Advances in simulation (London, England)最新文献

Simulation program staff and leadership often struggle to partner with front-line healthcare workers, their managers, and health system leaders. Simulation-based learning programs are too often seen as burdensome add-ons rather than essential mechanisms supporting clinical workforce readiness. Healthcare system leaders grappling with declining morale, economic pressure, and too few qualified staff often don't see how simulation can help them, and we simulation program leaders can't seem to bridge this gap. Without clear guidance from front-line clinicians and leaders, the challenge of building and maintaining sustainably relevant simulation offerings can seem overwhelming. We argue that three blind spots have limited our ability to see the path to collaborations that support front-line workforce readiness: We wrongly assume that our rigor in designing and delivering programs will lead to front-line participant engagement and positive impact, we overestimate the existence of shared priorities, mindsets, and expertise with our would-be partners, and we contribute to building a façade of superficial education compliance that distracts from vital skill development. How do we design simulation-based training programs that are valued, supported, and sustained by key partners over time? (1) By seeing ourselves as partners first and designers second; (2) by using a boundary spanning design process that shifts the primary psychological ownership of training outcomes to our partners; and (3) by focusing this shared design process on workforce readiness for the situations that our healthcare partners care about most. Drawing on lessons from more than 800 readiness plans developed by participants in our courses and the authors' successes and mistakes in partnering with healthcare teams for front-line readiness, we introduce the concepts, commitments, and practices of "readiness planning" along with three detailed examples of readiness planning in action.

Addressing health inequities in health professions education is essential for preparing healthcare workers to meet the demands of diverse communities. While simulation has become a widely recognized and effective method for providing safe and authentic clinical learning experiences, there has been limited attention towards the power of simulation in preparing health practitioners to work with groups who experience health disparities due to systems of inequality. Balancing technical proficiency with educational approaches that foster critical reflection and inform action oriented towards social accountability is essential. Transformational learning promotes the development of critical consciousness through critical reflection. Debriefing plays a crucial role in fostering learning in this direction by providing a structured opportunity to critically reflect on taken for granted assumptions, examine power and privilege embedded within systems and structures, and empower learners to take action toward changing those conditions. Building on the Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool, we propose a PEARLS Debriefing for Social Justice and Equity (DSJE) Tool that specifically directs attention to systems of inequality that contribute to health disparities for vulnerable groups across a range of simulation scenarios. This approach has two aims: (a) to transform debriefings into a critically reflective space by engaging learners in dialogue about social and structural determinants of health that may create or perpetuate inequities and (b) to foster critical reflection on what actions can be taken to improve the health and well-being of identified at risk and vulnerable groups. From this perspective, we can use the adapted PEARLS Tool to incorporate conversations about systems of inequality, equity, diversity, and inclusion (EDI) into our existing educational practices, and make concentrated efforts towards community-driven and socially conscious simulation-based education (SBE).

Healthcare debriefing is a cognitively demanding conversation after a simulation or clinical experience that promotes reflection, underpinned by psychological safety and attention to learner needs. The process of debriefing requires mental processing that engages both "fast" or unconscious thinking and "slow" intentional thinking to be able to navigate the conversation. "Fast" thinking has the potential to surface cognitive biases that impact reflection and may negatively influence debriefer behaviors, debriefing strategies, and debriefing foundations. As a result, negative cognitive biases risk undermining learning outcomes from debriefing conversations. As the use of healthcare simulation is expanding, the need for faculty development specific to the roles bias plays is imperative. In this article, we hope to build awareness about common cognitive biases that may present in debriefing conversations so debriefers have the chance to begin the hard work of identifying and attending to their potential detrimental impacts.

