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

Summary statement: The Republic of Moldova identified a desire to strengthen emergency and trauma care given its proximity to the war in Ukraine. We utilized in-situ simulation (ISS) as a rapid tool to assess the current trauma management practices in a tertiary care Emergency Department. We conducted three simulations, utilizing peer-reviewed scenarios, over the course of one day. Emergency Department teams managed the simulated patient according to their usual practice, involving General Surgery, Orthopedics, and Neurosurgery consultants. The ISS identified challenges in clear leadership, established roles, and team communication to ensure situational awareness and prioritization of interventions for patient resuscitation. Other patient care findings included no availability of mass transfusion protocols and inconsistent approach to secondary ATLS survey. Overall, we found ISS to be an effective method of assessing the current state of trauma care and identified areas on which to focus our initial efforts during the formation of a trauma Team.

Introduction: Effective simulation debriefing fosters reflective practice and enhanced learning outcomes. Although various debriefing frameworks and debriefer competency evaluation tools exist, less is known about the experience of giving and receiving debriefer feedback. The aims of this study were to explore simulation facilitators' perspectives of engaging in debriefer feedback conversations and to identify factors influencing the acceptance or rejection of the feedback.

Methods: A qualitative interpretive description approach, informed by action research, was used. Focus groups were conducted with 27 faculty participants to capture their experience of giving and receiving debriefer feedback. Thematic analysis was conducted to identify key patterns in faculty perceptions of the debriefer feedback conversations.

Results: The following 4 themes captured faculty perspectives of effective debriefer feedback: (1) establishing and maintaining a relational culture, (2) embracing a growth mindset, (3) creating a safe space for self-reflection, and (4) remaining objective and goal oriented. Faculty valued feedback for self-reflection and professional development, emphasizing the importance of trust, respect, and psychological safety. A strong relational culture, growth mindset, and safe environment enabled feedback givers and receivers to engage meaningfully with constructive feedback, lean into practical objectives, and remain future focused.

Conclusions: Effective debriefer feedback extends beyond structured frameworks and competency tools; it also depends on relational culture and implementation processes. When situated within a supportive and collegial environment and delivered via an integrated approach that prioritizes relationships and a growth mindset, debriefer feedback can be a valuable strategy for faculty development.

Introduction: Online experiential learning can benefit learners with scalable techniques to self-debrief and to develop cognitive skills in recognizing clinical cues.

Methods: We developed techniques for cue-detection exercises and self-debriefing, based on cognitive engineering-inspired expertise development approaches that focus on tacit knowledge, sensemaking, and mental models. Self-debriefing was structured by asking the learners to compare and then reflect on their choices and rationales against those provided by a panel of experts. Using these techniques, we generated scenario-based experiential learning materials in a virtual environment for a 2-hour module on deteriorating patient conditions that can lead to imminent cardiac arrests. The module was tested in a senior nursing course as an optional assignment. The volume of voluntarily submitted reflections by learners was used to assess engagement and subsequent thematic analysis to assess feasibility of the techniques.

Results: The module was completed by 189 of the 197 students invited (95.9%). Engagement level was high with all completed students submitting reflections after self-debriefing, most of which (between 53.4% and 87.8%) were specific enough for thematic analysis. The main theme of reflections was "missing something" in the scenario, followed by the themes of importance of reading the patient monitor and refining actions and priorities.

Conclusions: We demonstrated the feasibility of the techniques based on cognitive engineering-inspired approaches for virtual simulation learning in health care that structures self-debriefing by comparing a learner's situation assessment and responses with those of experts. The techniques have the potential to help learners in health care efficiently and consistently develop key critical thinking skills, especially those based on tacit knowledge to detect cues.

Summary statement: There is growing evidence that simulation-based education can contribute to professional identity development. This commentary discusses the potential theoretical underpinning of this process and considers the role of simulation debriefing to support significant periods of transition in professional identity. Transformative learning theory has been described as a theoretical basis for professional identity development in the context of simulation-based education, but the concepts of liminality, identity work, and narrative reflection are less well explored. These additional concepts offer more nuanced ways of understanding professional identity development during transitions and provide further theoretical underpinning for supportive interventions. This commentary provides simulation-based education strategies to support professional identity development during transitions that could be used as fruitful springboards for educational interventions and further research.

Introduction: Chest tube insertions (CTIs) have a high complication rate, prompting the training of technical skills in simulated settings. However, assessment tools require validity evidence prior to their implementation. This study aimed to collect validity evidence for assessment of technical skills in CTI on Thiel-embalmed human bodies.

Methods: Invitations were sent to residents and staff from the departments of surgery, pulmonology, and emergency medicine. Participants were familiarized with the Thiel body and the supplied equipment. Standardized clinical context and instructions were provided. All participants performed 2 CTIs and were assessed with the Assessment for Competence in Chest Tube InsertiON (ACTION) tool, consisting of a 17-item rating scale and a 16-item error checklist. Live and post hoc video-based assessments by 2 raters were performed. Generalizability analysis was performed to evaluate reliability. Mean scores and errors were compared using a mixed-model repeated measures analysis of variance (ANOVA). A pass/fail score was determined using the contrasting groups' method.

