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Srivastava A, Gibson M, Patel A. Low-Fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies. Arthroscopy 2022; 38:190-199.e1. [PMID: 34126219 DOI: 10.1016/j.arthro.2021.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify and appraise evidence assessing the effectiveness of low-fidelity arthroscopic simulation in the acquisition of arthroscopic surgical skills in a novice population. METHODS Four databases were electronically searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies, and review studies were excluded. Risk of bias assessment was conducted using the Cochrane Collaboration's Risk of Bias Tool or the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) checklist. RESULTS Sixteen studies were identified. Using the PRISMA algorithm, 6 studies were included with a total of 131 novice participants. Individual studies ranged from 8 to 40 novices and were of Level I to II evidence. Outcome measurements varied between studies (total 16 different outcomes used). Various outcome measures used for assessing arthroscopic surgical skills within all 6 studies demonstrated significant improvement. A cross-study subjective outcome synthesis revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (2 studies, P < .05), increased Arthroscopic Surgical Skill Evaluation Tool scores (2 studies, P < .01), and confirmed face validity (2 studies) and transfer of skills to cadavers (2 studies) or live patients (1 study). Cost data were under-reported in all studies apart from one. CONCLUSIONS Arthroscopic training using low-fidelity simulators likely improves the performance of novice participants in completing basic arthroscopic procedures. These simulators may also be more cost effective and thus more implementable than their high-fidelity counterparts. LEVEL OF EVIDENCE Level II, systematic review of Level I-II studies.
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Affiliation(s)
| | - Marc Gibson
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Akash Patel
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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2
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Tsuda S, Olasky J, Jones DB. Team training and surgical crisis management. J Surg Oncol 2021; 124:216-220. [PMID: 34245574 DOI: 10.1002/jso.26523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/11/2022]
Abstract
Team training and crisis management derive their roots from fundamental learning theory and the culture of safety that burgeoned forth from the industrial revolution through the rise of nuclear energy and aviation. The integral nature of telemedicine to many simulation-based activities, whether to bridge distances out of convenience or necessity, continues to be a common theme moving into the next era of surgical safety as newer, more robust technologies become available.
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Affiliation(s)
- Shawn Tsuda
- Valley Health System General Surgery Residency, Las Vegas, Nevada, USA
| | - Jaisa Olasky
- Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Daniel B Jones
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Seifert LB, Schnurr B, Herrera-Vizcaino C, Begic A, Thieringer F, Schwarz F, Sader R. 3D-printed patient individualised models vs cadaveric models in an undergraduate oral and maxillofacial surgery curriculum: Comparison of student's perceptions. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:799-806. [PMID: 32133720 DOI: 10.1111/eje.12522] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Recent advances in 3D printing technology have enabled the emergence of new educational and clinical tools for medical professionals. This study provides an exemplary description of the fabrication of 3D-printed individualised patient models and assesses their educational value compared to cadaveric models in oral and maxillofacial surgery. METHODS A single-stage, controlled cohort study was conducted within the context of a curricular course. A patient's CT scan was segmented into a stereolithographic model and then printed using a fused filament 3D printer. These individualised patient models were implemented and compared against cadaveric models in a curricular oral surgery hands-on course. Students evaluated both models using a validated questionnaire. Additionally, a cost analysis for both models was carried out. P-values were calculated using the Mann-Whitney U test. RESULTS Thirty-eight fourth-year dental students participated in the study. Overall, significant differences between the two models were found in the student assessment. Whilst the cadaveric models achieved better results in the haptic feedback of the soft tissue, the 3D-printed individualised patient models were regarded significantly more realistic with regard to the anatomical correctness, the degree of freedom of movement and the operative simulation. At 3.46 € (compared to 6.51 €), the 3D-printed patient individualised models were exceptionally cost-efficient. CONCLUSIONS 3D-printed patient individualised models presented a realistic alternative to cadaveric models in the undergraduate training of operational skills in oral and maxillofacial surgery. Whilst the 3D-printed individualised patient models received positive feedback from students, some aspects of the model leave room for improvement.
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Affiliation(s)
- Lukas B Seifert
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Benedikt Schnurr
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Carlos Herrera-Vizcaino
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Amira Begic
- Polyclinic for Dental Surgery and Implantology, Carolinum Dentistry University Institute gGmbH of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Florian Thieringer
- Department of Oral, Cranio-Maxillofacial Surgery, University Hospital, Basel University, Basel, Switzerland
| | - Frank Schwarz
- Polyclinic for Dental Surgery and Implantology, Carolinum Dentistry University Institute gGmbH of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Using Cognitive Task Analysis to train Orthopaedic Surgeons - Is it time to think differently? A systematic review. Ann Med Surg (Lond) 2020; 59:131-137. [PMID: 32994993 PMCID: PMC7511220 DOI: 10.1016/j.amsu.2020.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Working time restraints; senior led care; and a reduction in 'out of hours' operating has resulted in less operating time for orthopaedic trainees in the United Kingdom. Therefore, there has been an attempt to overcome these challenges by implementing novel techniques. Cognitive Task Analysis (CTA) focuses on the mental steps required to complete complex procedures. It has been used in training athletes and in general surgery but is new to orthopaedic training. Aim To undertake a systematic review to analyse if CTA is beneficial to train novice surgeons in common orthopaedic and trauma procedures. Materials and methods A systematic review was performed evaluating CTA in trauma and orthopaedic surgery on MEDLINE and EMBASE. Search terms used were: 'Cognitive task', 'mental rehearsal' and 'Orthop*'']. 33 studies were originally identified. Duplicate studies were excluded (11). Articles not relating to Orthopaedic surgery were excluded (15). The CTA research ranking scale was used to evaluate the impact of the studies included. Results 7 studies were identified as appropriate for inclusion. 264 participants. 178 M, 86F. All studies showed objective or subjective benefits from CTA in orthopaedic training when compared to traditional methods. The majority of the participants highlighted high subjective satisfaction with the use of the CTA tools and reported that they proved to be excellent adjuncts to the traditional apprenticeship model. Conclusion CTA learning tools have demonstrated significant objective and subjective benefits in trauma and orthopaedic training. It is cost effective, easily accessible and allows repeated practice which is key in simulation training.
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Roncallo HR, Ray JM, Kulacz RC, Yang TJ, Chmura C, Evans LV, Wong AH. An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation. Jt Comm J Qual Patient Saf 2020; 46:640-649. [PMID: 32919910 DOI: 10.1016/j.jcjq.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles. METHODS An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays. INTERVENTION/REFINEMENT To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program. IMPLICATIONS FOR PRACTICE A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.
