Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents

Impact of a Multidisciplinary Simulation-Based Training Program on the Multiple Techniques of Intraosseous Access: A Prospective Multicentric Study

OBJECTIVES

The aim of this study was to assess intraosseous (IO) access placement performance during a multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course.

METHOD

This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 6, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by 2 independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient. The continuous variables were compared using a Student t test or a nonparametric Mann-Whitney U test. Comparative analysis between the different groups used analysis of variance. Correlation analysis was performed by a nonparametric Spearman test. A P value of 0.05 was considered significant.

RESULTS

Ninety-eight participants were included. Intraclass correlation coefficient between the 2 observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semiautomatic device, P = 0.004 in tibia and P = 0.001 in humeral; for the manual device, P < 0.001). Simulation-based training significantly reduced time for IO access ( P = 0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training.

CONCLUSIONS

Simulation-based training improved the IO access using a semiautomatic or a manual device, regardless of the experience or status of the trainees. Simulation-based training would work for many disciplines regardless of locations (simulation or clinical facilities).

Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial

INTRODUCTION

This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid.

METHODS

In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™.

RESULTS

All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences.

CONCLUSIONS

Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

Effects of simulation-based education for neonatal resuscitation on medical students' technical and non-technical skills

Simulation is a learner-centered practice that helps develop and maintain knowledge, skills, and competencies. This study evaluated the effect of neonatal resuscitation simulation-based education for medical students in the fifth year (part of the regular clinical clerkship program) on the perceived performance of their technical and non-technical skills. In addition, we analyzed the difference between instructor's and learners' evaluations of technical skills after the simulation. A one-group pretest-posttest design was adopted. The simulation-based education of the neonatal resuscitation program (NRP) was conducted for 40 medical students from July to November 2020 at a medical school in South Korea. The simulation-based education comprised 5 minutes of pre-briefing, 10 minutes of running the simulation, and 30 minutes of debriefing (using a recorded video). The perceived performance of students' technical and non-technical skills before and after the simulation was compared by collecting and analyzing the pre- and post-questionnaires. The perceived performance of technical (p = .001) and non-technical skills (p < .001) was found to have significantly increased after the simulation. Particularly, the performance of technical skills, such as diagnostic (p = .007) and therapeutic actions (p < .001) and non-technical skills, such as leadership (p < .001), teamwork (p = .001), and task management (p = .020) improved significantly. There was no significant difference in the evaluations of the technical performance of the instructor and learners after the simulation (p = .953). Simulation-based education can improve technical skills, such as diagnostic and therapeutic actions for neonatal resuscitation. It is also effective in enhancing non-technical skills, such as leadership, teamwork, and task management. Further, after the simulation-based education, students can fully self-evaluate through objective reflection and improve their clinical competency.

Special consideration in neonatal resuscitation

Delivery room resuscitation of neonates is performed according to evidence-based neonatal resuscitation guidelines. Neonatal resuscitation guidelines focus on the resuscitation of newborns suffering from perinatal asphyxia. Special considerations are needed when resuscitating newborns in locations other than the delivery room and for newborns with congenital anomalies. In this review, we examine the resuscitation of newborns at home and in the emergency department and highlight special considerations for resuscitating newborns with specific congenital anomalies. In addition, we explore the resuscitation of neonates in the neonatal intensive care unit and discuss the potential use of pediatric advanced life support guidelines. Finally, we highlight the importance of simulation to prepare teams for neonatal resuscitations. This review aims to prepare healthcare professionals in all disciplines caring for neonates at risk for requiring resuscitation under special circumstances.

Guidelines for the management of urgent obstetric situations in emergency medicine, 2022

OBJECTIVE

To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward.

DESIGN

A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded.

METHODS

Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method.

RESULTS

Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made.

CONCLUSIONS

There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.

GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review

BACKGROUND

In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions.

METHODS

A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes.

RESULTS

Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions.

CONCLUSIONS

This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.

Procedural skill maintenance: Perspectives and motivations of pediatric emergency medicine faculty

BACKGROUND

Pediatric emergency medicine (PEM) physicians receive training in critical procedures, but these procedures are rare in practice. The literature on maintenance of procedural skills focuses on ways to practice (e.g., via simulation) and pays little attention to motivation's role. Understanding what motivates PEM physicians to maintain procedural skills can inform the design of supportive policies and interventions. Our study explores how PEM physicians conceptualize maintenance of procedural skills, what motivates them to maintain procedural skills, and barriers to procedural skill maintenance.

METHODS

This was a qualitative study of 12 PEM faculty guided by the self-determination theory (SDT) of motivation. SDT describes a typology that distinguishes extrinsic and intrinsic motivation, with intrinsic motivation based on autonomy, competence, and relatedness. Interviews were transcribed and coded using constant-comparative technique, and interviews continued until thematic sufficiency was achieved.

RESULTS

Participants had difficulty defining procedural skill maintenance by specific criteria and expressed ambivalence about external standards for competence, noting the need to account for individual and local practice factors. Three themes characterizing participants' motivation for procedural skills maintenance included: (1) desire to provide optimal patient care and fear of unsuccessful performance (competence), (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures (competence and relatedness), and (3) desire for accessibility and choice of options in maintaining procedural skills (autonomy). Participants identified lack of opportunities, time, and support as barriers to motivation and skills maintenance.

CONCLUSION

SDT concepts were integral to understanding faculty motivation, and this highlights the need for prioritizing faculty autonomy, competence, and relatedness in designing supports for procedural skill maintenance. Our findings regarding the difficulty in defining maintenance of skills emphasize the need for further discussion and study of this topic.