How to include medical students in your healthcare simulation centre workforce

Comparing reflection levels between facilitator-led and student-led debriefing in simulation training for paramedic students

BACKGROUND

Simulation in healthcare attempts to create relevant representations of patient encounters. It provides experiential learning, bridging typical classroom activities and clinical practice. This study aims to investigate whether the principle of Peer-Assisted Learning can be used in simulation by letting simulation-experienced paramedic students prepare, deliver, and debrief their own simulations, with minimal faculty assistance. This could be a way to support student learning by being involved in teaching, and it might at the same time optimise the cost-effectiveness of simulation-based training.

METHODS

This observational non-inferiority study compared reflection levels between facilitator-led and student-led simulation and debriefing, between scenario types, and compared the number of turns in which students are involved in both settings. Third-year Bachelor in Paramedic Science students' debriefings were filmed and transcribed. The degree of reflection in students' statements was rated according to a modified version of Fleck's analytical framework of reflection levels, assigning scores from lowest (R0 description) to highest (R4 critical reflection). Facilitator-led and student-led debriefings were compared using chi-square tests. Scenarios were also analysed according to type (paediatric emergencies and complex assessments) regardless of who led the simulation.

RESULTS

Ten facilitator-led and 12 student-led debriefings were analysed. Students gave 682 (49%) contributions in the facilitator-led debriefings, and 702 (51%) contributions in student-led debriefings. Comparison of reflection levels between facilitator-led and student-led debriefings was respectively: R0-level 32.7% vs 33.8%, R1-level 44.0% vs 44.3%, R2-level 14.7% vs 17.1%, R3-level 0.1% vs 1.3%, and R4-level 0.1% vs 0.1%. There were no statistically significant differences in reflection levels between facilitator-led and student-led debriefings (p = 0.178). Comparing the reflection levels between the scenarios on "paediatric emergencies" and "complex assessments", the results were respectively: R0-level 35.4% vs. 31.7%-level, R1-level 45.3% vs. 43.3%-level, R2-level 13.4% vs. 17.8%, R3-level 0.5% vs. 0.9%, and R4-level 0.0% vs. 0.3%. These differences were statistically significant (p = 0.010). No significant differences in engagement were found between debriefings led by a student or a facilitator, when measuring the number of turns in the conversations.

CONCLUSIONS

Facilitator-led and student-led debriefings resulted in equivalent reflection levels amongst students. Student-led simulation is potentially a cost-effective supplement to regular simulation within a healthcare degree program. Since complex scenarios provided higher reflection levels than paediatric, scenario design might influence reflection levels.

A Qualitative Study on the Experiences of Preclinical Students in Learning Clinical and Communication Skills at a Simulation Centre

Introduction

Simulation centres (SC) and its learning resources are now firmly established as part of medical education. In SC, medical students obtain both knowledge and skills based on a combination of theory and practice using provided resources. This study aims to explore medical students' use of SC learning resources to learn clinical and communication skills based on Kolb's experiential learning cycle. This is based on the research question 'How are the SC resources useful in supporting preclinical medical students' clinical and communication skills learning?' The findings of the study can make a case for further enhancement of SC design and resources for medical students in the preclinical phase.

Methods

A qualitative study involving 20 preclinical medical students with learning experiences in SC was conducted between December 2019 and 2020 at a medical school in Malaysia. Semi-structured interview questions were developed based on Kolb's learning cycle. The data were thematically analysed using the six phases of Braun and Clarke's thematic analysis.

Results

Three main themes were identified based on preclinical medical students' experiences in SC; they were 'preparation for authentic clinical experience', 'accessibility of multiple resources for learning and support' and 'opportunities to learn and improve'.

Conclusions

The SC's resources have a significant and positive role in supporting preclinical medical students learn clinical and communication skills. The SC resources prepared them for authentic clinical experiences with a patient-centred care approach and self-directed learning opportunities. Social support from peers, peer tutors and academics emerged as a key finding and resource of the SC as they help preclinical students learn and improve.

Data-driven resuscitation training using pose estimation

BACKGROUND

Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics.

METHODS

After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings.

RESULTS

The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions.

CONCLUSIONS

Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality.

TRIAL REGISTRATION

Not applicable.

Technology-enhanced simulation for healthcare professionals: A meta-analysis

Aim

There have been substantial changes in the simulation technology landscape, in particular virtual reality (VR), during the past decade, which have resulted in increased abundance and decreased cost. We therefore updated a previous meta-analysis conducted in 2011, aiming to quantify the impact of digital technology-enhanced simulation (T-ES) compared with traditional teaching in physicians, physicians-in-training, nurses, and nursing students.