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Zeltser MV, Nash DB. Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine .. Am J Med Qual 2019; 34:455-464. [PMID: 31479292 DOI: 10.1177/1062860619873215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Institute of Medicine has suggested that training in team behavior, leadership, communication, and other human factors could reduce medical errors and improve patient safety. Training on such topics has been adapted from teamwork training programs used in military and commercial aviation, called crew resource management (CRM). The principles behind CRM programs have been deployed in a number of clinical settings over the past 2 decades, and there are now several CRM vendors. Little is known about this nascent industry, and the emerging research supporting CRM programs lacks standardization and conclusive evidence. The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine.
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Affiliation(s)
- Marina V Zeltser
- 1 Medical student at UMDNJ-Robert Wood Johnson Medical School, East Brunswick, New Jersey
| | - David B Nash
- 2 Jefferson School of Population Health, Philadelphia, Pennsylvania
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Halls A, Kanagasundaram M, Lau-Walker M, Diack H, Bettles S. Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England. BMJ Open 2019; 9:e028572. [PMID: 31340967 PMCID: PMC6661592 DOI: 10.1136/bmjopen-2018-028572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/15/2019] [Accepted: 06/28/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Acutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this within primary care. Enhancing interprofessional working could ultimately improve care of the acutely ill patient. This proof of concept study aimed to develop an in situ simulation of a medical emergency to use within primary care, and assess its acceptability and utility through participants' reported experiences. SETTING Three research-active General Practices in south east England. Nine staff members per practice consented to participate, representing clinical and non-clinical professions. METHODS The intervention of an in situ simulation scenario of a cardiac arrest was developed by the research team. For the evaluation, staff participated in individual qualitative semistructured interviews following the in situ simulation: these focused on their experiences of participating, with particular attention on interdisciplinary training and potential future developments of the in situ simulation. RESULTS The in situ simulation was appropriate for use within the participating General Practices. Qualitative thematic analysis of the interviews identified four themes: (1) apprehension and (un)willing participation, (2) reflection on the simulation design, (3) experiences of the scenario and (4) training. CONCLUSIONS This study suggests in situ simulation can be an acceptable approach for interdisciplinary team training within primary care, being well-received by practices and staff. This contributes to a fuller understanding of how in situ simulation can benefit both workforce and patients. Future research is needed to further refine the in situ simulation training session.
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Affiliation(s)
- Amy Halls
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | - Hilary Diack
- Health Education England Kent, Surrey and Sussex, Crawley, UK
| | - Simon Bettles
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Bidassie B, Gunnar W, Starr L, Van Buskirk G, Warner L, Anckaitis C, Howard A. Data-driven process to improve VA surgical flow. Int J Health Care Qual Assur 2018; 31:283-294. [PMID: 29790447 DOI: 10.1108/ijhcqa-03-2017-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose During years 2014-2016, Veterans Health Administration National Surgery Office conducted a surgical flow improvement initiative (SFII) to assist low-performing surgery programs to improve their operating room efficiency (ORE). The initiative was co-sponsored by VHA National Surgery Office and VHA Office of Systems Redesign and Improvement. The paper aims to discuss this issue. Design/methodology/approach An SFII algorithm, based on first-time-start (FTS), cancellation rate (CR), lag time (LT) and OR utilization, assigned an ORE performance Level (1-low to 4-high) to each VA Medical Center (VAMC). In total, 15 VAMCs with low-performance surgery programs participated in SFII to assess the current state of their surgical flow processes and used redesign methods to focus on improvement objectives. Findings At the end of the project, 14 VSAs, 40 RPIWs, 45 "90-day projects" and 73 Just-Do-It's were completed with 65 percent (158/243) improvement actions and 86 percent sites improving/sustaining all four ORE metrics. There was a statistically significant difference in improvement across the three stages (baseline, improvement, sustain) for FTS (45.6-68.7 percent; F=44.74; p<0.000); CR (16.1-9.5 percent; F=34.46; p<0.000); LT (63.1-36.3 percent; F=92.00; p<0.000); OR utilization (43.4-57.7 percent; F=6.92; p<0.001) and VAMC level (1.7-3.65; F=80.11; p<0.000). The majority developed "fair to excellent" sustainment (91 percent) and spread (82 percent) plans. The projected annual estimated return-on-investment was $27,949,966. Originality/value The SFII successfully leveraged a small number of faculty, coaches, and industrial engineers to produce significant improvement in ORE across a large national integrated health care network. This strategy can serve healthcare leaders in managing complex healthcare issues in their facilities.
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Affiliation(s)
- Balmatee Bidassie
- Clinical Partnerships in Healthcare Transformation (CPHT), VA Center for Applied Systems Engineering (VA-CASE), Veterans Engineering Resource Center (VERC) Richard L. Roudebush, Indianapolis, Indiana, USA
| | - William Gunnar
- VHA National Surgery Office (10NC2), US Department of Veterans Affairs, Washington, District of Columbia, USA
- School of Medicine and Health Sciences, The George Washington University , Washington, District of Columbia, USA
| | - Leigh Starr
- VHA Office of Systems Redesign and Improvement, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - George Van Buskirk
- VHA Office of Systems Redesign and Improvement, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Lisa Warner
- VHA Office of Nursing Services, US Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Clifford Anckaitis
- VHA Office of Systems Redesign and Improvement, Washington, District of Columbia, USA
| | - Angela Howard
- Clinical Partnerships in Healthcare Transformation (CPHT), VA Center for Applied Systems Engineering (VA-CASE), Veterans Engineering Resource Center (VERC) Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
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Seymour NE. Reprint of: Computer-Based Simulation Training in Surgery. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Development and Utilization of 3D Printed Material for Thoracotomy Simulation. Emerg Med Int 2018; 2018:9712647. [PMID: 30581626 PMCID: PMC6276476 DOI: 10.1155/2018/9712647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022] Open
Abstract
Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).
