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

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.

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.