Design

We conducted a meta-analysis consisting of randomized controlled trials published in English between January 2011 and December 2021 in peer-reviewed journals indexed in seven databases. Moderators for study duration, instruction, type of healthcare worker, type of simulation, outcome measure, and study quality rated by Medical Education Research Study Quality Instrument (MERSQI) score were included in our model and used to calculate estimated marginal means (EMMs).

Results

The overall effect of T-ES was positive across the 59 studies included in the analysis compared with traditional teaching [overall effect size 0.80 (95% CI 0.60, 1.00)]. This indicates that T-ES is effective in improving outcomes across a wide variety of settings and participants. The impact of T-ES was found to be greatest for expert-rated product metrics such as procedural success, and process metrics such as efficiency, compared with knowledge and procedure time metrics.

Conclusions

The impacts of T-ES training on the outcome measures included in our study were greatest in nurses, nursing students and resident physicians. T-ES was strongest in studies featuring physical high-fidelity mannequins or centers, compared with VR sensory environment T-ES, though there was considerable uncertainty in all statistical analyses. Further high-quality studies are required to assess direct effects of simulation training on patient and public health outcomes.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions

Background

High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators’ guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator’s role during simulated scenarios.

Methods

A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.

Results

One main category, “Alternating between active and passive facilitation,” emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students’ understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator’s presence in the simulation room during the simulated scenarios influenced students’ emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.

Conclusions

The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00233-0.

How to plan for simulation integration into undergraduate physiotherapy training

Background. The benefits of simulation in healthcare education are undeniable, and in the current healthcare climate, a drastic change in delivering healthcare training is critical. Therefore, integration of simulation is essential, and necessitates detailed planning and well-trained educators. Objectives. To develop a conceptual framework for the integration of simulation in South African (SA) undergraduate physiotherapy programmes. Methods. A non-experimental descriptive research design using a modified Delphi survey was conducted. Results from a systematic review identifying simulation integration framework elements informed the Delphi survey. A purposive sample of 15 healthcare educationalists from SA and abroad were approached to participate. Data were analysed as percentages, and feedback was provided to panel members following each round. Results. A response rate of 73.3% (n=11) was achieved. Planning was explored as one of the themes. Both institutional- and discipline-specific needs analyses were identified as essential (93%), and societal needs were useful to consider (64%). Resource identification and sharing (84%) were regarded as vital, and expert collaboration in curriculum development (79%) with scaffolded skills integration (75%) was advised. The necessity for trained facilitators (93%) and educator role identification (71%) was evident. Statements related to mastery learning/deliberate practice and the use of simulation for assessment purposes yielded the least consensus. Conclusion. A constructively aligned curriculum based on both student and institutional needs and resource availability in guiding simulation integration was regarded as essential. Educator competency in both the development and delivery of the programme, especially debriefing methods, is vital for optimising student learning.

Promoting medical student engagement through co-development and peer-assisted learning: a new patient safety course as a case study

INTRODUCTION

Peer-assisted learning programs have been focused on providing students with competencies to deliver lectures and facilitate workshops, whereas involvement of students as co-developers of educational programmes has been relatively under-described in the literature. Likewise, the use of students as facilitators in simulation-based training and debriefing is also scarce. In this paper, we describe how medical students were co-developers of a novel course on patient safety and how they were trained as student facilitators to conduct simulation-based training and debriefing, as well as workshops.

METHODS

Medical students co-developed a course in patient safety consisting of three simulation-based scenarios and three workshops. The students were educated in relevant patient safety topics. They were trained to become student facilitators to conduct workshops, simulations and debriefings at a patient safety course for medical students. A questionnaire was developed to evaluate the course participants´ perception of the learning objectives and the student facilitators following the latest course in 2020. In addition, semi-structured interviews with the student facilitators were conducted to explore their perceptions of being part of the course.

RESULTS

A total of 92% of the course participants completed the evaluation of the course. The majority of the course participants found that the student facilitators created a safe learning environment and had the necessary skills to teach. The learning objectives for the course were found to be useful. A total of 10 interviews with the student facilitators were conducted. We found that the student facilitators were motivated to teach in the course, as a way of improving their teamwork, leadership qualities and communication skills, as well as their resume. Some of the student facilitators mentioned that they were able to create a safe learning environment, whereas others mentioned a feeling of inadequacy for their teacher role. In addition to developing their teaching skills, they mentioned that they developed their medical expertise, alongside their communication-, collaboration-, leadership- and professional skills.

CONCLUSION

This study illustrates how medical students were involved in the co-development, delivery and implementation of a course in patient safety. The evaluation of the course shows that student facilitators succeeded in creating a safe learning environment. The interviews of the student facilitators reveal their various motivations for teaching, in addition to different perceptions of their experience as a student facilitator. Some expressed a positive feeling of being able to establish a safe learning environment, whilst others expressed a feeling of inadequacy when facilitating peers. In addition, the student facilitators indicated that they developed themselves both professionally and personally.