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McKernon SL, Fox K, Balmer M. A randomised control trial evaluating non-technical skills acquisition using simulated situational training in oral surgery. Br Dent J 2018; 225:sj.bdj.2018.808. [PMID: 30287966 DOI: 10.1038/sj.bdj.2018.808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- S L McKernon
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - K Fox
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - M Balmer
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
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D'Asta F, Homsi J, Sforzi I, Wilson D, de Luca M. "SIMBurns": A high-fidelity simulation program in emergency burn management developed through international collaboration. Burns 2018; 45:120-127. [PMID: 30268630 DOI: 10.1016/j.burns.2018.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022]
Abstract
Acute management of a severely burned patient is an infrequent and stressful situation that requires medical knowledge as well as immediate coordinated action. Many adverse events in health care result from issues related to the application of 'non-technical' skills such as communication, teamwork, leadership and decision making rather than lack of medical knowledge. Training in these skills is known as Crisis Resource Management (CRM) training. In order to create well-prepared burn teams, it is critical to teach CRM principles through high-fidelity simulation (HFS). While CRM teaches foundational non-technical skills, HFS incorporates lifelike, whole-body, fully-responsive mannequins in order to provide a realistic emergency situation. The aim of the study is to describe the development of a novel high-fidelity simulation course called "SIMBurns: High Fidelity Simulation Program for Emergency Burn Management" that uses CRM as its foundation and is focused on management of burn injuries. The course was designed by a panel of simulation and burns experts from Meyer Children's Hospital in Italy and Birmingham Children's Hospital in the U.K. Simulation Program experts were certified by Boston Children's Hospital's Simulation Program. In this paper, we describe the course's design, development, structure, and participant's assessment of the course. Since the creation of the SIMBurns course in 2013, 9 courses have been conducted and 101 participants have attended the course. The course was well-received and its "Overall Satisfaction" was rated at 4.8/5. The primary objective in the SIMBurns course - to teach teamwork and CRM skills to medical staff involved in emergency burn care - was also met at 4.8/5. Participants felt that the course developed their ability to interact with other team members, further improved their understanding of how to appropriately use resources, emphasized the importance of role clarity and developed their communication skills. Additional quantitative and qualitative analyses obtained from participants were also reviewed after each course. The SIMBurns course aims to contribute to the education of those in healthcare in order to improve patient safety and to continue advancing the education of our emergency burn care teams.
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Affiliation(s)
- Federica D'Asta
- Burns Centre, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom; AOU Meyer Children Hospital, Florence, Italy. federica.d'
| | | | | | - David Wilson
- Burns Centre, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
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A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals. Pediatr Emerg Care 2018; 34:431-435. [PMID: 28719479 DOI: 10.1097/pec.0000000000001233] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. OBJECTIVE The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. METHODS We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. RESULTS Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12.9% from the first assessment (mean ± SEM = 64 ± 4.4) to the second assessment (77 ± 4.0, P = 0.022). The PRS score domains also showed improvements in coordination of pediatric patient care (median improvement, 50%), quality improvement activities (median improvement, 79%), patient safety initiatives (mean improvement, 7%), policies and procedures (mean improvement, 17%), and availability of pediatric equipment (mean improvement, 7%). CONCLUSIONS Participation in a simulation-based quality improvement collaborative was associated with improvements in pediatric readiness.
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Pinsky HM, Le JM, Sweier DG, Marti K. Dental students' ability to locate emergency equipment-lessons learned from aviation. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e19-e25. [PMID: 28019067 DOI: 10.1111/eje.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the dental student's ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic. METHODS A total of 138 second-year dental students (traditional group) participated in this study as part of a simulation-based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self-reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually. RESULTS Of the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group. CONCLUSION Whilst our students have lecture-based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second-year dental students supported that proper training may be used to achieve retention of knowledge. Based on our "novel group" results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands-on training.
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Affiliation(s)
- H M Pinsky
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - J M Le
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - D G Sweier
- Department of Cariology, Restorative Sciences & Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - K Marti
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Comparison of the Effectiveness of a Virtual Simulator With a Plastic Arm Model in Teaching Intravenous Catheter Insertion Skills. ACTA ACUST UNITED AC 2018; 36:98-105. [DOI: 10.1097/cin.0000000000000405] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Parsons JR, Crichlow A, Ponnuru S, Shewokis PA, Goswami V, Griswold S. Filling the Gap: Simulation-based Crisis Resource Management Training for Emergency Medicine Residents. West J Emerg Med 2017; 19:205-210. [PMID: 29383082 PMCID: PMC5785195 DOI: 10.5811/westjem.2017.10.35284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction In today’s team-oriented healthcare environment, high-quality patient care requires physicians to possess not only medical knowledge and technical skills but also crisis resource management (CRM) skills. In emergency medicine (EM), the high acuity and dynamic environment makes CRM skills of physicians particularly critical to healthcare team success. The Accreditation Council of Graduate Medicine Education Core Competencies that guide residency program curriculums include CRM skills; however, EM residency programs are not given specific instructions as to how to teach these skills to their trainees. This article describes a simulation-based CRM course designed specifically for novice EM residents. Methods The CRM course includes an introductory didactic presentation followed by a series of simulation scenarios and structured debriefs. The course is designed to use observational learning within simulation education to decrease the time and resources required for implementation. To assess the effectiveness in improving team CRM skills, two independent raters use a validated CRM global rating scale to measure the CRM skills displayed by teams of EM interns in a pretest and posttest during the course. Results The CRM course improved leadership, problem solving, communication, situational awareness, teamwork, resource utilization and overall CRM skills displayed by teams of EM interns. While the improvement from pretest to posttest did not reach statistical significance for this pilot study, the large effect sizes suggest that statistical significance may be achieved with a larger sample size. Conclusion This course can feasibly be incorporated into existing EM residency curriculums to provide EM trainees with basic CRM skills required of successful emergency physicians. We believe integrating CRM training early into existing EM education encourages continued deliberate practice, discussion, and improvement of essential CRM skills.
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Affiliation(s)
- Jessica R Parsons
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Amanda Crichlow
- University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Srikala Ponnuru
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Patricia A Shewokis
- Drexel University College of Nursing and Health Professions, Department of Nutrition Sciences & School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania
| | - Varsha Goswami
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Sharon Griswold
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania
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17
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Chung CH. Financial, Educational and Cultural ‘Revolutions’ for Emergency Medicine in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Johnsen BH, Westli HK, Espevik R, Wisborg T, Brattebø G. High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance. Scand J Trauma Resusc Emerg Med 2017; 25:109. [PMID: 29126452 PMCID: PMC5681813 DOI: 10.1186/s13049-017-0452-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. Method Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader’s frequency of shared mental model behavioral markers. Results The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information (“push” of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior. When separating the sample into higher versus lower performing teams, the higher performing teams had leaders who displayed a greater frequency of “push” of information and communication of SA and supportive behavior. No difference was found for the behavioral marker of team initiative, measured as bringing up suggestions to other teammembers. Conclusion The results of this study emphasize the team leader’s role in initiating and updating a team’s shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.
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Affiliation(s)
- Bjørn Helge Johnsen
- Department of Psychosocial Science, University of Bergen, Christiesgt 12, 5015, Bergen, Norway.
| | | | - Roar Espevik
- The Royal Norwegian Naval Academy, Bergen, Norway
| | - Torben Wisborg
- Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Guttorm Brattebø
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Trauma, Oslo University Hospital, Oslo, Norway
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Brown C, Thomas I. Twelve tips for conducting successful multiple patient encounter simulations (simultaneous simulations). MEDICAL TEACHER 2017; 39:660-664. [PMID: 28598737 DOI: 10.1080/0142159x.2017.1288864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Multiple patient encounter simulations (MPES), whereby learners are exposed to a number of simulated patients simultaneously, are gaining popularity as a method to address curricular gaps. Whilst this approach offers a host of benefits to educators and learners in ways single patient encounter simulations cannot, it also has significant challenges with regards to its implementation. We describe twelve tips for conducting successful MPES, divided into pre-, intra- and post-simulation considerations. By adhering to these twelve tips, educators can plan successful, fiscally responsible, well-organized, structured sessions for all learners (active and observing) that will achieve the learning outcomes desired using this advanced method of simulation.
