Simulation in Healthcare-Journal of the Society for Simulation in Healthcare最新文献

Introduction: Virtual Monitor Technicians (VMTs) are crucial in remotely monitoring inpatient telemetry. However, little is known about VMT workload and intratask performance changes, and their potential impact on patient safety. This exploratory study used a high-fidelity simulation aimed to evaluate VMTs' workload and performance changes over time in telemetry monitoring and identify future research directions for performance improvement.

Methods: The research team created a simulation of the current remote telemetry stations with 36 patient waveforms across 3 screens alongside a documentation screen, replicating VMTs' work. Twelve VMTs participated in a 1-hour session, and time-to-escalate and detection accuracy to auditory/visual alerts were recorded. Workload was measured using the NASA-Task Load Index.

Results: The post-task NASA-Task Load Index score showed an increased workload score of 64 of 100 from a prescore of 38 of 100, with mental and temporal demands being the largest contributors. The performance of VMTs did not change significantly over time, with a 52% correct response rate. Participants' ability to detect signals was slightly better than chance (d' = 0.477), and they tended to be cautious in their responses, β (M = 1.989, SD = 1.635). Urgent, Warning, and Medium audiovisual alerts were recognized in 9, 35, and 39 seconds, respectively, whereas advisory alerts (visual only) were recognized in 13 minutes.

Conclusion: This study sets a foundation for future work on VMT workload expectations. Although our work is exploratory, the results indicate a significant increase in VMT workload with no decline in performance; VMTs responded most quickly and accurately to urgent alerts, whereas overall response accuracy to nonurgent alerts was marginally better than chance. Future research needs to explore techniques to improve response accuracy rate beyond the 52% measured in this study.

Introduction: Chest tube insertions (CTIs) have a high complication rate, prompting the training of technical skills in simulated settings. However, assessment tools require validity evidence prior to their implementation. This study aimed to collect validity evidence for assessment of technical skills in CTI on Thiel-embalmed human bodies.

Methods: Invitations were sent to residents and staff from the departments of surgery, pulmonology, and emergency medicine. Participants were familiarized with the Thiel body and the supplied equipment. Standardized clinical context and instructions were provided. All participants performed 2 CTIs and were assessed with the Assessment for Competence in Chest Tube InsertiON (ACTION) tool, consisting of a 17-item rating scale and a 16-item error checklist. Live and post hoc video-based assessments by 2 raters were performed. Generalizability analysis was performed to evaluate reliability. Mean scores and errors were compared using a mixed-model repeated measures analysis of variance (ANOVA). A pass/fail score was determined using the contrasting groups' method.

Results: Ten novices and 8 experienced participants completed the study. The Generalizability coefficients were moderate for the rating scale (0.75), and low for the error checklist (0.4). Novices scored lower on the rating scale?? (44±6.7/68 vs 50.8 ± 5.7/68, P = 0.024), but did not commit significantly more errors (1.6 ± 1.1/16 vs 1.0 ± 0.6/16, P = 0.066). A pass/fail score of 47/68 was established.

Conclusion: The rating scale in the Assessment for Competence in Chest Tube InsertiON tool has a robust validity argument for use on Thiel-embalmed bodies, allowing it to be used in simulation-based mastery learning curricula. In contrast, its error checklist has insufficient reliability and validity to be used for summative assessment.

Introduction: Medical students find translating lessons from traditional lectures to caring for trauma patients challenging. We assess whether adding video-based virtual flashcards and videos of augmented reality-based trauma patients in an online learning environment improves performance.

Methods: We performed a between-subject experimental study. Thirty-five medical students were randomly assigned to the control and experimental groups. The control group viewed a traditional online lecture. The experimental group viewed the same online lecture and received virtual flashcard training. Each virtual flashcard consisted of a video of a virtual patient, and examination questions about diagnoses, treatment, and disposition. The experimental group also viewed a video of a physician coach providing an expert assessment of the virtual patient. Simulation-based assessment was used to measure performance and knowledge. The evaluation consisted of the following 3 scenarios: a video of a simulated patient followed by multiple-choice questions, a free-text examination, and the writing of a Subjective, Objective, Assessment and Plan note. Differences in performance for 3 measures (diagnoses, therapeutic interventions, and disposition) were assessed for pre-post change in accuracy. For these 3 measures, we used a binary logistic regression model. We assessed perceptions of performance and the training experience with a survey.

Results: The training intervention statistically significantly improved accuracy for diagnosis (P = 0.01) and self-reported performance (P < 0.01) compared with the control group. The themes for the experience were engaging, innovative, and valuing the expert's assessment, with 17 of 19 positive statements.

Conclusions: Adding virtual flashcards to traditional training significantly improved diagnostic accuracy while being engaging and innovative.

Summary statement: Simulated participants (SPs) are often employed to teach communication skills in medical education. Although there is a large number of qualitative and/or noncomparative studies in this field, there is no current evidence for the effectiveness of this teaching method based on quantitative comparative meta-data. The aim of this review was to evaluate the effectiveness of SP-based teaching on patient-centered communication skills in medical education compared with traditional teaching formats such as lecture or peer role play focusing on quantitative and comparative data. According to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched MEDLINE, Cochrane Library, PsycINFO, CINAHL, and ERIC databases for relevant studies published through February 2023. We also conducted hand searches and ancestry searches. Of the 8523 publications identified, 21 studies with 2500 participants and a Medical Education Research Study Quality Instrument score of 13.7 (SD = 1.3, N = 21) were included in the synthesis. Ten studies were eligible for meta-analysis. The pooled effect for communication skills outcomes suggests a medium effect preferring SP-based teaching to traditional teaching formats (standardized mean difference = 0.74, 95% confidence interval = 0.37 to 1.11, I2 = 95%, n = 2061). The heterogeneity is high among the analyzed studies. Further analysis reveals great differences among the studies' characteristics (population, objectives, interventions, control group settings, and outcome measurements).

Summary statement: Tabletop simulations (TTS) are a novel educational modality used in health care education. The objective of this scoping review was to describe the use of TTS in medical emergencies, specifically settings, specialties, participants, formats, and outcomes.We included 70 studies (33 descriptive studies [47%], 33 cohort studies [47%], and 2 randomized controlled trials [3%]), of which 65 reported positive results regarding reaction and learning educational outcomes (reaction: n = 37, 53%; learning: n = 25, 36%; behavior: n = 7, 10%; result: n = 1, 1%). The scenario for most TTS was a disaster (n = 56; 80%). Most TTS involved participants from several professions (n = 45; 64%). A board game was used in 26 studies (37%).Most studies on TTS in medical emergencies involved participants from multiple professions addressing disaster scenarios and showed positive results pertaining to reaction or learning educational outcomes.

Introduction: Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level.

Methods: Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes.

Results: A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent.

Conclusions: Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.

Summary statement: Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.