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

Introduction: Managing difficult airways and adverse respiratory events is critical for anesthesia providers. Fiber-optic intubation (FOI) is a strategic management approach in difficult airway situations. Clinical exposure to FOI can be limited, posing challenges for skill development. Simulation-based medical education offers a safe alternative for training. This study aims to evaluate the effectiveness of a simulation-based FOI training program for student registered nurse anesthetists (SRNAs) in an educational context.

Methods: A repeated measure study was conducted during the Pediatric Anesthesia Simulation for Student Nurse Anesthetists course at the Peter M. Winter Institute for Simulation, Education, and Research. One hundred twenty-three SRNAs participated in the FOI simulation program. For the analysis, students were stratified into 2 groups based on their performance in the summative testing of nasal FOI time. Baseline characteristics and the students' performance during the simulation were analyzed.

Results: Among the participants, 58 were categorized as "above median time" (AMT) and 65 as "below median time" (BMT) for FOI testing. No significant differences were observed in baseline characteristics. The AMT group exhibited longer mean times for summative testing FOI (50 vs. 26 seconds), first FOI attempt (97 vs. 78 seconds), and subsequent sets (third: 374 vs. 325 seconds, fourth: 323 vs. 268 seconds). Both groups showed performance improvement across training sets with reduced variability.

Conclusions: The simulation-based FOI training program effectively enhanced SRNA skill, with performance improvement during the training period. This study underscores the importance of simulation in anesthesia education, offering a safe and structured environment for skill development in FOI.

Introduction: Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential. However, unclear language around leadership limits facilitators' capacity for transformative reflective discussion.

Methods: Internal medicine trainees participated in simulated medical emergency scenarios. Video recordings of consenting participants were analyzed using template analysis. A priori codes from existing literature formed an initial coding template. This was modified with inductive codes from the observed behaviors to develop a taxonomy of leadership behaviors in simulated medical emergencies. The taxonomy was then transformed into an infographic, to be used as a leadership debriefing tool.

Results: The taxonomy of leadership behaviors consisted of the following 4 themes: Structuring, Decision making, Supporting, and Communicating . Structuring behaviors shaped the team, ensuring that the right people were in the right place at the right time. Decision-making behaviors steered the team, setting a direction and course of action. Communicating behaviors connected the team, sharing valuable information. Supporting behaviors nurtured the team, guiding team members to perform at their optimum level.

Conclusions: Debriefing-as-imagined is not always debriefing-as-done. A shared language of leadership can connect educators and learners, advancing critical debriefing conversations and enabling facilitators to drive meaningful reflective discussion. The use of infographics in simulation offers an opportunity to support educators in facilitating complex debriefing conversations.

Summary statement: This study highlights the growing significance of healthcare simulation in enhancing the quality and safety of patient care across Latin America and the Caribbean, by analyzing bibliometric trends and the impact of publications on simulation-based clinical training between 2012 and 2022. Leveraging the Scopus database and VOSviewer software for thesaurus interaction analysis, the research identified 610 documents, accumulating 4681 citations, thereby indicating a burgeoning interest in this field with notable publication spikes in 2017 and 2020. Brazil and the United States emerged as leading contributors, with a primary focus on "simulation training," "clinical competence," "medical education," and "education." The study observed an uptick in international collaboration, mirroring the increase in document count and citations. This bibliometric review underscores the emphasis on evaluating technical skills and clinical practices as prevailing areas of interest, highlighting Brazil's significant academic contributions, and suggesting a promising future for the implementation of clinical simulation in the region. The study advocates for continued scholarly output to align with global advancements in medical simulation, aiming to optimize patient outcomes.

Introduction: Health professions training programs must train future healthcare providers to meet the needs of equity-deserving patient populations. Standardized patient (SP) programs are one mechanism by which this training can occur. Our aim was to develop a set of recommendations for SP programs and educators around planning, organizing, and delivering SP-based education involving equity-deserving groups.

Methods: We undertook a qualitative analysis of interview transcripts of SPs, educators, and trainers involved in SP work with equity-deserving groups. Subsequently, we conducted a three-stage modified Delphi process to generate recommendations.

Results: We derived 10 tips to help stakeholders improve SP-based education involving equity-deserving groups. The underlying themes included collaborative involvement, including co-creation and co-delivery of content with members of equity-deserving groups, as well as consistent prioritization of the needs of SPs throughout the process.

Conclusions: Our findings suggest ways in which SP programs and educators can better train future healthcare providers to meet the needs of equity-deserving patient populations.

