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Parvin-Nejad FP, Vegunta G, Mele G, Sifri ZC. Stop the Bleed in the Era of Virtual Learning: A Novel Strategy for Remote Teaching and Evaluation. J Surg Res 2024; 296:759-765. [PMID: 38377702 DOI: 10.1016/j.jss.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/16/2023] [Accepted: 01/06/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Traumatic hemorrhage is a leading cause of preventable mortality worldwide. The Stop the Bleed (STB) course was developed to equip layperson bystanders with basic bleeding control knowledge and skills. However, large in-person courses have been disrupted due to COVID-19. The aim of this study was to determine the feasibility of teaching and evaluating STB skills through remote video-based instruction. METHODS After undergoing COVID-19 screening, groups of up to eight STB-naive adults were seated in a socially distanced manner and given individual practice kits. A remote STB-certified instructor provided the standard STB lecture and led a 10-min skills practice session via videoconferencing. Participants' skills were evaluated on a 10-point rubric by one in-person evaluator and three remote evaluators. Participants completed a postcourse survey assessing their perceptions of the course. RESULTS Thirty-five participants completed the course, all scoring ≥8/10 after examination by the in-person evaluator. Remote instructors' average scores (9.8 ± 0.45) did not significantly differ from scores of the in-person evaluator (9.9 ± 0.37) (P = 0.252). Thirty-three participants (94%) completed the postcourse survey. All respondents reported being willing and prepared to intervene in scenarios of life-threatening hemorrhage, and 97% reported confidence in using all STB skills. CONCLUSIONS STB skills can be effectively taught and evaluated through a live video-based course. All participants scored highly when evaluated both in-person and remotely, and nearly all reported confidence in skills and knowledge following the course. Remote instruction is a valuable strategy to disseminate STB training to students without access to in-person courses, especially during pandemic restrictions.
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Affiliation(s)
| | | | - Giovanna Mele
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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2
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Bui C, Parange N, Bezak E, Bidner A. The Role of Telehealth in Ultrasound Training for Remote Learners: A Systematic Review. Telemed J E Health 2024; 30:963-975. [PMID: 38052050 DOI: 10.1089/tmj.2023.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Introduction: Remote learners and educators face geographic, professional, and personal barriers that affect their access to quality ultrasound education. The integration of telehealth in ultrasound education enables learners performing ultrasound to receive real-time instruction from an educator at a distant or remote site. However, to date, there has been poor understanding of the efficacy, benefits, shortcomings, and economic impact of telehealth education in comparison to in-person ultrasound training. The aim of this research was to assess current literature on telehealth in ultrasound education and hands-on training, its outcomes and impact, and requirements for future development. Methods: This review examined international literature on telehealth in ultrasound training. The primary author and second investigator were involved in the research and reached consensus on the eligibility criteria, search strategy, included articles, data extraction, and quality assessment. Results: A total of 23 studies were obtained from Medline, Emcare and Scopus. Key themes identified: Most studies saw an equivalent improvement in knowledge and skills through pre and postassessments in both in-person and telehealth sessions. Generally, learners felt comfortable performing ultrasound guided by a remote educator and felt their skills had been advanced across all studies. Educators reported positive feedback, however compared with learners, educators expressed less satisfaction with the telehealth session. Conclusions: This study demonstrated the feasibility of telehealth in ultrasound training for remote learners with little to no experience. Quality studies with comparable outcomes are needed to ascertain the safe and effective application of telehealth in ultrasound training.
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Affiliation(s)
- Catthy Bui
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia
| | - Amber Bidner
- Department of Allied Health and Human Performance Unit, The University of South Australia, Adelaide, South Australia
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3
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Birido N, Brown KM, Olmo Ferrer D, Friedland R, Bailey SKT, Wawersik D, Charnetski M, Nair B, Kutzin JM, Gross IT, Palaganas JC. Health Care Simulation in Person and at a Distance: A Systematic Review. Simul Healthc 2024; 19:S65-S74. [PMID: 38240620 DOI: 10.1097/sih.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Distance simulation is a method of health care training in which the learners and facilitators are in different physical locations. Although methods of distance simulation have existed in health care for decades, this approach to education became much more prevalent during the COVID-19 pandemic. This systematic review studies a subset of distance simulation that includes combined in-person and distance simulation elements, identified here as "mixed- distance simulation." A review of the distance simulation literature identified 10,929 articles. Screened by inclusion and exclusion criteria, 34 articles were ultimately included in this review. The findings of this review present positive and negative aspects of mixed-distance simulation formats, a description of the most frequent configurations related to delivery, terminology challenges, as well as future directions including the need for faculty development, methodological rigor, and reporting details.
