Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.88
Tobias Chanin, Amit Dawar, J. Fanning
Background The delivery of teaching to foundation doctors (FDs) is most often by didactic lectures, delivered by consultants as subject matter experts. This is effective for information delivery but can struggle to engage FDs and does not always allow for interaction and detailed discussion. We aimed to challenge this model by using peer-to-peer teaching and feedback as a primary method of content delivery. Summary of Work Simulation based education for FDs takes place once a month. We engaged our year 2 FDs to design simulation scenarios based on real or synthesised cases. For this they had to set learning objectives, design an appropriate scenario, ensure any equipment needed was available and finally deliver the scenario. They would then put together a presentation on the main learning outcome and deliver this after the debrief. FDs were asked to develop their scenarios and email them to a facilitator prior to the teaching. They were then given feedback on these scenarios and adapted them accordingly. The 17/18 programme was evaluated by collecting a pre and post questionnaire from the FDs. Summary of results 12 simulation sessions were delivered over the year. 12 FDs completed the pre-programme questionnaire and 11 completed the post. When asked ‘How useful is simulation in developing you as an educator’ the FDs scored an average of 6.0 (range 2–9) on the pre and 8.2/10 (range 6–10) on the post-questionnaire. FDs answered ‘How useful has Sim been in developing understanding of learning styles and the educational needs of others´ with an average of 5.3 prior to the programme and 8.4/10 after. Aside from these obvious improvements, some FDs developed novel teaching session e.g. Running a public health, tabletop simulation of a pandemic, that showed even more creativity in teaching. Discussion and Conclusions We have demonstrated that it is possible to run an effective simulation-based teaching programme that allows peer-to-peer teaching and debriefing. We have shown that allowing these scenarios to be designed and delivered by FDs can improve engagement in teaching and assist in developing them as future educators.
{"title":"PG40 Building simulation into a foundation teaching programme to enhance learning and develop the clinical teacher","authors":"Tobias Chanin, Amit Dawar, J. Fanning","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.88","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.88","url":null,"abstract":"Background The delivery of teaching to foundation doctors (FDs) is most often by didactic lectures, delivered by consultants as subject matter experts. This is effective for information delivery but can struggle to engage FDs and does not always allow for interaction and detailed discussion. We aimed to challenge this model by using peer-to-peer teaching and feedback as a primary method of content delivery. Summary of Work Simulation based education for FDs takes place once a month. We engaged our year 2 FDs to design simulation scenarios based on real or synthesised cases. For this they had to set learning objectives, design an appropriate scenario, ensure any equipment needed was available and finally deliver the scenario. They would then put together a presentation on the main learning outcome and deliver this after the debrief. FDs were asked to develop their scenarios and email them to a facilitator prior to the teaching. They were then given feedback on these scenarios and adapted them accordingly. The 17/18 programme was evaluated by collecting a pre and post questionnaire from the FDs. Summary of results 12 simulation sessions were delivered over the year. 12 FDs completed the pre-programme questionnaire and 11 completed the post. When asked ‘How useful is simulation in developing you as an educator’ the FDs scored an average of 6.0 (range 2–9) on the pre and 8.2/10 (range 6–10) on the post-questionnaire. FDs answered ‘How useful has Sim been in developing understanding of learning styles and the educational needs of others´ with an average of 5.3 prior to the programme and 8.4/10 after. Aside from these obvious improvements, some FDs developed novel teaching session e.g. Running a public health, tabletop simulation of a pandemic, that showed even more creativity in teaching. Discussion and Conclusions We have demonstrated that it is possible to run an effective simulation-based teaching programme that allows peer-to-peer teaching and debriefing. We have shown that allowing these scenarios to be designed and delivered by FDs can improve engagement in teaching and assist in developing them as future educators.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"60 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83760494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.13
Veronica Lam, Cecilia Hm Kong, J. T. Fung, V. Tsang, M. Pang, J. Y. Wong
Introduction Integrating simulation-based education in undergraduate nursing curriculum is more common nowadays, as many studies documented simulation-based education can increase students’ clinical competence, critical thinking1 and confidence.2 The common mode of simulation-based teaching is one simulator to a group of students. In fact, in reality, one nurse has to take care of more than one patient within a shift duty, a single simulator to a group of nursing students is not sufficient to enhance their competence and less realism for engaging students to learn from a simulation environment. To make a simulation activity as real as possible, an innovative project is designed by using a ‘Simulation Ward’ model. This project focused on promoting students’ case management ability, prioritise the nursing actions, team work and communication skills. The use of mixed simulation model aimed