Advances in simulation (London, England)最新文献

Background: Teaching and learning debriefing and feedback skills-especially to a level of mastery-is challenging without an agreed-upon standard. There are a number of rating scales and rubrics to identify and evaluate debriefing and feedback skills that focus on an entire feedback or debriefing conversation. However, there is no rubric to assess and provide feedback on one of these conversations' most widely used microskills, the Advocacy-Inquiry technique. This study aimed to develop and preliminarily test the Advocacy-Inquiry Rubric (AIR)-a tool designed to support the teaching, coaching, and assessment of Advocacy-Inquiry, a widely used yet challenging debriefing microskill-through an international expert consensus process.

Method: Using a four-round Delphi process, we achieved expert consensus on the behavioral markers of effective and ineffective Advocacy-Inquiry techniques. Thirty-nine experts from 13 countries identified and refined a set of key behavioral anchors for each of Advocacy-Inquiry's five elements: Preview, Observation, Point of View, Inquiry, and Listen. These descriptors were embedded first in a seven-point numeric Behaviorally Anchored Rating Scale, then in a three-point emoji-based version, and finally in a teaching and learning version. The AIR underwent two rounds of usability testing and inter-rater testing of the emoji version. Using an interpretation-use argument approach, evidence was collected for AIR's validity across scoring, generalization, extrapolation, and implication.

Results: The Delphi process established descriptors for each element of Advocacy-Inquiry, categorized by proficiency level (beginner to advanced). Usability testing enhanced the AIR's graphic layout to support both numeric ratings and formative feedback. The AIR was adapted into three tailored versions: a numeric AIR for detailed evaluation and progress tracking, an emoji AIR for peer assessment, and a teaching and learning AIR. Evidence for validity was assessed, highlighting both strengths and gaps.

Conclusion: AIR is an empirical rubric based on expert-derived criteria to support teaching, coaching, and assessing Advocacy-Inquiry microskills. The AIR offers a structured framework for self-, peer-, and mentor-led feedback and assessment to enhance a core skill of facilitators. By anchoring assessments in clear behavioral descriptors, the AIR aims to improve the quality of feedback and debriefing conversations. Future work should focus on rater training, reliability testing, and exploring the AIR's impact on real-world outcomes.

Background: Simulation-based education is a well-established training technique in medical curricula, also for communication skills. Virtual reality (VR) technology can enhance this form of experience-based learning. How VR interacts with training communication skills for interpersonal and interprofessional medical encounters is, however, unclear. This study investigates how VR influences communication skills and behaviors in patient-student and team encounters in medical undergraduate simulations, in order to make recommendations for VR simulation-based communication skills training (CST).

Methods: We conducted a study with 22 third-year medical students completing a dyadic VR simulation (Smart Collaboration Tutor software). We coded communication skills and behaviors for team and patient-student communication in videorecorded VR simulations. We then analyzed communication patterns and finally developed themes for VR-mediated CST.

Results: Our findings revealed that students preferred the core communication skill of asking questions, informing, and thinking aloud as process communication skills in a VR simulation. Nonverbal and paraverbal behaviors were used with unclear intent. VR negatively impacted the focus of attention and flow of simulation-based communication skills training.

Discussion: Dyadic VR simulations tend to emphasize team and task-oriented communication. Its value for patient-student and relation-oriented communication is unclear. VR influenced conversational turn-taking by altering visual and auditory perceptions. Cognitive load was enhanced, potentially diverting attention from communication goals and observational focus.

Conclusion: Multiuser VR simulation shows certain possibilities for CST in medical undergraduate simulations. Recommendations on the contextual design of VR simulations, however, need to be taken into account to safeguard the focus of attention and flow of CST.

Background: The increasing use of artificial intelligence (AI) by scholars presents a pressing challenge to healthcare publishing. While legitimate use can potentially accelerate scholarship, unethical approaches also exist, leading to factually inaccurate and biased text that may degrade scholarship. Numerous online AI detection tools exist that provide a percentage score of AI use. These can assist authors and editors in navigating this landscape. In this study, we compared the scores from three AI detection tools (ZeroGPT, PhraslyAI, and Grammarly AI Detector) across five plausible conditions of AI use and evaluated them against human assessments.

