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

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.

Introduction: Ultrasound-guided intravenous (USIV) cannulation is a common alternative when IV access cannot otherwise be obtained. Many hospitals teach this skill with the commercial CAE Blue Phantom gelatinous training blocks. However, their cost is a barrier. This has led to experimentation with creative alternatives. Recent studies have trialed SCOBY (Symbiotic Culture of Bacteria and Yeast) in the production of training models for medical procedures. SCOBY is a biofilm-like structure appearing as a thick, rubbery film. We aimed to develop a 2-vessel SCOBY-based model and compare its effectiveness for teaching USIV against the Phantom.

Methods: Participants, 23 emergency medicine clinicians, performed USIV on each model and completed a pre- and post-procedure questionnaire.

Results: Seventy-four percent of participants indicated that the SCOBY model more closely resembled the clinical reality of human tissue compared with 13% for the Phantom. SCOBY provided an improved visual appearance, physical touch, feel of the procedure, and appearance of "subdermal tissues" on ultrasound compared to the Phantom.

Conclusion: These results suggest a promising future for SCOBY as a cost-effective alternative to teaching clinical skills.

Summary statement: The exponential growth of telehealth in health care, triggered by the COVID-19 pandemic, has necessitated updates to educational standards including the integration of telehealth competencies in academic curricula to prepare students for technology-enabled clinical practice. Simulation-based experiences (SBEs) are a valuable pedagogical tool for teaching and assessing telehealth skills in safe and controlled virtual learning environments. Simulated or standardized patients (SPs) are an essential component of SBEs for creating high-quality and engaging learning experiences. SPs in telehealth environments must learn to manage technical interfaces, modify communication for virtual interactions, and convey physical ailments without in-person contact. SP educators and teaching faculty have a valuable role in preparing SPs to effectively portray authentic and consistent telehealth roles while navigating technology and maintaining case fidelity. SP educators contribute critical expertise in SP methodology and are essential collaborators in the development, implementation, and evaluation of telehealth simulation programs. Telehealth SBEs have unique considerations, workflows, and technologies that differ from in-person encounters, and the complexities of these differences underscore the critical need for specialized training approaches for creating authentic and effective telehealth simulations. Formal published resources for training SPs in telehealth contexts remain limited. This article provides guidance to support comprehensive simulation programs delivering telehealth education, specifically emphasizing SP methodology for remote settings.

Introduction: Effective debriefing is a key element of simulation-based learning, providing an opportunity to facilitate critical reflection and promote constructive conversations, with generalization of the learning experience to real-life health care and collaborative practice. Co-debriefing, meaning a debrief involving more than 1 simulation facilitator, has potential benefits as well as challenges. Interprofessional co-debriefing, where 2 or more members of different professional groups debrief together, has not yet been fully explored in the literature.

Methods: A qualitative approach was used to explore the benefits and challenges of interprofessional co-debriefing from a simulation faculty perspective. Individual semistructured interviews were recorded and transcribed, with data analyzed using reflexive thematic analysis.

Results: Ten interviews were conducted with health care professionals in Christchurch, New Zealand, who co-debrief simulation with faculty from other professions. Three major themes were identified: 1. Developing Debriefers-simulation faculty require opportunities to develop interprofessional co-debriefing skills; 2. Teaming and Collaboration-bringing co-debriefing teams together, role modeling interprofessional collaboration; 3. Logistics and Sustainability-top-down institutional/bottom-up champion support is required to overcome logistical barriers of bringing together multiple professional groups . The reported benefits and challenges of interprofessional co-debriefing were linked to these themes.

Conclusions: This interprofessional group of simulation debriefers identified a number of benefits to interprofessional co-debriefing, along with several challenges. Debriefers require support to develop as role models of interprofessional collaboration. Peer mentoring and faculty development opportunities, along with consideration of the logistics that make this model of debriefing sustainable are needed for this nascent field of simulation-based education practice to evolve and mature.

Summary statement: This special article explores the transformative contributions of Dr. Howard S. Barrows to health professions education, focusing on his pioneering development of two seminal methodologies: problem-based learning and standardized patients. Drawing on Barrows's work, educational literature, and the reflections of Gayle Gliva-McConvey, a leading pioneer in standardized patient methodology and close collaborator of Dr. Barrows, this article provides an in-depth historical account of how these innovations reshaped curriculum design, clinical reasoning, and simulation-based assessment. It also discusses the global adoption, theoretical underpinnings, and enduring impact of these learner-centered strategies, which continue to shape health professions education today.

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: Facilitating debriefings in simulation is a complex task with high task load. The increasing availability of generative artificial intelligence (AI) offers an opportunity to support facilitators. We explored simulation facilitation and debriefing strategies using a large language model (LLM) to decrease facilitators' task load and allow for a more comprehensive debrief.