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Affiliation(s)
- Craig Brown
- a Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen , UK
| | - Ian Thomas
- a Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen , UK
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20
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Abstract
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.
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Thompson R, Lu Y, Potvin M, Holmes J, Di Prospero L, Keller B, Szumacher E, Liszewski B, Catton P, Giuliani M, Pitcher B, Pintilie M, Bissonnette JP. Hazards and incidents: Detection and learning in radiation medicine, a comparison of 2 educational interventions. Pract Radiat Oncol 2017; 7:e431-e438. [PMID: 28377137 DOI: 10.1016/j.prro.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/16/2017] [Accepted: 02/19/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Interprofessional, educational live simulations were compared with group discussion-based exercises in terms of their ability to improve radiation medicine trainees' ability to detect hazards and incidents and understand behaviors that may prevent them. METHODS AND MATERIALS Trainees and recent graduates of radiation therapy, medical physics, and radiation oncology programs were recruited and randomized to either a simulation-based or group discussion-based training intervention. Participants engaged in hazard and incident detection, analysis, and a discussion of potential preventive measures and the concept of the "highly reliable team." A video examination tool modeled on actual incidents, using 5-minute videos created by faculty, students, and volunteers, was created to test hazard and incident recognition ability before and after training. Hazard and incident detection sensitivity and specificity analyses were conducted, and a survey of the participants' and facilitators' perceptions was conducted. RESULTS Twenty-seven participants were assigned to the simulation (n = 15) or discussion group (n = 12). Hazard and incident-detection sensitivity ranged from 0.04 to 0.56 before and 0.04 to 0.35 after training for the discussion and simulation groups, respectively. The pre- and posttraining difference in sensitivity between groups was 0.03 (P = .75) for the minimum and 0.33 (P = .034) for the maximum reaction time. Participant perceptions of the training's educational value in a variety of domains ranged from a mean score of 6.58 to 8.17 and 7 to 8.07 for the discussion and simulation groups, respectively. Differences were not statistically significant. Twenty-six of the 27 participants indicated that they would recommend this event to a colleague. CONCLUSIONS Participants' ability to detect hazards and incidents as portrayed in 5-minute videos in this study was low both before and after training, and simulation-based training was not superior to discussion-based training. However, levels of satisfaction and perceptions of the training's educational value were high, especially with simulation-based training.
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Affiliation(s)
- Robert Thompson
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Yilan Lu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marc Potvin
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Michener Institute, University Health Network, Toronto, Ontario, Canada
| | - Jordan Holmes
- Michener Institute, University Health Network, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Brian Keller
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Brian Liszewski
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Pamela Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Bethany Pitcher
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jean-Pierre Bissonnette
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Techna Institute, Toronto, Ontario, Canada.
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Banaszek D, You D, Chang J, Pickell M, Hesse D, Hopman WM, Borschneck D, Bardana D. Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill: A Randomized Controlled Trial. J Bone Joint Surg Am 2017; 99:e34. [PMID: 28375898 DOI: 10.2106/jbjs.16.00324] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions. METHODS Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis. RESULTS Trainees on both simulators demonstrated a significant improvement (p < 0.05) in arthroscopic skills compared with baseline scores and untrained controls, both in and ex vivo. The virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task. CONCLUSIONS Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality simulation was superior to bench-top simulation in the acquisition of arthroscopic skills, both in the laboratory and in vivo. Further clinical investigation is needed to interpret the importance of these results.
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Affiliation(s)
- Daniel Banaszek
- 1Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada 2Department of Surgery, Kingston General Hospital, Kingston, Ontario, Canada
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Munzer BW, Love J, Shipman BL, Byrne B, Cico SJ, Furlong R, Khandelwal S, Santen SA. An Analysis of the Top-cited Articles in Emergency Medicine Education Literature. West J Emerg Med 2016; 18:60-68. [PMID: 28116010 PMCID: PMC5226765 DOI: 10.5811/westjem.2016.10.31492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction Dissemination of educational research is critical to improving medical education, promotion of faculty and ultimately patient care. The objective of this study was to identify the top 25 cited education articles in the emergency medicine (EM) literature and the top 25 cited EM education articles in all journals, as well as report on the characteristics of the articles. Methods Two searches were conducted in the Web of Science in June 2016 using a list of education-related search terms. We searched 19 EM journals for education articles as well as all other literature for EM education-related articles. Articles identified were reviewed for citation count, article type, journal, authors, and publication year. Results With regards to EM journals, the greatest number of articles were classified as articles/reviews, followed by research articles on topics such as deliberate practice (cited 266 times) and cognitive errors (cited 201 times). In contrast in the non-EM journals, research articles were predominant. Both searches found several simulation and ultrasound articles to be included. The most common EM journal was Academic Emergency Medicine (n = 18), and Academic Medicine was the most common non-EM journal (n=5). A reasonable number of articles included external funding sources (6 EM articles and 13 non-EM articles.) Conclusion This study identified the most frequently cited medical education articles in the field of EM education, published in EM journals as well as all other journals indexed in Web of Science. The results identify impactful articles to medical education, providing a resource to educators while identifying trends that may be used to guide EM educational research and publishing efforts.
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Affiliation(s)
- Brendan W Munzer
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Jeffery Love
- Georgetown University Hospital/Washington Hospital Center, Department of Emergency Medicine, Washington, D.C
| | - Barbara L Shipman
- University of Michigan, Alfred Taubman Health Sciences Library, Ann Arbor, Michigan
| | - Brendan Byrne
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan; Naval Medical Center Portsmouth, Department of Emergency Medicine, Portsmouth, Virginia
| | - Stephen J Cico
- Indiana University, Department of Emergency Medicine, Indianapolis, Indiana
| | - Robert Furlong
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Sorabh Khandelwal
- Ohio State University, Department of Emergency Medicine, Columbus, Ohio
| | - Sally A Santen
- University of Michigan, Department of Learning Health Sciences, Ann Arbor, Michigan
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Morey JC, Salisbury M. Introducing Teamwork Training into Healthcare Organizations: Implementation Issues and Solutions. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120204602516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This practitioner paper describes a variety of training development, assessment, and implementation issues and solutions that emerged from our research to develop behavior-based teamwork training for healthcare providers. These lessons-learned are based on our experiences in adapting aviation crew resource management (CRM) training for healthcare providers in the specialty areas of emergency care and labor and delivery. The discussion covers (a) issues surrounding training content and delivery, (b) methodological issues in conducting training evaluations, and (c) institutional characteristics, cultural change, and sustaining the behavioral intervention.