Methods: Thirty open access articles published in the journals Advances in Simulation and Simulation in Healthcare prior to 2022 were selected, and the article introductions were extracted. Five experimental conditions were examined, including: (1) 100% human written; (2) human written, light AI editing; (3) human written, heavy AI editing; (4) AI written text from human content; and (5) 100% AI written from article title. The resulting materials were assessed by three open-access AI detection tools and five blinded human raters. Results were summarized descriptively and compared using repeated measures analysis of variance (ANOVA), intraclass correlation coefficients (ICC), and Bland-Altman plots.

Results: The three AI detection tools were able to differentiate between the five test conditions (p < 0.001 for all), but varied significantly in absolute score, with ICC ranging from 0.57 to 0.95, raising concerns regarding overall reliability of these tools. Human scoring was far less consistent, with an overall accuracy of 19%, indistinguishable from chance.

Conclusion: While existing AI detection tools can meaningfully distinguish plausible AI use conditions, reliability across these tools is variable. Human scoring accuracy is uniformly low. Use of AI detection tools by scholars and journal editors may assist in determining potentially unethical use but they should not be relied upon alone at this time.

Background: Generative artificial intelligence models are being introduced as low-cost tools for creating simulated patient cohorts in undergraduate medical education. Their educational value, however, depends on the extent to which the synthetic populations mirror real-world demographic diversity. We therefore assessed whether two commonly deployed large language models produce patient profiles that reflect the current age, sex, and ethnic composition of the UK.

Methods: GPT-3.5-turbo-0125 and GPT-4-mini-2024-07-18 were each prompted, without demographic steering, to generate 250 UK-based 'patients'. Age was returned directly by the model; sex and ethnicity were inferred from given and family names using a validated census-derived classifier. Observed frequencies for each demographic variable were compared with England and Wales 2021 census expectations by chi-square goodness-of-fit tests.

Results: Both cohorts diverged significantly from census benchmarks (p < 0.0001 for every variable). Age distributions showed an absence of very young and older individuals, with certain middle-aged groups overrepresented (GPT-3.5: χ2(17) = 1310.4, p < 0.0001; GPT4mini: χ2(17) = 1866.1, p < 0.0001). Neither model produced patients younger than 25 years; GPT-3.5 generated no one older than 47 years and GPT-4-mini no one older than 56 years. Gender proportions also differed markedly, skewing heavily toward males (GPT-3.5: χ2(1) = 23.84, p < 0.0001; GPT4mini: χ2(1) = 191.7, p < 0.0001). Male patients constituted 64.7% and 92.8% of the two cohorts. Name diversity was limited: GPT-3.5 yielded 104 unique first-last-name combinations, whereas GPT-4-mini produced only nine. Ethnic profiles were similarly imbalanced, featuring overrepresentation of some groups and complete absence of others (χ2(10) = 42.19, p < 0.0001).

Conclusions: In their default state, the evaluated models create synthetic patient pools that exclude younger, older, female and most minority-ethnic representations. Such demographically narrow outputs threaten to normalise biased clinical expectations and may undermine efforts to prepare students for equitable practice. Baseline auditing of model behaviour is therefore essential, providing a benchmark against which prompt-engineering or data-curation strategies can be evaluated before generative systems are integrated into formal curricula.

Background: A large portion of preventable deaths is a result of uncontrolled bleeding due to a delay in medical intervention. While publicly accessible tourniquets raise the concern of incorrect application by laypeople, tourniquets have proven efficacy and can be effectively applied by bystanders. This systematic review aims to identify if tourniquets applied by laypeople using a basic manikin or tourniquet trainer extremity with little to no training can effectively control bleeding.

