Advances in simulation (London, England)最新文献

Introduction: Healthcare simulation programmes measuring their value risk wasting resources in attempts to prove they impact patient outcomes. Simulation is one of many strategies used to enhance healthcare systems, and proving specific correlation with simulation will prove impossible in many circumstances. To maintain accountability but ensure feasibility, we argue simulation services need measurement processes that are robust, achievable, and synergistic with their mission. In 2023, the STORK service in Queensland, Australia, began measuring the impact of simulation on systems rather than patients to define the extent to which their educational programmes could impact system improvement.

Methods: Translational simulation methodologies and quality improvement measures were embedded in an established educational course. We used simulation activities to diagnose environmental and system-level problems in participants' workplaces throughout Queensland. Courses included dedicated time to discuss site-specific actionable solutions with participants and identified local champions to implement quality improvement changes. By designing a novel electronic reporting process (Optimus PRIME Course Summary), we documented issues and solutions identified in regional healthcare facilities and ensured they reached key stakeholders. We audited our ability to improve these systems through follow-up data collection via phone and emails with local educators across the state.

Results: From 40 courses delivered across 37 facilities, 242 issues were identified, primarily related to drug safety and equipment management. At follow-up, 45.5% of the issues were resolved, with 44.6% still being addressed. Recommended resources were successfully implemented in 64% of sites.

Conclusion: This process demonstrates that focusing on system-level changes can significantly enhance healthcare systems. The reporting framework provided a robust, achievable, and synergistic method to measure simulation impact and influence change. Additionally, we share key lessons learned from the process to guide other simulation services in improving their own measurement strategies.

Background: Simulation is widely used across many aspects of health professions education and, in recent years, has begun to be explored as an assessme nt tool, particularly in relation to examining technical clinical skills. Although previous research has suggested that simulation may be an effective tool for assessing clinical skills, there is a lack of evidence exploring which form of technology may be a more reliable assessment tool. This crossover study aimed to compare two forms of simulation technology-a high-fidelity manikin and virtual reality, as potential tools for assessing acute clinical care assessment skills.

Methods: The participating students completed two different simulation scenarios: one scenario using a high-fidelity manikin and one using a virtual reality system. The two scenarios were then marked using a checklist created for the research and a global assessment score. The results for each simulation technology were compared with one another and compared with the participants' medical final summative assessment scores.

Results: Sixteen students participated in the research. The assessment checklist scores from the two technologies were comparable, with no statistically significant difference (p = 0.918) and a strong positive correlation between the two (correlation coefficient = 0.665, p = 0.005). However, neither simulation technology had a statistically significant correlation with the summative final written examination paper (high-fidelity manikin: correlation coefficient = - 0.25, p = 0.927; virtual reality: correlation coefficient = 0.363, p = 0.167) or final clinical examination scores (high-fidelity manikin: correlation coefficient = - 0.204, p = 0.449; virtual reality: correlation coefficient = - 0.201, p = 0.455).

Conclusions: The findings from this research suggest that virtual reality simulation is comparable to high-fidelity simulation when comparing student scores across the two forms of simulation. However, neither method demonstrated a strong correlation with final summative examination outcomes, suggesting that a single scenario assessment using either technology may not provide an appropriate alternative to existing final summative examinations. To better understand the role of simulation in assessment, further research is needed to compare these two simulation technologies in more depth and provide additional evidence to support educators in understanding how they can be best used within health professions education.

Background: Healthcare simulation services are increasingly expected to demonstrate their value-a term that remains highly context-dependent and frequently misunderstood. While traditional models such as Kirkpatrick and Phillips have supported early evaluation efforts, they embed hierarchical assumptions about which types of data matter most. These assumptions can constrain recognition of simulation's broader contributions and lead to misguided or inefficient measurement practices.