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Affiliation(s)
- Nuha Birido
- From the Royal College of Surgeons in Ireland-Medical University of Bahrain (N.B., B.N.), Busaiteen, Bahrain; Johns Hopkins University School of Nursing (K.M.B.), Baltimore, MD; Norfolk and Norwich University (D.O.-F.), Norfolk, UK; University of South Florida (S.K.T.B.), Tampa, FL; Nova Southeastern University (D.W.), Fort Lauderdale, FL; Dartmouth Health (M.C.), Lebanon, NH; The Mount Sinai Hospital (J.M.K.). New York, NY; Yale University School of Medicine (I.T.G.), New Haven, CT; and MGH Institute of Health Professions (J.C.P.), Boston, MA
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4
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Kishimoto N, Sanuki T, Liu Y, Tran SD, Seo K. Simulation training for medical emergencies of dental patients: A review of the dental literature. Jpn Dent Sci Rev 2023; 59:104-113. [PMID: 36937224 PMCID: PMC10017307 DOI: 10.1016/j.jdsr.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.
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Affiliation(s)
- Naotaka Kishimoto
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
- Corresponding author at: Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274, Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan.
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Younan Liu
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Kenji Seo
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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5
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Park JO, Lee-Jayaram J, Sato E, Eto Y, Kahili-Heede M, Hirayama K, Berg BW. A scoping review of remote facilitation during simulation-based healthcare education. BMC Med Educ 2023; 23:592. [PMID: 37605196 PMCID: PMC10464104 DOI: 10.1186/s12909-023-04551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Remote facilitation is a synchronous distance education method where instructors facilitate a lesson, in real-time, in physically separate conditions. In this scoping review, we aimed to describe types of remote facilitation used in a healthcare simulation, the influences on learner outcomes, and related factors. METHODS We accessed PubMed, EMBASE, CINAHL, ERIC, and Web of Science using our search strategies. Five reviewers performed the review using the Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping Reviews (PRISMA-ScR) framework, and the Johanna Briggs Institute (JBI) guidelines. RESULTS We included a total of 29 articles presenting 28 simulation studies. The most common tool was videoconferencing (n = 26, 89.7%). Knowledge improvement was the most frequently measured outcome. There was no significant difference in learning outcomes between the two teaching modes. There were differences in learners' preferences and satisfaction with remote facilitators before and after COVID-19. CONCLUSIONS Our scoping review indicates that remote facilitation has been widely accepted in many healthcare professions using various types of simulation modalities. Remote facilitation can be used to overcome logistical problems of synchronous multi-location education, and to improve learner knowledge, skills, and confidence measured by instructor evaluation or self-assessment.
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Affiliation(s)
- Ju Ok Park
- Department of Emergency Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong-si, South Korea.
| | - Jannet Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, , Honolulu Hawaii, USA
| | - Eri Sato
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, , Honolulu Hawaii, USA
| | - Yuka Eto
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, , Honolulu Hawaii, USA
| | - Melissa Kahili-Heede
- Health Science Library, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu Hawaii, USA
| | - Krystal Hirayama
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, , Honolulu Hawaii, USA
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, , Honolulu Hawaii, USA
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6
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Yasser NBM, Tan AJQ, Harder N, Ashokka B, Chua WL, Liaw SY. Telesimulation in healthcare education: A scoping review. Nurse Educ Today 2023; 126:105805. [PMID: 37062239 DOI: 10.1016/j.nedt.2023.105805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN A scoping review. DATA SOURCES A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.
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Affiliation(s)
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Balakrishnan Ashokka
- Department of Anaesthesia, National University Hospital, Singapore; Centre for Medical Education, CenMED, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Bloom AD, Aliotta RE, Mihas A, Peterson DT, Robinett DA, White ML. Tele-Simulated Instruction and Learner Perceptions of Fiberoptic Intubation and Nasopharyngoscopy: A Pilot Study. West J Emerg Med 2023; 24:104-109. [PMID: 36602496 PMCID: PMC9897257 DOI: 10.5811/westjem.2022.11.58053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Andrew D. Bloom
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Rachel E. Aliotta
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, Alabama
| | - Alexander Mihas
- University of Alabama at Birmingham, Department of Orthopaedic Surgery, Birmingham, Alabama
| | - Dawn Taylor Peterson
- University of Alabama at Birmingham, Department of Medical Education, Birmingham, Alabama
| | - Derek A. Robinett
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Marjorie Lee White
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, Alabama
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8
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Affiliation(s)
- Fahad Alam
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre.,Sunnybrook Simulation Centre, Toronto, Ontario, Canada.,Wilson Centre for Research in Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Anesthesiologists' Society-Simulation and Education Section, Toronto, Ontario, Canada.,Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde Matava
- Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Pfennig M, Lee A, Mi M. How does telementoring impact medical education within the surgical field? A scoping review. Am J Surg 2022; 224:869-880. [PMID: 35545476 PMCID: PMC9417933 DOI: 10.1016/j.amjsurg.2022.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Background Surgical education strongly involves the use of mentorship to improve the confidence and efficiency of trainees. Social distancing due to the COVID-19 pandemic may serve as a catalyst to promote the use of telementoring and other remote learning opportunities in medical education. Methods A comprehensive literature review was performed using the electronic databases PubMed, Embase, Web of Science, Scopus, and the Cochrane Library with respect to telementoring in the surgical field. Results The overall consensus of telementoring experience among all 25 studies was generally positive, citing “positive experience,” “increased confidence,” and “increased surgical skill.” Using over 15 different technologies, a total of 12 simulations, 149 tasks, and 491 surgeries were conducted via telementoring. Eight mentor-mentee relationships were identified, with the most common relationship being surgeon-to-surgeon in 12 studies. Conclusions The implementation of telementoring has been shown to be effective in improving surgical skills and learner experiences while overcoming financial and geographical barriers.