to provide an environment for students to immerse in a ward setting environment. Methods It was a longitudinal study with convenience sampling. Year IV undergraduate nursing students recruited for this project were required to participate in the ‘Simulation Ward’ activity for three to six sessions, depending on their availability. In each session, three nursing students were required to provide nursing care to the mixed human simulators which included two high-fidelity and one mid-fidelity simulators, and a standardize patient. After a session, two teachers independently assessed students’ clinical competence by using the six domains QSEN Competency Checklist. Results Thirty-five Year IV nursing students participated in the study. Mixed-model for repeated measures has been used to analysis the data. Students had significant improvement in clinical competence in the domains of knowledge, skills and attitude (KSA) elements. The pairwise mean difference of knowledge, skills and attitudes were 1.33 (p Discussion and Conclusion This study suggested that the ‘simulation ward’ teaching model could enhance nursing students’ clinical competence. Students had significant improvement in knowledge, skills and attitudes after participating in three to six simulation sessions. They could apply the knowledge that they learnt to mixed simulators. Furthermore, the teachers had overcome the challenges in conducing the activity in a simulated ward environment. The challenges mainly related to designing the timeline for allowing the events of each simulator to happen, adding in risk alerts, integrating standardised patients in each session and some unpredictable technology issues. Despite the challenges, it was a fruitful experience for teachers in designing and conducting other simulation ward activities in future. References Park HR, Park JW, Kim CJ, & Song JE. Development and validation of simulation teaching strategies ina n integrated nursing practicum. Collegian 2017:24:479–486. Zapko KA, Ferranto ML, Blasiman R & Shelestak D. Evaluating best educational practices, student sati
目前，在本科护理课程中整合基于模拟的教学较为普遍，许多研究表明基于模拟的教学可以提高学生的临床能力、批判性思维能力和自信心基于仿真的教学模式通常是一个模拟器对一群学生。事实上，在现实中，一名护士必须在轮班期间照顾不止一名患者，一群护理学生的单一模拟器不足以提高他们的能力，并且对于吸引学生从模拟环境中学习缺乏现实感。为了使模拟活动尽可能真实，使用“模拟病房”模型设计了一个创新项目。本项目注重培养学生的个案管理能力、护理行动优先性、团队合作能力和沟通能力。混合模拟模型的使用旨在为学生提供一个沉浸在病房设置环境中的环境。方法采用方便抽样的纵向研究方法。为这个项目招募的四年级本科护理学生被要求参加“模拟病房”活动三到六次，这取决于他们的可用性。每期要求3名护生分别对2个高保真度和1个中保真度的混合人体模拟器和1名标准化患者进行护理。一节课后，两位教师分别使用QSEN胜任力量表评估学生的临床胜任力。结果共35名四年级护生参与研究。采用重复测量混合模型对数据进行分析。学生在知识、技能和态度(KSA)要素领域的临床能力有显著提高。知识、技能、态度的两两平均差值为1.33 (p)。讨论与结论“模拟病房”教学模式能提高护生的临床能力。学生在参加三至六次模拟课程后，在知识、技能和态度方面均有显著改善。他们可以将所学的知识应用到混合模拟器中。此外，老师们克服了在模拟病房环境中进行活动的挑战。挑战主要涉及设计允许每个模拟器事件发生的时间表，添加风险警报，在每个会话中整合标准化患者以及一些不可预测的技术问题。尽管面临诸多挑战，但这对教师今后设计和开展其他模拟病房活动是一个有益的经验。参考文献:Park HR, Park JW, Kim CJ, Song JE。综合护理实习中模拟教学策略的开发与验证。学院的学生2017:24:479 - 486。张建军，张建军，张建军，等。模拟教学中学生满意度与自信心的关系研究。护理教育今日2018;60:28-44。
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Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.35
Ashley Holt, Lucine Nahabedian, Ashish Patel, A. Copeman
Context Simulation-based education encourages a safe environment to learn both clinical management and non-technical skills. Group contribution to the debrief can be critical to this learning. However, participants on these courses may not be known to each other, and may come from a range of health disciplines and experiences. We utilised a series of activities in our courses prior to the simulation scenarios to ‘break the ice’ between participants and encourage both positive interaction and communication skills. Description Four of the icebreaker activities used in our simulation courses are listed below: ‘Drawing Board’ – participants form two teams; one having to describe an image on a hidden whiteboard to their colleagues, and the other having to draw an exact replica from the information given. The ‘Helium Stick’ – dividing into groups, the participants form two lines facing each other and support a stick between them before trying to lower it to the ground. The stick classically rises until the team devise a strategy and follow a single leader. ‘Catch the ball’ – the participants stand in a circle and throw an increasing number of balls between them without it falling to the floor. ‘Mr Potato Head’ – the team are briefly shown a slide of a ‘Mr Potato Head’ toy accessorised in a certain configuration, and asked to put the character back together to match the (now hidden) image. Observation/Evaluation 182 participants have participated in 38 paediatric courses using these ‘icebreaker’ tools in our local simulation centre (SimWard) between 2016–2019. The participants were often advised on how to use closed-loop communication to see how it affected the activity, followed by a short debriefing discussion. All participants reported finding all aspects of the course relevant to their learning and free-text feedback has been overwhelmingly positive. Discussion Much like resuscitation teams, simulation courses bring together a variety of participants who form an ad hoc team and must develop shared models of communication.1 2 Communication ‘icebreakers’ serve not only as ideal introductions for new candidates to the environment and each other, but also to non-technical skills and as an educational session themselves. They are low-resource, and work well as brief teaching sessions in time-critical setting. Also, having multiple icebreaker activities available keeps the session novel for participants who attend multiple courses. References Hargestam M, et al. Communication in interdisciplinary teams: exploring closed-loop communication during in-situ trauma team training. BMJ Open 2013;3:e003525 Sherman JM, et al. Communication and teamwork barriers during resuscitation in a pediatric emergency department. Pediatrics 2018;141:342