Methods: The authors used EBSCOHost to simultaneously search the following databases: Cumulated Index in Nursing and Allied Health Literature (CINAHL) Ultimate, Academic Search Premier, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Medical Literature Analysis and Retrieval System Online (MEDLINE) with Full Text. Boolean search strategy included tourniquet AND (layperson OR laypeople) AND ((bleeding AND control) OR (hemorrhage AND control) OR "stop the bleed") NOT surgery. The search was limited to January 1, 2013, to August 31, 2023. Inclusion criteria were layperson participants in peer-reviewed randomized controlled or clinical trials, available in English, that assessed at least one outcome measure related to the efficacy of tourniquet application in a simulated context. Articles including duplicate data and those regarding tourniquet use/efficacy in settings other than prehospital care or bleeding control were excluded. Two independent reviewers selected studies according to prespecified inclusion and exclusion criteria. Risk of bias was assessed using the Cochrane RoB 2 tool.

Results: The initial search identified 83 studies, with 10 retained for inclusion in this review. Two different windlass rod tourniquets and one ratcheting strap tourniquet performed the best in terms of successful application by laypeople. Completing formal bleeding control training increased the average application success rate compared to no prior training. The Layperson Audiovisual Assist Tourniquet was the only audiovisual point-of-care aid that significantly increased the rate of successful applications. Just-in-Time visual cards also increased success rates significantly, showing comparable benefits to manufacturer instructions.

Conclusion: Although some laypeople can successfully place tourniquets without prior training, successful placement rates can be improved with point-of-care aids and formal bleeding control training using a basic manikin or tourniquet trainer extremity.

Background: Safer Births Bundle of Care (SBBC) is a continuous quality improvement (CQI) program, implemented in 30 facilities in Tanzania, resulting in a 75% reduction in maternal deaths. Simulation training was introduced as a component of the CQI efforts, targeting individual and team skills, focusing on identified clinical needs.

Objective: The aim of this study was to describe the frequency of documented simulation sessions and the number of recurrent participants and associations with changes in maternal death.

Methods: SBBC was a stepped-wedge cluster randomised implementation study in 30 facilities in 5 regions of Tanzania from 2020 through 2023. The SimBegin® facilitator training program was introduced to train facilitators and support implementation of a training cascade. Fifteen selected healthcare workers were trained in three levels of SimBegin® to become facilitators (level 1) and mentors (level 2). Eight were trained to become instructors (level 3). In total, 90 local facilitators were trained to review local clinical data, run simulation sessions, and document in logbooks. Clinical data were collected from patient files by independent data collectors and looped back to the facilities on a weekly basis. Training interventions were planned, conducted, and evaluated based on identified gaps. Output measures were the frequency of simulation sessions, the number of recurring participants, and maternal death within 7 days postpartum the following month.

Results: Overall, 281,165 parturient women were included in this study. The SBBC implementation period was 24-32 months, and 1280 simulation sessions were documented. Maternal deaths declined from 240/100,000 births in the baseline to 60/100,000 after the start of SBBC. There was an association between the frequency of simulation sessions and the reduction in maternal deaths (23% reduction per each unit increase on the log scale, P = 0.0018), and between the number of recurring participants and the reduction in maternal deaths (16% reduction per each unit increase on the log scale, P = 0.0006).

Conclusion: This study documents a significant and clinically relevant association between the frequency of and participation in simulation sessions and the reduction of maternal deaths the following month.

Trial registration: SBBC main protocol ISRCTN Registry: ISRCTN30541755. Prospectively registered 12.10.2020.

Background: The following study aims to determine the learning curve experienced by anesthesia residents when training for an ultrasound-guided popliteal sciatic block and the transference of this training to real patient situations.

Methods: After approval by the ethics committee, eleven first-year anesthesia residents were recruited to participate in a simulation-based training program to perform a single shot in plane popliteal sciatic block. Training consisted of 10 individual sessions, with direct feedback from the instructor, with a specific Laerdal® popliteal sciatic block phantom, lasting one hour and distributed weekly. At the end of each session, the resident's performance was assessed. Residents were videotaped while performing the block, which was to be evaluated using a validated global rating scale (GRS). Additionally, a tracking motion device attached to the operator's hands (Imperial College Surgical Assessment Device, ICSAD) recorded the total distance traveled by both hands (Total path length, TPL), number of movements (NM), and total procedure time (TPT). One week later, the same assessment was done on a real patient.