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Affiliation(s)
- John C. Morey
- Crew Performance Group, Dynamics Research Corporation Andover, Massachusetts
| | - Mary Salisbury
- Crew Performance Group, Dynamics Research Corporation Andover, Massachusetts
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25
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Brown LL, Overly FL. Simulation-Based Interprofessional Team Training. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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O'Keeffe DA, Bradley D, Evans L, Bustamante N, Timmel M, Akkineni R, Mulloy D, Goralnick E, Pozner C. Ebola Emergency Preparedness: Simulation Training for Frontline Health Care Professionals. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10433. [PMID: 30800728 PMCID: PMC6354722 DOI: 10.15766/mep_2374-8265.10433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/27/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION At Brigham and Women's Hospital, we identified the need for a comprehensive training program designed to prepare frontline staff to safely manage a patient with Ebola viral disease (EVD). The primary goal of this program was to ensure the safety of staff, patients, and the general public by training staff in the correct use of personal protective equipment (PPE) before, during, and after care of patients with EVD. METHODS We delivered a 4-hour experiential training program to frontline health care professionals who would be expected to care for a patient with EVD. The program occurred in a simulation center with multiple flexible spaces and consisted of demonstration, multiple skills practice sessions, and a patient simulation case. We analyzed completed pre- and posttraining questionnaires. The questionnaire assessed their subjective level of confidence in three key areas: donning and doffing PPE, performing clinical skills while wearing PPE, and management of a contamination breach. RESULTS This program was effectively deployed in the STRATUS Center for Medical Simulation over a 4-month period, with 220 health care professionals participating in the training and 195 participants completing the pre-/posttraining questionnaires. Our intervention significantly increased the confidence of participants on each primary objective (p = .001 for all three stations). DISCUSSION This interprofessional simulation-based program has been shown to be a well-received method of training clinicians to manage patients collaboratively during an EVD outbreak. Our intent is that the skills taught in this training program would also be transferable to management of other infectious diseases in the clinical setting.
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Affiliation(s)
- Dara Ann O'Keeffe
- Senior Lecturer in Surgical Education, National Surgical Training Centre, Royal College of Surgeons in Ireland
| | - Dorothy Bradley
- Nursing Simulation Program Director, Brigham and Women's Hospital
| | - Linda Evans
- Program Director, Center for Nursing Excellence, Brigham and Women's Hospital
| | - Nirma Bustamante
- Fellow in International Emergency Medicine, Brigham and Women's Hospital
| | | | | | | | - Eric Goralnick
- Medical Director of Emergency Preparedness, Brigham and Women's Hospital
- Assistant Professor of Emergency Medicine, Harvard Medical School
| | - Charles Pozner
- Medical Director, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital
- Associate Professor of Emergency Medicine, Harvard Medical School
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Yu TC, Webster CS, Weller JM. Simulation in the medical undergraduate curriculum to promote interprofessional collaboration for acute care: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:90-96. [DOI: 10.1136/bmjstel-2016-000103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
This literature review summarises interprofessional, simulation-based interventions in the context of preparing undergraduate and prelicensure healthcare students for the management of acutely unstable patients. There was a particular focus on the impact of such interventions on medical students. The review sought to identify the range of described interprofessional education (IPE) learning outcomes, types of learners, methods used to evaluate intervention effectiveness and study conclusions. We systematically compiled this information and generated review findings through narrative summary. A total of 18 articles fulfilled the review criteria. The diversity of IPE interventions described suggests a developing field where the opportunities provided by simulation are still being explored. With significant heterogeneity among the studies, comparison between them was unfeasible, but each study provided a unique narrative on the complex interplay between intervention, curriculum, learning activities, learners and facilitators. Together, the narratives provided in these studies reflect positively on undergraduate simulation-based interventions to promote interprofessional collaboration in acute care settings, and provide the basis for recommendations for future IPE design and delivery, and areas requiring further research.
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"Thinking on your feet"-a qualitative study of debriefing practice. Adv Simul (Lond) 2016; 1:12. [PMID: 29449981 PMCID: PMC5806473 DOI: 10.1186/s41077-016-0011-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/25/2016] [Indexed: 12/02/2022] Open
Abstract
Background Debriefing is a significant component of simulation-based education (SBE). Regardless of how and where immersive simulation is used to support learning, debriefing has a critical role to optimise learning outcomes. Although the literature describes different debriefing methods and approaches that constitute effective debriefing, there are discrepancies as to what is actually practised and how experts or experienced debriefers perceive and approach debriefing. This study sought to explore the self-reported practices of expert debriefers. Methods We used a qualitative approach to explore experts’ debriefing practices. Peer-nominated expert debriefers who use immersive manikin-based simulations were identified in the healthcare simulation community across Australia. Twenty-four expert debriefers were purposively sampled to participate in semi-structured telephone interviews lasting 45–90 min. Interviews were transcribed and independently analysed using inductive thematic analysis. Results Codes emerging through the data analysis clustered into four major categories: (1) Values: ideas and beliefs representing the fundamental principles that underpinned interviewees’ debriefing practices. (2) Artistry: debriefing practices which are dynamic and creative. (3) Techniques: the specific methods used by interviewees to promote a productive and safe learning environment. (4) Development: changes in interviewees’ debriefing practices over time. Conclusions The “practice development triangle” inspired by the work of Handal and Lauvas offers a framework for our themes. A feature of the triangle is that the values of expert debriefers provide a foundation for associated artistry and techniques. This framework may provide a different emphasis for courses and programmes designed to support debriefing practices where microskill development is often privileged, especially those microskills associated with techniques (plan of action, creating a safe environment, managing learning objectives, promoting learner reflection and co-debriefing). Across the levels in the practice development triangle, the importance of continuing professional development is acknowledged. Strengths and limitations of the study are noted.
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Seymour NE, Paige JT, Arora S, Fernandez GL, Aggarwal R, Tsuda ST, Powers KA, Langlois G, Stefanidis D. Putting the MeaT into TeaM Training: Development, Delivery, and Evaluation of a Surgical Team-Training Workshop. JOURNAL OF SURGICAL EDUCATION 2016; 73:136-142. [PMID: 26481423 DOI: 10.1016/j.jsurg.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/11/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum. METHODS Workshops were conducted at 3 national meetings. Participants completed preworkshop and postworkshop questionnaires to define experience, confidence in using simulation, intention to implement, as well as workshop content quality. The course consisted of (A) a didactic review of Preparation, Implementation, and Debriefing and (B) facilitated small group simulation sessions followed by debriefings. RESULTS Of 78 participants, 51 completed the workshops. Overall, 65% indicated that residents at their institutions used patient simulation, but only 33% used the American College of Surgeons-the Association of Program Directors in Surgery team-training modules. The workshop increased confidence to implement simulation team training (3.4 ± 1.3 vs 4.5 ± 0.9). Quality and importance were rated highly (5.4 ± 00.6, highest score = 6). CONCLUSIONS Preparation for simulation-based team training is possible in this workshop setting, although the effect on actual implementation remains to be determined.