There is growing recognition that preparing health professionals to work with complex social issues in the delivery of healthcare requires distinct theoretical and pedagogical approaches. Recent literature highlights the significance of employing simulated environments which aim to immerse learners in the experiences of diverse populations and bridge the gap between academic learning and lived realities across a diverse society. Virtual Reality (VR) is gaining traction as a promising pedagogical approach in this context. VR has been argued to offer distinct advantages over traditional educational methods by allowing learners to see the world through the eyes of diverse populations, and to learn about social injustices while immersed in a mediated environment. It also has practical benefits in its capacity to expose large number of students to these topics with relatively modest resources compared to other approaches. This debate article explores VR as an innovative pedagogical approach for facilitating critical reflection, dialogue and transformative learning about social issues in health professions education (HPE). It examines the potential affordances as well as risks and dangers of integrating VR into educational programs and highlights key pedagogical, practical, and ethical considerations. Emphasis is placed on the importance of these considerations in efforts toward ethical, safe, and respectful use of VR in educational settings. This paper contributes to the ongoing dialogue on VR simulation as an innovative approach to HPE and highlights the importance of creating conditions that maximize its educational benefits and minimize potential harms.

Racism continues to plague Western societies' institutions, including the healthcare system. Despite the evidence of racism's negative impacts on healthcare providers, administrators, patients, and families, healthcare workers report hesitancy in taking action to address racism in the workplace. Simulation, with its experiential pedagogy and foundation in psychological safety, may be an educational tool to support practical training. Guided by a social cognitive view of regulation of learning, we piloted virtual reality (VR) modules focused on addressing bias, privilege, and microaggressions. We used pre-/post-surveys, reflective journals, built-in VR platform data, and simulation debriefing session notes to better understand the effectiveness and usability of these VR modules in our organization. Overall, participants found the VR modules highly valuable, and we noted a shift in participants' reported intentions to take action to address racism in the workplace. Participants also noted the importance of a multifaceted plan that goes beyond education to ensure a meaningful culture shift toward addressing racism at work. Practical lessons from this pilot study included the necessity of an informed debriefing plan focused on participants' positionality and power and the need to deeply understand our institution's information technology (IT) environment to ensure successful deployment of VR technology.

Background: Positive outcomes of simulation programmes to prepare students for placement are widely noted. However, few studies adequately describe considerations for designing allied health placement simulations. There exists a conceptual framework to guide such simulation design, which draws on theory and educational expertise but to date lacks varied stakeholder perspectives. This study aimed to identify implications for the design of allied health placement simulation from participants' experiences of a simulation-based, interprofessional, novice placement preparation programme.

Methods: Occupational therapy, physiotherapy and podiatry students finishing their first year of study were offered a 1-week intensive interprofessional simulation immediately before their first placement. Focus groups in the following weeks allowed participants to discuss their experiences of the programme, preparation for student placements, and recommendations. These were transcribed and interpreted using reflexive thematic analysis and then abductively related to the conceptual framework.

Results: In total, 22 participants broadly representative of the simulation programme participants contributed to separate focus groups with domestic-enrolled students (n = 7), international students (n = 5), external practice educators (n = 6), and simulated participants (n = 4). Inductive reflexive thematic analysis generated six themes: (i) engaging learning environment, (ii) realism and relevance, (iii) student confidence and communication, (iv) international students' needs, (v) recommendations to facilitate further preparation for placement, and (vi) importance of preparation to engage in simulation. All participant groups were invested in the programme and highlighted learning opportunities. An immersive and relatable experience with active participation contributed to confidence and communication skill development. International students noted needs pertaining to cultural and language expectations. Other participant recommendations related to the equity of opportunities and specific preparation for placement student-educator interactions. Finally, every participant group noted features of effective preparation for simulation-based education.

Conclusions: Relating these findings abductively to the literature and conceptual frameworks, this study highlights simulation design considerations for learner needs assessment, engagement, realism, psychological safety, and challenge to prepare learners for their first clinical placement. Specific implications for adequately preparing all participant groups, design considerations for the needs of culturally diverse students, and balancing interprofessional and discipline-specific learning are highlighted from a lived experience viewpoint. Future research may engage greater stakeholder co-design in simulation-based education.

