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

Summary statement: This article provides a framework for simulation educators to integrate students from Communication Sciences and Disorders (CSD) into simulation-enhanced interprofessional education (Sim-IPE). Despite their essential contributions to managing communication, hearing, and swallowing disorders, CSD students remain underrepresented in interprofessional simulations. Drawing on current literature and guided by a 4-step integration framework, the article outlines practical strategies for inclusive scenario design, role clarity, interprofessional reflection, and program refinement. It highlights the educational and clinical value of CSD participation, addresses common implementation barriers, and offers tailored assessment approaches for simulation-based contexts. This work aims to advance more inclusive, realistic, and collaborative simulation experiences that better prepare health care teams to meet complex patient needs.

Summary statement: Distance simulation in health care has advanced rapidly, offering potential to reduce geographical barriers, costs, and carbon emissions while increasing global access to medical education. This systematic review evaluated hands-on technical skills training via distance simulation compared to traditional on-site training. Following PRISMA guidelines, 104 studies were analyzed. Laparoscopic skills, suturing, and ultrasound were the most studied tasks. Distance simulation, using decentralized portable simulators and centralized telementoring, demonstrated comparable or superior outcomes to on-site training. However, only 2 studies assessed skill transfer to clinical settings, and 1 reported patient-related outcomes. Rigorous randomized controlled trials (RCTs) are needed to further evaluate skill retention and clinical impact.

Introduction: Basic orthopedic surgery skills (BOSS) have been identified as critical in resident surgeons' training. Costs and limited evidence hinder integrating simulation training into resident surgeons' curricula. This study aimed to gather validity evidence for a low-cost simulation-based test to assess BOSS.

Method: We modified 5 practical stations testing BOSS from a previous study. All stations were made of standard items from hardware stores and 3D prints. The Messick framework was used to gather validity evidence for the tests. A novice and an expert group were invited to participate and repeated testing each station until the plateau score was reached. The Levene test and Student t test were applied to compare performances. The expert group's mean plateau score was used as pass/fail score. Another novice group was invited to perform the test.

Results: The total costs were less than 900 USD for all stations. We included 11 novices and 9 experts yielding an interclass correlation coefficient (ICC) of 0.40 to 0.95, demonstrating moderate to high reliability. The mean plateau scores for the 5 stations were 2.6 to 17.9 mm for the novice group. The expert group performed statistically significantly better (0.9-6.9 mm, P-value of 0.002-0.022) and the mastery standard was defined as the experts' mean. A second novice group (n = 10) all achieved the mastery standard across all stations after a median of 53.5 attempts (IQR: 33-85.5) and 61.5 minutes (IQR: 45.2-111.2).

Conclusion: We modified a low-cost, practical test to assess BOSS with supporting validity evidence. A credible mastery standard was established enabling evidence-based and objective testing for assessing BOSS.

Introduction: Medical students find translating lessons from traditional lectures to caring for trauma patients challenging. We assess whether adding video-based virtual flashcards and videos of augmented reality-based trauma patients in an online learning environment improves performance.

Methods: We performed a between-subject experimental study. Thirty-five medical students were randomly assigned to the control and experimental groups. The control group viewed a traditional online lecture. The experimental group viewed the same online lecture and received virtual flashcard training. Each virtual flashcard consisted of a video of a virtual patient, and examination questions about diagnoses, treatment, and disposition. The experimental group also viewed a video of a physician coach providing an expert assessment of the virtual patient. Simulation-based assessment was used to measure performance and knowledge. The evaluation consisted of the following 3 scenarios: a video of a simulated patient followed by multiple-choice questions, a free-text examination, and the writing of a Subjective, Objective, Assessment and Plan note. Differences in performance for 3 measures (diagnoses, therapeutic interventions, and disposition) were assessed for pre-post change in accuracy. For these 3 measures, we used a binary logistic regression model. We assessed perceptions of performance and the training experience with a survey.

Results: The training intervention statistically significantly improved accuracy for diagnosis ( P = 0.01) and self-reported performance ( P < 0.01) compared with the control group. The themes for the experience were engaging, innovative, and valuing the expert's assessment, with 17 of 19 positive statements.

Conclusions: Adding virtual flashcards to traditional training significantly improved diagnostic accuracy while being engaging and innovative.

Introduction: Bone marrow biopsy is a critical skill in hematology-oncology and internal medicine training. Less experienced practitioners more frequently obtain suboptimal specimens, leading to misdiagnoses, delays, or repeated procedures; rare but serious complications can occur during training on actual patients. Although cadaveric simulation and commercial simulators are valuable training tools, they present significant cost and accessibility challenges. Current 3-dimensional (3D)-printed simulators lack essential features necessary for widespread implementation.

Methods: Based on the biomedical properties of the posterior superior iliac spine, we designed a 3D-printed procedural simulator to democratize bone marrow biopsy training. Key features include functional fidelity to enhance learner confidence and rapid acquisition of high-quality specimens (at least 15 mm in length), ease of printing and assembly, low cost, and durability. We compared this simulator to cadaveric practice in a randomized crossover study.