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Affiliation(s)
- Neal E Seymour
- Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.
| | - John T Paige
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Sonal Arora
- Imperial College School of Medicine, London, UK
| | - Gladys L Fernandez
- Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | | | | | - Kinga A Powers
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Gerard Langlois
- Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
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Mediouni M, Volosnikov A. The trends and challenges in orthopaedic simulation. J Orthop 2015; 12:253-9. [PMID: 26566328 PMCID: PMC4601998 DOI: 10.1016/j.jor.2015.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/24/2015] [Indexed: 11/19/2022] Open
Abstract
Generally, in some universities of medicine, orthopaedic training procedures represent a difficult task due to the inadequacies of the systems, the resources, and the use of technologies. This article explains the challenges and the needs for more research in the issue of orthopaedic simulation around the world.
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Affiliation(s)
| | - Alexander Volosnikov
- Federal State Budgetary Institution, Russian Ilizarov Scientific Center, Restorative Traumatology and Orthopaedics of Ministry of Healthcare, Russian Federation
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The Template of Events for Applied and Critical Healthcare Simulation (TEACH Sim): a tool for systematic simulation scenario design. Simul Healthc 2015; 10:21-30. [PMID: 25514586 DOI: 10.1097/sih.0000000000000058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Simulation-based training (SBT) affords practice opportunities for improving the quality of clinicians' technical and nontechnical skills. However, the development of practice scenarios is a process plagued by a set of challenges that must be addressed for the full learning potential of SBT to be realized. Scenario templates are useful tools for assisting with SBT and navigating its inherent challenges. This article describes existing SBT templates, explores considerations in choosing an appropriate template, and introduces the Template of Events for Applied and Critical Healthcare Simulation (TEACH Sim) as a tool for facilitating the formation of practice scenarios in accordance with an established evidence-based simulation design methodology. TEACH Sim's unique contributions are situated within the landscape of previously existing templates, and each of its component sections is explained in detail.
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Kessler DO, Walsh B, Whitfill T, Dudas RA, Gangadharan S, Gawel M, Brown L, Auerbach M. Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study. J Emerg Med 2015; 50:403-15.e1-3. [PMID: 26499775 DOI: 10.1016/j.jemermed.2015.08.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/14/2015] [Accepted: 08/08/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Each year in the United States, 72,000 pediatric patients develop septic shock, at a cost of $4.8 billion. Adherence to practice guidelines can significantly reduce mortality; however, few methods to compare performance across a spectrum of emergency departments (EDs) have been described. OBJECTIVES We employed standardized, in situ simulations to measure and compare adherence to pediatric sepsis guidelines across a spectrum of EDs. We hypothesized that pediatric EDs (PEDs) would have greater adherence to the guidelines than general EDs (GEDs). We also explored factors associated with improved performance. METHODS This multi-center observational study examined in situ teams caring for a simulated infant in septic shock. The primary outcome was overall adherence to the pediatric sepsis guideline as measured by six subcomponent metrics. Characteristics of teams were compared using multivariable logistic regression to describe factors associated with improved performance. RESULTS We enrolled 47 interprofessional teams from 24 EDs. Overall, 21/47 teams adhered to all six sepsis metrics (45%). PEDs adhered to all six metrics more than GEDs (93% vs. 22%; difference 71%, 95% confidence interval [CI] 43-84). Adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. In a multivariable regression model, only greater composite team experience had greater adjusted odds of achieving an adherent sepsis score (adjusted odds ratio 1.38, 95% CI 1.01-1.88). CONCLUSIONS Using standardized in situ scenarios, we revealed high variability in adherence to the pediatric sepsis guideline across a spectrum of EDs. PEDs demonstrated greater adherence to the guideline than GEDs; however, in adjusted analysis, only composite team experience level of the providers was associated with improved guideline adherence.
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Affiliation(s)
- David O Kessler
- Department of Pediatrics, Columbia University Medical Center, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York
| | - Barbara Walsh
- Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins University, St. Petersburg, Florida
| | - Sandeep Gangadharan
- Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Marcie Gawel
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Linda Brown
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Marc Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Chetlen AL, Mendiratta-Lala M, Probyn L, Auffermann WF, DeBenedectis CM, Marko J, Pua BB, Sato TS, Little BP, Dell CM, Sarkany D, Gettle LM. Conventional Medical Education and the History of Simulation in Radiology. Acad Radiol 2015; 22:1252-67. [PMID: 26276167 DOI: 10.1016/j.acra.2015.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 05/29/2015] [Accepted: 07/08/2015] [Indexed: 01/22/2023]
Abstract
Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.
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Haga SB, Mills R, Aucoin J, Taekman J. Interprofessional education for personalized medicine through technology-based learning. Per Med 2015; 12:237-243. [PMID: 29771651 DOI: 10.2217/pme.14.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The delivery of personalized medicine utilizing genetic and genomic technologies is anticipated to involve many medical specialties. Interprofessional education will be key to the delivery of personalized medicine in order to reduce disjointed or uncoordinated clinical care, and optimize effective communication to promote patient understanding and engagement regarding the use of or need for these services. While several health professional organizations have endorsed and/or developed core competencies for genetics and genomics, the lack of interprofessional guidelines and training may hamper the delivery of coordinated personalized medicine. In this perspective, we consider the potential for interprofessional education and training using technology-based approaches, such as virtual simulation and gaming, compared with traditional educational approaches.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | - Julia Aucoin
- Office of Nursing Research, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA
| | - Jeff Taekman
- Human Simulation & Patient Safety Center, 8 Searle Center Drive, 5015 Trent Semans Center, Durham, NC 27710, USA
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Stirling ERB, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res 2014; 9:126. [PMID: 25523023 PMCID: PMC4299292 DOI: 10.1186/s13018-014-0126-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 01/22/2023] Open
Abstract
Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in ‘hands-on’ experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons.
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Affiliation(s)
- Euan R B Stirling
- Orthopaedic Department, Northampton General Hospital, Cliftonville, Northampton, NN1 5BD, UK.
| | - Thomas L Lewis
- General Surgery, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, KT2 7QB, UK.
| | - Nicholas A Ferran
- Shoulder Fellow, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia.
