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

Introduction: Simulation-based learning (SBL) is essential in health care education, integrating theoretical knowledge with practical experience through reflective learning in debriefs. Although reflective learning during postsimulation debriefs enhances theory-practice integration, its role in fostering intrinsic motivation and professional self-actualization is not fully understood.This study examines how reflective learning, rooted in humanistic learning principles, influences students' self-actualization in the Critical Care Flight Paramedic Program (CCFPP). Specifically, it seeks to understand how and why reflective learning influences CCFPP students' intrinsic motivation, professional growth, and self-actualization through the framework of Self-Determination Theory (SDT).

Methods: The research used a qualitative case study design aligned with a relativist-constructivist framework. It is grounded in humanistic learning principles outlined by Gage and Berliner, which shaped the interview questions. Data were collected through semistructured interviews with 11 participants and analyzed using thematic analysis. The study examined the responses and results within the framework of SDT, which also provides the theoretical basis for understanding professional self-actualization.

Results: Analysis revealed that reflective learning significantly contributed to professional self-actualization by promoting autonomy, enhancing competence, and fostering relatedness. The findings highlight the rapid transformation facilitated by the intensive SBL environment and emphasize the role of reflective learning in linking theory with real-world applications.

Conclusion: The study highlights reflective learning's crucial role in fostering professional self-actualization among CCFPP students. Integrating humanistic principles into SBL, particularly during postsimulation debriefs, can develop competent and motivated health care professionals, aiding in their journey toward professional self-actualization.

Introduction: Cognitive load (CL) theory provides a framework for optimizing learning in simulation. Measures of CL components (intrinsic [IL], extraneous [EL] and germane [GL]) may inform simulation design but lack validity evidence. The optimal timing for CL assessment and contributions of debriefing to CL are not established.

Methods: This prospective observational study assessed self-reported CL for first-year anesthesiology residents during 10 individual-learner simulations. Following each simulation and before debriefing, participants completed 4 CL measures: Paas scale, National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Cognitive Load Component questionnaire (CLC) and Cognitive Load Assessment Scales in Simulation (CLAS-Sim). After debriefing, participants repeated the Paas and CLAS-Sim.

Results: Twenty-nine first-year anesthesiology residents participated. Correlations were significant among all total CL measures (r range = 0.51-0.69) and between CLC and CLAS-Sim IL (r = 0.66), EL (r = 0.41), and GL (r = 0.61) (all P < 0.01). We observed a significant interaction between total CL measures and case complexity, and a significant main effect of case complexity for CLC and CLAS-Sim IL, with no main effect for IL measure. The CLAS-Sim EL was higher (P = 0.001) than respective CLC scales across cases, with no difference for GL. Participants reported higher CLAS-Sim GL after (versus before) debriefing (P < 0.001), with no difference in IL, EL, or Paas scores.

Conclusions: This study provides further validity evidence for the CLAS-Sim and demonstrates generalizability in a different population of medical trainees. The CLAS-Sim GL increases following debriefing, reflecting expected learning, demonstrating initial GL scale validity evidence.

Introduction: Online experiential learning can benefit learners with scalable techniques to self-debrief and to develop cognitive skills in recognizing clinical cues.

Methods: We developed techniques for cue-detection exercises and self-debriefing, based on cognitive engineering-inspired expertise development approaches that focus on tacit knowledge, sensemaking, and mental models. Self-debriefing was structured by asking the learners to compare and then reflect on their choices and rationales against those provided by a panel of experts. Using these techniques, we generated scenario-based experiential learning materials in a virtual environment for a 2-hour module on deteriorating patient conditions that can lead to imminent cardiac arrests. The module was tested in a senior nursing course as an optional assignment. The volume of voluntarily submitted reflections by learners was used to assess engagement and subsequent thematic analysis to assess feasibility of the techniques.

Results: The module was completed by 189 of the 197 students invited (95.9%). Engagement level was high with all completed students submitting reflections after self-debriefing, most of which (between 53.4% and 87.8%) were specific enough for thematic analysis. The main theme of reflections was "missing something" in the scenario, followed by the themes of importance of reading the patient monitor and refining actions and priorities.

Conclusions: We demonstrated the feasibility of the techniques based on cognitive engineering-inspired approaches for virtual simulation learning in health care that structures self-debriefing by comparing a learner's situation assessment and responses with those of experts. The techniques have the potential to help learners in health care efficiently and consistently develop key critical thinking skills, especially those based on tacit knowledge to detect cues.

Introduction: Clinical reasoning (CR) is a complex skill that requires great depth of knowledge and practical skills to provide comprehensive care in a dynamic health care setting. Within health care education programs, simulation experiences, such as an educational escape room (EER), create realistic, meaningful, and engaging learning environments that can aid in developing CR. Research on the impact of an EER on CR development through the student lens is limited. This study aimed to understand physical therapy (PT) students' perceptions of CR and its development, including the impact of an EER activity.

