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

Introduction: Harassment is a persistent issue in medical training, negatively impacting trainees' well-being, learning, and professional development. Although bystander intervention programs aim to address harassment, little is known about how medical residents respond in real-time situations. This study examines internal medicine (IM) residents' bystander responses during a simulation-based anti-harassment training.

Methods: We used an interpretivist thematic analysis to address our research questions in this article as part of a larger anti-harassment research study. Seventeen IM residents watched an educational anti-harassment video and then participated in a standardized simulation of a central line procedure, where they witnessed a senior resident (SR) harassing a medical student (MS), both portrayed by actors. Video and audio recordings captured verbal and nonverbal responses, which were coded iteratively. Descriptive frequency analysis tracked response patterns over time.

Results: All residents used all 3 main categories of responses in the following order of frequency: MS-centered (reassuring, empathetic, or knowledge driven), passive (education focused, reattribution, avoidant, or unreactive), or SR-related (immediate direct, immediate indirect, or delayed responses). All residents used both reassuring and unreactive responses. Residents' use of the 3 main response categories varied over the course of the simulation. MS-centered responses were used throughout the simulation, whereas SR-related responses only started to appear midway through the simulation.

Conclusion: IM residents used varied intervention strategies, yet many defaulted to passive responses, potentially indicating hesitancy, uncertainty, or deference to hierarchy. These findings highlight the need for structured bystander training to build confidence in active intervention and improve responses to harassment in medical training.

Background: Point-of-care ultrasound (POCUS) is an essential tool in the practice of internal medicine (IM) and is increasingly integrated into clinical practice for immediate bedside diagnosis and management decisions. However, there is a gap in the training of IM specialists in the effective utilization of POCUS.

Methods: This study evaluates the impact of a theoretical-practical pulmonary POCUS course on first-year IM residents compared with third-year residents without formal training, using a quasi-experimental, nonequivalent control group study. Implemented at Pontificia Universidad Católica de Chile, the course comprised online theoretical classes and practical sessions using a portable ultrasound device. Performance was assessed via theoretical and practical tests before and after the course.

Results: Results demonstrated significant improvement in the skills and knowledge of first-year residents following the course, with overall performance increasing from 43% to 86%. In contrast, third-year residents exhibited similar performance to first-year residents before course assessments, emphasizing the need for structured POCUS training in residency curricula. In addition, residents reported improved self-perceived skills and a greater appreciation for the utility of lung ultrasound (LUS) after training.

Conclusions: This study highlights the effectiveness of structured POCUS training in enhancing residents' skills and knowledge and provides a potential approach for incorporating POCUS teaching into the IM residency program curriculum.

Introduction: Few studies have evaluated the stress-related factors experienced by medical students during gynecological examination training or the effectiveness of different teaching strategies involving real patients. This study aims to assess the impact of 3 distinct instructional approaches, each incorporating a commercially available pelvic examination simulator, on medical students' clinical skills, attitudes, and comfort levels when performing gynecological examinations.

Methods: A total of 138 clerkship students received a commercially available pelvic examination simulator and were randomly assigned to the following interventions: reading a handout (reading), watching a video of pelvic examination on a pelvic model (model video), or watching a video of patient experience with pelvic examinations (testimonial video). Skill performance, measures of fear/anxiety/comfort, and overall satisfaction were assessed during both simulated and real patient encounters to evaluate the impact of each teaching modality.

Results: Mixed analysis of variance revealed statistically significant differences in all dependent variables for time (all P < 0.001) and for the time × group interaction on the Fear of Pelvic Examination Scale (F-PEXS) for discomfort (P = 0.038). Post hoc analyses between subjects in the real-life environment revealed higher total F-PEXS (P = 0.034) and F-PEXS discomfort (P = 0.009) scores for the model video compared with reading and higher scores for the testimonial video compared with reading on the pelvic examination checklist (P = 0.034).

Conclusions: Despite good acquisition of skills, the model video group demonstrated greater fear of performing pelvic examinations. By contrast, the reading group exhibited the lowest acquisition of skills, but lower levels of fear. The testimonial video group exhibited good acquisition of skills and low fear levels. These findings support the ongoing discussion and potential implementation of brief, targeted educational strategies for teaching pelvic examination techniques.

Summary statement: This systematic review synthesizes 34 key performance indicators (KPIs) from 36 hospital-wide simulation studies (2000 to November 2025), adhering to the PRISMA 2020 guidelines. Using PubMed, Scopus, and Web of Science, studies were assessed via the Critical Appraisal Skills Programme checklist, with discrete event simulation dominating (83%). Departmental stratification revealed coverage of the emergency department in 78%, inpatient units in 56%, operating rooms in 31%, and outpatient clinics in 22% of studies. KPIs were categorized into structural (eg, utilization rate), process (eg, length of stay), and outcome (eg, patient throughput) indicators. A novel impact metric (% KPI improvement per simulation effort) and hybrid models integrating qualitative KPIs (eg, patient satisfaction) are proposed. This framework guides simulationists in designing validated models for hospital efficiency, with applications in logistics and manufacturing.

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.