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Ferguson E, Buttery A, Miles G, Tatalia C, Clarke DD, Lonsdale AJ, Baxendale B, Lawrence C. The temporal rating of emergency non-technical skills (TRENT) index for self and others: psychometric properties and emotional responses. BMC MEDICAL EDUCATION 2014; 14:240. [PMID: 25431182 PMCID: PMC4330940 DOI: 10.1186/s12909-014-0240-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND To enhance the non-technical skills (NTS) assessment literature by developing a reliable and valid peer and self-assessment tool for NTS in a simulated ward setting to include emotional reactions: the Temporal Rating of Emergency Non-Technical skills (TRENT) Index. The paper aims to document (1) the psychometric properties of the TRENT index (e.g., reliability, idiosyncrasy biases) and (2) its validity in terms of performance-emotional associations in the high fidelity simulated ward environment. METHODS Two samples of doctors (Ns =150 & 90) taking part in emergency simulations provided both self and peer-assessment of NTS, with the second sample also providing self-assessments of mood. The psychometric properties of the TRENT were explored for self- and peer-assessment, and pre- and post-simulation environment mood was used to assess validity. RESULTS A psychometrically reliable and valid 5-factor assessment of NTS was developed. While there was evidence for both intra-rater and inter-rater reliability, inter-rater idiosyncrasy was also observed. Self-rated, but not peer-rated, negative performance was positively associated with post simulation negative mood. CONCLUSION These are the first results that pertain to inter-, intra-rater reliability as well as idiosyncratic biases in NTS assessment and the first to show that simulator performance can influence mood after assessment. Potential clinical carry-over effects of mood are discussed.
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Affiliation(s)
- Eamonn Ferguson
- Personality and Social Psychology (PSPH) group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Andy Buttery
- Trent Simulation and Clinical Skills Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Giulia Miles
- Trent Simulation and Clinical Skills Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Christina Tatalia
- Personality and Social Psychology (PSPH) group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - David D Clarke
- Personality and Social Psychology (PSPH) group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Adam J Lonsdale
- Department of Psychology, Oxford Brookes University (Formally PSPH group), Oxford, UK.
| | - Bryn Baxendale
- Trent Simulation and Clinical Skills Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Claire Lawrence
- Personality and Social Psychology (PSPH) group, School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
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Wallston KA, Slagle JM, Speroff T, Nwosu S, Crimin K, Feurer ID, Boettcher B, Weinger MB. Operating room clinicians' ratings of workload: a vignette simulation study. J Patient Saf 2014; 10:95-100. [PMID: 24522226 DOI: 10.1097/pts.0000000000000046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases. METHODS Thirty-six OR clinicians (13 anesthesia providers, 11 surgeons, and 12 nurses) used the QWAT to rate 6 cases varying from easy to moderately difficult based on actual ratings made by clinicians involved with the cases. Cases were presented and rated in random order. Before rating anticipated individual and team difficulty, the raters read prepared clinical vignettes containing case synopses and much of the same written case information that was available to the actual clinicians before the onset of each case. Then, before rating perceived individual and team difficulty, they read part 2 of the vignette consisting of detailed role-specific intraoperative data regarding the anesthetic and surgical course, unusual events, and other relevant contextual factors. RESULTS Surgeons had higher interrater reliability on the QWAT than did OR nurses or anesthesia providers. For the anticipated individual and team workload ratings, there were no statistically significant differences between the actual ratings and the ratings obtained from the vignettes. There were differences for the 3 provider types in perceived individual workload for the median difficulty cases and in the perceived team workload for the median and more difficult cases. CONCLUSIONS The case difficulty items on the QWAT seem to be sufficiently reliable and valid to be used in other studies of anticipated and perceived clinical workload of surgeons. Perhaps because of the limitations of the clinical documentation shown to anesthesia providers and OR nurses in the current vignette study, more evidence needs to be gathered to demonstrate the criterion-related validity of the QWAT difficulty items for assessing the workload of nonsurgeon OR clinicians.
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Affiliation(s)
- Kenneth A Wallston
- From the Geriatric Research Education and Clinical Center and the Health Services Research and Development Service, VA Tennessee Valley Healthcare System, Nashville, Tennessee
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Rosenman ED, Shandro JR, Ilgen JS, Harper AL, Fernandez R. Leadership training in health care action teams: a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1295-306. [PMID: 25006708 DOI: 10.1097/acm.0000000000000413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To identify and describe the design, implementation, and evidence of effectiveness of leadership training interventions for health care action (HCA) teams, defined as interdisciplinary teams whose members coordinate their actions in time-pressured, unstable situations. METHOD The authors conducted a systematic search of the PubMed/MEDLINE, CINAHL, ERIC, EMBASE, PsycINFO, and Web of Science databases, key journals, and review articles published through March 2012. They identified peer-reviewed English-language articles describing leadership training interventions targeting HCA teams, at all levels of training and across all health care professions. Reviewers, working in duplicate, abstracted training characteristics and outcome data. Methodological quality was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Of the 52 included studies, 5 (10%) focused primarily on leadership training, whereas the remainder included leadership training as part of a larger teamwork curriculum. Few studies reported using a team leadership model (2; 4%) or a theoretical framework (9; 17%) to support their curricular design. Only 15 studies (29%) specified the leadership behaviors targeted by training. Forty-five studies (87%) reported an assessment component; of those, 31 (69%) provided objective outcome measures including assessment of knowledge or skills (21; 47%), behavior change (8; 18%), and patient- or system-level metrics (8; 18%). The mean MERSQI score was 11.4 (SD 2.9). CONCLUSIONS Leadership training targeting HCA teams has become more prevalent. Determining best practices in leadership training is confounded by variability in leadership definitions, absence of supporting frameworks, and a paucity of robust assessments.
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Affiliation(s)
- Elizabeth D Rosenman
- Dr. Rosenman is acting instructor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Shandro is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Ilgen is assistant professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Ms. Harper is associate librarian, Health Sciences Library, University of Washington Library Services, Seattle, Washington. Dr. Fernandez is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
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Spraggon M, Bodolica V. Social ludic activities: a polymorphous form of organizational play. JOURNAL OF MANAGERIAL PSYCHOLOGY 2014. [DOI: 10.1108/jmp-01-2012-0009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to seek to contribute to the field of workplace play by introducing the notion of social ludic activities (SLAs) as a specific form of play in organizations.
Design/methodology/approach
– The conceptualization of SLAs is built upon insights from the practice and organizational play literatures.
Findings
– SLAs can be deployed not only for productively engaging with work but also as an instrument to resist authority, boycott work or challenge firm contingencies. The particular enactments of SLAs may be influenced by how employees perceive and interpret the organizational climate (i.e. corporate culture, management style, job design and task complexity, and intra-firm interactions) in which they are embedded.