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Affiliation(s)
- Mitchell Pfennig
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Andrew Lee
- Third-year Medical Student, Oakland University William Beaumont School of Medicine, USA.
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, USA.
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10
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Tham AC, Himdi L, Nguyen LH, Frenkiel S, Tewfik MA. Conducting an Endoscopic Sinus Surgery Dissection Course via Telesimulation: An Initial Experience. OTO Open 2022; 6:2473974X221083981. [PMID: 35274075 PMCID: PMC8902190 DOI: 10.1177/2473974x221083981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Medical education has been severely disrupted by the COVID-19 pandemic, with many
in-person educational activities transitioned to distance learning. To overcome this
challenge, we utilized telesimulation to conduct an endoscopic sinus surgery (ESS)
dissection course. Our objectives were to evaluate the effectiveness and acceptability
of telesimulation as an alternative to in-person dissection courses for resident
training. Study Design Cross-sectional study. Setting Academic medical centers. Methods The course, consisting of lectures and hands-on dissection, was conducted entirely over
the Zoom platform. The participants were allocated outpatient clinic rooms at 2
hospitals, while the instructors supervised remotely. We utilized the camera systems in
the clinics and 3-dimensional–printed sinus models for the dissection. Laptops with
cameras were used to capture the endoscopic image and the dissector. We evaluated the
effectiveness of telesimulation, the surgical skills of the participants, and the course
by way of pre- and posttest and a questionnaire. Results A total of 8 participants and 7 instructors participated in the study. Telesimulation
was found to be effective in helping participants gain knowledge and skills in ESS. All
participants improved on their pretest scores (31.5% vs 73.4%, P =
.003) and felt more comfortable with ESS postcourse (1.9 vs 3.2, P =
.008). Participants and instructors opined that telesimulation is an acceptable
alternative to in-person dissection courses. Conclusion Telesimulation is an effective, acceptable, and viable alternative to in-person
dissection courses. It also has the advantage of overcoming temporal and geographic
constraints to surgical training in residency.
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Affiliation(s)
- Alex C. Tham
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Canada
| | - Lamiae Himdi
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Canada
| | - Lily H.P. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Saul Frenkiel
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Canada
| | - Marc Antoine Tewfik
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Canada
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James EJG, Vyasam S, Venkatachalam S, Sanseau E, Cassidy K, Ramachandra G, Rebekah G, Adhikari DD, Deutsch E, Nishisaki A, Nadkarni VM. Low-Cost "Telesimulation" Training Improves Real Patient Pediatric Shock Outcomes in India. Front Pediatr 2022; 10:904846. [PMID: 35967566 PMCID: PMC9364444 DOI: 10.3389/fped.2022.904846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, process of care, and patient outcomes in both simulated and real patient settings. MATERIALS AND METHODS We conducted a prospective quasi-experimental interrupted time series cohort study over 9 months. We conducted 40 telesimulation sessions for 76 participants in teams of 3 or 4, utilizing the video telecommunication platform (Zoom©). Trained observers recorded time-critical interventions on real patients for the pediatric emergency teams composed of residents, fellows, and nurses. Data were collected on 332 pediatric patients in shock (72% of whom were in septic shock) before, during, and after the intervention. The data included the first hour time-critical intervention checklist, patient hemodynamic status at the end of the first hour, time for the resolution of shock, and team leadership skills in the emergency room. RESULTS There was a significant improvement in the percent completion of tasks by the pediatric emergency team in simulated scenarios (69% in scenario 1 vs. 93% in scenario 2; p < 0.001). In real patients, completion of tasks as per time-critical steps reached 100% during and after intervention compared to the pre-intervention phase (87.5%), p < 0.05. There was a significant improvement in the first hour hemodynamic parameters of shock patients: pre (71%), during (79%), and post (87%) intervention (p < 0.007 pre vs. post). Shock reversal time reduced from 24 h pre-intervention to 6 h intervention and to 4.5 h post intervention (p < 0.002). There was also a significant improvement in leadership performance assessed by modified Concise Assessment of Leader Management (CALM) instrument during the simulated (p < 0.001) and real patient care in post intervention (p < 0.05). CONCLUSION Telesimulation training is feasible and improved the process of care, time-critical interventions, leadership in both simulated and real patients and resolution of shock in real patients. To the best of our knowledge, this is one of the first studies where telesimulation has shown improvement in real patient outcomes.