{"title":"PP16 Closing the loop to break the ice: improving communication through fun introductory activities","authors":"Ashley Holt, Lucine Nahabedian, Ashish Patel, A. Copeman","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.35","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.35","url":null,"abstract":"Context Simulation-based education encourages a safe environment to learn both clinical management and non-technical skills. Group contribution to the debrief can be critical to this learning. However, participants on these courses may not be known to each other, and may come from a range of health disciplines and experiences. We utilised a series of activities in our courses prior to the simulation scenarios to ‘break the ice’ between participants and encourage both positive interaction and communication skills. Description Four of the icebreaker activities used in our simulation courses are listed below: ‘Drawing Board’ – participants form two teams; one having to describe an image on a hidden whiteboard to their colleagues, and the other having to draw an exact replica from the information given. The ‘Helium Stick’ – dividing into groups, the participants form two lines facing each other and support a stick between them before trying to lower it to the ground. The stick classically rises until the team devise a strategy and follow a single leader. ‘Catch the ball’ – the participants stand in a circle and throw an increasing number of balls between them without it falling to the floor. ‘Mr Potato Head’ – the team are briefly shown a slide of a ‘Mr Potato Head’ toy accessorised in a certain configuration, and asked to put the character back together to match the (now hidden) image. Observation/Evaluation 182 participants have participated in 38 paediatric courses using these ‘icebreaker’ tools in our local simulation centre (SimWard) between 2016–2019. The participants were often advised on how to use closed-loop communication to see how it affected the activity, followed by a short debriefing discussion. All participants reported finding all aspects of the course relevant to their learning and free-text feedback has been overwhelmingly positive. Discussion Much like resuscitation teams, simulation courses bring together a variety of participants who form an ad hoc team and must develop shared models of communication.1 2 Communication ‘icebreakers’ serve not only as ideal introductions for new candidates to the environment and each other, but also to non-technical skills and as an educational session themselves. They are low-resource, and work well as brief teaching sessions in time-critical setting. Also, having multiple icebreaker activities available keeps the session novel for participants who attend multiple courses. References Hargestam M, et al. Communication in interdisciplinary teams: exploring closed-loop communication during in-situ trauma team training. BMJ Open 2013;3:e003525 Sherman JM, et al. Communication and teamwork barriers during resuscitation in a pediatric emergency department. Pediatrics 2018;141:342","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"21 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83077739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.165
Aaliya Uddin, E. Laurent, S. Hussain, T. Toi, S. Seraj, Christopher Hadjittofi, Osamah Niaz, S. Haque
Background COVID-19 brought uncertainty to the delivery of simulation based education and the use of simulation facilities worldwide. The Clinical Skills and Simulation Centre at Edge Hill University, which only opened during autumn 2019, is a new Centre for the Faculty of Health, Social Care and Medicine. With the onset of COVID-19 appropriate measures, guidance and risk assessments had to be put in place to ensure the safety of staff and students, but with the aim of keeping the centre open for those that needed it. Summary of Work As a result of the COVID-19 pandemic clinical skills teaching was delivered to help staff returning or being relocated to different areas in the NHS. This began in April 2020 and very quickly this developed into offering the staff simulation sessions. The centre then reopened for the faculty’s students particularly those who had begun university in January and had been unable to attend any placements. This resulted in 150 student nurses attending in June with other ODP, paramedic and physician associate students attending over the summer for skills, simulation or OSCEs. Summary of Results Evaluations showing the impact in terms of student engagement and achieving the required outcomes from the sessions held during COVID-19 for nursing and other students will be presented. In addition an overview of measures taken and the lessons learnt will be provided. Discussion and Conclusions The results have shown the importance of students being able to still attend simulation and skills sessions during the pandemic. At the same time it has been necessary to readjust the risk assessments to ensure the continual safety of staff and students. Traditionally there is a tendency to work in silos as a university in terms of skills and simulation but one of the positives resulting from the pandemic has been the opportunity to have regular meetings with other universities in the North West. This has enabled the sharing of ideas and concerns ensuring that we are taking similar approaches. Recommendations The use of simulation based education can be adapted to varying situations, but there needs to be continual review to ensure that it is being used in the most appropriate way and that alternative measures have been explored. Reference Ingrassia, PL; Capogna, G; Diaz-Navarro, C; Szyid, D; Tomola, S & Leon-Castelao, E. ( 2020) COVID-19crisis, safe reopening of simulation centres and the new normal: food for thought. Advances in Simulation 5:13.