Methods: This prospective, observational, simulation-based pilot study was conducted at Yale University School of Medicine. For each simulation, a debriefing script was generated by passing a real-time transcription of the simulation case as input to the GPT-4o LLM. Thereafter, facilitators and learners completed surveys and task workload assessments. The primary outcome was the task workload as measured by the NASA-TLX scale. The secondary outcome was the perception of the AI technologies in the simulation, measured with survey-based questions.

Results: This study involved four facilitators and 25 learners, with all data being self-reported. All showed strong enthusiasm for AI integration, with mean Likert scores of 4.75/5 and 4.0/5, respectively. NASA-TLX scores revealed moderate to high mental demand for facilitators (M = .8/21; SD = 6.4) and learners (M = 9.9/21; SD = 4.5). AI was perceived to help maintain focus (M = 4.8/5), support learning objectives (M = 4.2/5), and minimize distractions for both facilitators (M = 4.6/5) and teams (M = 4.5/5).

Conclusions: This study highlights LLM integration in aiding debriefing by organizing complex information. Though facilitators reported a considerable task load, findings suggest that LLM can enhance simulation-based debrief quality, while there remains a continuous need for human oversight.

Introduction: Learning ultrasound-guided vascular access in simulations requires specially designed phantoms. However, commercial phantoms are expensive, and homemade models suffer from a lack of realism. This study aimed to develop and evaluate a novel homemade phantom prototype for simulation training of the US-guided vascular puncture technique.

Method: The prototype had to be low cost, reproducible, modular, realistic, and ecological. The design phase was divided into 2 parts: the first for developing a solid, watertight reusable mold and the second for the internal structure (vessels and internal gel). The prototype was evaluated based on cost, lifespan, echogenicity, and practical utility. For the latter, professionals with expertise in ultrasound-guided vascular puncture tested the prototype and completed a 14-question digital self-questionnaire (4 sociodemographic questions and 10 questions about the prototype).

Results: The prototype costs are less than €100 (€67 one-off cost for the external structure + €28,25 consumables) and could be manufactured by one team member in less than half a day of effort (with a short period of assistance from a volunteer model). When stored in a refrigerator, the agarose gel chosen for the project has an estimated shelf life of more than 3 months. The professionals' responses to the questionnaires revealed predominantly positive feedback after experimentation and the superiority of the prototype over other phantoms used in their previous simulation experiences.

Conclusions: This prototype is a novel, effective, homemade phantom that meets all of the expected criteria. Its low cost and simplicity make it accessible to many people while offering an immersive simulation experience.

Introduction: Despite the high prevalence of harassment in health professions education, empirical investigations into effective anti-harassment interventions remain scarce. Our study examined the effectiveness of an innovative anti-harassment intervention that featured instructional videos and high-fidelity simulation training for medical residents. We drew from the knowledge-learning-instruction framework and the idea of productive failure to conceptualize our research questions and discussion. We examined how the sequence of educational activities may be linked to simulation performance and increases in knowledge levels.

Method: Our pretest posttest study contacted all 88 eligible internal medicine residents, randomly assigning them to the intervention (n = 60) or equivalent training later (n = 28). Of those assigned to the intervention, 52 (86.6%) consented and were further randomized to a video-first or simulation-first group. We provided educational activities in different sequences accordingly. We assessed knowledge via a questionnaire, and simulation performance via a performance checklist.

Results: The video-first group demonstrated significantly better initial simulation performance compared with the simulation-first group, aligning with traditional learning sequential benefits. Both groups showed significant postintervention knowledge gains. Notably, the simulation-first group, despite starting with lower performance, ended with significantly higher knowledge levels than the video-first group, suggesting the efficacy of the productive failure approach in fostering deeper learning.

Conclusions: The sequence of educational activities may impact the effectiveness of anti-harassment training. The video-first approach enhances immediate performance, while the simulation-first approach fosters better knowledge retention. Further research should investigate the long-term effects of such educational strategies and their applicability in diverse healthcare settings.

Summary statement: We conducted a systematic review of competency-based simulation education for medical procedural skills, encompassing a diverse range of healthcare domains and professions. Meta-analysis showed competency-based simulation is more effective than noncompetency-based simulation for skill outcomes (large effect). Outcomes are favorable, but small, for behaviors in practice and patient effects. Specific instructional design features examining different simulators and different types and sources of feedback were common themes identified among studies though no instructional design features were found to have significant impact on skill acquisition. This review also identified significant gaps in research including a lack of standardized terminology and reporting methods as well as a limited number of studies assessing the impact on behaviors in practice and patient effects. This study contributes to the ongoing evidence to support competency-based simulation training and highlights the need for further research to enhance the efficacy and efficiency of training of healthcare professionals.