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Affiliation(s)
- Ebor Jacob G James
- Pediatric Critical Care, Department of Pediatrics, Christian Medical College, Vellore, India.,Pediatric Simulation Training and Research Society of India, Hyderabad, India
| | - Siva Vyasam
- Pediatric Critical Care, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Shakthi Venkatachalam
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elizabeth Sanseau
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kyle Cassidy
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States
| | - Geethanjali Ramachandra
- Pediatric Simulation Training and Research Society of India, Hyderabad, India.,Department of Pediatric Intensive Care, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Debasis D Adhikari
- Pediatric Critical Care, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Ellen Deutsch
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Vinay M Nadkarni
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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12
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Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Teleguidance facilitated intubation has recently reemerged during the coronavirus disease 2019 pandemic as a strategy to provide expert airway management guidance and consultation to practitioners in settings where such expertise is not readily available onsite or in-person. We conducted a scoping review to provide a synthesis of the available literature on teleguidance facilitated intubation. Specifically, we aimed to evaluate the feasibility, safety, and efficacy of teleguidance facilitated intubation given existing technology. DATA SOURCES: A librarian-assisted search was performed using three primary electronic medical databases from January 2000 to November 2020. STUDY SELECTION: Articles that reported outcomes focused on implementing or evaluating the performance of teleguidance facilitated intubation were included. DATA EXTRACTION: Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. DATA SYNTHESIS: Of 255 citations identified, 17 met eligibility criteria. Studies included prospective investigations and proof of technology reports. These studies were performed in clinical and simulation environments. Five of the prospective investigations that examined time to intubation and intubation success rates. Multiple different commercially available and noncommercial teleconference software systems were used in these studies. CONCLUSIONS: There is a limited body of literature evaluating the feasibility, safety, and efficacy of teleguidance facilitated intubation. Based on the studies available that examined a variety of technologies within simulation and clinical environments, teleguidance facilitated intubation appears to be feasible, safe, and efficacious. Given the exponential growth in the use of telemedicine technology during the coronavirus disease 2019 pandemic and the evidence supporting teleguidance facilitated intubation, there is a need to critically evaluate the most effective mechanisms to integrate and optimize these technologies across diverse practice settings.
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Mileder LP, Bereiter M, Wegscheider T. Telesimulation as a modality for neonatal resuscitation training. Med Educ Online 2021; 26:1892017. [PMID: 33602053 PMCID: PMC7899687 DOI: 10.1080/10872981.2021.1892017] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 05/31/2023]
Abstract
Introduction: Telesimulation may allow simulationists to continue with essential simulation-based training programs during the COVID-19 pandemic. Hence, we investigated the feasibility of telesimulation for neonatal resuscitation training, assessed participants' attitudes towards telesimulation as well as its effect on neonatal resuscitation knowledge, and compared results between medical students and neonatal nurses. Methods: For this prospective observational pilot study, medical students and neonatal nursing staff were recruited on a voluntary basis. Pre- and post-training knowledge was assessed using a 20-question questionnaire. Following the educational intervention, participants further answered a six-item questionnaire on their perception of telesimulation. For the telesimulation session, participants received a simulation package including a low-fidelity mannequin and medical equipment. The one-hour telesimulation session was delivered by an experienced instructor and broadcasted via Cisco Webex for groups of 2-3 participants, covering all elements of the neonatal resuscitation algorithm and including deliberate technical skills practice. Results: Nine medical students and nine neonatal nurses participated in a total of seven telesimulation sessions. In general, participants enjoyed the telesimulation session, acknowledged a positive learning effect and found telesimulation suitable for neonatal resuscitation training, but were critical of potential technical issues, training logistics, and the quality of supervision and feedback. Neonatal resuscitation knowledge scores increased significantly after the educational intervention both for medical students and nurses. Conclusions: Telesimulation is feasible for neonatal resuscitation training and associated with significant improvements in knowledge of current resuscitation guidelines, without differences between medical students and neonatal nurses.
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Affiliation(s)
- Lukas P. Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Clinical Skills Center, Medical University of Graz, Graz, Austria
| | - Michael Bereiter
- Clinical Skills Center, Medical University of Graz, Graz, Austria
| | - Thomas Wegscheider
- Clinical Skills Center, Medical University of Graz, Graz, Austria
- Division of Special Anesthesiology, Pain and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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14
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Roach E, Okrainec A. Telesimulation for remote simulation and assessment. J Surg Oncol 2021; 124:193-199. [PMID: 34245571 DOI: 10.1002/jso.26505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022]
Abstract
Telesimulation (TS), the process of using the internet to link educators and trainees at locations remote from one another, harnesses the powers of technology to enable access to high-quality simulation-based education and assessment to learners across the globe. From its first uses in the teaching and assessment of laparoscopic skills to more recent interpretations during the current pandemic, TS has shown promise in helping educators to address pressing dilemmas in medical education.
