Advances in simulation (London, England)最新文献

Background: Simulation-based training is increasingly used in healthcare education. It allows students to practice in realistic environments using high-fidelity patient simulators and to engage with complex or rare diagnoses without risking harm to real patients. During the debriefing phase, students and facilitators reflect on actions taken and discuss what went well and what could be improved in future simulation sessions. To engage in productive reflection, students must be aware of their mistakes and performance gaps. Although the literature emphasizes the importance of providing both positive and corrective feedback, many facilitators struggle to deliver negative feedback due to concerns about hurting students' feelings or damaging their relationships. This study explores how facilitators use nursing students' mistakes to prompt reflection and discussion during healthcare simulation debriefings.

Method: This was a qualitative video-supported observational study. 17 facilitators and 89 students from three universities in Norway participated in mandatory simulation-based training in their second year of education. The framework of Heath, Hindmarsh, and Luff (2010) inspired video analysis. The units of data consisted of verbal utterances, bodily conduct, gaze, and facial expressions, as noted through observations of participants' turns at talk. We complemented this by using thematic analysis inspired by Braun & Clarke of selected video transcripts to support and deepen the analysis.

Results: The facilitators who elicited the most reflections and discussions among the students during debriefings consistently employed five communication elements: inquiries, positive feedback, hints and cues, suppressions, and summarizing.

Conclusion: The main findings provide new insights into facilitators' actions when eliciting student reflections and discussions. Many structured debriefing frameworks today include inquiries, positive feedback, and hints and cues. This analysis identified additional communication elements not previously recognized in the debriefing literature, namely suppressions and the use of summaries. Few studies have examined the facilitators' actions during debriefings to elicit student reflection and discussion, particularly through naturalistic observation of real-world practice. Further research is needed to expand our understanding of these interactional dynamics and the situated strategies employed by facilitators.

Objectives: To determine the experience of midwives in a master's program undertaking simulation-based education for postpartum hemorrhage management.

Methods: This is a qualitative study using a descriptive phenomenological approach. The study was conducted at Selçuk University, Selçuk Simulation Center between December 15-16, 2022. Purposive sampling was used to recruit 15 midwives who were students in a master's program. Simulation-based education for postpartum hemorrhage management was applied with scenarios. Data were collected using a semi-structured interview with midwives using an in-depth bilateral interview technique. All interviews were transcribed into an electronic text file.

Results: According to the midwives' views on the simulation-based education experience, four main themes were developed: simulation experience, awareness formation, emotional effects, and the effects of the team members.

Conclusions: Midwives described that simulation-based education in postpartum hemorrhage management increased their awareness and confidence, provided valuable experiential learning, elicited emotional responses such as stress and happiness, and fostered collaboration among team members.

Background: Effective debriefings in simulation-based education require accurate observation of team interactions, yet facilitators face challenges due to cognitive load, observer bias, and the complexity of team dynamics. Generative artificial intelligence (AI) tools offer a potential means to support this process by analyzing verbal communication and providing structured feedback. This study explored how AI tools can contribute to teamwork observation and debriefing in immersive medical simulations.

Methods: We conducted a qualitative, exploratory study using thematic analysis of simulation participants' and debriefers' experiences with AI-generated teamwork reports. Forty-one participants (anesthesia nurses, residents, and attendings) participated in immersive scenarios at the University Hospital Zurich simulation center. Verbal interactions were transcribed with AI-assisted speech recognition and analyzed using two large language model-based systems (Isaac and ChatGPT-4o) guided by a prompt based on the Team-FIRST framework. Structured reports were generated for each scenario and reviewed by four simulation experts. Semi-structured interviews captured learners' perspectives on being observed by AI tools.

Results: A total of 26 AI-generated reports and 27 learner interviews were analyzed. Experts valued the detailed transcripts and illustrative quotes, which supported structured feedback and captured observations that might otherwise be missed. Limitations included inaccuracies in categorization, misattribution of speakers, overly generalized interpretations, and the absence of contextual or nonverbal information. Learners expressed openness and optimism about AI's potential benefits: efficiency, objectivity, and enhanced perception, while also raising concerns about transparency, data protection, interpretation errors, and risks of overreliance. Both groups emphasized the necessity of human oversight.

Conclusion: Generative AI tools can complement simulation debriefings by structuring communication data and highlighting teamwork patterns, supporting reflective practice. Current limitations highlight the need for multimodal approaches, refined prompting strategies, and integration with expert facilitation to ensure AI functions as a support tool rather than a replacement in simulation-based education.

Trial registration: BASEC ID: Req-2024-01642.