Main body: In this paper, we propose the value-based simulation in healthcare (VBSH) model, an adaptation of Phillips' framework that offers simulation-specific nomenclature and a service-level lens. Structured as a taxonomy rather than a hierarchy, the VBSH model comprises six freestanding but interdependent categories: Service Products, Program Perceptions, Acquired Expertise, Workplace Performance, System Benefit, and Value Analyses. This model is designed to support simulation teams and organizational leaders in selecting relevant measurement strategies, aligning simulation work with institutional goals, and co-creating metrics that are operationally meaningful.

Conclusion: By reframing simulation as a vector for insight, improvement, and transformation-not just training delivery-the VBSH model aims to shift the conversation from metric power to metric relevance, fostering a more accurate, efficient, and context-aware narrative of simulation's value in healthcare.

Background: Impostor phenomenon (IP) is a common experience among healthcare professionals, characterised by persistent feelings of inadequacy, fear of being exposed as a fraud, and self-doubt, despite external evidence of competence. In healthcare simulation, where educators frequently transition between roles and responsibilities, little is known about how simulation educators experience and navigate IP throughout their careers. This study aims to explore the lived experiences of IP among healthcare simulation educators.

Methods: The study builds on our earlier work in which simulation educators used the Clance Impostor Phenomenon Scale for identifying self-reported IP. Participants were recruited through professional networks. Using a hermeneutic phenomenological approach, we explored the lived experiences of 20 simulation educators. Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Data were analysed using an iterative process of interpretation grounded in hermeneutic inquiry.

Results: Four themes were identified: (1) I don't have the right badges, where educators described feeling unqualified and in constant need of external validation; (2) Now you see me, now you don't, illustrating how IP led participants to minimise themselves in professional settings; (3) Friend or foe, revealing the dual role of IP as both a motivator and a source of insecurity; and (4) Hello, my old friend, highlighting the cyclical nature of IP, where feelings of self-doubt resurface.

Conclusions: IP is a persistent and cyclical experience among healthcare simulation educators. While IP can drive some educators to strive for excellence, it can also lead to anxiety, self-minimisation, and missed opportunities. We call on the healthcare simulation community to develop and study strategies such as tailored professional development, mentorship, and communities of practice, to support educators in managing and mitigating negative impacts of IP on performance and well-being.

Background: Healthcare systems are inherently complex, shaped by dynamic interactions and interdependencies rather than rigid structures. Simulation-based training interventions must embrace this complexity. Complex Adaptive Systems and Resilient Healthcare provide complementary theoretical frameworks for understanding how healthcare systems can respond to internal and external needs while maintaining adaptability and functionality. Incorporating concepts from Complex Adaptive Systems and Resilient Healthcare into simulation-based interventions increases the likelihood of their success within contemporary healthcare systems. A focus on adaptability, continuous learning, and system-wide resilience is necessary for healthcare improvement, and simulation interventions can help develop and reinforce these capabilities. In this article, we argue that simulation must be reimagined to reflect the realities of complex healthcare systems and propose a conceptual framework to support this shift.

Main body: We propose a three-component conceptual framework for simulation practitioners seeking to design and deliver interventions that embrace complexity: (1) Problem identification, (2) simulation design, and (3) evaluation strategies. The three components function across organizational levels, supporting a dynamic and adaptive approach to addressing healthcare system challenges. By integrating Complex Adaptive Systems and Resilient Healthcare principles, simulation-based interventions can foster a complexity-aware mindset, enabling healthcare professionals and organizations to anticipate, respond to, and recover from challenges more effectively. To illustrate this framework, we introduce three vignettes demonstrating how simulation-based interventions may benefit at different levels within healthcare systems. The vignettes illustrate how challenges at the institutional, departmental, and individual levels can be identified and addressed effectively by simulation-based interventions.

Conclusion: Simulation interventions can strengthen healthcare systems by supporting organizational learning and embedding principles from complexity science and resilience thinking. This requires reimagining simulation not as isolated training events but as complex interventions that operate across levels and respond to dynamic system needs. By adopting this systems-based approach, simulation practitioners, healthcare leaders, and policymakers can better align simulation with real-world conditions - bridging theory and practice while fostering more adaptive and resilient care.