2019冠状病毒病给全球模拟教育的提供和模拟设施的使用带来了不确定性。边山大学的临床技能和模拟中心于2019年秋季才开放，是卫生、社会护理和医学学院的一个新中心。随着COVID-19的爆发，必须采取适当的措施、指导和风险评估，以确保工作人员和学生的安全，同时保持中心向需要的人开放。由于COVID-19大流行，提供了临床技能教学，以帮助工作人员返回或被重新安置到NHS的不同地区。这始于2020年4月，并很快发展成为提供员工模拟课程。然后，该中心重新开放给学院的学生，特别是那些在1月份开始上大学而无法参加任何实习的学生。这导致150名学生护士在6月份与其他ODP，护理人员和医师助理学生在夏季参加技能，模拟或osce。将介绍2019冠状病毒病期间为护理和其他学生举办的会议在学生参与方面的影响以及取得所需成果的评估摘要。此外，还将概述所采取的措施和吸取的教训。讨论和结论结果表明，在大流行期间，学生仍然能够参加模拟和技能课程的重要性。同时，有必要重新调整风险评估，以确保教职员工和学生的持续安全。传统上，作为一所大学，在技能和模拟方面有一种孤立的趋势，但疫情带来的积极影响之一是有机会与西北地区的其他大学定期举行会议。这使我们能够交流想法和关切，确保我们采取类似的办法。以模拟为基础的教育的使用可以适应不同的情况，但需要不断进行审查，以确保以最适当的方式使用模拟教育，并探索了替代措施。参考文献Ingrassia, PL;Capogna G;Diaz-Navarro C;Szyid D;Tomola, S & Leon-Castelao, E. (2020) covid -19危机、模拟中心安全重新开放和新常态:值得思考。《模拟进展》5:13。
{"title":"PG117 All change: the journey of adjusting to the impact of COVID-19 in a university’s new simulation centre","authors":"Aaliya Uddin, E. Laurent, S. Hussain, T. Toi, S. Seraj, Christopher Hadjittofi, Osamah Niaz, S. Haque","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.165","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.165","url":null,"abstract":"Background COVID-19 brought uncertainty to the delivery of simulation based education and the use of simulation facilities worldwide. The Clinical Skills and Simulation Centre at Edge Hill University, which only opened during autumn 2019, is a new Centre for the Faculty of Health, Social Care and Medicine. With the onset of COVID-19 appropriate measures, guidance and risk assessments had to be put in place to ensure the safety of staff and students, but with the aim of keeping the centre open for those that needed it. Summary of Work As a result of the COVID-19 pandemic clinical skills teaching was delivered to help staff returning or being relocated to different areas in the NHS. This began in April 2020 and very quickly this developed into offering the staff simulation sessions. The centre then reopened for the faculty’s students particularly those who had begun university in January and had been unable to attend any placements. This resulted in 150 student nurses attending in June with other ODP, paramedic and physician associate students attending over the summer for skills, simulation or OSCEs. Summary of Results Evaluations showing the impact in terms of student engagement and achieving the required outcomes from the sessions held during COVID-19 for nursing and other students will be presented. In addition an overview of measures taken and the lessons learnt will be provided. Discussion and Conclusions The results have shown the importance of students being able to still attend simulation and skills sessions during the pandemic. At the same time it has been necessary to readjust the risk assessments to ensure the continual safety of staff and students. Traditionally there is a tendency to work in silos as a university in terms of skills and simulation but one of the positives resulting from the pandemic has been the opportunity to have regular meetings with other universities in the North West. This has enabled the sharing of ideas and concerns ensuring that we are taking similar approaches. Recommendations The use of simulation based education can be adapted to varying situations, but there needs to be continual review to ensure that it is being used in the most appropriate way and that alternative measures have been explored. Reference Ingrassia, PL; Capogna, G; Diaz-Navarro, C; Szyid, D; Tomola, S & Leon-Castelao, E. ( 2020) COVID-19crisis, safe reopening of simulation centres and the new normal: food for thought. Advances in Simulation 5:13.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"24 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90516801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.40
Isle Polonko, R. Claflin
Introduction Gynecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology has been utilized for decades in effective breast, pelvic and urogenital examination clinical skills instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with genital examination. While data has shown it is the most effective way to learn these procedures, outside of the United States and Canada, there are few GTA and MUTA programs in existence at medical learning institutions. Methods The GTA/MUTA acts as both instructor and live simulated patient, using their own bodies as primary teaching tools to guide learners through examination techniques while providing them with real-time, instant feedback. This provides a unique opportunity for skills acquisition: learners receive step-by-step ‘hands on’ instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centered form of instruction also addresses the complicated emotional reaction patients may have to these exams. Therefore, GTA/MUTA instruction also includes: patient education and communication skills, relaxation and transition techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of genital examination and the embarrassment often accompanying the exam, does not become an obstacle to acquiring safe, effective clinical technique. Results Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including: higher overall scores; superior communication skills; better ability to identify pathology having been introduced to healthy well patient anatomy; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’; ability to conduct safe, effective genital examination techniques on patients after exposure to a GTA/MUTA instructor. Discussion and conclusion Despite definitive results over decades of research in both qualitative and quantitative studies, GTA/MUTA instruction is not routinely used in the UK or the rest of Europe and almost not at all in other areas of the world including Asia, South America and Africa. Brief exploration of cultural and historical stop gaps to inclusion of this method will be discussed following explanation of the method, its effectiveness and use in the US and Canada as well as brief review of the data. Reference Kleinman DE, et al. Pelvic examination instruction and experience: a comparison of lay-woman trained and physician trained students. Academic Medicine 1996;Nov 71 (11):1239–43. Smith PP, et al. The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis. Med
{"title":"PP21 Genital exam education and instruction: lowering anxiety and raising competence","authors":"Isle Polonko, R. Claflin","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.40","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.40","url":null,"abstract":"Introduction Gynecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology has been utilized for decades in effective breast, pelvic and urogenital examination clinical skills instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with genital examination. While data has shown it is the most effective way to learn these procedures, outside of the United States and Canada, there are few GTA and MUTA programs in existence at medical learning institutions. Methods The GTA/MUTA acts as both instructor and live simulated patient, using their own bodies as primary teaching tools to guide learners through examination techniques while providing them with real-time, instant feedback. This provides a unique opportunity for skills acquisition: learners receive step-by-step ‘hands on’ instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centered form of instruction also addresses the complicated emotional reaction patients may have to these exams. Therefore, GTA/MUTA instruction also includes: patient education and communication skills, relaxation and transition techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of genital examination and the embarrassment often accompanying the exam, does not become an obstacle to acquiring safe, effective clinical technique. Results Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including: higher overall scores; superior communication skills; better ability to identify pathology having been introduced to healthy well patient anatomy; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’; ability to conduct safe, effective genital examination techniques on patients after exposure to a GTA/MUTA instructor. Discussion and conclusion Despite definitive results over decades of research in both qualitative and quantitative studies, GTA/MUTA instruction is not routinely used in the UK or the rest of Europe and almost not at all in other areas of the world including Asia, South America and Africa. Brief exploration of cultural and historical stop gaps to inclusion of this method will be discussed following explanation of the method, its effectiveness and use in the US and Canada as well as brief review of the data. Reference Kleinman DE, et al. Pelvic examination instruction and experience: a comparison of lay-woman trained and physician trained students. Academic Medicine 1996;Nov 71 (11):1239–43. Smith PP, et al. The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis. Med","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"1 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89754345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.60
