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

Introduction: Immersive virtual reality simulation (IVRS) is an increasingly popular tool in health education. This qualitative study explores the integration of IVRS into a distributed practical nurse-to-registered nurse program. The intervention included hardware and software deployment, faculty and student orientation, and the integration of IVRS scenarios into existing courses. This study aimed to (1) describe the IVRS intervention and its implementation; (2) explore the perceptions and experiences of students, faculty, and information technology staff involved in the first iteration of the IVRS intervention; and (3) offer reflections and recommendations for optimizing student learning.

Methods: Using an educational design framework and generic qualitative methodology, we collected data through demographic surveys and postintervention focus groups and interviews.

Results: Thematic analysis revealed 3 key themes: user experience, IVRS impact on learning, and achieving consensus. Although faculty responses were positive, student responses were mixed. Findings suggest that successful implementation of IVRS in distributed nursing education requires deliberate planning, comprehensive orientation, and ongoing support.

Conclusions: IVRS has the potential to enhance nursing education. Success hinges on thorough preparation; ongoing student, faculty, and institutional support; and clear communication. Recommendations for future interventions include enhancing student preparation, explicitly communicating the purpose and expectations of IVRS integration to strengthen alignment between faculty and students.

Summary statement: Simulation-based surgical training (SBST) provides a risk-free environment for surgical skill development. Integrating deliberate practice (DP) into SBST may enhance training effectiveness. This systematic review examines the application of DP elements in SBST for open general and subspecialty surgery, and their effectiveness in improving surgical skills. It aims to systematically synthesize the use of DP elements within SBST and evaluate effects on trainee performance. To preserve methodological comparability, this review focused on open procedures in general surgery and its subspecialties.The search identified 22 studies for inclusion, predominantly from North America and Europe. Most studies incorporated feedback and allowed repetition but commonly lacked structured assessments of learner motivation and individualized task design. Studies generally reported improvements in surgical skills after DP-informed SBST; however, the correlation between the number of DP elements used and learning outcomes was inconsistent. Kirkpatrick levels 1 and 2 evaluations were most common. The results suggest that DP-informed SBST improves skill acquisition in open surgery, although variations in DP implementation limit direct comparison across studies. Enhanced instructional design aligning closely with DP principles may bridge gaps in training quality, providing a structured pathway.

Introduction: Early defibrillation significantly improves survival following out-of-hospital cardiac arrest. Public access automated external defibrillators (AEDs) facilitate rapid shock delivery, enhancing survival rates and neurological outcomes. Language barriers may impede the effectiveness of these devices, particularly in multilingual environments. This study aimed to evaluate AED operation skills and time during a simulated cardiac arrest scenario, comparing native language instructions (Spanish: AEDnative) with foreign language instructions (English: AEDforeign).

Materials and methods: A randomized pilot study was conducted with 50 Spanish-speaking university students (42% female, median age: 21 years) with no prior AED training and a minimum B1 level of foreign language proficiency (English). Participants were randomly assigned to either the AEDnative or AEDforeign group. The simulated cardiac arrest scenario was performed on a mannequin using a multilingual AED trainer. AED performance, response times, language proficiency, and demographic data were recorded. Participant actions were video-recorded and analyzed using observational methodology.

Results: Both groups achieved high completion rates (>70%) in most AED operation steps. However, the AEDnative group performed significantly better in two critical safety actions: ensuring no one touched the victim before shock (96% vs. 12%) and initiating CPR after shock delivery (83% vs. 12%). No differences were found in the time to pad placement, but the AEDforeign group delivered the shock significantly faster after pad placement (19 s vs. 33 s; P = 0.016).

Conclusions: AED use remains feasible, even in a nonnative language; however, foreign-language instructions may compromise performance safety and delay or omit postshock CPR initiation.

Background: Emergency medicine (EM) physicians must be competent in managing distal radius fractures, yet training gaps exist. This study evaluated academic EM physician proficiency in managing a simulated distal radius fracture and the impact of a simulation-based mastery learning (SBML) intervention.

Methods: We conducted a pretest-posttest study of board-certified or board-eligible EM physicians at a university-based training hospital between August and December 2023. Four trained facilitators assessed participants on distal radius fracture management using a task trainer and a 41-item checklist with a minimum passing standard (MPS) of 37/41 (90.2%). The SBML intervention included baseline assessment, individualized feedback, deliberate practice, and reassessment.

Results: Fifty-one physicians participated in the pretest, with a median score of 32/41 (78.0%) and 10 (19.6%) achieving the MPS initially. Of the 20 participants who completed the posttest, 19 (95%) achieved the MPS after SBML intervention. The intervention resulted in a significant mean score improvement of 8.4 points (95% confidence interval: 6.92-9.78; P < 0.01). Only performing a distal radius fracture reduction in the past year significantly predicted higher pretest performance (3.3 points higher, P = 0.04). Participant comfort with all aspects of distal radius fracture management significantly improved after SBML.

Conclusions: Academic EM physicians demonstrated performance gaps in distal radius fracture management that were effectively addressed by SBML. Few clinical experience metrics predicted performance, suggesting a need for targeted educational interventions to maintain skills in this important procedural area.

