Advances in simulation (London, England)最新文献

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.

Introduction: Interprofessional education (IPE) improves outcomes for staff and patients, yet most pre-licensure training remains siloed. Simulation-based education (SBE) enhances clinical and communication skills, with particular benefit during transitions in training. While immersive simulation is costly, could integrating IPE and SBE at key transition points optimize its educational impact? This study explores how interprofessional simulation can support transitions to practice, and what unique value it can contribute to the learning experience.

Methods: This phenomenological study explored medical students' experience of an interprofessional SBE programme. Adopting a sequential, mixed-methods design, students were asked about their experiences of participating in interprofessional simulations using various data collection methods over their transition from pre-licensure to professional practice. Methods included surveys (n = 229), one-on-one interviews (n = 29), focus groups (13 participants) and 1-year follow up interviews (n = 7). The qualitative data from interviews and focus groups are reported here. Codes and meaning units were developed and then scrutinized to develop a nuanced understanding of how the elements of the interprofessional simulation experience intertwined and the impact this had on the students.

Results: Three overarching themes were identified from the analysis and were explored in greater detail: realism, gaining confidence and learning to observe (noticing). Interprofessional SBE provides the realistic environment for a unique educational experience in which students develop skills of observing interprofessional clinical practice, and can gain confidence for the transition into that practice. The implications are that the time and effort invested in overcoming the obstacles to offering interprofessional SBE lead to learning outcomes that may not otherwise be achieved. The results are further discussed through three theoretical lenses: Meyer and Land's threshold concepts, Richards' interdependent agentic capabilities and Lave and Wenger's legitimate peripheral participation.

Conclusion: Interprofessional simulation offers students immersive, emotionally resonant experiences that enhance confidence, professional identity, and integration into clinical teams. These simulations prompt reflection on future roles and foster deeper understanding of interprofessional dynamics. The study identifies specific attributes of simulation that meaningfully contribute to learning, extending current SBE literature. By using a qualitative lens, this research highlights the unique value of interprofessional SBE in preparing students for collaborative practice and the complexities of modern healthcare.

Background: Interprofessional simulation-based education (IPSE) holds the potential to prepare healthcare students to handle the complexity of healthcare. However, complexity and resilience are traditionally not addressed deliberately in IPSE. The aim of this study was to explore the effect of resilience-focused debriefing (RFD) that addresses complexity and resilience, on reflection and teamwork in IPSE for pre-graduate healthcare students.

Methods: In a convergent mixed methods intervention study, 149 nursing and medical students in their last semester participated in a full-day IPSE course with five progressively challenging scenarios. Fifteen facilitators were instructed to use RFD. Qualitative date, comprised of transcripts from nine debriefings, were analysed using topic analysis. An intervention check was performed to assess the use of RFD. Quantitative data comprised pre-post ratings of team performance in videorecorded scenarios (1 and 5) from 18 groups using the Team Emergency Assessment Measure (TEAM). Additionally, a study-specific rating scale was employed to assess the extent of participants' perceived challenges during scenarios.

Results: RFD helped facilitators to guide the students' attention to the complexity of teamwork and how to manage such complex situations successfully by adapting crisis resource management principles and performing resilient actions (e.g., attunement, adaptive leadership), both as individuals and as teams. Applying RFD brought the students' attention to how they were able to succeed despite the difficulties they encountered. Although the assessed team performance was on an acceptable level, students initially had difficulties in recognizing and learning from actions that led to successful outcomes. The significant decrease in the degree of challenges experienced suggests that students developed a greater tolerance for complexity. Nevertheless, the quantitative data showed that there was no pre-post difference in team performance as assessed by TEAM.

Conclusions: RFD can be used to increase healthcare students' attention to the complexity of interprofessional teamwork in acute dynamic situations and help them recognize and learn from both successful actions and overcoming challenging situations. Although we did not find a significant gain in team performance, the integrated results suggest that RFD may potentially improve interprofessional teamwork. Further research is warranted to develop instruments measuring team performance that are sensitive to various aspects of resilience, as well as to deepen the understanding of RFD in the simulation-based education.

Background: Simulation-based education (SBE) improves learner competence, patient safety and workforce readiness. Yet, existing frameworks such as INACSL and ASPiH provide limited guidance on developing sustainable, institution-wide strategies, particularly in decentralised, multidisciplinary contexts. This study aimed to create a faculty-wide SBE strategy using the e-Delphi method to build consensus among diverse stakeholders.