C. Arrowsmith, Francis Hanlon, Rosie Fish
Problem Due to the highly infectious nature of Covid-19, aerosol generating procedures (AGP’s) have had to evolve to ensure the safety of the patients and staff. At the same time social distancing measures and a reduction in education time has created an environment where it is challenging to educate teams around these changes. Solution We designed and filmed a short series of simulated videos showing a team of medical professionals safely completing a Paediatric Rapid Sequent Intubation, and managing a Paediatric Cardiac Arrest. Method We invited multi-disciplinary clinicians from Paediatrics, Anaesthetics, Paediatric Intensive Care (PIC) and Paediatric Emergency Medicine (PEM) to discuss the dangers of each scenario and develop a series of safe and effective countermeasures to the observed risks. We then conducted a simulation of both scenarios using a multi-camera high definition audio/visual system to record the simulations in real time. We included camera footage from the patient’s room, the anteroom used for kit and drug preparation and the corridor outside to illustrate the difficulties encountered and potential solutions. We used editing software to create two 20min videos of the each scenario. The multi-camera system allowed us to display the activity in different areas in tandem, illustrating for example how the drug and kit preparation can take place outside of the patient’s room whilst resuscitation is on-going inside. We also spliced images of our local guidelines into the video at relevant points for reference. The videos were shown to the clinical leads for PIC, the Paediatric Emergency Department, and the Resuscitation Service, to given an opportunity for feedback. Their comments were then incorporated into the videos. Finally we uploaded the videos to the Hospital Intranet allowing them to be accessed and viewed by all staff in the Hospital at any time. Results Feedback has been unanimously excellent from staff from across the MDT and across many different levels of seniority. Staff describe feeling more comfortable with these difficult situations, and have fed back that the videos have helped alleviate the fear of conducting AGP’s in the time of Covid-19. Future Work Social distancing is likely to be with us for a significant period of time, therefore any strategy to improve training and education, whilst reducing the need to attend training days will be of great value. We will continue to develop videos of other AGP’s and upload them to our hospital intranet.
{"title":"PG11 Film one, do one, teach one. Using video to educate and innovate in a Covid-19 world","authors":"C. Arrowsmith, Francis Hanlon, Rosie Fish","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.60","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.60","url":null,"abstract":"Problem Due to the highly infectious nature of Covid-19, aerosol generating procedures (AGP’s) have had to evolve to ensure the safety of the patients and staff. At the same time social distancing measures and a reduction in education time has created an environment where it is challenging to educate teams around these changes. Solution We designed and filmed a short series of simulated videos showing a team of medical professionals safely completing a Paediatric Rapid Sequent Intubation, and managing a Paediatric Cardiac Arrest. Method We invited multi-disciplinary clinicians from Paediatrics, Anaesthetics, Paediatric Intensive Care (PIC) and Paediatric Emergency Medicine (PEM) to discuss the dangers of each scenario and develop a series of safe and effective countermeasures to the observed risks. We then conducted a simulation of both scenarios using a multi-camera high definition audio/visual system to record the simulations in real time. We included camera footage from the patient’s room, the anteroom used for kit and drug preparation and the corridor outside to illustrate the difficulties encountered and potential solutions. We used editing software to create two 20min videos of the each scenario. The multi-camera system allowed us to display the activity in different areas in tandem, illustrating for example how the drug and kit preparation can take place outside of the patient’s room whilst resuscitation is on-going inside. We also spliced images of our local guidelines into the video at relevant points for reference. The videos were shown to the clinical leads for PIC, the Paediatric Emergency Department, and the Resuscitation Service, to given an opportunity for feedback. Their comments were then incorporated into the videos. Finally we uploaded the videos to the Hospital Intranet allowing them to be accessed and viewed by all staff in the Hospital at any time. Results Feedback has been unanimously excellent from staff from across the MDT and across many different levels of seniority. Staff describe feeling more comfortable with these difficult situations, and have fed back that the videos have helped alleviate the fear of conducting AGP’s in the time of Covid-19. Future Work Social distancing is likely to be with us for a significant period of time, therefore any strategy to improve training and education, whilst reducing the need to attend training days will be of great value. We will continue to develop videos of other AGP’s and upload them to our hospital intranet.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"76 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86712853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.148
Christopher Taylor
The North East Simulation Trainee and Teaching Fellow Interest Group was established in 2018 to address the needs of all healthcare professionals in the North East of England, both undergraduate, and postgraduate, who are interested in simulation, medical education, human factors and patient safety. Simulation, as an educational and patient safety tool, is continuing to grow in popularity locally, and nationally. The pace of change is fast, and the ever-increasing landscape of simulation is becomingly more complex every year. Despite this, few are trained early in their careers in how to best deliver simulation activities, leading to large numbers of projects being replicated locally, and nationally. The goals of NESTFIG are to facilitate high quality simulation training across the region, in an effective and efficient format, focusing on trainees and teaching fellows, as the key players in upskilling the workforce, to better support local HCP development and transformation, and ultimately develop high quality, and safer, patient care. The website was launched on the 20th August 2020 to support trainees and teaching fellows starting their new roles. The rationale for an online pool of resources was in part due to the impact of COVID-19 pandemic limiting face-to-face training sessions, the geographic distance between centres in the North East, and to provide a central point to access resources at any time and facilitate continuous development over a one-off training intervention. The NESTFIG website provides learners with access to continuous professional development resources to structure their time during the year and within a lifelong career in simulation. It also hosts resources summarising several common topics in simulation, medical education and non-technical skills titled ‘As-sim-il-ate’ bite-size learning content, as well as an array of free to use resources developed with a user-experience focus. Despite promotion at a regional training session, and intermittent social-media promotional messages, uptake has remained low. This poster will present the website metrics up to the conference with user visits, most commonly accessed resources, and geographic distribution. This work may prove beneficial to provide an example for anyone wishing to create a similar web-based resource.