Results: Ten residents completed the training and the assessments. Median values of GRS scores significantly improved from 15 to 28.3 through the training (p = 0.006). Regarding ICSAD scores, TPT improved from 126 to 63.4 s (p = 0.002), and TPL improved from 11.07 to 9.4 m (p = 0.322). When comparing the last simulated session and the subsequent measurement in an actual patient, median values of GRS, TPL and NM were not different.

Conclusions: This simulation-based training program significantly improved residents' proficiency in an ultrasound-guided popliteal sciatic block. The learning curve plateaued at session 7, and this improvement was transferred to the real patient setting. As expected, residents needed more time for the first block on a real patient than for the last simulated session.

Clinical trial number: ClinicalTrials.gov, identifier NCT06081790.

Background: The acquisition and maintenance of technical skills in surgical specialties has become increasingly challenging for postgraduate trainees, exacerbated by factors such as the shift from traditional apprenticeship models, reduced operative time, and the impact of the COVID-19 pandemic. Virtual reality (VR) simulators offer a promising adjunct to traditional surgical training, though their integration into routine practice remain underexplored.

Objective: This qualitative study investigates the experiences and motivations of general surgical trainees who engaged with a VR laparoscopic simulator as part of a structured training program.

Methods: A case study methodology was chosen to explore the experiences of 22 general surgery trainees using a VR laparoscopic simulator over a period of 3 months. Each of the trainees were adviced to practise a minimum of five repetitions across 25 laparoscopic simulator exercises. The study was designed using Kopta's theory of technical skill learning, focusing on the cognitive phase, where trainees repetitively practised individual steps with feedback. Data collection involved qualitative questionnaires, semi-structured interviews (of seven of the trainees, 8 months later), and quantitative data from the simulator. The qualitative data was analysed using thematic analysis, and descriptive statistical tests were applied to the quantitative data for triangulation.

Results: The study identified key factors influencing trainee engagement, including ease of access, the importance of periodic rather than frequent simulation sessions, Annual Review of Competency Progression (ARCP) overview and the value of setting specific performance goals. The findings suggest that simulation can effectively complement traditional surgical training when incorporated into routine practice, with potential for broader application if barriers such as time constraints and access issues are addressed.

Conclusion: This study contributes to the literature on surgical education by highlighting the need for targeted strategies to enhance the use of simulation as an adjunct alongside more traditional training.

Background: Angiography simulator training (AST) can help to train important clinical aspects of complex angiography procedures before real patient contact. The aim of the present analysis was to synthesize the results of studies on endovascular interventions performed by interventionalists with and without AST in a meta-analysis.

Methods: A systematic literature research was performed in PubMed, Web-of-Science and CINAHL to identify all relevant studies. Inclusion criteria were original research, English language and comparison of endovascular interventions in procedure time (PT) and fluoroscopy time (FT) performed by interventionalists with and without AST. Study quality was assessed using modified Downs-and-Black-instrument (maximum 8 points). Heterogeneity-analysis (study design and I²) was determined, and fixed- or random-effects model was applied to pool the effect, mean difference (MD), from the individual studies. All analyses were performed two-sided, and the level-of-significance was 0.05.

Results: Overall, 9 studies with 10 datasets and 7774 interventions were included. Study quality was 7 ± 0 for both PT and FT. Heterogeneity was present in the studies on PT (I² = 61%) and FT (I² = 99%), and a random-effects model was applied. MD for PT was significant with -2.63 min between the AST-group and control-group among the included studies (p = 0.02). In contrast, MD was not significant with -1.33 min between the AST-group and control-group among the included studies for FT (p = 0.21).

Conclusion: AST translates into an improved PT and similar FT in real interventions compared to conventional training. Angiography simulators offer a valuable, radiation-free alternative and expand training opportunities. Evidence is limited by study heterogeneity.