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

Introduction: Clinical reasoning is fundamental in kinesiology education, but its assessment remains a challenge. The Script Concordance Test (SCT) is a tool for assessing reasoning under conditions of uncertainty. This study assesses the feasibility of using the SCT to evaluate clinical reasoning in kinesiology students and gathers preliminary validity evidence for its application in simulation-based education.

Methods: An observational analytic study with a pretest and posttest design was used. Fifty-two kinesiology students participated in 7 simulated tele-rehabilitation scenarios in neurokinesiology, cardiorespiratory rehabilitation, and musculoskeletal rehabilitation. SCTs were administered before and after the simulations to measure changes in reasoning. The Wilcoxon signed-rank test and Cohen's effect size (d) were used to evaluate differences in scores.

Results: Three of the 7 SCTs met reliability criteria (Cronbach's α > 0.7). Postsimulation SCT scores significantly improved (P = 0.021), with a small effect size (Cohen's d = 0.22). A new Script Concordance Simulation Index was developed, showing high discriminatory ability (AUC = 0.989) between student reasoning categories.

Conclusions: The SCT can be utilized as a tool to evaluate clinical reasoning in kinesiology students within simulation-based education. Our study contributes to the generation of evidence supporting the feasibility and potential validity of the SCT in this context. The Simulation Script Concordance Test Index introduces an innovative approach to tracking cognitive trajectories after simulation. Future studies should provide additional evidence to strengthen the validity of the SCT in simulation-based education, and by deepening the understanding of the reasoning that underlies students' decision-making changes.

Summary statement: Virtual simulations are a promising teaching strategy, but little is known about the barriers to their use. This scoping review examines health professions students' experiences with asynchronous virtual simulations outside traditional classrooms, highlighting key barriers, benefits and outcomes. We included 34 reports. Barriers included technical difficulties, time and motivation constraints, limited feedback or interaction, complex structure, and lack of realism. Faculty also struggle with adapting to digital methods due to time constraints, inadequate training, and a reliance on lecture-based approaches. Identified benefits included learning, realism, flexibility and accessibility, improved scores, psychological safety, and improved communication and teamwork through immersive scenarios. Key outcomes included cognitive gains, positive reactions, perceived readiness for practice, and performance improvements. Overall, the review underscores the promise of asynchronous virtual simulations while emphasizing the need for further research to refine their design and implementation across diverse health programs.

Summary statement: Simulation is an excellent educational methodology for healthcare learners to practice skills for medical scenarios that are low in frequency but high in emotional intensity. However, these educational experiences may cause distress to participants. As learners must master these skills to be effective healthcare providers, psychological safety warrants attention. All participants must trust that they are not at risk of being shamed, that they are free to acknowledge distress, and that they will receive needed support to master the exercise. We describe the procedures used by our institution to promote psychological safety during the Assessment and Management of Sexual Assault course to offer a potential model for other institutions to consider when engaging in high-intensity healthcare simulation.

Background: Acute ischemic stroke requires rapid intervention to optimize patient outcomes, yet community hospitals often face challenges in minimizing door-to-needle time (DNT) and door-to-groin time (DGT). Simulation-based education offers a structured approach to enhancing workflow efficiency and interdisciplinary coordination. This quality improvement initiative evaluates the impact of a targeted simulation and workflow optimization program on stroke treatment times at a community hospital.

Methods: A quality improvement initiative was implemented at Northwest Community Hospital, part of the Endeavor Health System. The intervention consisted of 6 multidisciplinary simulation sessions conducted over 9 weeks to train emergency department and interventional radiology teams on an optimized stroke workflow. Pre- and postintervention data were collected on stroke response times from actual patient cases over 3 time periods: preintervention (12 months), during intervention (3 months), and postintervention (10 months). The primary outcome was DNT, with DGT as a secondary outcome.