{"title":"PG100 The North East simulation trainee and teaching fellow interest group website launch review","authors":"Christopher Taylor","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.148","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.148","url":null,"abstract":"The North East Simulation Trainee and Teaching Fellow Interest Group was established in 2018 to address the needs of all healthcare professionals in the North East of England, both undergraduate, and postgraduate, who are interested in simulation, medical education, human factors and patient safety. Simulation, as an educational and patient safety tool, is continuing to grow in popularity locally, and nationally. The pace of change is fast, and the ever-increasing landscape of simulation is becomingly more complex every year. Despite this, few are trained early in their careers in how to best deliver simulation activities, leading to large numbers of projects being replicated locally, and nationally. The goals of NESTFIG are to facilitate high quality simulation training across the region, in an effective and efficient format, focusing on trainees and teaching fellows, as the key players in upskilling the workforce, to better support local HCP development and transformation, and ultimately develop high quality, and safer, patient care. The website was launched on the 20th August 2020 to support trainees and teaching fellows starting their new roles. The rationale for an online pool of resources was in part due to the impact of COVID-19 pandemic limiting face-to-face training sessions, the geographic distance between centres in the North East, and to provide a central point to access resources at any time and facilitate continuous development over a one-off training intervention. The NESTFIG website provides learners with access to continuous professional development resources to structure their time during the year and within a lifelong career in simulation. It also hosts resources summarising several common topics in simulation, medical education and non-technical skills titled ‘As-sim-il-ate’ bite-size learning content, as well as an array of free to use resources developed with a user-experience focus. Despite promotion at a regional training session, and intermittent social-media promotional messages, uptake has remained low. This poster will present the website metrics up to the conference with user visits, most commonly accessed resources, and geographic distribution. This work may prove beneficial to provide an example for anyone wishing to create a similar web-based resource.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"11 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86477018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.100
A. Shah, Mark Rowson, Liam Harrison, A. Bidwai
Introduction From 2001, all dental anaesthetic procedures were moved into a hospital setting to improve patient safety1. The Merseycare and Bridgewater community dental teams have a collaboration with Whiston Hospital to provide paediatric anaesthesia for dental treatment. A dedicated paediatric dental chair, in an outpatient setting is used2. As it is an isolated site, all staff who regularly attend this unit are required to keep their Paediatric Life Support (PLS) knowledge up to date. Annual PLS scenarios are recommended. We performed an in situ paediatric simulation in the dental suite. There is little documented evidence to show routine use of in-situ simulation in paediatric dental chair anaesthesia. Methods The simulation was performed on separate days for each trust, in the dental suite, using the paediatric sim-man. The scenario initially presented as stridor, with escalation to cardiac arrest, with the anaesthetic and dental team present. It was further attended by the paediatric team, the resuscitation officer and anaesthetic emergency team. A survey was taken pre and post intervention, focusing on confidence and knowledge of paediatric cardiac arrest management using five multiple choice questions. Results All participants significantly improved their knowledge and confidence when dealing with a paediatric cardiac arrest, table 1. 100% of the attendees surveyed either agreed or strongly agreed that the simulation, enhanced their understanding of their role and management of a paediatric cardiac arrest and was a valuable learning experience leading to improved care. Discussion/conclusions Key issues were highlighted, such as locating and using algorithms as an aide memoire and the limited amount of space within the dental suite. Task fixation was evident in the lead anaesthetist in trying to cannulate the patient. An intraosseous needle was placed into their hand by the operating department practitioner (ODP) using non-verbal communication. There was a good example of challenging by the recovery nurse, ‘The heart rate is 50, we need to start compressions.’ The simulation improved confidence and participants were keen to have simulation regularly scheduled. Recommendations Allocation of team roles at the beginning of the session. Due to limited space, a gate keeper would be best placed to avoid overcrowding. The HALT procedure should be implemented in order to overcome communication barriers. References Kaye Cantlay, BA MB ChB MRCP FRCA, Sean Williamson, MB ChB FRCA, Julian Hawkings, BSc BDS DGDP(UK) FDSRCPS, Anaesthesia for dentistry, Continuing Education in Anaesthesia Critical Care & Pain June 2005; 5(3):71–75. https://doi.org/10.1093/bjaceaccp/mki020 Lola Adewale, MBChB DCH FRCA, Anaesthesia for paediatric dentistry, Continuing Education in Anaesthesia Critical Care & Pain, Volume 12, Issue 6, December 2012, Pages 288–294, https://doi.org/10.1093/bjaceaccp/mks045