Results: Thirty-eight first-year internal medicine residents participated in the simulation. Residents reported similar levels of appreciation and confidence in performing a biopsy after practicing on the novel 3D-printed simulators and human cadavers. Within 10 minutes of practice with the simulator, 86% successfully obtained lifelike specimens of at least 15 mm (2.5 specimens, mean 27 mm), compared to 60% with cadaver practice (2.1 specimens, mean 17 mm).

Conclusions: Using this 3D-printed simulator, residents obtained higher quality specimens than with cadaveric practice, allowing them to focus on mastering the controlled drilling motion through the bone cortex and marrow, the key challenge of this procedure. Democratizing biopsy simulation, educators can easily assemble this low-cost simulator for use in diverse training settings.

Summary statement: Given the large accumulation of research focused on the effectiveness of in-person simulation-based education (SBE), this umbrella review-or systematic review of systematic reviews-was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to analyze collective findings and close identified literature gaps. This study presents a descriptive analysis of the most effective modalities, methods, and measurements of in-person SBE, as well as major themes that emerged during analysis as it relates to SBE outcomes.The major patterns or themes that emerged confirm for the first time a longstanding sentiment in the literature, specifically the following: a need to produce higher-quality research with greater rigor, larger sample sizes, more randomized controlled trials, mixed methods, and longitudinal studies. These findings suggest a need to redirect scientific efforts in SBE. Despite the nearly ubiquitous issues noted across the systematic reviews' findings, results of this umbrella review seem to support the notion that in-person simulation-based education improves learning outcomes including technical and nontechnical skills and behavioral and attitudinal change. Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.

Introduction: Hands-on training of basic epistaxis management is often minimal during pregraduate medical training. The objective was to develop and gather structured content validity evidence for a 3D-printed model for simulation-based training and assessment of technical skills in basic epistaxis management.

Methods: A simulator for epistaxis management training was built based on publicly available 3D-print files with addition of tubing to mimic anterior bleeding. Ten otorhinolaryngologists evaluated the model after performing nasal cavity inspection and insertion and insufflation of a nasal tamponade device. Content validity evidence was collected following Messick's framework.

Results: Two content experts contributed to define features in the iterative building process. In the structured evaluation of the model, experienced clinicians found the appearance of the outer nose and the resistance when insufflating a nasal tamponade device into the nasal cavity satisfying (mean score of 3.9 and 4.7 out of 5, respectively), whereas the nasal cavity was found to be a bit too spacious compared with typical real-life conditions.

Conclusions: A 3D-printed simulator for simulation-based training of basic epistaxis management was successfully built. Content validity was gathered, and overall, content experts found the model to adequately represent the technical skills challenges for training novices such as medical students and junior doctors.

Summary statement: Tabletop simulations (TTS) are a novel educational modality used in health care education. The objective of this scoping review was to describe the use of TTS in medical emergencies, specifically settings, specialties, participants, formats, and outcomes.We included 70 studies (33 descriptive studies [47%], 33 cohort studies [47%], and 2 randomized controlled trials [3%]), of which 65 reported positive results regarding reaction and learning educational outcomes (reaction: n = 37, 53%; learning: n = 25, 36%; behavior: n = 7, 10%; result: n = 1, 1%). The scenario for most TTS was a disaster (n = 56; 80%). Most TTS involved participants from several professions (n = 45; 64%). A board game was used in 26 studies (37%).Most studies on TTS in medical emergencies involved participants from multiple professions addressing disaster scenarios and showed positive results pertaining to reaction or learning educational outcomes.

Summary statement: Simulated participants (SPs) are often employed to teach communication skills in medical education. Although there is a large number of qualitative and/or noncomparative studies in this field, there is no current evidence for the effectiveness of this teaching method based on quantitative comparative meta-data. The aim of this review was to evaluate the effectiveness of SP-based teaching on patient-centered communication skills in medical education compared with traditional teaching formats such as lecture or peer role play focusing on quantitative and comparative data. According to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched MEDLINE, Cochrane Library, PsycINFO, CINAHL, and ERIC databases for relevant studies published through February 2023. We also conducted hand searches and ancestry searches. Of the 8523 publications identified, 21 studies with 2500 participants and a Medical Education Research Study Quality Instrument score of 13.7 (SD = 1.3, N = 21) were included in the synthesis. Ten studies were eligible for meta-analysis. The pooled effect for communication skills outcomes suggests a medium effect preferring SP-based teaching to traditional teaching formats (standardized mean difference = 0.74, 95% confidence interval = 0.37 to 1.11, I2 = 95%, n = 2061). The heterogeneity is high among the analyzed studies. Further analysis reveals great differences among the studies' characteristics (population, objectives, interventions, control group settings, and outcome measurements).