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

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.

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.