Introduction: Emergency providers risk encountering firearms in the emergency department, but a minority report familiarity with handling firearms. It may be unsafe if unfamiliar, untrained providers attempt to remove a firearm from the clinical care space. This study assessed the efficacy of an educational intervention training resident physicians in this task.

Methods: Five emergency medicine residency programs conducted a prospective, single-blinded randomized controlled trial assessing performance of safely removing a firearm from the clinical care space during a simulated patient encounter. The primary outcome was completion of critical actions previously assessed in a pilot study. Residents viewed a 5-minute educational video developed for this study detailing the principles of safely removing a firearm from the clinical care space. The training video was emailed to prospective participants in the intervention group ahead of the simulation session. Afterward, a debriefing session was held with all participants to review the safe handling of firearms.

Results: Sixty-six of 170 prospective participants (38.8%) consented to participate. There were no significant differences in gender, clinical training level, environment of upbringing, confidence in handling firearms, firearm usage frequency, or prior firearm training. Twenty-nine participants handled the firearm during simulation. The intervention group performed significantly better than the control group, completing a median of 7 critical actions (interquartile range, 7-8) versus 6 critical actions (interquartile range, 5-7), P = 0.035. This effect held among participants who handle firearms outside of work and/or have prior firearms training.

Conclusions: This study demonstrates how a brief educational intervention was associated with improvement in participants' ability to safely remove a firearm from a simulated clinical care space. This approach can be integrated into existing curricula, and its success suggests broad applicability.

Introduction: Virtual patients (VPs) are increasingly used in health professions education. How learners engage with VPs and the relationship between engagement and authenticity is not well understood. We explored learners' perceptions of VP education to gain an understanding of the characteristics promoting meaningful engagement in learning, including perceived authenticity.

Methods: Using a constructivist grounded theory approach, we conducted interviews and focus groups with 11 students from 2 Canadian Physician Assistant programs, where VP learning was implemented to supplement clinical education during the COVID-19 pandemic. We explored trainee perspectives on the use of VPs as an educational modality. Data were iteratively collected and descriptively analyzed thematically using a constant comparison approach until theoretical sufficiency was reached.

Results: We identified 3 groups of factors influencing these students' VP learning experiences: (1) technical factors related to the VP platform influenced the perceived authenticity of the patient interactions; (2) individual factors of learners' attitudes influenced their engagement and motivation; and (3) contextual factors related to the learning environment influenced the acceptability and perceived value of the learning experience. Overall, the psychological authenticity of the learning platform and students' motivation for self-directed learning were perceived as most important for students' learning experiences.

Conclusions: Implementing VP learning as a supplement to clinical education should be done with consideration of factors that enhance the psychological authenticity of the learning platform, promote learner engagement and accountability, and encourage acceptability of the learning modality through curricular placement and messaging.

Introduction: Despite the increasing use of distributed healthcare teams, performance evaluation is largely lacking. This study examined rural emergency health care in Sweden to determine the effect of teams being either co-located or distributed with remote physicians accessible via telemedicine.

Method: In this crossover study, 17 three-person teams were video recorded during co-located and distributed simulated scenarios. Team performance in the video recordings was evaluated using the TEAM instrument.

Results: Co-located scenarios had significantly higher Total ratings for the instrument (items 1-11), in the teamwork domain (items 3-9), and in overall performance (item 12) compared with distributed scenarios ( P < 0.005). Item-level analysis revealed that co-located teams were better at completing tasks on time (item 4) and showed greater adaptability to changing situations (item 7).

Conclusions: The higher rating of the performance of co-located teams underscores the challenges facing distributed teams. Given that distributed healthcare teams are a reality in rural areas in northern Sweden, education and training must be adapted to address these challenges. This adaptation is crucial for ensuring high-quality patient care by distributed teams.

Summary statement: Otherwise known as debriefing the debrief, meta-debriefing describes the practice of debriefing simulation facilitators after they have facilitated, or observed, a debriefing. It is a vital component of enhancing debriefing skills, irrespective of where debriefers may be in terms of their professional development journey from novice to expert. We present the following 4 fundamental pillars, which underpin the creation of an impactful meta-debriefing strategy: theoretically driven, psychologically safe, context dependent, and formative in function. Furthermore, we describe various strategies that, underpinned by these 4 key pillars, contribute to a toolbox of techniques that enable meta-debriefers to develop proficiency and flexibility in their practice. We have synthesized and critically reviewed the current evidence base, derived mostly from the debriefing literature, and highlighted gaps to address in meta-debriefing contexts. We hope this article stimulates discussion among simulation practitioners, progresses the science and art of meta-debriefing, and prompts further research so that meta-debriefing can become an integral evidence-based component of our faculty development processes.