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

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.

Summary statement: Learners in simulation-based education (SBE) experience a kaleidoscope of emotions, which shape learning, performance, and professional identity formation. This article provides a conceptual commentary of the emotional landscape in SBE, using the children's book The Colour Monster as an illustrative lens, while also highlighting the complexities of emotions in adult learners.Lessons drawn from this book highlight that feeling emotions is a normal and expected part of the learning process, the critical importance of the facilitator in helping participants work with their emotions, and the potential role of emotional regulation strategies in optimizing emotions for learning and performance. Deepening appreciation of these concepts may facilitate more consistent appreciation and integration of emotion into simulation design and delivery.

Introduction: A recent retrospective study conducted in Tanzania reported that 87.5% of neonatal deaths occur within the first week of life, highlighting a critical opportunity to reduce mortality through improvements in the quality of care. The aim of this study is to describe a distance learning program supported by a newly developed device specifically designed for telesimulation-based training. This program was created to facilitate continuous professional development for healthcare personnel involved in neonatal care.

Methods: After identifying sustainable objectives for improving the quality of neonatal care, a cooperative program was established. This initiative involved medical instrumentation providers and neonatologists to support on-site care and clinical coaching. A telesimulation tool, capable of being managed both locally and remotely, was developed and implemented to enhance accessibility and training sustainability.

Results: The analysis conducted using an operational checklist applied to neonatal resuscitation simulations revealed a statistically significant improvement in performance, with an average percentage improvement of 38.78% for technical skills and 71.42% for nontechnical skills.

Conclusions: This telesimulation tool demonstrated promising outcomes in reinforcing essential neonatal resuscitation knowledge. The innovative advantage of our simulation system lies in its dual-mode operation, functioning both autonomously on-site and under remote supervision. This capability establishes the foundation for a sustainable and continuous training model.

Introduction: Observers in simulation-based education often lack structured roles, leading to disengagement and reduced learning. Crisis resource management (CRM) principles, focusing on nontechnical skills like communication and situational awareness, offer a potential framework to enhance observer engagement.

Methods: We conducted a prospective cohort study with senior-cycle medical students in critical care simulations. In the intervention group (n = 44), observers were oriented to CRM principles and assigned domains such as leadership, communication, or situational awareness. Using structured checklists, they documented behaviors and contributed findings during debriefs. A control cohort (n = 56) completed standard simulations without structured roles. Postsimulation questionnaires assessed engagement, focus, confidence, and perceived educational value. Data were analyzed using nonparametric tests (Mann-Whitney U, χ2, or Fisher's exact test where appropriate), with statistical significance defined as P < 0.05.

Results: Observers in the intervention group reported significantly higher confidence in identifying key actions and decisions compared with the control group (odds ratio = 2.50, 95% confidence interval [1.12-5.91], P = 0.037; Mann-Whitney U = 778, P = 0.0007). 95.5% of students reported improved focus during scenarios, and 93% endorsed continued CRM use. Prior simulation experience did not differ significantly between groups (χ2(1, N = 100) = 0.7959, P = 0.3723). Free-text feedback highlighted increased interactivity and deeper understanding of team dynamics. The CRM-based approach proved adaptable across a range of simulation scenarios, suggesting potential for widespread application.

Conclusions: Structured observer engagement through CRM principles improves learning outcomes, enhances critical thinking, and builds confidence in evaluating teamwork and communication skills. Integrating CRM principles provides observers with a clear analytical focus and promotes meaningful participation. This structured, low-cost approach offers a scalable method to improve the educational experience for simulation observers in undergraduate medical education.

Introduction: Durotomies can lead to cerebrospinal fluid leakage, resulting in various complications. Repairing a durotomy is an essential skill for orthopedic and neurosurgical trainees, but the learning process can be challenging. Therefore, there is a need for effective simulators that allow surgical trainees to practice the technique in a controlled environment without endangering patient safety.

Methods: This study describes the development of a novel 3-dimensional (3D) printed simulation model designed for teaching the repair of intraoperative durotomies to surgical trainees. Junior and senior residents, fellows, and attending spine surgeons used the simulation. Inter- and intragroup performance was examined.

Results: A novel durotomy repair simulation model with lumbar and thoracic windows was developed using 3D-printed and repurposed components to create a lifelike representation of an in vivo intraoperative scenario. Senior residents, fellows, and attendings outperformed junior residents at the initial attempt. All groups improved with repeated exposure to the simulator.

Conclusions: The model offers surgical trainees a controlled environment to practice technical skills without increasing risk for patients or prolonging surgical cases. The model demonstrated its validity by showing that more senior participants outperformed junior residents during their initial attempts. Performance improvement across all groups with repeated exposure indicates that the model not only tests a relevant and realistic skill set, but also facilitates skill development over time. Given the challenges associated with intraoperative training as well as the complications associated with durotomies, the proposed simulator has the potential to benefit surgical trainees and patients.

Introduction: Males have higher odds of receiving bystander cardiopulmonary resuscitation (B-CPR) and surviving out-of-hospital cardiac arrest compared with females. Studies suggest that concerns about breast exposure, causing injury, or being accused of sexual harassment may contribute to gender disparities in B-CPR. This study examines whether using the ReviveHer breast attachment during CPR training impacts Emergency Medical Technician (EMT) students' willingness, comfort, confidence, and concerns when performing CPR on breasted and nonbreasted individuals.

Methods: EMT students at North Seattle College participated in a 2-day CPR training and completed pre- and posttraining surveys assessing participants' willingness, confidence, and concerns specific to providing CPR to breasted and nonbreasted individuals. Participants were randomized into control or experimental groups. The control group used standard flat-chested manikins, whereas the experimental group trained with the ReviveHer breast attachment.

Results: The experimental group showed significantly increased willingness to initiate CPR across all body types and settings: breasted public (P = 0.011), breasted private (P = 0.015), nonbreasted public (P = 0.009), and nonbreasted private (P = 0.024). They also reported greater comfort in unclothing a breasted body in a private setting to perform CPR (P = 0.017), increased confidence in providing compressions to an unclothed breasted body (P = 0.043), and decreased fear of sexual harassment accusations (P = 0.044).

Conclusions: Incorporating the ReviveHer breast attachment into CPR training enhances EMT students' preparedness to administer CPR to both breasted and nonbreasted individuals. It increases comfort and confidence while reducing concerns related to social and legal repercussions, potentially addressing key barriers to equitable B-CPR delivery.