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

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.

Introduction: The Evaluation of Learning and Performance standard of the International Nursing Association for Clinical Simulation and Learning proposes evaluating all simulation-based experiences. Over the years, multiple instruments have been designed to evaluate simulation. The Simulation Effectiveness Tool-Modified (SET-M) was developed by Leighton and colleagues in English in 2015. This tool has been translated and validated in different languages and cultures, presenting stable psychometric properties. Although a Spanish validation of the instrument has been found, it was conducted with medical students after participating in telesimulation. To date, no validation has been found for its use after face-to-face simulation with Spanish-speaking nursing students. This study aims to validate the psychometric properties of the SET-M in advanced nursing bachelor's students engaged in face-to-face simulation from 2 Spanish-speaking countries.

Methods: A multicenter, cross-sectional, analytical, and psychometric validation study was conducted. The sample consisted of 232 students from the final 2 years of their Bachelor's Degree in Nursing at 2 privately managed universities, 1 in Argentina and the other 1 in Spain. The bootstrap Exploratory Graphical Analysis (EGA) approach was used to determine the structural consistency and stability of the items.

Results: An EGA identified 4 communities with adequate stability and structural consistency values. Furthermore, the SET-M was found to be invariant among nursing students in Argentina and Spain.

Conclusions: The Spanish version of the SET-M demonstrated adequate psychometric properties, confirming its validity and reliability for assessing simulation-based education effectiveness in undergraduate nursing students in Argentina and Spain. This study provides a valuable tool for self-assessment in simulation education within Spanish-speaking contexts.

Introduction: Newborns in rural hospitals face an increased risk of morbidity and mortality compared to those born in hospitals with a Neonatal Intensive Care Unit (NICU). Although causes are multifactorial, low delivery volume leads to infrequent neonatal resuscitation exposure. Simulation enables deliberate practice to maintain skills, but rural hospitals face barriers to accessing this training. The objectives of this study were to assess rural clinicians' ability to assess and recognize changes of state in a mixed reality (MR) simulator, HoloBaby, developed for neonatal resuscitation training, and to compare their experience to mannequin-based simulation, and their real neonatal resuscitation experience, using a mixed methods study design.

Methods: Forty-five interprofessional clinicians from 3 rural hospitals participated in identical neonatal resuscitation simulations using first a programmable "high-technology" mannequin (HTM) and then HoloBaby. Surveys were conducted after each simulation experience and facilitated focus groups at the end of each study session to gauge clinicians' experience with the simulation technologies and their ability to effectively assess and recognize changes in patients. Logistic mixed effects regression models assessed the association between survey question components and training method. Thematic analysis was used to identify codes and themes from the focus group transcripts.

Results: Participants reported that they were better able to effectively recognize shock in HoloBaby over the HTM. No other significant differences were noted between the technologies. Thematic analysis identified 3 main themes: novelty of MR technology, advantages and disadvantages of HoloBaby compared to the HTM, and value of simulation training (regardless of technology).

Conclusion: The MR simulator, HoloBaby, offers the experience of simulation-based team training and matches the HTM in user ability to assess and recognize all changes in state measured, and exceeding HTM in users' ability to recognize shock. In addition, MR could reduce financial and geographic barriers to accessing regular simulation training in rural settings.

Introduction: Ventral hernia repair is a common procedure performed by general surgeons, with approximately 400,000 performed each year in the United States. Robotic ventral hernia repairs (rVHRs) continue to increase, and simulation is vital for robotic skills acquisition; however, a realistic rVHR training platform does not currently exist. The goal of this study was to assess a novel rVHR model for robotic simulation training and to compare baseline rVHR experience with performance of rVHR simulated tasks.

Methods: The Robotic Instructional Platform for Surgery on the Abdominal Wall (RIP SAW) was developed via an iterative process for use with the da Vinci Surgical System. Staff general surgeons, surgical residents, and medical students were recruited at a single military academic institution. All participants completed an assessment trial designed to mimic rVHR. Staff surgeons answered questions about model fidelity and realism. Performances on the tasks were compared between subgroups based on time and composite score.

Results: All staff surgeons who participated reported that the model was acceptable for rVHR simulation training. There was a significant difference in composite scores between groups ( F (2,21) = 66.75, P < 0.001, η 2 = 0.86). There was also a significant difference in operative times between groups ( F (2,21) = 17.34, P < 0.001, η 2 = 0.62). A linear regression using total career rVHRs performed as a predictor demonstrated a significant correlation between rVHR cases and composite score ( F (1,22) = 6.55, P = 0.018).

Conclusions: The RIP SAW is a novel cost-effective model for rVHR simulation training. Pilot testing demonstrated evidence of fidelity and validity and provides a unique nonvirtual reality option for robotic surgery training.

Summary statement: This scoping review examined the economic components of implementing Objective Structured Clinical Examinations (OSCEs) in health professions education. Forty-nine studies published between 1986 and 2024, spanning multiple countries, professions, and simulation modalities, were analyzed. Key cost categories included standardized patients, evaluator compensation, infrastructure, logistics, and digital resources. Reported costs ranged from less than US$7 per student to more than US$150,000 per cycle. Traditional in-person OSCEs incurred higher recurring operational expenses, whereas online and hybrid formats concentrated spending in initial infrastructure and showed potential for scalability and cost containment. Significant inconsistencies in cost definitions and reporting practices limited comparability across studies. The findings highlight the urgent need for standardized economic frameworks, cost-reporting tools, and context-sensitive strategies to guide sustainable OSCE implementation, particularly in low- and middle-income countries where resource allocation must be strategic and aligned with institutional capacity.

Introduction: Simulation operations specialists (SOSs) play a critical yet ill-defined role in healthcare simulation. Despite their critical involvement in operations, orientation, and support of simulation-based education, no validated needs assessment tool existed to guide professional development. This study aimed to design and validate the Simulation Operations Needs Assessment Tool (SONAT) to identify knowledge and skills gaps, guide onboarding, and inform SOS professional development.

Methods: The SONAT was developed using best practice, community, and peer-reviewed documents, including the Certified Healthcare Simulation Operations Specialist Blueprint, SimGHOSTS Capability Framework, and the Healthcare Simulation Standards of Best Practice. Messick's Unified Validity Theory guided the validation process using Lawshe's method to assess survey items. Following expert feedback and item revision, the tool was disseminated for psychometric analysis. Internal consistency was assessed using Cronbach's alpha for each section of the tool.

Results: Content validity indices (CVIs) for the final SONAT exceeded the .70 acceptability threshold (CVI = .738). A sample of 256 SOSs completed the SONAT. Internal consistency was strong across 4 domains (α = .730-.912). Respondents reported high proficiency in manikin-based and task trainer simulation but less in emerging modalities (eg, Augmented Reality/Virtual Reality). Awareness of professional standards was strong, although gaps were noted in knowledge of ethics and leadership opportunities, particularly among noncertified individuals.

Conclusions: SONAT collects valid and reliable data when assessing SOS developmental needs across diverse roles and backgrounds. It has the potential to standardize orientation, support tailored professional development, and strengthen skillsets of the evolving SOS profession.