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

Introduction: Cocreating virtual simulations with learners during a course is an innovative approach to improving student preparation for real-world practice while helping simulationists meet learner needs, support authentic assessment, and maximize the impact of simulation-based learning. This study explores differences in healthcare students' experiences of learner-educator cocreation of virtual simulations (LECoVSs) using phenomenographic methods. Identifying differences in perceptions of LECoVSs enables educators to make evidence-informed decisions about engaging in simulation cocreation as a tool to maximize learning.

Methods: Phenomenography focuses on identifying different ways that participants can experience the same phenomenon, in this case, LECoVSs. The setting was a collaborative interprofessional simulation assignment between navigation and nursing students. Participants completed a demographic survey then submitted reflective journals completed during the course and/or an open-ended survey. Data analysis occurred in iterative stages, from familiarization with the data to grouping and interpreting themes.

Results: Nineteen open-ended surveys and 13 reflective journals from navigation and nursing students who completed the simulation assignment between 2021 and 2023 were analyzed. Students experienced LECoVSs in 4 increasingly complex ways: (1) supporting consistent student progress, (2) amending course expectations, (3) sharing decision-making, and (4) fostering mutual growth.

Conclusions: Simulationists may leverage cocreation to improve student learning, access, empowerment, and professional growth. However, for students to achieve higher learning outcomes, educators need to clearly communicate the full potential of cocreation, how it can occur, and why it can support learning. This study's findings may be used as a framework for explaining simulation cocreation to students to maximize their learning.

Summary statement: This review aimed to explore existing literature on the use of in situ simulation to identify latent safety threats in emergency medicine. Studies were required to take place in a clinically active emergency department and have either a primary or secondary aim of identifying latent safety threats. A total of 2921 articles were retrieved through database searches and a total of 15 were deemed to meet the inclusion criteria.Latent safety threats were detected by a variety of methods including documentation during debrief/discussion (66%), during the simulation itself (33%), participant surveys (20%), and video analysis (20%). Using a multimodality approach with input from observers and participants from different professional backgrounds yielded the highest number of threats per simulation case (43 per case). Equipment was the most commonly reported threat (83%), followed by teamwork/communication (67%). Some studies did not report on mitigation of identified risks; formal processes should be implemented for the management of latent safety threats identified by in situ simulation. Future research should focus on translational outcomes to further strengthen the position of in situ simulation in emergency medicine.

Introduction: Medical students have previously been shown to be just as effective for video rating as experts. We want to compare medical students to experienced surgeons as video assessors of simulated robot-assisted radical prostatectomy (RARP) performance.

Materials and methods: Video recordings of three RARP modules on the RobotiX (formerly Simbionix) simulator from a previous study were used. Five novice surgeons, five experienced robotic surgeons, and five experienced robotic surgeons in RARP performed a total of 45 video-recorded procedures. The videos were assessed with the modified Global Evaluative Assessment of Robotic Skills tool as both full-length and an edited edition that only included the first 5 minutes of the procedure.

Results: Fifty medical students and two experienced RARP surgeons (ES) performed a total of 680 video ratings of full-length videos and 5-minute videos (2-9 ratings per video). Medical students and ES showed poor agreement for both full-length videos and 5-minute videos (0.29 and -0.13, respectively). Medical students could not discriminate between the skill level of the surgeons in either full-length videos or 5-minute videos ( P = 0.053-0.36 and P = 0.21-0.82), whereas ES could discriminate between novice surgeons and experienced surgeons (full-length, P < 0.001, and 5 minutes, P = 0.007) and intermediate and experienced surgeons (full-length, P = 0.001, and 5 minutes, P = 0.01) in both full-length videos and 5-minute videos.

Conclusion: We found that medical students cannot be used to assess RARP because they showed poor agreement with the ES rating for both full-length videos and 5-minute videos. Medical students could not discriminate between surgical skill levels.

Introduction: Volumetric capnography depicts volumetric capnograms [ie, the plot of expired carbon dioxide (CO 2 ) over the tidal volume]. This bench study aimed to determine the reliability, accuracy, and precision of a novel infant simulator for volumetric capnography. This simulator would be clinically valuable for teaching purposes because it reflects the entire cardiopulmonary physiology within 1 breath.

Methods: An infant lung simulator was fed with CO 2 supplied by a mass flow controller (VCO 2-IN ) and ventilated using standard settings. A volumetric capnograph was placed between the endotracheal tube and the ventilatory circuit. We simulated ventilated babies of different body weights (2, 2.5, 3, and 5 kg) with a VCO 2 ranging from 12 to 30 mL/min. The correlation coefficient ( r2 ), bias, coefficient of variation (CV = SD/ x × 100), and precision (2 × CV) between the VCO 2-IN and the elimination of CO 2 recorded by the capnograph (VCO 2-OUT ) were calculated. The quality of the capnogram's waveforms was compared with real ones belonging to anesthetized infants using an 8-point scoring system, where 6 points or greater meant that the simulated capnogram showed good, 5 to 3 points acceptable, and less than 3 points an unacceptable shape.

Results: The correlation between VCO 2-IN and VCO 2-OUT was r2 = 0.9953 ( P < 0.001), with a bias of 0.16 (95% confidence intervals from 0.12 to 0.20) mL/min. The CV was 5% or less and the precision was 10% or less. All simulated capnograms showed similar shapes compared with real babies, scoring 6 points for 3 kg and 6.5 points for 2-, 2.5-, and 5-kg babies.

Conclusions: The simulator of volumetric capnograms was reliable, accurate, and precise for simulating the CO 2 kinetics of ventilated infants.

Introduction: Translational research has been identified as a research priority for the National Institutes of Health (NIH) and the Society for Simulation in Healthcare (SSH). Despite a larger focus on translational research in recent years, the overall amount of simulation-based translational research remains low. Greater understanding of how to approach translational simulation is required to inform novice simulation and translational researchers. This study sought to answer the following research questions: How do simulation experts describe the barriers and facilitators to implementing translational simulation programs? How do simulation experts describe their various approaches to implementing translational simulation programs? What recommendations do simulation experts describe for overcoming barriers to implementing translational simulation programs?

Methods: A qualitative instrumental case study was used to elicit multiple instances of translational simulation research to gather an in-depth description from study participants. Three data sources were used: documents, semistructured interviews, and a focus group.

Results: Data analyses revealed 5 major themes: clarifying goals and definitions, special considerations, social networking, research, and factors external to the simulation program.

Conclusions: Key findings include a lack of a standardized definitions for translational simulation and simulation-based translational research, the challenge of demonstrating the value of translational simulation, and the need for translational simulation programs to be integrated into departmental quality, patient safety, and risk management work. The findings and advice from the experts in this research can assist new researchers or those encountering challenges in implementing translational simulations.