Results: A total of 58 stroke cases were analyzed preintervention, 13 during intervention, and 70 postintervention. The mean DNT improved from 46 minutes preintervention to 39 minutes postintervention (P = 0.0209), whereas the mean DGT improved from 106 to 79 minutes (P = 0.0001). Simulation participants reported increased confidence in stroke response tasks, with postsession surveys indicating strong agreement in preparedness and safety measures.

Conclusion: The integration of a structured simulation-based education program significantly reduced stroke treatment times in a community hospital setting. This initiative highlights the value of simulation in refining clinical workflows and improving time-sensitive emergency care. Further research is warranted to explore long-term patient outcomes and the broader applicability of this approach in nonacademic hospitals.

Introduction: Women who experience postpartum hemorrhage (PPH) after giving birth rapidly lose blood, which may lead to shock or death without immediate intervention. PPH most often results from uterine atony, when the uterus fails to contract after delivery. Worldwide, PPH causes 10 deaths hourly, with most deaths occurring in low-income settings. In these settings, medical staff may lack the training to identify the complication. Although uterine atony training models exist, many cost >$5000.

Methods: To address the need for affordable training models, the Hemorrhage Education Reimagined (HER) model was created to train medical professionals to identify an atonic uterus through a bimanual examination after vaginal delivery. Twenty-five obstetrics and gynecology residents and attendings from an academic hospital evaluated the stages of atony of the HER model. Participants were asked to physically evaluate the model and give feedback on improvements to the model.

Results: More than 80% of medical professionals were able to correctly discern an atonic uterus from a healthy uterus, but many had difficulty differentiating the moderately atonic uterus model from the severely atonic uterus model. The model met established design criteria, including low cost (<$100) and durability (more than 100 uses).

Conclusions: The HER model is a low-cost uterine atony model. Its implementation empowers medical professionals to practice identifying uterine atony, with potential implications to improve the diagnosis of PPH. Current limitations include use of high-cost fabrication methods, such as laser cutting and 3D printing. Lower-cost options could include constructing the abdomen using cardboard or wood and hand molding the vaginal canal using clay.

Introduction: Wearable sensing technologies incorporated into virtual reality (VR) headsets can provide a number of unique, previously hidden insights into individual and team learning and performance in complex environments. However, the most impactful and efficient mechanisms for conveying multimodal data (e.g., gaze, mental workload, etc) allowing for unique insights are not well understood. This study used a human-centered design process to develop and evaluate a multimodal debriefing dashboard.

Methods: Twelve Advanced Cardiac Life Support (ACLS) Instructors completed VR cardiac arrest simulations and participated in interviews and design thinking workshops to identify dashboard features, leading to high-fidelity mock-ups and an interactive prototype. A second group of 6 ACLS instructors then evaluated the prototype by providing mock feedback on simulation performance with and without the dashboard in a pre-post format, followed by surveys assessing usability, acceptability, appropriateness, feasibility, trust, and perceived accuracy.

Results: The final prototype dashboard features a video, a timeline of clinical actions, automatic error identification, mental workload, and visual attention data. It also generates closed-loop communication reports on a separate webpage. The evaluation study showed that participants provided performance analysis and feedback to students when using the dashboard, targeting specific (non)technical skills aligned with ACLS learning objectives. Participants rated the dashboard highly, with a System Usability Scale score of 88.9%, reflecting above-average usability.

Conclusions: An interactive multimodal debriefing dashboard prototype was developed using a user-design framework with prototyping and iterative feedback. Use of the dashboard resulted in improved evaluation and debriefing practices targeting learning outcomes, with participants rating the dashboard favorably. This dashboard has the potential to enhance simulation-based learning by offering near real-time analytics that promote a deeper understanding of individual and team technical and nontechnical skill acquisition and mastery.

Background: Simulation-based education (SBE) is an essential teaching modality in healthcare; learner engagement in SBE is critical for knowledge retention. Numerous scales are validated to measure engagement, but none are specific for use in SBE. We present development and initial validation evidence for the Engagement Scale for Simulation-Based Education (ESSBE), a self-report tool measuring behavioral, cognitive, emotional, and social dimensions of the engagement construct within scenario-based SBE.