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Affiliation(s)
- Eileen Roach
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Temerty Advanced Surgical Education and Simulation Center, University Health Network, Toronto, Ontario, Canada
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15
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Liu M, Salmon M, Zaidi R, Nagdev A, Debebe F, Muller MF, Ruhangaza CF, Emiru H, Belachew Y, Tumebo A, Paoletti M, Okrainec A, Chan V, Niazi AU. Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia. Reg Anesth Pain Med 2021; 46:722-726. [PMID: 33903219 DOI: 10.1136/rapm-2020-102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia. METHODS Eighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist. RESULTS Participants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test. CONCLUSIONS Teaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.
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Affiliation(s)
- Monica Liu
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Rene Zaidi
- InnovationsCZ, Goma, Congo (the Democratic Republic of the)
| | - Arun Nagdev
- Emergency Department, Alameda County Medical Center, Oakland, California, USA
| | - Finot Debebe
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Mundenga Furaha Muller
- Department of Orthopedics, HEAL Africa Hospital, Goma, Congo (the Democratic Republic of the)
| | - Cito Furaha Ruhangaza
- Department of Orthopedics, HEAL Africa Hospital, Goma, Congo (the Democratic Republic of the)
| | - Haimanot Emiru
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Yonas Belachew
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Aklilu Tumebo
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | | | - Allan Okrainec
- Department of General Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Chan
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ahtsham U Niazi
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
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16
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Kishimoto N, Nguyen BH, Tran SD, Seo K. Telesimulation training applying flipped classroom in the dental clinic for medical emergencies. J Dent Anesth Pain Med 2021; 21:179-181. [PMID: 33880411 PMCID: PMC8039157 DOI: 10.17245/jdapm.2021.21.2.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Naotaka Kishimoto
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | | | - Simon D Tran
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Kenji Seo
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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17
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Madani A, Hirpara D, Chadi SA, Dhar P, Okrainec A. Leveraging Videoconferencing Technology to Augment Surgical Training During a Pandemic. Ann Surg Open 2021; 2:e035. [PMID: 36590033 DOI: 10.1097/AS9.0000000000000035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/04/2023] Open
Abstract
Our objective was to review the use of videoconferencing as a practical tool for remote surgical education and to propose a model to overcome the impact of a pandemic on resident training. Summary Background Data In response to the coronavirus disease 2019 pandemic, most institutions and residency programs have been restructured to minimize the number of residents in the hospital as well as their interactions with patients and to promote physical distancing measures. This has resulted in decreased resident operative exposure, responsibility, and autonomy, hindering their educational goals and ability to achieve surgical expertise necessary for independent practice. Methods We conducted a narrative review to explore the use of videoconferencing for remote broadcasting of surgical procedures, telecoaching using surgical videos, telesimulation for surgical skills training, and establishing a didactic lecture series. Results and Conclusions We present a multimodal approach for using practical videoconferencing tools that provide the means for audiovisual communication to help augment residents' operative experience and limit the impact of self-isolation, redeployment, and limited operative exposure on surgical training.
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18
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Sanseau E, Lavoie M, Tay K, Good G, Tsao S, Burns R, Thomas A, Heckle T, Wilson M, Kou M, Auerbach M. TeleSimBox: A perceived effective alternative for experiential learning for medical student education with social distancing requirements. AEM Educ Train 2021; 5:e10590. [PMID: 33842815 PMCID: PMC8019484 DOI: 10.1002/aet2.10590] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/08/2021] [Accepted: 02/23/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic the Association of American Medical Colleges recommended that medical students not be involved with in-person patient care or teaching, necessitating alternative learning opportunities. Subsequently we developed the telesimulation education platform: TeleSimBox. We hypothesized that this remote simulation platform would be feasible and acceptable for faculty use and a perceived effective method for medical student education. METHODS Twenty-one telesimulations were conducted with students and educators at four U.S. medical schools. Sessions were run by cofacilitator dyads with four to 10 clerkship-level students per session. Facilitators were provided training materials. User-perceived effectiveness and acceptability were evaluated via descriptive analysis of survey responses to the Modified Simulation Effectiveness Tool (SET-M), Net Promoter Score (NPS), and Likert-scale questions. RESULTS Approximately one-quarter of students and all facilitators completed surveys. Users perceived that the sessions were effective in teaching medical knowledge and teamwork, though less effective for family communication and skills. Users perceived that the telesimulations were comparable to other distance learning and to in-person simulation. The tool was overall positively promoted. CONCLUSION Users overall positively scored our medical student telesimulation tool on the SET-M objectives and promoted the experience to colleagues on the NPS. The next steps are to further optimize the tool.
