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

Objective: Adherence to the International Liaison Committee on Resuscitation (ILCOR) algorithm optimizes the initial management of critically ill neonates. In this randomized controlled trial, we assessed the impact of a customizable sequential digital cognitive aid (DCA), adapted from the 2020 ILCOR recommendations, compared with a poster cognitive aid (standard of care [SOC]), on technical and nontechnical performance of junior trainees during a simulated critical neonatal event at birth.

Methods: For this prospective, bicentric video-recorded study, students were recruited on a voluntary basis, and randomized into groups of 3 composed of a pediatric resident and two midwife students. They encountered a simulated cardiac arrest at birth either (1) with DCA use and ILCOR algorithm poster displayed on the wall (intervention group) or (2) with sole ILCOR algorithm poster (poster cognitive aid [SOC]). Technical and nontechnical skills (NTS) between the two groups were assessed using a standardized scoring of videotaped performances. A neonate specific NTS score was created from the adult Team score.

Results: 108 students (36 groups of three) attended the study, 20 groups of 3 in the intervention group and 16 groups of 3 in the poster cognitive aid (SOC) group. The intervention group showed a significant improvement in the technical score ( P < 0.001) with an average of 24/27 points (24.0 [23.5-25.0]) versus 20.8/27 (20.8 [19.9-22.5]) in poster cognitive aid (SOC) group. No nontechnical score difference was observed. Feedback on the application was positive.

Conclusions: During a simulated critical neonatal event, use of a DCA was associated with higher technical scores in junior trainees, compared with the sole use of ILCOR poster algorithm.

Introduction: As part of onboarding and systems testing for a clinical expansion, immersive virtual reality (VR) incorporating digital twin technology was used. While digital twin technology has been leveraged by industry, its use in health care has been limited with no prior application for onboarding or training. The tolerability and acceptability of immersive VR for use by a large population of healthcare staff were unknown.

Methods: A prospective, observational study of an autonomous immersive VR onboarding experience to a new clinical space was conducted from May to September 2021. Participants were healthcare staff from several critical care and acute care units. Primary outcomes were tolerance and acceptability measured by reported adverse effects and degree of immersion. Secondary outcomes were attitudes toward the efficacy of VR compared with standard onboarding experiences.

Results: A total of 1522 healthcare staff participated. Rates of adverse effects were low and those with prior VR experience were more likely to report no adverse effects. Odds of reporting immersion were high across all demographic groups, though decreased with increasing age. The preference for VR over low-fidelity methods was high across all demographics; however, preferences were mixed when compared with traditional simulation and real-time clinical care.

Conclusions: Large-scale VR onboarding is feasible, tolerable, and acceptable to a diverse population of healthcare staff when using digital twin technology. This study also represents the largest VR onboarding experience to date and may address preconceived notions that VR-based training in health care is not ready for widespread adoption.

Introduction: The optimal simulator training duration for flexible optical bronchoscopic (FOB) intubation is unknown. This study aimed to determine whether a learning curve-based training modality was noninferior to a fixed training time modality in terms of clinical FOB intubation time.

Methods: This multicenter, randomized, noninferiority study was conducted from May to August 2022. Anesthesiology residents or interns were enrolled. Eligible participants were randomized in a 1:1 ratio to receive new learning curve-based simulator training (individualized training time based on performance, group New) or reference fixed training time simulator training (1 hour, group Reference). The primary outcome was the time to complete FOB intubation in patients, which was defined as the time from the introduction of the FOB into the mouth until the first capnography visualization. The margin for detecting clinical significance was defined as 10 seconds.

Results: A total of 32 participants were included in the analysis (16 in each group). All trainees successfully intubated the patients. The mean intubation time (95% confidence interval [CI]) was 81.9 (65.7-98.1) seconds in group New and 97.0 (77.4-116.6) seconds in group Reference. The upper bound of the 1-sided 97.5% CI for the mean difference of clinical intubation time between groups was 9.3 seconds. Noninferiority was claimed. The mean duration of the training in group New was 28.4 (95% CI, 23.5-33.4) minutes. The total number of training procedures on simulators in group New was significantly less than that in group Reference ( P < 0.01).

Conclusions: The clinical FOB intubation time in group New was noninferior to that in group Reference.