Immersive 360° videos in health and social care education: a scoping review

BACKGROUND

Research on the pedagogical use of immersive 360° videos is a rapidly expanding area within health and social care education. Despite this interest, there is a paucity of empirical data on its application.

METHOD

A scoping review methodology framework was used to search for relevant articles published between 1970 and July 2021. Six databases were used to identify studies using immersive 360° videos for training and education purposes within health and social care: PubMed, Ovid Medline, Psych Info, Psych Articles, Cochrane Database and Embase. Research questions included: Is there any evidence that immersive 360° videos increase learning outcomes and motivation to learn in health and social care education? What are the key pedagogical concepts and theories that inform this area of research? What are the limitations of using immersive 360° videos within health and social education? The four dimensions contained within Keller's ARCS model (attention, relevance, confidence and satisfaction) frame the results section.

RESULTS

Fourteen studies met our inclusion criteria. Learning outcomes confirm that immersive 360° videos as a pedagogical tool: increases attention, has relevance in skill enhancement, confidence in usability and user satisfaction. In particular, immersive 360° videos has a positive effect on the user's emotional response to the learning climate, which has a significant effect on users' motivation to learn. There was a notable lack of pedagogical theory within the studies retrieved and a general lack of clarity on learning outcomes.

CONCLUSION

Studies examining the effectiveness of such interventions remains weak due to smaller sample sizes, lack of randomised control trials, and a gap in reporting intervention qualities and outcomes. Nevertheless, 360° immersive video is a viable alternative to VR and regular video, it is cost-effective, and although more robust research is necessary, learning outcomes are promising.

FUTURE DIRECTIONS

Future research would do well to focus on interactivity and application of pedagogical theory within immersive 360° videos experiences. We argue that more and higher quality research studies, beyond the scope of medical education, are needed to explore the acceptability and effective implementation of this technology.

Behavioral responses to a cyber attack in a hospital environment

Technical and organizational steps are necessary to mitigate cyber threats and reduce risks. Human behavior is the last line of defense for many hospitals and is considered as equally important as technical security. Medical staff must be properly trained to perform such procedures. This paper presents the first qualitative, interdisciplinary research on how members of an intermediate care unit react to a cyberattack against their patient monitoring equipment. We conducted a simulation in a hospital training environment with 20 intensive care nurses. By the end of the experiment, 12 of the 20 participants realized the monitors' incorrect behavior. We present a qualitative behavior analysis of high performing participants (HPP) and low performing participants (LPP). The HPP showed fewer signs of stress, were easier on their colleagues, and used analog systems more often than the LPP. With 40% of our participants not recognizing the attack, we see room for improvements through the use of proper tools and provision of adequate training to prepare staff for potential attacks in the future.

Most significant barriers and proposed solutions for medical schools to facilitate simulation-based undergraduate curriculum in OBGYN

Despite having a good understanding of medicine, doctors lack clinical skills, problem-solving abilities, and the ability to apply knowledge to patient care, particularly in unanticipated circumstances. To overcome this, medical education has evolved into a system-oriented core curriculum with cognitive, psychomotor, and affective learning goals. With an emphasis on problem-based learning, the educator's aim is to establish a long-term, predetermined improvement in the learner's behavior, acquired skills, and attitudes (Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167-172. https://doi.org/10.1016/S0377-1237(12)60040-9 ). However, teaching these disciplines to real patients is almost impossible; this is where simulation comes in. This opinion paper will discuss the relevance and necessity of a simulation-based undergraduate curriculum in obstetrics and gynecology. What are the biggest obstacles that medical schools face in making the most of simulation-based learning, and how can they be overcome?

Medical student-led simulation in COVID-19 crisis

BACKGROUND

Simulation training is an effective tool for improving confidence in healthcare workers. During the recent COVID-19 pandemic, large numbers of staff required re-training to manage unfamiliar situations. We present a set of medical student-led clinical simulation sessions and evaluate their effects on (i) confidence among redeployed healthcare workers managing COVID-19 patients and (ii) medical students' confidence as educators.

METHODS

Half-day simulation training sessions consisting of three COVID-related clinical scenarios were devised by senior medical students and delivered to a group of approximately 150 healthcare workers over six repeated sessions prior to redeployment to COVID-19 wards. We distributed an anonymous pre- and post-simulation questionnaire to 36 participants in the final group exploring their experiences. The confidence scores were analysed using the Wilcoxon signed-rank test. Following the delivery of teaching, medical students completed a questionnaire assessing their personal experiences of designing and delivering the exercises.

