Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development?

Professionals in-place: the role of the practice-based research coordinator

BACKGROUND

The authors were members of a large, interorganisational research project conducted by a university and an English NHS trust. The project's success relied on building positive partnerships and networks over three years. Recognising the challenges of working across different organisations, the authors created a new role for a nurse: the 'in-place research coordinator' (IPRC).

AIM

To introduce and explain the new role and provide examples of how the authors devised and applied it during their research.

DISCUSSION

The IPRC was a member of the NHS trust, so brought valuable organisational insights to the research team while gaining research experience through applying her professional knowledge and connections.

CONCLUSION

The IPRC enabled this inter-organisational research to take place, and had measurable efficacy and impact.

IMPLICATIONS FOR PRACTICE

The authors recommend that future collaborative inter-organisational research projects include an IPRC, with specific budgeting for the role and recruitment from practice.

The effect of a team-based blended simulation training program on cardiopulmonary resuscitation on healthcare professionals' perception, performance, and costs: a mixed-method study

BACKGROUND

The quality of Cardio Pulmonary Resuscitation (CPR) and Automated External Defibrillations (AED) treatment provided by individual practitioners is the most important factor in surviving an in-hospital cardiac arrest (IHCA); therefore, healthcare professionals (HCPs) require sufficient resuscitation competency. This study aimed to analyze the effects of a blended team-based CPR and AED simulation training (riAniMO program) on HCPs performance, satisfaction and perception on transferability, and costs.

METHODS

The riAniMO is based on a multimedia training program with video lessons and a virtual CPR resuscitation simulation, and a team-based CPR and AED simulation. The study utilized a mixed-method design. The quantitative phase involved a retrospective cohort study with a comparison group to assess the impact of the riAniMO. Meanwhile, the qualitative phase involved four focus groups (FGs) to investigate the viewpoints of professionals on the strengths and limitations of the riAniMO. We compared the 845 HCPs who participated in the BLSD (Basic Life Support- early Defibrillation) re-training program with ERC (European Resuscitation Council) approach and the 1,167 who participated in the riAniMO re-training program. BLSD re-training took place between January and December 2019 and riAniMO re-training took place between January and December 2022.

RESULTS

From quantitative analysis, a slight increase in the number of HCPs satisfied with retraining in the riAniMO group compared to the BLSD group was found. However, the percentage of HCPs certified decreased by 9% in the riAniMo group (90.2%) compared to the BLSD group (99.2%). The RiAniMO approach resulted in cost savings by training 322 more healthcare providers and saving € 61.7 per participant. From the FG analysis, five themes emerged: 1) Realism in Learning: Experimenting in your own operating context and using your own devices; 2) Strength of the working group and multidisciplinarity; 3) Improved perception of training burden; 4) Facilitator as consultant and guide, which provides real-time situational feedback; 5) Transparency on evaluations and certifications for the simulations.

CONCLUSIONS

The riAniMO approach maintained high standards in terms of HCPs' satisfaction and performance and seemed to be cost-saving. Further studies are necessary to verify the long-term effectiveness of training methods for team-based CPR and AED simulation.

Simulation in plastic and reconstructive surgery: a scoping review

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

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.

Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education

Cultural historical activity theory (CHAT) is a social theory which is useful as a methodological framework for the vital task of studying practice-based learning in complex learning environments. CHAT is an apparatus considering learning as occurring through practice, through collective activity, and mediated by culturally specific instruments. Because CHAT is increasingly drawn upon in medical education academia, it is necessary for medical educationalists to be familiar with this theory. This methodology article explains how CHAT theorizes learning in dynamic workplaces within an activity system comprising multiple practitioners engaged in activity, which is collaborative, multi-voiced, and bounded by a shared intended object. It provides an accessible overview of the central concepts within CHAT and a description of a methodological strategy (activity system analysis) to incorporate CHAT into one's own work. CHAT also theorizes where tensions lie within and between activity systems, causing difficulties in achieving the intended object, defining such tensions as contradictions. It is through the overcoming of past contradictions that activity has come to exist in its current form, abiding by social norms of the present time, and CHAT allows consideration of how practice within a system may be changed through resolution of contradictions. For example, the Change Laboratory is a contrived intervention where practitioners consciously contribute to developing and embedding new, improved ways of practicing using CHAT principles. This allows practitioners to have agency in improving their own areas of learning and practice. Throughout this article, examples are provided of how CHAT has been usefully applied to various aspects of medical education research, including undergraduate education, postgraduate education, and continuous professional development. By building on the introduction to CHAT provided in this article, the reader can start to use CHAT methodologically to describe complexity, identify practice-based contradictions, and develop improved forms of practice-based learning, in his/her own context.