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Affiliation(s)
- Elizabeth Sanseau
- Department of PediatricsDivision of Emergency MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Megan Lavoie
- Department of PediatricsDivision of Emergency MedicineChildren’s Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Khoon‐Yen Tay
- Department of PediatricsDivision of Emergency MedicineChildren’s Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Grace Good
- Center for Simulation, Advanced Education and InnovationChildren’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Suzana Tsao
- Clinical Emergency MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Rebekah Burns
- Pediatric Emergency MedicineSeattle Children’s HospitalUniversity of WashingtonSeattleWashingtonUSA
| | - Anita Thomas
- Pediatric Emergency MedicineSeattle Children’s HospitalUniversity of WashingtonSeattleWashingtonUSA
| | - Tanner Heckle
- Division of General PediatricsSeattle Children’s HospitalUniversity of WashingtonSeattleWashingtonUSA
| | - Meghan Wilson
- Division of General PediatricsYale School of MedicineNew HavenConnecticutUSA
| | - Maybelle Kou
- Emergency MedicineGeorge Washington University School of MedicineWashingtonDCUSA
| | - Marc Auerbach
- Pediatrics and Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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19
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Abstract
BACKGROUND Digital methods of instruction have proven to be effective in assisting learning in many fields at various levels. However, none of the meta-analyses have studied the effects of digital learning vs. traditional learning in the field of anaesthesiology. OBJECTIVE We conducted a meta-analysis to review the role of digital learning in anaesthesiology by comparing the effect sizes of the involved studies. DESIGN A systematic review and meta-analysis of randomised controlled trials and assessment of the quality of evidence by the Medical Education Research Study Quality Instrument. DATA SOURCES Educational databases (EBSCOhost and LearnTechLib) and medical databases (PubMed, Embase and Cochrane) were searched from January 1998 to February 2019. ELIGIBILITY CRITERIA We conducted a search by using key words related to digital learning and anaesthesiology. Articles that compared traditional instruction and digital instruction methods for learners in anaesthesiology were considered. RESULTS The 15 studies involved 592 trainees from the field of anaesthesiology. Considering substantial heterogeneity (I2 = 73%), a random-effect model was used. Pooled effect size presented a standardised mean deviation of 0.79, P < 0.001, indicating a statistically significant difference between traditional and digital learning groups, favouring the digital learning group. Results of subgroup analyses showed that using clinical performance to measure learning outcomes exhibited no heterogeneity, digital learning method was more consistent and effective for anaesthetic professionals, and the digital learning method was more effective than traditional learning method in the studies teaching the instructional contents of echocardiography and clinical scenarios. CONCLUSION The current study demonstrated positive effects of digital instruction in the field of anaesthesiology. Training through digital materials may assist professional training between the stages of didactic training and clinical training.
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Affiliation(s)
- Yu-Chih D Shih
- From the Department of English Language and Literature, Fu Jen Catholic University, New Taipei City (Y-CDS), Department of Anesthesiology, Taipei Medical University Hospital (C-CL, C-CC, Y-WL) and Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (C-CC, Y-WL)
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20
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Nelsen BR, Chen YK, Lasic M, Bader AM, Arriaga AF. Advances in anesthesia education: increasing access and collaboration in medical education, from E-learning to telesimulation. Curr Opin Anaesthesiol 2020; 33:800-7. [PMID: 33060385 DOI: 10.1097/ACO.0000000000000931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The landscape of medical education continues to evolve. Educators and learners must stay informed on current medical literature, in addition to focusing efforts on current educational trends and evidence-based methods. The present review summarizes recent advancements in anesthesiology education, specifically highlighting trends in e-learning and telesimulation, and identifies possible future directions for the field. RECENT FINDINGS Websites and online platforms continue to be a primary source of educational content; top websites are more likely to utilize standardized editorial processes. Podcasts and videocasts are important tools desired by learners for asynchronous education. Social media has been utilized to enhance the reach and visibility of journal articles, and less often as a primary educational venue; its efficacy in comparison with other e-learning platforms has not been adequately evaluated. Telesimulation can effectively disseminate practical techniques and clinical knowledge sharing, extending the capabilities of simulation beyond previous restrictions in geography, space, and available expertise. SUMMARY E-learning has changed the way anesthesiology learners acquire knowledge, expanding content and curricula available and promoting international collaboration. More work should be done to expand the principles of accessible and collaborative education to psychomotor and cognitive learning via telesimulation.
