2018-000387] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/28/2019] [Accepted: 03/09/2019] [Indexed: 12/12/2022]
Abstract
BackgroundThe use of in situ simulation has previously been shown to increase confidence, teamwork and practical skills of trained professionals. However, a direct benefit to patient outcomes has not been sufficiently explored. This review focuses on the effect of in situ simulation training in a hospital setting on morbidity or mortality.MethodsA combined search was conducted in PUBMED, OVID, WEB OF SCIENCE, CINAHL, SCOPUS and EMBASE. 478 studies were screened with nine articles published between 2011 and 2017 meeting the inclusion criteria for analysis.ResultsThis review selected eight prospective studies and one prospective-retrospective study. Three studies isolated in situ simulation as an experimental variable while the remaining studies implemented in situ programmes as a component of larger quality improvement initiatives. Seven studies demonstrated a significant improvement in morbidity and/or mortality outcomes following integrated in situ simulation training.ConclusionExisting literature, albeit limited, demonstrates that in situ training improves patient outcomes either in isolation or within a larger quality improvement programme. However, existing evidence contains difficulties such as isolating the impact of in situ training from various potential confounding factors and potential for publication bias.
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Barlow M, Dickie R, Morse C, Bonney D, Simon R. Documentation framework for healthcare simulation quality improvement activities. Adv Simul (Lond) 2017; 2:19. [PMID: 29450020 PMCID: PMC5806278 DOI: 10.1186/s41077-017-0053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Robyn Dickie
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Catherine Morse
- Center for Medical Simulation, Queenslane, Brisbane, Australia
| | - Donna Bonney
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Robert Simon
- Center for Medical Simulation, Queenslane, Brisbane, Australia
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