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

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.

Introduction: Interprofessional simulation (IP-Sim) training in crisis resource management (CRM) is widely used to improve team performance. Emerging social sensor-based technology and measurement provide an opportunity to enhance IP-Sim. Using these methods, signals generated by team members in action are collected, analyzed, and presented in a debriefing session as visual aids and statistics that summarize behavioral markers of teamwork and taskwork. We developed a novel social sensor-based measuring system and tested it in a pilot study to demonstrate its feasibility, acceptance, and relevance during IP-sim in CRM.

Methods: During 6 immersive scenario-based IP-Sim sessions, we gathered both quantitative (survey) and qualitative (videotaped debriefing) postsimulation exposure data. Six experimental teams, each containing 3 trainees (2 nurses and 1 physician), were involved in a scenario in which a life-threatening emergency in a hospital setting had to be identified and managed.

Results: By conducting successful deployment in a simulated environment, we demonstrated the viability of the proposed system and outlined the remaining obstacles (feasibility check). We documented users' successful and unsuccessful methods for incorporating the solution into existing training frameworks (acceptability check). In addition, we determined how users interpreted behavioral markers during debriefing such as space occupation, gaze dynamics, and verbal interaction to improve situational awareness and common understanding (relevance check).

Conclusions: We detailed the conditions under which a new sensor-based approach can be successfully integrated into immersive scenario-based simulation and identified areas for further development. The findings indicated that social sensor technology and measurement have the potential to enhance the overall experience of IP-Sim sessions in CRM.

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).

Introduction: This systematic review aims to investigate the impact of team composition on learning outcomes following simulation-based training of teamwork competencies for healthcare professionals and healthcare students.

Methods: We searched Ovid Embase, CINAHL, and OVID Medline from 2011 to July 3, 2023, and included randomized trials and observational studies with a control group. Risk of bias was assessed using the revised Cochrane Risk-of-Bias tool and the Risk of Bias in Non-Randomized Studies tool. We did not conduct a meta-analysis because of heterogeneity. We evaluated certainty of evidence using GRADE methodology.

Results: We screened 14,309 abstracts and included 11 studies. We found 6 studies investigating uniprofessional (UP) versus multiprofessional (MP) teams, 3 studies investigating team size, 1 study investigating dynamic versus stable teams, and 1 study investigating the effect of gender composition. Studies overall found that team composition may affect team performance. Studies on UP versus MP teams investigated skill acquisition, knowledge acquisition, and self-efficacy, showing no difference between groups or a small benefit of MP team training. The certainty of evidence was very low.

Discussion: We identified very low certainty evidence, suggesting that team composition affects team performance and MP team training should be considered as opposed to UP team training when providers are expected to work together across professions in clinical practice. Further research is needed to identify the optimal team composition for training of teamwork competencies.

Summary statement: The evidence base supporting the adoption of simulation in health care has not kept pace with the rapid growth of the field. Although there is a growing body of research in health care simulation, many published studies describe small-scaled, underpowered projects with insufficient methodological rigor to inform our understanding of simulation. This problem is indicative of a larger challenge: the lack of focused, cohesive programs of research designed to advance the science of simulation. The METRICS framework is a model of scholarship that categorizes scholarship into 7 intersecting domains: Metascholarship, Evaluation, Translation, Research, Innovation, Conceptual, and Synthesis. In this article, we aim to explore how the METRICS framework can serve as a roadmap for researchers to develop cohesive simulation research programs. We also describe how the METRICS framework applies to existing institutional and network-based programs of health care simulation research and discuss future implications for the global health care simulation community.

Summary statement: Biometric technology shows substantial promise to enhance patient safety and transform provider training. In patient care, biometric technology enables outpatient providers to optimize chronic disease by alerting providers to changes in patient conditions with real-time data. In provider training, biometric technology can inform training environments and curriculum. Certainly, there are hurdles to technology implementation including hardware fragility, cost, and software integration. Despite challenges, biometric technology has been effectively implemented in simulations and real patient settings.Looking forward, future developments focused on data security and privacy, standardizing data collection, and improving system compatibility will facilitate the wider adoption of biometric technology and improve health care quality, especially in resource-limited settings. Collaborative efforts among informatics experts, patient safety advocates, and health care providers are essential to overcome challenges and fully leverage biometric technology's potential in enhancing patient outcomes. The purpose of this commentary is to review current applications, identify key challenges, and offer recommendations to the simulation community for testing biometric technology, use in training programs, and facilitating systems integration to improve outcomes.

Background: Clinical residents play a crucial role in educating other healthcare professionals; however, formal training programs to develop teaching skills remain limited. This study evaluated the effectiveness of a "residents as teachers" course incorporating standardized learners (SLs) to enhance teaching competencies among clinical residents.

Methods: A single group pre-post intervention study was conducted with 38 second-year residents participating in the course between 2020 and 2023. Residents completed pre- and post-course assessments based on teaching entrustable professional activities (TEPAs). In addition, 26 residents completed a survey evaluating their perceptions of using SLs as a teaching and evaluation tool.

Results: Residents in the 2023 study group showed notable improvements in most teaching competencies after the course. Median scores increased significantly in TEPA 01, 02, 03, 05, 06, and 08 (P < 0.05), while no significant changes were observed in TEPA 07, and a decrease was noted in TEPA 04. Boxplot analysis indicated not only performance gains but also greater consistency among residents after training. In addition, 92% of participants rated SLs as highly useful for developing teaching skills, supporting their use across various educational contexts such as student engagement, classroom teaching, and feedback delivery.

Conclusions: Integrating SLs into resident training programs offers a highly accepted and effective strategy to strengthen teaching competencies and boost resident confidence in educational roles. Future studies should explore the long-term impact of SL-based training on residents' teaching practices and student learning outcomes.