Advances in simulation (London, England)最新文献

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: 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.