Methods: Following an EER experience, 17 individual semi-structured interviews were completed through a basic interpretive qualitative design. Data analysis used open and axial coding to discover common themes.

Results: The 4 central themes identified as impacting the development of CR by PT students were (1) understanding the why, (2) graduate learning experience, (3) application of knowledge in practice, and (4) growth. Through an EER experience, participants gained a deeper understanding of CR, were able to apply concepts in a safe environment, gained valuable experience in a controlled setting, and emphasized the importance of reflection in and on action.

Conclusions: Integrating a novel EER activity early in the educational curriculum can facilitate CR development through the lens of the student learner. This activity stresses the importance of applying knowledge and practicing skills in a safe and engaging environment while replicating the clinical setting, which challenges students' ability to adapt to new and stressful situations.

Background: The increasing integration of point-of-care ultrasound into clinical practice necessitates effective training tools. One such practice is pelvic abscess drainage using a vaginal probe, where an appropriate training model does not exist.

Objective: To develop and evaluate an economical, user-friendly phantom for simulating pelvic abscess drainage.

Methods: The phantom was constructed using readily available materials, including ballistic gel and a simulant for purulent material. The phantom was designed to simulate pelvic abscess drainage through a vaginal probe. Ten independent investigators and 2 authors evaluated the phantom's realism and utility using a visual analog scale (VAS), ranging from "not realistic and useful" (0) to "very realistic and useful" (10) for anatomical fidelity, material suitability, and ease of performing the examination. Three evaluators with previous experience in abscess drainage compared the phantom to real-life scenarios using the same VAS scale. The median time required for each health care professional to perform the procedure was also measured.

Results: The phantom was constructed at a cost of approximately US$ 30.00. Evaluators scored the phantom highly for realism and utility, with mean VAS values of 8.75, 9, and 9.2 for anatomical fidelity, material properties, and ease of performing the examination, respectively. Three senior radiologists, each with extensive experience in real-life abscess drainage procedures, compared the phantom to their clinical experiences. They rated the phantom as highly realistic, assigning it a mean VAS score of 9.8. The median time to perform the procedure was 1 minute and 51 seconds.

Conclusion: The developed phantom effectively simulates pelvic abscess drainage, providing a realistic and practical training tool. This phantom fills a significant gap in current medical simulation resources, offering a cost-effective solution for training health care professionals in essential ultrasound-guided procedures.

Introduction: We used cognitive load theory to design the Queen's University Airway Mastery (QUMAC) pilot course to work toward reliable mastery of Emergency Airways Management elements in all participants.

Methods: We describe the process of designing QUMAC using 4-Component Instructional Design to harness the cognitive load theory as a learning tool. We evaluated the effectiveness of QUMAC using an outcome-based mixed-methods approach including Objective Structured Assessment of Technical Skills (OSATS) and 2 Objective Structured Clinical Examinations (OSCEs) at course completion using blinded expert video review. We also conducted semistructured interviews at course completion and after 6 months of independent practice. Interviews were analyzed thematically.

Results: Mean OSCE Global Performance Scores were 4.1 (±0.56) of 5 for both OSCE scores; and 4.0-4.4 (±0.48-0.89) on OSATS. At course completion, 4 themes were identified: Overall Experience with the Course, Facilitators of Performance, Recommendations, and Transfer to Practice. At 6 months of independent practice 5 themes emerged: Level of Confidence, Management of Cognitive Load, Persistence, Barriers to Application, and Recommendations.

Conclusions: All participants demonstrated a high degree of competence when assessed by OSCEs and majority did so with the OSATS. All noticed an increase in confidence and reduced cognitive load while managing airways. These persisted over 6 months of independent practice where the participants were actively managing airways as staff physicians in new workplaces. High performance expectations, automation, schemas, spaced repetition, and homework were the elements most associated with better performance and more confidence. Decreased cognitive load freed up resources for higher order thinking, while the overall sense of competence reduced the anxiety of going to work as a new emergency department staff.

Summary statement: Nontechnical skills (hereinafter referred to as NTS), such as task management, leadership, situational awareness, communication, and decision making contribute to safe and efficient team performance. The importance during cardiopulmonary resuscitation is being increasingly emphasized. We carried out the intercultural adaptation of the TEAM score in Italian and to evaluate the reliability and validity of the resulting Italian version ( i -TEAM). A forward-backward translation was made with the author called i -TEAM. Psychometric properties of the i -TEAM score were evaluated, including acceptability, construct validity, and interrater reliability. We divided the participants into 3 groups based on their experience, and we verified if there was a correlation between the final score NTS of i -TEAM and the groups. The Cronbach coefficient was 0.91 for the Total i -TEAM score. The descriptive statistics showed that there was no correlation between NTS score and experience (group). Our results show that i -TEAM has psychometric properties similar to the original score.