Results: Ten novices and 8 experienced participants completed the study. The Generalizability coefficients were moderate for the rating scale (0.75), and low for the error checklist (0.4). Novices scored lower on the rating scale?? (44±6.7/68 vs 50.8 ± 5.7/68, P = 0.024), but did not commit significantly more errors (1.6 ± 1.1/16 vs 1.0 ± 0.6/16, P = 0.066). A pass/fail score of 47/68 was established.

Conclusion: The rating scale in the Assessment for Competence in Chest Tube InsertiON tool has a robust validity argument for use on Thiel-embalmed bodies, allowing it to be used in simulation-based mastery learning curricula. In contrast, its error checklist has insufficient reliability and validity to be used for summative assessment.

Introduction: Simulation-based learning (SBL) is essential in health care education, integrating theoretical knowledge with practical experience through reflective learning in debriefs. Although reflective learning during postsimulation debriefs enhances theory-practice integration, its role in fostering intrinsic motivation and professional self-actualization is not fully understood.This study examines how reflective learning, rooted in humanistic learning principles, influences students' self-actualization in the Critical Care Flight Paramedic Program (CCFPP). Specifically, it seeks to understand how and why reflective learning influences CCFPP students' intrinsic motivation, professional growth, and self-actualization through the framework of Self-Determination Theory (SDT).

Methods: The research used a qualitative case study design aligned with a relativist-constructivist framework. It is grounded in humanistic learning principles outlined by Gage and Berliner, which shaped the interview questions. Data were collected through semistructured interviews with 11 participants and analyzed using thematic analysis. The study examined the responses and results within the framework of SDT, which also provides the theoretical basis for understanding professional self-actualization.

Results: Analysis revealed that reflective learning significantly contributed to professional self-actualization by promoting autonomy, enhancing competence, and fostering relatedness. The findings highlight the rapid transformation facilitated by the intensive SBL environment and emphasize the role of reflective learning in linking theory with real-world applications.

Conclusion: The study highlights reflective learning's crucial role in fostering professional self-actualization among CCFPP students. Integrating humanistic principles into SBL, particularly during postsimulation debriefs, can develop competent and motivated health care professionals, aiding in their journey toward professional self-actualization.

Introduction: Clinical reasoning (CR) is a complex skill that requires great depth of knowledge and practical skills to provide comprehensive care in a dynamic health care setting. Within health care education programs, simulation experiences, such as an educational escape room (EER), create realistic, meaningful, and engaging learning environments that can aid in developing CR. Research on the impact of an EER on CR development through the student lens is limited. This study aimed to understand physical therapy (PT) students' perceptions of CR and its development, including the impact of an EER activity.

Methods: Following an EER experience, 17 individual semi-structured interviews were completed through a basic interpretive qualitative design. Data analysis used open and axial coding to discover common themes.

Results: The 4 central themes identified as impacting the development of CR by PT students were (1) understanding the why , (2) graduate learning experience , (3) application of knowledge in practice , and (4) growth . Through an EER experience, participants gained a deeper understanding of CR, were able to apply concepts in a safe environment, gained valuable experience in a controlled setting, and emphasized the importance of reflection in and on action.

Conclusions: Integrating a novel EER activity early in the educational curriculum can facilitate CR development through the lens of the student learner. This activity stresses the importance of applying knowledge and practicing skills in a safe and engaging environment while replicating the clinical setting, which challenges students' ability to adapt to new and stressful situations.

Introduction: There is a growing imperative to integrate clinical reasoning (CR) training more centrally into medical school curricula. As a pedagogical tool that facilitates explicit CR teaching, high-fidelity simulation (HFS) is perhaps uniquely situated to meet this need. While barriers to CR for medical students on clinical placement are well-documented, a comprehensive understanding of barriers specific to HFS was previously lacking.

Methods: Fourth-year medical students at the University of Sunderland were purposively sampled. Data were gathered via semistructured videoconferencing interviews between April and May 2023. A reflexive, data-driven, inductive thematic analysis was undertaken, and a thematic framework was generated. Data collection ceased upon thematic saturation after 14 interviews.

Results: Barriers to CR during HFS were identified across student and simulation domains. Students reported barriers to (1) information synthesis-due to inadequate knowledge and difficulty interpreting clinical findings-and (2) engaging in metacognition-due to procedural rigidity, stress, and cognitive bias. Simulation-related barriers arose from (3) case design-including excessive case complexity and cognitive overload-and (4) the simulation environment-such as inadequate prebriefing, technological limitations, and overreliance on facilitators. Some findings, such as the impact of cognitive bias, align with existing literature on barriers to CR in other contexts. Others, including the limitations of technology, appear unique to the HFS setting.

Conclusions: Barriers to CR identified within this context contribute novel findings to the existing body of educational research. We advocate that educators should carefully consider these barriers when designing HFS sessions, and when optimizing students for learning through simulation, to enhance CR training.