{"title":"PG52 The paediatric ‘dental chair’ anaesthetic emergency – simulation training","authors":"A. Shah, Mark Rowson, Liam Harrison, A. Bidwai","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.100","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.100","url":null,"abstract":"Introduction From 2001, all dental anaesthetic procedures were moved into a hospital setting to improve patient safety1. The Merseycare and Bridgewater community dental teams have a collaboration with Whiston Hospital to provide paediatric anaesthesia for dental treatment. A dedicated paediatric dental chair, in an outpatient setting is used2. As it is an isolated site, all staff who regularly attend this unit are required to keep their Paediatric Life Support (PLS) knowledge up to date. Annual PLS scenarios are recommended. We performed an in situ paediatric simulation in the dental suite. There is little documented evidence to show routine use of in-situ simulation in paediatric dental chair anaesthesia. Methods The simulation was performed on separate days for each trust, in the dental suite, using the paediatric sim-man. The scenario initially presented as stridor, with escalation to cardiac arrest, with the anaesthetic and dental team present. It was further attended by the paediatric team, the resuscitation officer and anaesthetic emergency team. A survey was taken pre and post intervention, focusing on confidence and knowledge of paediatric cardiac arrest management using five multiple choice questions. Results All participants significantly improved their knowledge and confidence when dealing with a paediatric cardiac arrest, table 1. 100% of the attendees surveyed either agreed or strongly agreed that the simulation, enhanced their understanding of their role and management of a paediatric cardiac arrest and was a valuable learning experience leading to improved care. Discussion/conclusions Key issues were highlighted, such as locating and using algorithms as an aide memoire and the limited amount of space within the dental suite. Task fixation was evident in the lead anaesthetist in trying to cannulate the patient. An intraosseous needle was placed into their hand by the operating department practitioner (ODP) using non-verbal communication. There was a good example of challenging by the recovery nurse, ‘The heart rate is 50, we need to start compressions.’ The simulation improved confidence and participants were keen to have simulation regularly scheduled. Recommendations Allocation of team roles at the beginning of the session. Due to limited space, a gate keeper would be best placed to avoid overcrowding. The HALT procedure should be implemented in order to overcome communication barriers. References Kaye Cantlay, BA MB ChB MRCP FRCA, Sean Williamson, MB ChB FRCA, Julian Hawkings, BSc BDS DGDP(UK) FDSRCPS, Anaesthesia for dentistry, Continuing Education in Anaesthesia Critical Care & Pain June 2005; 5(3):71–75. https://doi.org/10.1093/bjaceaccp/mki020 Lola Adewale, MBChB DCH FRCA, Anaesthesia for paediatric dentistry, Continuing Education in Anaesthesia Critical Care & Pain, Volume 12, Issue 6, December 2012, Pages 288–294, https://doi.org/10.1093/bjaceaccp/mks045","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"19 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86441612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.129
J. Ward, V. Shetty, N. Krishnamohan, Amir Tabassum, Laura Ingleson
Background The advent of Covid19 brought rapid changes in practice and new standard operating procedures (SOPs). We ran sessions for surgical ward and theatre staff to become familiar with new processes and pathways, to assess their practicability in the clinical environment and to come to standardised processes. Summary of Work In situ simulation sessions were organised for staff on surgical wards and in theatre, working through a range of scenarios appropriate to that team. For ward staff this included admission process, management of possible Covid19 infection, as well as theatre processes, including consent, documentation and transfer. In theatre the scenarios included team brief, PPE plans, theatre set up, patient transfer and peri-operative processes. These sessions were separate to other simulations of new technical procedures Summary of Sessions/Results We ran 5 sessions for ward staff involving a total of 48 participants, and 6 sessions for 44 theatre staff. The distribution of staff is shown in the attached table 1. Discussion and Conclusions/Recommendations As the Covid19 pandemic approached NHS staff were beset by multiple new procedures, often coming in ‘at pace,’ which led to confusion and differences in application between teams. Whereas much simulation covered specific technical procedures we focussed on basic aspects of the patient pathway which still caused confusion. Involving a wide range of medical/nursing staff enabled wide scrutiny of new SOPs and discussion about their practicability in the clinical setting, introducing any required changes. It also helped standardisation between teams. This was crucial to successful implementation and developing a culture of adaptation to future change. It was also helpful in reducing hierarchy. This supports the importance of in situ simulation in the introduction of new procedures to assess their practicability as well as in educating staff about such changes.