RESULTS

Data are available for 35/36 participants approached. Respondents reported being significantly more confident after the training in all aspects of managing COVID-19 patients, including triage, complex discharge, recognising deterioration, initiating basic life support, managing symptoms and advising on visiting policies (p < 0.001); 97% of respondents rated the training as useful. Thematic analysis of medical students' responses demonstrated mutual benefit.

DISCUSSION

This study demonstrates the strengths of simulation training in helping to build staff confidence in a rapidly evolving situation and highlights the value of medical students in supporting a hospital's response to an outbreak. We recommend further studies of student-led simulation exercises, including longer-term follow-up.

Paradigm of technological convergence and digital transformation: The challenges of CH sectors in the global COVID-19 pandemic and commencing resilience-based structure for the post-COVID-19 era

Technology and digitalization are vital for helping organizations to survive in the competitive marketplace. The global COVID-19 pandemic has fixated attention on the cultural heritage sectors. This study presents technological convergence and new digital platforms that require business societies to transform into new sustainable meanings. The concept of technological convergence to the autonomous ecosystem is supported by cutting-edge technologies, a distinctive life cycle for value-added creation. This study is based on a five-part conceptual context to examine the impact of pandemic on the cultural heritage sectors. The major impacts like institutional issues, financial limitations, data access policies, and stakeholders diverging views are fully addressed. An additional impression of this study is that it has comprehensively expressed the opportunities and capabilities of technological convergence in terms of competence, integration, impound and novelty for higher value creation most related to the cultural heritage sectors in the current and post COVID-19 pandemic era.

Developing future medical educators in an Australian medical program: supervisors' reflections on the first four years of MD Professional Project implementation

BACKGROUND

Increasingly, professional bodies expect doctors to not only provide patient care but also educate students, trainees and patients. Few medical students, however, receive formal tuition in terms of the theory and practice of medical education. A curriculum restructure from an MBBS to a Doctor of Medicine (MD) program provided an opportunity to develop three Masters streams: Clinical research, Capstones and educational Professional Projects. This submission describes how one Australian medical school is preparing some students for their future roles as medical educators through MD Professional Projects.

DESIGN

Framed by the 12 roles of the medical 'teacher', most students undertaking these projects take on Resource Developer (including simulation) and Assessor roles. For those choosing resource development (excluding simulation) or assessment, the Association for Medical Education (AMEE) Student Essential Skills in Medical Education (ESME) Course is compulsory. For those choosing educational research, the ESME Course is optional.

OUTCOMES

By December 2020, four MD cohorts will have graduated with 69 students having undertaken educational MD Professional Projects, with fifty-one completing the ESME Course. MD students have created a range of resources for the curriculum, their colleagues and the local healthcare community. In addition to the expected learning we identified additional value-added outcomes for learners (e.g. skill development), the curriculum (e.g. areas of difficulty), academic supervisors' roles (e.g. role-modelling) and for the health care community (e.g. as expert reviewers).

CONCLUSIONS

Engaging in scholarly activities such the ESME Course and developing learning resources not only provided MD students with a more in-depth theoretical knowledge in a range of clinical areas, but also developed skills that would prepare them for their future roles as medical educators. As supervisors, we identified the value these projects add to the broader health community as well as personal and professional benefits for ourselves.

Using simulation to help healthcare professionals relaying patient information during telephone conversations

BACKGROUND

The purpose of this paper is to describe a development project in which simulation was used to improve the telephone-based conversations between nurses in an emergency department (ED) and physicians from different specialties taking care of acutely ill patients.

METHODS

A needs analysis consisting of observations and interviews was conducted and a one-day simulation-based interprofessional team training course was developed. Observations of phone conversations pre-course, three and six months after the course were conducted in the clinical setting with 20 participants in each point of time. A 14-item evaluation tool was used to record how many information pieces were communicated.

RESULTS

Five courses were conducted for 66 nurses/nurse assistants and 17 physicians. 9 out of the 14 items were reported significantly more after the course. Item that were not reported in the pre-measurement, increased to around 20% reporting three months after the course but then fell to close to 0% again after six months.

CONCLUSIONS

The patterns of retention and decrease of the effect could be an indicator for norms, values and beliefs held by professions about what constitutes their task.

The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: practical tips and resources from Norway, Denmark, and the UK

In this paper, we describe the potential of simulation to improve hospital responses to the COVID-19 crisis. We provide tools which can be used to analyse the current needs of the situation, explain how simulation can help to improve responses to the crisis, what the key issues are with integrating simulation into organisations, and what to focus on when conducting simulations. We provide an overview of helpful resources and a collection of scenarios and support for centre-based and in situ simulations.