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

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: 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: 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.

Introduction: Hemorrhage continues to be the leading cause of preventable death in trauma, and tourniquet application has been associated with survival. The purpose of our study was to evaluate the efficacy of telesimulation (TeleSIM) versus in-person training (SIM) for teaching tourniquet application for life-threatening hemorrhage control.

Methods: We performed a prospective randomized study of participants enrolled in a Stop The Bleed course at a university medical school. The TeleSIM group completed the course with an instructor streaming live from an off-site location. The SIM group completed the course in the standard fashion with a live instructor present. The primary endpoint was the successful application of a combat application tourniquet to a bleeding extremity in a simulation scenario. We also evaluated the time for successful tourniquet application according to training modality. Participants' thoughts, feelings, and attitudes pertaining to their experience in the course were obtained via a postcourse survey.

Results: Ninety-four of 97 (96.9%) eligible subjects participated in the study. There was no difference in the proportion of participants in each group who successfully applied a combat application tourniquet during their simulation scenario: TeleSIM group, 100% (95% CI, 92.5-100.0); SIM group, 100% (95% CI, 92.7-100.0). We also observed no significant difference in the mean time it took the participants to apply a tourniquet regardless of their training modality. Both groups reported their learning modality as an effective way to learn hemorrhage control.

Conclusion: A telesimulation-based instructional delivery design is an effective way to teach tourniquet application for hemorrhage control.

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.