{"title":"PG81 In situ simulation of surgical patient processes during the early onset of Covid19","authors":"J. Ward, V. Shetty, N. Krishnamohan, Amir Tabassum, Laura Ingleson","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.129","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.129","url":null,"abstract":"Background The advent of Covid19 brought rapid changes in practice and new standard operating procedures (SOPs). We ran sessions for surgical ward and theatre staff to become familiar with new processes and pathways, to assess their practicability in the clinical environment and to come to standardised processes. Summary of Work In situ simulation sessions were organised for staff on surgical wards and in theatre, working through a range of scenarios appropriate to that team. For ward staff this included admission process, management of possible Covid19 infection, as well as theatre processes, including consent, documentation and transfer. In theatre the scenarios included team brief, PPE plans, theatre set up, patient transfer and peri-operative processes. These sessions were separate to other simulations of new technical procedures Summary of Sessions/Results We ran 5 sessions for ward staff involving a total of 48 participants, and 6 sessions for 44 theatre staff. The distribution of staff is shown in the attached table 1. Discussion and Conclusions/Recommendations As the Covid19 pandemic approached NHS staff were beset by multiple new procedures, often coming in ‘at pace,’ which led to confusion and differences in application between teams. Whereas much simulation covered specific technical procedures we focussed on basic aspects of the patient pathway which still caused confusion. Involving a wide range of medical/nursing staff enabled wide scrutiny of new SOPs and discussion about their practicability in the clinical setting, introducing any required changes. It also helped standardisation between teams. This was crucial to successful implementation and developing a culture of adaptation to future change. It was also helpful in reducing hierarchy. This supports the importance of in situ simulation in the introduction of new procedures to assess their practicability as well as in educating staff about such changes.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"98 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89114179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/bmjstel-2020-aspihconf.109
C. Mather, Victoria McGloughlin
Communicating in the Emergency department is challenging, as this is the only part of a hospital that is ‘unbounded’ with a potential unlimited number of presentations. Staff deal with up to 42 communication events per hour, with this time pressure impacting on the effectiveness of communicating with patients, families and colleagues.1 Nurses are frequently in a position to deliver ‘bad news’.2 This is never as common an occurrence as in the domain of Emergency Care. There are many reasons this interaction needs to be done well,3 consensus appears to cite Nurses as lacking confidence in performing this role.4 As part of an innovative Emergency Care module, an educational intervention was designed as follows; a cohort of 30 emergency care staff where taught by an experienced palliative care education lead in a theoretical classroom session on communication theory, with particular focus on the SPIKES model.5 Simulated scenarios then took place in an immersion suite, streamed back into the classroom. Two briefed and experienced simulated patients were used. The candidates from the group were given a ‘handover’ prior to entering the simulation setting. A facilitator was in the classroom keeping focus on observation and note taking. A second facilitator was in the immersion suite (off camera) to ensure technical/pastoral support and time keeping. Upon completion of scenarios, the candidates and actors returned to debrief the scenario with vicarious learning from the ‘audience’. The simulated patients remained in character to provide valuable ‘in role’ feedback. Before subsequently taking part in a broader debrief with the group. Candidate feedback; ‘Gained knowledge of importance of body language and now feel more comfortable handling breaking bad news/difficult conversations’. ‘Knowing models like SPIKE etc will help me structure conversations with patients more effectively and also enable constructive reflection.’ ‘It was excellent - thank you!’ Simulated patient feedback; ‘Everyone seemed invested and it felt really useful to be able to discuss ‘in role’, I felt that there was a lot of positivity. The immersion suite was a really interesting way of facilitating scenarios as it added to the reality and atmosphere for the participant, and preserved the intimacy of the interaction.’ Reference Malone M & Biese K. ( 2018) Care for the older adult in the emergency department, an issue of clinics in geriatric medicine. Elsevier. U.S.A Grudzen C, Richardson L, Johnson P, Hu M, Wang B, Ortiz J, Kistler E, Chen A and Morrison R. Emergency Department-initiated palliative care in advanced cancer: A randomised clinical trial. JAMA Oncology 2016;Vol 1;2 (5):p591598. JAMA Network.
在急诊科沟通是具有挑战性的，因为这是医院中唯一一个“不受限制”的部分，可能有无限数量的演示。工作人员每小时要处理多达42个沟通事件，这种时间压力影响了与患者、家属和同事沟通的有效性护士经常处于传递“坏消息”的位置这种情况在紧急护理领域从来没有发生过。这种互动需要做好的原因有很多，共识似乎是护士在扮演这一角色方面缺乏信心作为创新的紧急护理模块的一部分，设计了以下教育干预措施:一组30名急诊护理人员，由经验丰富的姑息治疗教育领导讲授沟通理论课堂课程，特别侧重于SPIKES模型然后，模拟场景在浸入式套件中进行，并传回教室。我们使用了两名经验丰富的模拟患者。这组候选人在进入模拟环境之前进行了“交接”。一个引导者在教室里专注于观察和记笔记。另一名协调员在沉浸式套件中(镜头外)，以确保技术/牧师支持和时间保持。场景完成后，候选人和演员回到现场，向“观众”进行模拟学习。模拟的病人保持在角色中，以提供有价值的“角色”反馈。在随后参加更广泛的小组汇报之前。候选人的反馈;“了解了肢体语言的重要性，现在可以更自如地处理突发坏消息/棘手的对话。”“了解SPIKE等模型将帮助我更有效地组织与患者的对话，并进行建设性的反思。“太棒了——谢谢你!”模拟患者反馈;“每个人似乎都很投入，能够讨论‘在角色中’真的很有用，我觉得有很多积极的东西。”沉浸式套件是一种非常有趣的促进场景的方式，因为它为参与者增加了现实感和氛围，并保留了互动的亲近感。参考文献Malone M & Biese K.(2018)急诊科老年人的护理，老年医学诊所的问题。爱思唯尔。刘建军，刘建军，刘建军，王斌，刘建军，刘建军，刘建军，刘建军，刘建军。JAMA Oncology; 2016;Vol . 1;2 (5):p591598。《美国医学会杂志》网络。
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