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

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.

Summary statement: Linguistic barriers create challenges in delivering effective healthcare, particularly in emergency medicine (EM) where miscommunication has dire consequences. A unique partnership of undergraduate students and EM faculty used design thinking to identify innovative solutions to improve provider understanding of the effects of those barriers on patient care. Empathy interviews with patients and providers evaluated contrasts in patient care between language concordant and discordant encounters, directing development and implementation of a preferred-language role-reversal simulation exercise.This novel exercise was an effective tool to provide education and experience on the care of language-discordant patients. Evaluation exposed lack of confidence in available options and need for technology and resources to help alleviate barriers when traditional avenues for communication fail. Easily adaptable, simulation is useful to explore the impact of language on patient experience. This study highlights the need for further efforts to address quality of patient care when language barriers are present.

Introduction: Healthcare professionals often hesitate to participate in team-based simulation activities because of perceived psychological risk, which can undermine learning, collaboration, and innovation. Psychological safety-defined as a shared belief that the team is safe for interpersonal risk-taking-is critical in healthcare simulation but remains understudied in the Indian context. This study aims to assess baseline perceptions of psychological safety and explore barriers and enablers within interprofessional simulation teams in South India.

Methodology: We employed an explanatory sequential mixed-methods design. In the quantitative phase, 127 healthcare professionals (doctors, nurses, and paramedics) participated in an online survey using Edmondson's Psychological Safety Questionnaire. We analyzed psychological safety scores in relation to team familiarity, profession, and seniority. In the qualitative phase, we purposively sampled participants with high and low psychological safety scores for focus group discussions. Thematic analysis was conducted to identify key barriers and enablers.

Results: Psychological safety scores were higher among teams with familiar members, nurses, and junior team members. Conversely, lower scores were reported among paramedics, unfamiliar teams, and both senior and junior-most members. Team familiarity showed a significant positive association with psychological safety. Thematic analysis revealed 6 main themes with various subthemes for barriers: Internalized Hierarchy, Fear of Judgment, Knowledge Deficits, Facilitator Behavior, Silencing Mechanisms, Role Confusion. Two main themes with various subthemes for enablers included Facilitation that Builds Trust and Structure and Clarity. Unique local barriers included debriefing in English (a non-native language), physician-only facilitators, and challenges experienced by introverted participants.

Conclusion: Team familiarity and facilitator skill sets are vital to promoting psychological safety in interprofessional simulation. To address contextual barriers in resource-limited and hierarchical settings, interventions should include inclusive faculty development, diverse facilitation teams, tailored debriefing based on personality traits, and use of the local language during debriefing. These findings contribute to the broader global understanding of psychological safety by offering insights from a previously underrepresented setting.

Introduction: Neonatal mortality remains a critical public health challenge in sub-Saharan Africa. This is due to numerous factors, including limitations in health worker education to provide essential care at birth. Improving the skills of available health workers could affect the quality of health care and reduce neonatal mortality. This qualitative study describes the experience of frontline health workers who participated in essential care education using digital learning platforms.

Methods: Frontline health workers in 4 secondary healthcare institutions in Yobe, Gombe, and Borno states in Nigeria participated in focus group discussions and key informant interview after educational sessions delivered remotely and skills practice using a neonatal simulator providing digital feedback. Qualitative data collection sought both personal insights and group-level dynamics regarding the participants' educational and clinical experiences. Data were analyzed using reflexive thematic analysis.

Results: The study findings show that the participants learned essential newborn care practices like skin-to-skin contact and delaying cord clamping. They also reported that these new skills and practices improved how they care for newborns, including enabling timely and effective resuscitation at birth. However, challenges such as limited access to educational simulators and issues with internet connectivity acted as barriers to education; workload and equipment shortages limited implementation in the clinical setting.

Conclusion: Health care workers were able to learn improved techniques for newborn care and resuscitation through digital technologies. However, further improved outcomes will require addressing technical and structural challenges that affect the implementation process.

Introduction: We used cognitive load theory to design the Queen's University Airway Mastery (QUMAC) pilot course to work toward reliable mastery of Emergency Airways Management elements in all participants.

Methods: We describe the process of designing QUMAC using 4-Component Instructional Design to harness the cognitive load theory as a learning tool. We evaluated the effectiveness of QUMAC using an outcome-based mixed-methods approach including Objective Structured Assessment of Technical Skills (OSATS) and 2 Objective Structured Clinical Examinations (OSCEs) at course completion using blinded expert video review. We also conducted semistructured interviews at course completion and after 6 months of independent practice. Interviews were analyzed thematically.

Results: Mean OSCE Global Performance Scores were 4.1 (±0.56) of 5 for both OSCE scores; and 4.0-4.4 (±0.48-0.89) on OSATS. At course completion, 4 themes were identified: Overall Experience with the Course, Facilitators of Performance, Recommendations, and Transfer to Practice. At 6 months of independent practice 5 themes emerged: Level of Confidence, Management of Cognitive Load, Persistence, Barriers to Application, and Recommendations.

Conclusions: All participants demonstrated a high degree of competence when assessed by OSCEs and majority did so with the OSATS. All noticed an increase in confidence and reduced cognitive load while managing airways. These persisted over 6 months of independent practice where the participants were actively managing airways as staff physicians in new workplaces. High performance expectations, automation, schemas, spaced repetition, and homework were the elements most associated with better performance and more confidence. Decreased cognitive load freed up resources for higher order thinking, while the overall sense of competence reduced the anxiety of going to work as a new emergency department staff.