Faculty development in medical simulation is a growing need, given the increased use of simulation-based learning in healthcare. Training of trainers is demanding and resource-consuming; therefore, there is a need for accessible, practical, and resource-saving solutions enabling efficient faculty development. For that purpose, we investigated whether a massive open online course (MOOC) could meet these challenges. This manuscript presents a MOOC, its pedagogical strategies, and its impacts on faculty development. The University of Liège Medical Simulation Center developed a MOOC with five learning units focused on the foundations of simulation training. Each unit ends with a set of theoretical and practical exercises. Our results showed knowledge and skills acquisition (objective exercise score data) among participants with a success rate of 67%, as well as high levels of engagement and confidence in learning (self-reported data). We demonstrate that a MOOC for faculty development in healthcare simulation is effective, has the potential to be an accessibility enabler, and offers an additional tool for trainer training. We recommend designing it with various asynchronous online modalities and multiplying social interactions with peers and trainers to favor trainees' engagement and subsequent learning. Further perspectives should study blended learning strategies in faculty development and define the optimum ratio between face to face and online synchronous and asynchronous modalities.

Background: Interprofessional simulation-based team training (ISBTT) is commonly used to optimize interprofessional teamwork in healthcare. The literature documents the benefits of ISBTT, yet effective interprofessional collaboration continues to be challenged by complex hierarchies and power dynamics. Explicitly addressing these issues during ISBTT may help participants acquire skills to navigate such challenges, but guidelines on how to do this are limited.

Methods: We applied an educational design research approach to develop and pilot structured facilitator guidelines that explicitly address power and hierarchy with interprofessional teams. We conducted this work in a previously established ISBTT program at our institution, between September 2020 and December 2021. We first reviewed the literature to identify relevant educational theories and developed design principles. We subsequently designed, revised, and tested guidelines. We used qualitative thematic and content analysis of facilitator interviews and video-recording of IBSTT sessions to evaluate the effects of the guidelines on the pre- and debriefs.

Results: Qualitative content analysis showed that structured guidelines shifted debriefing participation and content. Debriefings changed from physician-led discussions with a strong focus on medical content to conversations with more equal participation by nurses and physicians and more emphasis on teamwork and communication. The thematic analysis further showed how the conversation during debriefing changed and how interprofessional learning improved after the implementation of the guidelines. While power and hierarchy were more frequently discussed, for many facilitators these topics remained challenging to address.

Conclusion: We successfully created and implemented guidelines for ISBTT facilitators to explicitly address hierarchy and power. Future work will explore how this approach to ISBTT impacts interprofessional collaboration in clinical practice.

Background: Debriefings are central to effective learning in simulation-based medical education. However, educators often face challenges when conducting debriefings, which are further compounded by the lack of empirically derived knowledge on optimal debriefing processes. The goal of this study was to explore the technical feasibility of audio-based speaker diarization for automatically, objectively, and reliably measuring debriefing interaction patterns among debriefers and participants. Additionally, it aimed to investigate the ability to automatically create statistical analyses and visualizations, such as sociograms, solely from the audio recordings of debriefings among debriefers and participants.

Methods: We used a microphone to record the audio of debriefings conducted during simulation-based team training with third-year medical students. The debriefings were led by two healthcare simulation instructors. We processed the recorded audio file using speaker diarization machine learning algorithms and validated the results manually to showcase its accuracy. We selected two debriefings to compare the speaker diarization results between different sessions, aiming to demonstrate similarities and differences in interaction patterns.

Results: Ten debriefings were analyzed, each lasting about 30 min. After data processing, the recorded data enabled speaker diarization, which in turn facilitated the automatic creation of visualized interaction patterns, such as sociograms. The findings and data visualizations demonstrated the technical feasibility of implementing audio-based visualizations of interaction patterns, with an average accuracy of 97.78%.We further analyzed two different debriefing cases to uncover similarities and differences between the sessions. By quantifying the response rate from participants, we were able to determine and quantify the level of interaction patterns triggered by instructors in each debriefing session. In one session, the debriefers triggered 28% of the feedback from students, while in the other session, this percentage increased to 36%.

Conclusion: Our results indicate that speaker diarization technology can be applied accurately and automatically to provide visualizations of debriefing interactions. This application can be beneficial for the development of simulation educator faculty. These visualizations can support instructors in facilitating and assessing debriefing sessions, ultimately enhancing learning outcomes in simulation-based healthcare education.

Background: Assessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.

Methods: ASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1-C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.

Results: Included were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885-0.996 [0.806, 0.998]) in all cases. Following participation, students' confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.

Conclusions: Hybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback. Trial registration ClinicalTrials.gov Identifier: NCT05895799.