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

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.

Background: The increasing integration of point-of-care ultrasound into clinical practice necessitates effective training tools. One such practice is pelvic abscess drainage using a vaginal probe, where an appropriate training model does not exist.

Objective: To develop and evaluate an economical, user-friendly phantom for simulating pelvic abscess drainage.

Methods: The phantom was constructed using readily available materials, including ballistic gel and a simulant for purulent material. The phantom was designed to simulate pelvic abscess drainage through a vaginal probe. Ten independent investigators and 2 authors evaluated the phantom's realism and utility using a visual analog scale (VAS), ranging from "not realistic and useful" (0) to "very realistic and useful" (10) for anatomical fidelity, material suitability, and ease of performing the examination. Three evaluators with previous experience in abscess drainage compared the phantom to real-life scenarios using the same VAS scale. The median time required for each health care professional to perform the procedure was also measured.

Results: The phantom was constructed at a cost of approximately US$ 30.00. Evaluators scored the phantom highly for realism and utility, with mean VAS values of 8.75, 9, and 9.2 for anatomical fidelity, material properties, and ease of performing the examination, respectively. Three senior radiologists, each with extensive experience in real-life abscess drainage procedures, compared the phantom to their clinical experiences. They rated the phantom as highly realistic, assigning it a mean VAS score of 9.8. The median time to perform the procedure was 1 minute and 51 seconds.

Conclusion: The developed phantom effectively simulates pelvic abscess drainage, providing a realistic and practical training tool. This phantom fills a significant gap in current medical simulation resources, offering a cost-effective solution for training health care professionals in essential ultrasound-guided procedures.

Introduction: Virtual Monitor Technicians (VMTs) are crucial in remotely monitoring inpatient telemetry. However, little is known about VMT workload and intratask performance changes, and their potential impact on patient safety. This exploratory study used a high-fidelity simulation aimed to evaluate VMTs' workload and performance changes over time in telemetry monitoring and identify future research directions for performance improvement.

Methods: The research team created a simulation of the current remote telemetry stations with 36 patient waveforms across 3 screens alongside a documentation screen, replicating VMTs' work. Twelve VMTs participated in a 1-hour session, and time-to-escalate and detection accuracy to auditory/visual alerts were recorded. Workload was measured using the NASA-Task Load Index.

Results: The post-task NASA-Task Load Index score showed an increased workload score of 64 of 100 from a prescore of 38 of 100, with mental and temporal demands being the largest contributors. The performance of VMTs did not change significantly over time, with a 52% correct response rate. Participants' ability to detect signals was slightly better than chance ( d ' = 0.477), and they tended to be cautious in their responses, β ( M = 1.989, SD = 1.635). Urgent, Warning, and Medium audiovisual alerts were recognized in 9, 35, and 39 seconds, respectively, whereas advisory alerts (visual only) were recognized in 13 minutes.

Conclusion: This study sets a foundation for future work on VMT workload expectations. Although our work is exploratory, the results indicate a significant increase in VMT workload with no decline in performance; VMTs responded most quickly and accurately to urgent alerts, whereas overall response accuracy to nonurgent alerts was marginally better than chance. Future research needs to explore techniques to improve response accuracy rate beyond the 52% measured in this study.