Background: Clinical debriefing (CD) positively impacts individuals, teams and systems and has been shown to improve patient outcomes and staff wellbeing. Although there is a growing evidence base supporting CD, it has not been routinely adopted by many healthcare organisations. Despite the work environment being an important component of transfer of learning, there has been minimal focus on how it influences implementation and maintenance of CD in practice. The overall aim of this study was to explore the work environment barriers and enablers influencing the transfer of clinical debriefing skills from simulation to clinical practice.

Methods: Following ethical approval, medical registrars who had participated in a simulation course involving a within-scenario CD were invited to participate in semi-structured interviews. These utilised Burke and Hutchins' evaluation model as the initial conceptual framework and took place at least two months post-course. Interviews explored participants' experiences of transferring learning related to CD from simulation to the clinical workplace, and were transcribed verbatim and dual coded using template analysis.

Results: Fifteen medical registrars participated in interviews between January and May 2025. The work environment influences from Burke and Hutchins' evaluation model resonated as important factors affecting adoption of CD. With the addition of subthemes generated inductively from the data, the model provided a framework for identification and articulation of the barriers and enablers to CD in the workplace. The most striking finding was participants' sense of personal responsibility to engage with CD. In addition, participants identified the requirement for cultural change to enable CD.

Conclusions: Work environment influences represent both barriers and enablers of CD in relation to the transfer of learning from simulation to clinical practice. Personal responsibility and workplace culture are important drivers of CD, and attention should be paid to the influence of both constructs in this context. Recommendations for practice, based on our findings, are designed to enable educators and organisations to promote the adoption of CD in their own settings. This will help to bridge the gap and make CD the norm, not the exception.

Background: Globally, in excess of one billion children experience violence and abuse every year, leading to upwards of 40,000 deaths. Child safeguarding education typically occurs in professional silos across healthcare, often focusing on specific undergraduate competencies. In practice, however, child safeguarding requires a multi-professional approach, necessitating effective communication in emotionally charged contexts. To address these needs, we designed an interprofessional course using simulation-based education for experienced healthcare professionals working in the emergency department.

Methods: On three occasions, we delivered an in-person, two-day course with 32 healthcare professionals from medicine, nursing, and social work. We collected data using multiple methods including participant demographics and child safeguarding experience (n = 32), observational field notes, individual semi-structured interviews (n = 14) and focus groups (n = 4). We analyzed the data using landscapes of practice theory as a sensitizing concept.

Results: Using landscapes of practice theory, we deductively generated three key themes from our data: (1) collaborative learning, (2) the medium of language, and (3) creating a safe space. These themes encapsulate our participants' experiences in navigating interprofessional learning within newly established teams, during simulated child safety scenarios in the emergency department. Findings also detail participants' knowledge gains and confidence in reporting child safeguarding concerns.

Conclusions: This co-designed interprofessional simulation-based child safeguarding course created space for learners to renegotiate safeguarding as a shared, interdependent responsibility. Authentic, emotionally charged scenarios in a psychologically safe environment helped participants tolerate uncertainty, rehearse reporting decisions, and develop a shared safeguarding lexicon. The resulting design principles may assist educators seeking to foreground psychological safety, authentic collaboration and the child's voice in interprofessional safeguarding education.

Background: Simulation-based training facilitates learning of advanced laparoscopic surgical procedures. Such procedures are challenging to master due to their technical complexity, which can elicit stress responses in surgical trainees. Previous research has demonstrated the impact of stress on trainees' learning processes in skills lab. However, there is limited data comparing trainees' stress responses during advanced procedural training using box-trainers in skills lab, to those experienced during operating training in realistic simulation environments. This study aims to explore the physiological responses, self-reported stress responses, and experiences of stress of surgical trainees during advanced laparoscopic procedural training in two different simulation environments. Insights into stress mechanisms may suggest improvements for the design of future training courses.

Methods: This observational study explored participants' stress experiences through semi-structured interviews and investigated their stress responses by measuring the heart rate variability, saliva cortisol levels, and trainees' self-reported stress using a validated instrument. Participants performed advanced laparoscopic procedures on box-trainers and live animal models in operating room settings.

Results: Twelve experienced surgical trainees were included in the study. No differences were observed for physiological parameters between training activity on the box-trainer simulator and live animal models. In interviews, trainees reported experiencing higher stress levels during procedural training in operating room environment. The main themes related to elevated stress were realism and functional task alignment, perceived level of risk, and interpersonal dynamics in simulation environments. The trainees perceived the increased stress response levels as beneficial for their focus and for performing advanced procedures.

Conclusion: In this study, no significant differences were identified in trainees' physiological or self-reported stress responses across the two simulation settings. However, qualitative interview data revealed that trainees perceived greater stress when training with animal models in highly realistic operating room environments, suggesting the potential educational value of such immersive simulation environments.