Summary statement: We conducted a systematic review to assess if any condition before- or after simulation-based training of teamwork competencies for healthcare professionals affects learning or transfer of skills to the clinical environment.We searched CINAHL, Medline, and Embase for studies published between January 1, 2011, and July 10, 2023. We screened 13,149 abstracts and 335 full texts, of which 5 studies were included. We included primary studies with and without a comparator published in English. We assessed risk of bias using the ROBINS-I tool before narrative synthesis. All studies were observational and reported heterogeneous conditions such as posters, coaching, and leadership support initiatives. Very low certainty evidence suggested that implementing conditions in the clinical environment such as coaching, wider communication of learning objectives, or leadership initiatives could be considered to facilitate the transfer of skill to the clinical environment. Funding: Society for Simulation in Healthcare. Prospero registration: CRD42022320721.

Summary statement: Life and Death 2: The Brain was the first computerized neurosurgical simulator. It was developed as a commercial video game for a general audience. Despite this, it contains many valuable lessons for the simulation and education of nontechnical skills as well as being a historical landmark in the field of neurosurgery and medical simulation.

Introduction: With increased incorporation of simulation-based methodologies into quality improvement activities, standards for reporting on simulation-specific elements in healthcare improvement research are needed.

Methods: We followed established consensus process methodology to iteratively create simulation-based extensions for SQUIRE 2.0 reporting guidelines. Initial steps involved forming a steering committee, defining the scope, and conducting premeeting activities with an expert panel of simulation and quality improvement researchers. Recommendations from the expert panel were brought to a consensus meeting where existing guidelines were reviewed and recommendations made. Steering Committee members reviewed all recommendations, reconciled differences, and made final recommendations, which were piloted by experienced simulation and quality improvement researchers.

Results: Fifteen Steering Committee members, 59 experts in simulation and quality improvement research, and 86 consensus meeting attendees reviewed SQUIRE 2.0 reporting guidelines and ultimately recommended simulation-based reporting guidelines for 22 of the 41 (54%) SQUIRE 2.0 guidelines. Those items for which simulation-based extensions were identified were: Notes to Authors, 1 (Title), 2a (Abstract), 2b (Abstract), 4 (Introduction: Available knowledge), 5 (Introduction: Rationale), 7 and 8a & b (Methods: Context and intervention), 9a (Methods - Study of the intervention), 9b (Methods - Study of the intervention), 10a (Methods - Measures), 10b (Methods-Measures), 10c (Methods-Measures), 11b (Methods- Analysis), 12 (Methods - Ethical considerations), 13a (Results), 13e (Results), 14b (Discussion - Summary), 15a-e (Discussion - Interpretation), 16a (Discussion - Limitations), 16b (Discussion - Limitations), 17c (Discussion - Conclusions), and 17d (Discussion - Conclusions).

Conclusions: We created simulation-based extensions to SQUIRE 2.0 reporting guidelines to improve the quality and standardization of reporting on simulation-specific elements of healthcare improvement research.

Introduction: Simulation is an ideal tool for interprofessional (IP) team training. Debriefing after simulation is key to IP learning, although engagement and participation may be adversely influenced by cultural and hierarchical barriers. This mixed-methods study explored factors influencing learner engagement and participation in IP debriefing and the experience of "silent but apparently engaged" participants.

Methods: Semistructured profession-specific focus groups were conducted with participants from a weekly IP pediatric simulation program. Focus groups were recorded, transcribed, and thematically analyzed. Eligible participants were assigned to "silent" or "verbal" groups according to observed behavior and received a questionnaire. Participants' self-rated engagement scores were compared using a t test.

Results: Thirty-six of 81 eligible participants were included, 13 completed a questionnaire, and 23 (8 physicians, 10 nursing staff, 4 pharmacists, 1 respiratory therapist) participated in 13 focus groups. Twenty-two subthemes were grouped into 6 themes: psychological safety, realism, distractors, stress, group characteristics, and facilitator behavior, with differences in perspective according to profession. Of the 36 respondents, 18 were "silent" and 18 "verbal." Self-rated engagement scores differed between groups (3.65 vs. 4.17, P = 0.06); however, "silent" participants described themselves as engaged.

Conclusions: Themes identified that influenced learner engagement in debriefing included aspects of prebriefing and the simulation. Some aligned with general simulation best practices, such as psychological safety, prebriefing, and facilitator behavior. Findings unique to IP simulation included importance of realism to nonphysician professions, protecting time for training, group composition, and direct probing by cofacilitators to decrease physician bias and emphasize IP contributions. Silent participants reported engagement.