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21
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Patel SM, Miller CR, Schiavi A, Toy S, Schwengel DA. The sim must go on: adapting resident education to the COVID-19 pandemic using telesimulation. Adv Simul (Lond) 2020; 5:26. [PMID: 32999738 PMCID: PMC7522907 DOI: 10.1186/s41077-020-00146-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic and social distancing rules necessitated the suspension of all in-person learning activities at our institution. Consequently, distance learning became essential. We adapted a high-fidelity immersive case-based simulation scenario for telesimulation by using the virtual meeting platform Zoom® to meet our curricular needs. The use of telesimulation to teach a complex case-based scenario is novel. Two cohorts of anesthesiology residents participated 2 weeks apart. All learners were located at home. Four faculty members conducted the telesimulation from different locations within our simulation center in the roles of director, simulation operator, confederate anesthesiologist, and confederate surgeon. The anesthesiologist performed tasks as directed by learners. The scenario was divided into four scenes to permit reflection on interventions/actions by the participants based on the clinical events as the scenario progressed, to facilitate intermittent debriefing and learner engagement. All residents were given a medical knowledge pretest before the telesimulation and a posttest and learner satisfaction survey at the conclusion. The scenario was authentic and immersive, represented an actual case, and provided the opportunity to practice lessons that could be applied in the clinical setting. Participants rated telesimulation a reasonable substitution for in-person learning and expressed gratitude for continuation of their simulation-based education in this format during the pandemic. Participants in the second cohort reported feeling more engaged (p = 0.008) and stimulated to think critically (p = 0.003). Audio quality was the most frequently noted limitation. Fifty-three residents completed both pre- and posttests. The two cohorts did not differ in knowledge pretest scores (62% vs 60%, p = 0.80) or posttest scores (78% vs. 77%, p = 0.87). Overall, knowledge scores improved with the telesimulation intervention (pretest mean = 61% [SD = 14%]; posttest mean = 78% [SD = 12%]; t (41) = - 7.89, p < 0.001). Thus, using a Zoom format, we demonstrated the feasibility of adapting a complex case for telesimulation and effective knowledge gain. Furthermore, we improved our process in real time based on participant feedback. Participants were satisfied with their learning experience, suggesting that this format may be used in other distance learning situations.
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Affiliation(s)
- Shivani M Patel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Charlotte R. Bloomberg Children's Center, Room 6349G, Baltimore, MD 21287 USA
| | - Christina R Miller
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Charlotte R. Bloomberg Children's Center, Room 6349G, Baltimore, MD 21287 USA
| | - Adam Schiavi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Charlotte R. Bloomberg Children's Center, Room 6349G, Baltimore, MD 21287 USA
| | - Serkan Toy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Charlotte R. Bloomberg Children's Center, Room 6349G, Baltimore, MD 21287 USA
| | - Deborah A Schwengel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Charlotte R. Bloomberg Children's Center, Room 6349G, Baltimore, MD 21287 USA
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22
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Cassara M, Schertzer K, Falk MJ, Wong AH, Hock SM, Bentley S, Paetow G, Conlon LW, Hughes PG, McKenna RT, Hrdy M, Lei C, Kulkarni M, Smith CM, Young A, Romo E, Smith MD, Hernandez J, Strother CG, Frallicciardi A, Nadir N. Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine. AEM Educ Train 2020; 4:S22-S39. [PMID: 32072105 PMCID: PMC7011411 DOI: 10.1002/aet2.10418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT. METHODS The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT. RESULTS AND ANALYSIS Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT. CONCLUSIONS/IMPLICATIONS FOR EDUCATORS We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.
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Affiliation(s)
| | | | | | | | | | - Suzanne Bentley
- Elmhurst Hospital Center/Icahn School of Medicine at Mt SinaiElmhurstNY
| | | | - Lauren W. Conlon
- University of Pennsylvania/Perelman School of MedicinePhiladelphiaPA
| | - Patrick G. Hughes
- Florida Atlantic University Charles E. Schmidt College of MedicineBoca RatonFL
| | - Ryan T. McKenna
- University of South Florida Morsani College of MedicineTampaFL
| | | | - Charles Lei
- Vanderbilt University School of MedicineNashvilleTN
| | | | - Colleen M. Smith
- Mount Sinai Hospital/Icahn School of Medicine at Mt SinaiNew YorkNY
| | - Amanda Young
- University of Arkansas for Health SciencesLittle RockAR
| | | | | | | | | | | | - Nur‐Ain Nadir
- Kaiser Permanente Central Valley/Kaiser Permanente School of MedicinePasadenaCA
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23
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Donohue LT, Hoffman KR, Marcin JP. Use of Telemedicine to Improve Neonatal Resuscitation. Children (Basel) 2019; 6:E50. [PMID: 30939758 PMCID: PMC6518228 DOI: 10.3390/children6040050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.