Method: The study was conducted at a UK higher education institution without a centralised simulation centre. An e-Delphi process was used to refine strategic statements across three survey rounds. Panellists were purposively sampled and included internal and external academics, postgraduate and undergraduate students, and international contributors from 7 countries and 15 healthcare-related professions. Initial statements were derived from established SBE frameworks and refined based on quantitative agreement (≥ 80% consensus) and thematic analysis of free-text feedback.

Result: Of 111 invited participants, 41 completed Round 1, increasing to 43 in Rounds 2 and 3. The process produced 39 final strategic statements grouped under eight strategic priorities: (1) Leadership and governance; (2) Communication and networking; (3) Training and development; (4) Standards and quality assurance; (5) Research and evaluation; (6) Accessibility; (7) Preparation and planning; and (8) Finance. These priorities map to three overarching themes-Connectivity, collaboration and partnership; Promoting quality; and Stability, sustainability and growth of SBE. The strategy embeds SBE into institutional processes, aligning it with budgeting, infrastructure planning, workforce development, and digital transformation. It emphasises multi-level governance, sustainability planning, technology integration and inclusivity through student patient and public involvement and engagement (PPIE) representation.

Conclusion: The e-Delphi method effectively built consensus on a comprehensive SBE strategy tailored to a decentralised, multidisciplinary faculty. The strategy goes beyond existing frameworks by integrating sustainability, multi-level governance, and structured technology planning, while embedding student and PPIE perspectives. It offers a scalable, replicable model for institutions seeking to align simulation provision with strategic priorities, accreditation standards and equitable access. Future research should examine the strategy's impact on educational outcomes, workforce readiness and its adaptability across disciplines and institutional contexts.

Background: In situ simulation can identify latent safety threats in healthcare, yet there has been limited focus on how these threats are subsequently addressed. Adopting a systematic approach to identifying, reporting, and resolving threats found during in situ simulations could enhance clinical safety and system resilience. This study investigated the resolution of safety threats detected through in situ simulation courses in Aotearoa New Zealand hospitals, aiming to quantify resolution rates and examine factors influencing successful resolution.

Methods: This multicentre study used an exploratory sequential mixed-methods design. We collected data on latent safety threats identified after in situ simulations using a structured reporting tool and assessed their resolution three months post-course. Associations between resolution and threat classification, risk assessment score, course type, and hospital size were analysed. Qualitative interviews with hospital simulation convenors explored contextual and experiential factors affecting resolution.

Results: Across 20 courses in 15 hospitals, 278 safety threats were identified at the three-month follow-up, with 28% resolved. Threats involving equipment, environmental layout, and tasks were more often resolved than those related to teamwork or organisational factors. Smaller hospitals showed higher resolution rates; multilevel regression confirmed hospital size and threat classification as significant predictors of resolution. Qualitative thematic analysis of 15 interviews identified five key themes: influence of threat type; motivation to resolve the threat; identifying and communicating the threat; clinician agency within their organisation; and hospital structures and processes to support resolution of identified safety threat. Tangible threats within clinicians' control were addressed more readily, often through straightforward interventions; conversely, threats requiring cross-departmental collaboration or structural change remained unresolved due to limited authority, time, and institutional support.

Conclusion: While in situ simulation effectively identifies latent safety threats, threat resolution remains limited. Our findings highlight the need to align institutional processes with frontline clinicians' insights. Effective threat mitigation depends on both threat characteristics and organisational context. To fully realise the opportunity presented by in situ simulation to improve patient safety, healthcare systems must move beyond threat identification to actively support resolution-by empowering clinicians, enabling multidisciplinary collaboration, and embedding clear processes for follow-up and accountability.

Background: As more people age, healthcare professionals require skills in using tools for interprofessional, holistic health needs assessments to support aging in place. While simulation training is recognized to build professional skills, its application in training interprofessional teams by using tools to holistically assess and plan care for older adults at home remains limited.

Aim: To explore healthcare professionals' perceptions of interprofessional simulation training in assessing the holistic health needs of older adults living at home (i.e., physical, cognitive, mental, sensory, behavioral, and social) and their views on appropriate measures.