Methods: A mixed methods approach included item generation, expert review, and cognitive pretesting. Learners already attending undergraduate and graduate healthcare education programs at a southeastern simulation center voluntarily completed an 18-item, 7-point frequency response questionnaire immediately after a simulation session (n = 402). Reliability was tested using Cronbach's alpha and Spearman's Rank (rho). Dimensionality was assessed via confirmatory factor analysis (CFA) and metric invariance testing.

Results: From several structural models tested, best-fit was obtained using a 2nd order/4-dimensional model with 11 retained items (CMIN/3.3, CFI/0.945, TLI/0.91, SRMR/0.055, RMSEA/0.075). Additional empirical evidence supported scale reliability (alphas ≥ 0.610; rho r(401) ≥ 0.434, P < 0.01) and metric invariance (held for Δ SRMR and Δ RMSEA).

Conclusion: Future studies are needed to strengthen the validation evidence for the ESSBE before the tool is ready for general use. For example, we have not yet tested convergent/divergent validity with existing metrics or whether ESSBE responses are associated with learner outcomes. We provide initial evidence supporting the 11-item, 4-dimension ESSBE as a potentially reliable and valid measurement of engagement in SBE.

Summary statement: Simulation-based education (SBE) in health care is expanding in both scope and relevance. As on-the-job training is challenging in extracorporeal membrane oxygenation (ECMO), SBE features strongly in its curricula, yet little is known regarding its efficacy. We searched 4 databases through May 13, 2022 and conducted a narrative synthesis of 28 studies investigating SBE in ECMO. Notably, there were no standardized SBE ECMO curricula among studies. Nonetheless, taken together, these articles suggest that simulation improves competency scores, confidence, teamwork, troubleshooting emergencies, and times to critical actions and cannulation. Though the reporting of SBE in ECMO is heterogeneous, simulation may be comparable to, or more effective than, conventional training methods. Retention of knowledge and skills over time remains unclear though regular simulation training may be beneficial. There is a need to establish standardized ECMO curricula, of which SBE should be a core component.

Introduction: Teamwork practice through simulation-based education (SBE) is effective, but optimal instructional design remains uncertain. Preinstruction targeting technical skills (TS) and non-TS (NTS) has shown promise in supporting their respective acquisition through simulation. However, evidence remains limited on whether preteaching TS can enhance NTS acquisition, such as crisis resource management (CRM). This study aims to assess the impact of presimulation instruction of TS on the acquisition of CRM during SBE.

Methods: We used a convergent mixed-method design, combining a quantitative post-test-only control group design with a complementary qualitative component. The intervention group had access to preinstruction of the TS necessary for managing an acutely ill patient, whereas the control group was exposed to a sham video. The main outcome was CRM skills acquisition, as measured by the Ottawa Global Rating Scale (OGRS) after 2 SBE sessions held 3 months apart (T 0 and T 3 ). Secondary objectives were the intervention's effect on anxiety, cognitive load, and participants' perceptions of the intervention. Quantitative outcomes were assessed with a repeated-measures general linear model. Semistructured interviews were conducted after each simulation, and thematic analyses were performed.

Results: Sixty-four postgraduate year 1 (PGY1) residents were randomized into intervention and control groups. Participants who received preinstruction of TS in addition to SBE of NTS achieved significantly higher overall OGRS scores than those who received SBE of NTS alone. There were no between-group differences in anxiety measures. Qualitative analysis revealed high variability in the intervention's impact on participants, some revealing lower cognitive load, whereas others heightened levels of performance anxiety.

Conclusions: In PGY1 residents, preinstruction of TS may reduce cognitive load during simulation training and enhance CRM skill acquisition at 3 months, although not via anxiety reduction. Responsiveness to the study intervention was variable and highlights the need for further research on the impact of instructional design adaptations on different learner subsets.