2007 Simulation Education Summit

A conceptual framework for simulation in healthcare education - The need

This study used a social constructivist approach to explore the literature in relation to the acknowledgment and application of models and frameworks in simulation based learning and teaching activities in health care education. This paper addresses the data collection phases in the research design in developing a Conceptual Framework for Simulation in Healthcare Education.

BACKGROUND

Two literature review activities occurred in the study. The first literature review explored the challenges in the literature for further research in relation to the educational factors that have an impact upon simulation as a learning and teaching modality. This part of the research process was to identify the publications that address simulation as a learning and teaching modality and uncover evidence to justify the study. The literature revealed that there were limited publications in relation to simulation as a learning and teaching modality that was underpinned by a conceptual framework.

DESIGN

The study research design employed Evaluation Research to conduct a further intensive review of the literature as part of phase one of data collection. The second part of phase one of data collection was the surveying of randomly selected simulation education centres around the world to ascertain their employment of a conceptual framework in the application of simulation as a learning and teaching modality. Phase two was the genesis of the conceptual framework and Phase three was the evaluation of the draft framework using a modified Delphi Technique by randomly selected simulation experts.

RESULTS

The intensive literature review highlighted that authors acknowledged education-based theories but this did not extend to the application of a conceptual framework to simulation as a learning and teaching modality. The survey provided the evidence to support the development of a Conceptual Framework for Simulation in Healthcare Education for the conceptualisation, design, development and delivery of simulation teaching and learning activities in health care education. The simulation experts provided valuable data and commentary in the final formation of the conceptual framework.

CONCLUSION

Based on the outcomes of the literature review, questionnaire and modified Delphi Technique the need for the development, and subsequent structure and utility of the Conceptual Framework for Simulation in Healthcare Education was verified.

Use of a Portable Functional Near-Infrared Spectroscopy (fNIRS) System to Examine Team Experience During Crisis Event Management in Clinical Simulations

Objective: The aim of this study was to investigate the utilization of a portable functional near-infrared spectroscopy (fNIRS) system, the fNIRS Pioneer^TM, to examine team experience in high-fidelity simulation-based crisis event management (CEM) training for anesthesiologists in operating rooms.

Background: Effective evaluation of team performance and experience in CEM simulations is essential for healthcare training and research. Neurophysiological measures with wearable devices can provide useful indicators of team experience to compliment traditional self-report, observer ratings, and behavioral performance measures. fNIRS measured brain blood oxygenation levels and neural synchrony can be used as indicators of workload and team engagement, which is vital for optimal team performance.

Methods: Thirty-three anesthesiologists, who were attending CEM training in two-person teams, participated in this study. The participants varied in their expertise level and the simulation scenarios varied in difficulty level. The oxygenated and de-oxygenated hemoglobin (HbO and HbR) levels in the participants’ prefrontal cortex were derived from data recorded by a portable one-channel fNIRS system worn by all participants throughout CEM training. Team neural synchrony was measured by HbO/HbR wavelet transformation coherence (WTC). Observer-rated workload and self-reported workload and mood were also collected.

Results: At the individual level, the pattern of HbR level corresponded to changes of workload for the individuals in different roles during different phases of a scenario; but this was not the case for HbO level. Thus, HbR level may be a better indicator for individual workload in the studied setting. However, HbR level was insensitive to differences in scenario difficulty and did not correlate with observer-rated or self-reported workload. At the team level, high levels of HbO and HbR WTC were observed during active teamwork. Furthermore, HbO WTC was sensitive to levels of scenario difficulty.

Conclusion: This study showed that it was feasible to use a portable fNIRS system to study workload and team engagement in high-fidelity clinical simulations. However, more work is needed to establish the sensitivity, reliability, and validity of fNIRS measures as indicators of team experience.

International overview of high-level simulation education initiatives in relation to critical care

The use of simulation in health care education has become very topical across all professions and specialties in order to improve patient safety and quality of care. In the last decade, the adoption of more realistic simulation-based teaching methodologies, which serves as a bridge between the acquisition and application of clinical skills, knowledge, and attributes, has been accompanied by the development of a multitude of international and national simulation societies. These serve as important exchange fora for educators, clinicians, researchers, and engineers who desire to learn and share their experience and knowledge around simulation-based education. Several countries have derived their own strategy in order to promote the use of such training methodology. Current key national strategies will be presented in this paper alongside a discussion of their expected impact. Various approaches have been adopted and each has their own place and the potential to be adopted by other nations depending on their political, economic or even geographic context. Within the critical care arena, simulation has generated considerable interest and there is a growing evidence base for its use as a learning and teaching strategy within this environment. A number of critical care-related associations and societies are now recognizing simulation as an appropriate pedagogical approach and acknowledging its potential to improve patient care and clinical outcomes. Its implementation should be carefully considered to ensure that developments are based on current best educational practice to maximize the efficiency of these educational interventions.