Method: A qualitative, exploratory study with five simulation training sessions focused on assessing health needs in older adults living at home. The simulation included 11 participants (nurses, physical therapists, and occupational therapists). The simulation sessions comprised introduction, briefing, scenario with role play, and debriefing, and were conducted in a home-like laboratory. The introduction prepared participants through e-modules. The briefing covered information about the scenario, participant roles, and tools to assess physical, cognitive, mental, sensory, behavioral, and social health needs. Participants chose either an active or an observer role in a scenario involving a health needs assessment in an older adult's home. This was followed by debriefing during which participants shared their experiences. The debriefing transcripts served as the study data and were analyzed using thematic analysis.

Results: Participants reported that the tools to assess health needs provided systematic and holistic insight on the health of a simulated older adult. They perceived that interprofessional collaboration supported both the assessment process and engagement with the older adult. Participants perceived that assessment scores informed decisions about necessary measures and could enhance older adults' awareness of their functional abilities, potentially stimulating health-promoting actions. Participants perceived the simulation training as useful and realistic, and both the active and observer roles gave valuable experiences.

Conclusion: Interprofessional simulation training enabled healthcare professionals to practice holistic assessment and identify the health needs of older adult. They perceived that such assessments could inform appropriate measures and promote health. The participants reported the simulation training to be authentic and meaningful.

Background: There is limited evidence and humanistic thinking about the thoughts and reactions of peer observers during nursing simulation. An increased understanding may provide new insights and opportunities to advance therapeutic relationships and holistic care. This study explored peer observer and active participant thoughts during simulation to better understand how shared learning experiences transform and improve nursing practice.

Methods: A qualitive descriptive design generated data via peer observers and active participants' self-reported experiences from pre-registration second-year, nursing students. Responses were synthesized and analyzed using reflexive thematic analysis.

Results: From 175 peer-observer accounts, four codes were generated and synthesized into three themes: Observer self-critique and critique of others; observer empathy and affect; and observers' outsider perspective. Six codes were generated from the analysis of 234 active participant accounts analysis and synthesized into three themes: participant affect; participant cognition and participant confidence.

Conclusions: The peer observer role can experience simulation as an immersive and emotive encounter that may indicate active and deep learning is occurring. Simulation learning design should prioritize the identification of empathy experienced by observers for the participants and explicitly include it in cognitive processing undertaken during simulation debrief. Linking the experience of empathy with nursing theory in simulation is a powerful learning tool.

Background: Simulation-based education offers a risk-free platform to prepare future health professionals for interprofessional collaboration during high-stakes emergencies. This study involved the design, implementation, and evaluation of a disaster-focused simulation to enhance interprofessional competencies among health professions students.

Methods: An interprofessional education (IPE) simulation covering the four disaster preparedness and management phases (mitigation, preparedness, response, recovery) was conducted for undergraduate health professions students. Students, assessors, and standardized patients (SPs) participated in the evaluation. Data on interprofessional competencies were collected from students using the Team's Perception of Collaborative Care Questionnaire, from assessors using the Modified McMaster-Ottawa Scale, and from SPs using the Standardized Patient Team Evaluation Instrument. Descriptive statistics were used to summarize study variables. Paired sample t-tests were conducted to compare score differences between assessors. Learning curve across cases were tested using one-way repeated measures ANOVA, and associations between global scores and demographic variables were analyzed using t-test or ANOVA, as appropriate.

Results: Thirty-three students, 13 assessors, and 8 SPs participated in the evaluation. response rates were 33.3% (students), 92.9% (assessors), and 100% (SPs). Students self-reported positive perceptions of teamwork in the activity, with over 90% agreement across all domains. Assessors' ratings for the response phase corroborated these findings, with over 80% of students scoring at or above expectations in all domains. SPs' evaluations were also high, with 70% agreeing that students demonstrated positive interprofessional practice behaviors. For the diabetic ketoacidosis case, teams' global performance scores were calculated as the mean of the two assessors' ratings. Students with prior IPE experience (M = 2.42, 95% CI: 2.24-2.60) and those who had completed a prior practice placement (M = 2.48, 95% CI: 2.30-2.65) performed significantly better than students without IPE experience (M = 2.06, 95% CI: 1.80-2.33) or a prior practice placement (M = 2.12, 95% CI: 1.86-2.37). While not statistically significant, a trend towards improved performance across cases in the response phase suggested a learning curve effect.

Conclusions: Simulation-based IPE can strengthen interprofessional competencies for disaster preparedness and management, with greatest benefit when preceded by other IPE activities and clinical placements.