Practical implications
– The recognition that emergent forms of play may be conducive to the generation of valuable outcomes without managerial intervention can save managers’ time and efforts required for dealing with potential employees’ resistance. Taking advantage from spontaneous manifestations of play implies understanding the logic of players and creating favorable corporate contexts for the emergence of SLAs rather than attempting to interfere in the natural experiences of flow.
Originality/value
– SLAs are conceived as an alternative form of organizational play that is a priori unselfconscious and emergent, inherits autotelic and rational dimensions from prior views of play, draws upon practice insights, and represents the employee perspective.
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Tofil NM, Peterson DT, Wheeler JT, Youngblood A, Zinkan JL, Lara D, Jakaitis B, Niebauer J, White ML. Repeated versus varied case selection in pediatric resident simulation. J Grad Med Educ 2014; 6:275-9. [PMID: 24949131 PMCID: PMC4054726 DOI: 10.4300/jgme-d-13-00099.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 08/21/2013] [Accepted: 12/10/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases. OBJECTIVE We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios. METHODS Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6). RESULTS Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups. CONCLUSIONS Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.
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Lazzara EH, Benishek LE, Dietz AS, Salas E, Adriansen DJ. Eight Critical Factors in Creating and Implementing a Successful Simulation Program. Jt Comm J Qual Patient Saf 2014; 40:21-9. [DOI: 10.1016/s1553-7250(14)40003-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evaluation of a Computer-Based Educational Intervention to Improve Medical Teamwork and Performance During Simulated Patient Resuscitations. Crit Care Med 2013; 41:2551-62. [DOI: 10.1097/ccm.0b013e31829828f7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
In this chapter, we discuss the application of human factors and ergonomics to developing effective simulation training in health care. Simulation provides a safe, effective method for training and assessing human performance. In aviation, simulation-based training and assessment has been widely used, significantly improving safety. This progress would have been impossible without the involvement of human factors and ergonomics. Although aviation and health care have similarities, there also are differences that complicate the widespread implementation of simulation in health care.
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Dowson A, Russ S, Sevdalis N, Cooper M, De Munter C. How in situ simulation affects paediatric nurses' clinical confidence. ACTA ACUST UNITED AC 2013; 22:610, 612-7. [PMID: 23899728 DOI: 10.12968/bjon.2013.22.11.610] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Considering the emphasis on safety in health care, new methods for training qualified nurses are being considered. The use of simulation technologies to provide regular and repeated training for qualified nurses in the management of paediatric emergencies has yet to be investigated. This paper presents the results of a study designed to determine if and how a period of regular simulation training in the management of paediatric emergencies improves qualified nurses' clinical confidence. A mixed methods design was employed using a group of qualified paediatric nurses (n=20) who were matched into two groups. The intervention group (n=10) received three simulation-based training sessions and the control group (n=10) had no training. Each nurse completed a pre- and post-clinical confidence questionnaire and were interviewed. Results demonstrated a statistically significant improvement in confidence following simulation training, which was explained by the provision of insight and preparation for real life. Further research should aim to replicate these findings using larger sample sizes and direct assessments of nurses' clinical performance.
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Affiliation(s)
- Anne Dowson
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Research Fellow, Imperial College London
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Competency in chaos: lifesaving performance of care providers utilizing a competency-based, multi-actor emergency preparedness training curriculum. Prehosp Disaster Med 2013; 28:322-33. [PMID: 23731521 DOI: 10.1017/s1049023x13000368] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Providing comprehensive emergency preparedness training (EPT) to care providers is important to the future success of disaster operations in the US. Few EPT programs possess both competency-driven goals and metrics to measure performance during a multi-patient simulated disaster. METHODS A 1-day (8-hour) EPT course for care providers was developed to enhance provider knowledge, skill, and comfort necessary to save lives during a simulated disaster. Nine learning objectives, 18 competencies, and 34 performance objectives were developed. During the 2-year demonstration of the curriculum, 24 fourth-year medical students and 17 Veterans Hospital Administration (VHA) providers were recruited and volunteered to take the course (two did not fully complete the research materials). An online pre-test, two post-tests, course assessment, didactic and small group content, and a 6-minute clinical casualty scenario were developed. During the scenario, trainees working in teams were confronted with three human simulators and 10 actor patients simultaneously. Unless appropriate performance objectives were met, the simulators "died" and the team was exposed to "anthrax." After the scenario, team members participated in a facilitator-led debriefing using digital video and then repeated the scenario. RESULTS Trainees (N = 39) included 24 (62%) medical students; seven (18%) physicians; seven (18%) nurses; and one (3%) emergency manager. Forty-seven percent of the VHA providers reported greater than 16 annual hours of disaster training, while 15 (63%) of the medical students reported no annual disaster training. The mean (SD) score for the pre-test was 12.3 (3.8), or 51% correct, and after the training, the mean (SD) score was 18.5 (2.2), or 77% (P < .01). The overall rating for the course was 96 out of 100. Trainee self-assessment of "Overall Skill" increased from 63.3 out of 100 to 83.4 out of 100 and "Overall Knowledge" increased from 49.3 out of 100 to 78.7 out of 100 (P < .01). Of the 34 performance objectives during the disaster scenario, 23 were completed by at least half of the teams during their first attempt. All teams except one (8 of 9) could resuscitate two simulators and all teams (9 of 9) helped prevent anthrax exposure during their second scenario attempt. CONCLUSIONS The 1-day EPT course for novice and experienced care providers recreated a multi-actor clinical disaster and enhanced provider knowledge, comfort level, and EPT skill. A larger-scale study, or multi-center trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.
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Measuring oral sensitivity in clinical practice: a quick and reliable behavioural method. Dysphagia 2013; 28:501-10. [PMID: 23515637 DOI: 10.1007/s00455-013-9460-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/18/2013] [Indexed: 12/31/2022]
Abstract
This article aims to offer a behavioural assessment strategy for oral sensitivity that can be readily applied in the clinical setting. Four children, ranging in age and with a variety of developmental and medical problems, were used as test cases for a task analysis of tolerance to touch probes in and around the mouth. In all cases, the assessment was sensitive to weekly measures of an intervention for oral sensitivity over a 3-week period. Employing an inexpensive, direct, specific to the individual, replicable, reliable, and effective measure for a specific sensory problem would fit better with the edicts of evidence-based practice. The current method offered the initial evidence towards this goal.
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Prewett MS, Brannick MT, Peckler B. Training teamwork in medicine: An active approach using role play and feedback. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2013. [DOI: 10.1111/j.1559-1816.2012.01001.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brenner GJ, Nemark JL, Raemer D. Curriculum and Cases for Pain Medicine Crisis Resource Management Education. Anesth Analg 2013; 116:107-10. [DOI: 10.1213/ane.0b013e31826f0ae0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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