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Affiliation(s)
- Lee T Donohue
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Kristin R Hoffman
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - James P Marcin
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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24
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Kim TE, Tsui BCH. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents. Korean J Anesthesiol 2018; 72:13-23. [PMID: 30481945 PMCID: PMC6369343 DOI: 10.4097/kja.d.18.00317] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023] Open
Abstract
Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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25
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Abstract
PURPOSE OF REVIEW Ultrasound-guided regional anesthesia is a challenging, complex skill and requires competence in teaching. The aim of this study was to review current literature on identification of education and learning of ultrasound-guided regional anesthesia and to summarize recent findings on teaching concepts. RECENT FINDINGS Several teaching programs have been described and implemented into daily routine. Factors relevant to current practice are the knowledge of sonoanatomy, the acquisition of manual skills, the teaching ability, and the feedback given to the trainee. Simulation is a rapidly growing field and is supported by the development of phantoms. Needle visualization is one of the core competencies that is necessary for successful ultrasound-guided procedures and could be supported by technical developments in the future to improve teaching concepts. SUMMARY Although a lot of key questions cannot be answered by the latest study results, some interesting findings were able to improve existing education programs. These results should be tailored to the individual need of a trainee, and the effects of improved training programs on patient safety and quality of care have to be investigated. The see one, do one, teach one approach is obsolete and should be abandoned.
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McCoy CE, Sayegh J, Alrabah R, Yarris LM. Telesimulation: An Innovative Tool for Health Professions Education. AEM Educ Train 2017; 1:132-136. [PMID: 30051023 PMCID: PMC6001828 DOI: 10.1002/aet2.10015] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 05/11/2023]
Abstract
Telesimulation is a new and innovative concept and process that has been used to provide education, training, and assessment in health-related fields such as medicine. This new area of simulation, and its terminology, has its origins within the past decade. The face validity and ability to provide the benefits of simulation education to learners at off-site locations has allowed the wide and rapid adoption of telesimulation in the field of medical education. Telesimulation has been implemented in areas such as pediatric resuscitation, surgery, emergency medicine, ultrasound-guided regional anesthesia in anesthesiology, nursing, and neurosurgery. However, its rapid expansion and current use has outgrown its recent description less than a decade ago. To date, there is no unifying definition of telesimulation that encompasses all the areas where it has been used while simultaneously allowing for growth and expansion in this field of study. This article has two main objectives. The first objective is to provide a comprehensive and unifying definition of telesimulation that encompasses all the areas where it has been used while allowing for growth and expansion in the field of study. The secondary objective is to describe the utility of telesimulation for emergency medicine educators in the context of the current evidence to serve as a background and framework that educators may use when considering creating educational programs that incorporate telecommunication and simulation resources. This article is complementary to the large group presentation where this new comprehensive and unifying definition was introduced to the simulation community at the International Meeting on Simulation in Healthcare in January 2016.
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Affiliation(s)
| | - Julie Sayegh
- Department of Emergency MedicineUC IrvineIrvineCA
| | - Rola Alrabah
- Department of Emergency MedicineUC IrvineIrvineCA
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Papanagnou D. Telesimulation: A Paradigm Shift for Simulation Education. AEM Educ Train 2017; 1:137-139. [PMID: 30051024 PMCID: PMC6001830 DOI: 10.1002/aet2.10032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/23/2017] [Indexed: 05/16/2023]
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28
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Peterson CM, Apolzan JW, Wright C, Martin CK. Video chat technology to remotely quantify dietary, supplement and medication adherence in clinical trials. Br J Nutr 2016; 116:1646-55. [PMID: 27753427 DOI: 10.1017/S0007114516003524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We conducted two studies to test the validity, reliability, feasibility and acceptability of using video chat technology to quantify dietary and pill-taking (i.e. supplement and medication) adherence. In study 1, we investigated whether video chat technology can accurately quantify adherence to dietary and pill-taking interventions. Mock study participants ate food items and swallowed pills, while performing randomised scripted 'cheating' behaviours to mimic non-adherence. Monitoring was conducted in a cross-over design, with two monitors watching in-person and two watching remotely by Skype on a smartphone. For study 2, a twenty-two-item online survey was sent to a listserv with more than 20 000 unique email addresses of past and present study participants to assess the feasibility and acceptability of the technology. For the dietary adherence tests, monitors detected 86 % of non-adherent events (sensitivity) in-person v. 78 % of events via video chat monitoring (P=0·12), with comparable inter-rater agreement (0·88 v. 0·85; P=0·62). However, for pill-taking, non-adherence trended towards being more easily detected in-person than by video chat (77 v. 60 %; P=0·08), with non-significantly higher inter-rater agreement (0·85 v. 0·69; P=0·21). Survey results from study 2 (n 1076 respondents; ≥5 % response rate) indicated that 86·4 % of study participants had video chatting hardware, 73·3 % were comfortable using the technology and 79·8 % were willing to use it for clinical research. Given the capability of video chat technology to reduce participant burden and outperform other adherence monitoring methods such as dietary self-report and pill counts, video chatting is a novel and promising platform to quantify dietary and pill-taking adherence.
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