Summary statement: Sim2Lead: A New Era in Leadership Training for Healthcare Professionals is a descriptive program report supplemented by early qualitative impressions. It describes a conundrum faced by the international healthcare professional community on how to train leadership, co-leadership, and teamwork skills to clinical healthcare teams to manage a high-stake critical medical event such as a complex resuscitation. The background of the creation of the Sim2Lead program at Starship Child Health and the foundations of the program content are described in the article. This novel combination of high-fidelity side-by-side coaching during simulated scenarios and a new simulation debriefing framework with a specific focus on leadership skills are described alongside mindfulness and predictable strategic tools. This article presents qualitative data findings from postcourse surveys with thematic coding. The future intentions of the Sim2Lead program to train a high standard of leadership and co-leadership skills for critical event management through simulation are also described. Sim2Lead combines simulation methods to train the next generation of critical event leaders. This early descriptive program report is limited by its qualitative impressions rather than this being an outcomes study. This limitation is likely to be addressed through future studies investigating performance-based data or follow-up to assess transfer of practice of Sim2Lead participants.

Introduction: Peer role-playing, in which medical students alternate between provider and patient roles, is a core component of peer-assisted learning. While the educational value of playing the provider is well established, the extent to which students gain medical knowledge through acting as patients remains unclear.

Methods: In this quantitative study with qualitative components, 178 first-year medical students portrayed patients during a high-fidelity prehospital simulation. Medical knowledge was assessed with a 21-item multiple-choice test after simulation (162 responses; 91.0% response rate). An open-ended reflection prompt captured students' perceived learning. Chi-square analyses compared knowledge performance between students who portrayed a given scenario ("Actors") and those who did not ("nonactors"). Qualitative data were analyzed using reflexive thematic analysis.

Results: Quantitative analysis revealed no statistically significant differences in performance between actors and nonactors across test items (P = 0.17-0.99). However, 160 students (89.9%) reported perceived gains in medical knowledge. Thematic analysis identified 3 primary learning mechanisms: observational learning, experiential learning, and direct instruction.

Conclusions: Although knowledge gains specific to patient roles were not captured through multiple-choice testing, students perceived substantial learning through peer role-play. The student-as-patient role may be intentionally designed to support cognitive as well as affective learning in simulation-based medical education.

Summary statement: Spaced learning is increasingly used in simulation-based education, yet its impact on learning, performance, and patient outcomes is unclear. We compared spaced training (several discrete sessions) with massed training (a single session) for skills acquisition in health professionals. We systematically reviewed randomized or prospective comparative studies. Of 4572 citations screened, 15 met inclusion criteria. Studies covered resuscitation and surgical procedures, most with spacing intervals of about 1 week. Despite heterogeneity in study design, participants, and outcomes, spaced training was generally as effective as massed training. Some evidence suggested advantages for spaced training in skill retention, particularly for time to complete procedures. Findings were inconsistent across other outcomes. No studies demonstrated improvements in patient care practices, patient outcomes, or broader educational effects. These results suggest spaced simulation may offer retention benefits for certain skills, but more research is needed to assess its impact on clinical and system-level outcomes.

Introduction: Large language model-based generative AI tools, such as the Chat Generative Pre-trained Transformer (ChatGPT) platform, have been used to assist with writing academic manuscripts. Little is known about ChatGPT's ability to accurately cite relevant references in health care simulation-related scholarly manuscripts. In this study, we sought to: (1) determine the reference accuracy and citation relevance among health care simulation debriefing articles generated by 2 different models of ChatGPT and (2) determine if ChatGPT models can be trained with specific prompts to improve reference accuracy and citation relevance.

Methods: The ChatGPT-4 and ChatGPT o1 models were asked to generate scholarly articles with appropriate references based upon three different article titles about health care simulation debriefing. Five articles with references were generated for each article title-3 ChatGPT-4 training conditions and 2 ChatGPT o1 training conditions. Each article was assessed independently by 2 blinded reviewers for reference accuracy and citation relevance.

Results: Fifteen articles were generated in total: 9 articles by ChatGPT-4 and 6 articles by ChatGPT o1. A total of 60.4% of the 303 references generated across 5 training conditions were classified as accurate, with no significant difference in reference accuracy between the 5 conditions. A total of 22.2% of the 451 citations were classified as highly relevant, with no significant difference in citation relevance across the 5 conditions.

Conclusions: Among debriefing articles generated by ChatGPT-4 and ChatGPT o1, both ChatGPT models are unreliable with respect to reference accuracy and citation relevance. Reference accuracy and citation relevance for debriefing articles do not improve even with some degree of training built into ChatGPT prompts.

Background: Families overwhelmingly want to be present during pediatric resuscitations, and their presence offers myriad benefits. However, there is little evidence on how to teach and assess key patient- and family-centered communication behaviors. Our objective was to apply a modified Delphi methodology to develop and refine a simulation-based assessment tool focusing on crucial behaviors for healthcare providers providing emotional support to patients and families during pediatric medical resuscitations.

Methods: We identified 4 behavioral domains and 14 subdomains through a literature review, focus groups with our institution's Family and Youth Advisory Councils, and adaptation of existing simulation-based communication assessment tools. A panel of 9 national experts conducted rounds of iterative revision and rating of candidate behaviors for inclusion, and we calculated mean approval ratings (1 = Do not include; 2 = Include with modifications; 3 = Include as is) for each subdomain.

Results: Experts engaged in 5 iterative rounds of revision. None of the candidate behaviors were eliminated, and 1 ("Option to step out") was added to the "Respect and Value" domain. There was near-perfect consensus on the language of the final tool, with mean approval scores of 3.0 for all but 1 subdomain ("Introductions"), which had a mean score of 2.83 for minor grammatical edits; these were incorporated in the final assessment tool.

Conclusions: We created a novel simulation assessment tool based on a literature review, key stakeholder input, and a consensus of national experts through a modified Delphi method. Our final simulation assessment tool is behaviorally anchored, can be completed by a simulated participant or observer, and may serve to educate healthcare teams engaged in pediatric resuscitations regarding patient- and family-centered communication.