Background: Changes in healthcare systems are often highly stressful experiences for healthcare teams, contributing to disengagement and resistance to change. Translational simulation has been shown to be impactful at both organisational and department-based levels; however, its impact on the experience of change for frontline staff has not, to date, been explicitly explored. Understanding the impact of translational simulation on the perception of teams exposed to healthcare system changes, and how to optimise our approaches to support change management on a team and individual level, may be the difference between an overwhelmed and disengaged workforce and a positive and engaged one.

Methods: We used template analysis as an analytic tool to gain new understanding of the impact of translational simulation on the experiences of staff members undergoing change. Utilising Bartunek et al.'s (2006) conceptual framework to inform the priori themes of our template, we interviewed nine Registered Nurses involved in a major relocation into a purpose-built paediatric hospital in Edinburgh, UK. We sequenced the interviews to take place in the lead up to a planned simulation event, with a follow up second interview 1 month after the hospital move. On the day of the simulation, we additionally collected a series of 'headline' thoughts from the group across the simulation to track their thoughts and feelings toward the move. Interviews and 'headlines' were recorded, transcribed, and thematically analysed using template analysis methods.

Results: Our findings demonstrate that the use of translational simulation significantly enhanced staff preparedness and engagement during a major hospital relocation, suggesting that incorporating such approaches can be a valuable component of change management strategies in healthcare settings.

Conclusions: Whilst further research is required, these findings promote the considered use of translational simulation as a potentially significant component of the change management process.

Background: Interprofessional team training is increasingly implemented in healthcare, especially in the acute care domain. Research shows a positive effect of Crew Resource Management (CRM) training on teamwork and non-technical skills, and there are indications that it might improve patient care. However, CRM training requires a lot of resources, time, and energy. There is a paucity of data on the costs of these programs. The objective of this study was to evaluate and categorize costs related to an in-situ CRM training program for surgical teams in the Netherlands.

Methods: An evaluation of costs was made for an in-situ CRM training program in the operating room (OR) in a tertiary academic center in the Netherlands. The program consisted of 20 half-day training sessions per year. Costs were evaluated for the year 2024. A distinction was made between costs and missed revenues due to not performing elective surgeries.

Results: Total costs of one half-day session added up to roughly €11.700-€15.700,of which 68-76% was due to missed revenues. The other major costs concern salaries of the participants, which made up 12-16% of the total cost of a training session.

Conclusions: In-situ CRM training in the OR is expensive, especially due to missed revenues. These costs need to be transparent to enable healthcare administrators to carefully allocate funds in their institutions. The costs of in-situ team training might balance against possible advantages in training quality due to the use of the actual clinical environment and to potential financial benefits through improved team performance. But this remains as yet unclear. (Quasi-)experimental studies are required to compare simulations on both patient or learner outcomes and financial aspects.

Background: Learners should ideally be taught low-frequency, high-acuity procedures in a simulated clinical environment to limit patient harm. Evidence supporting a simulation scenario with educational adjuncts to teach procedures versus a traditional procedure laboratory have not been previously demonstrated. To investigate the effects of simulation adjuncts on procedural skills attainment, we compared performances of learners who trained on a modified airway task trainer within the context of a simulation scenario with educational adjuncts for balloon tamponade placement to those who trained on the same task trainer in a typical procedure laboratory setting.

Methods: Fifty learners completed the curriculum: 37 emergency medicine residents, 8 emergency medicine/internal medicine residents, and 5 gastroenterology fellows. Learners were randomized into a simulation scenario with adjuncts (SA) or a control group using a modified task trainer in a procedure laboratory (PL) setting. We conducted baseline, approximately 1-month, and 5-month post-training assessments of self-identified competence, knowledge of the procedure, and observed procedural skills.

Results: Learners from both groups demonstrated significant improvement on all three assessments from baseline to the first post-training session. Between the first and second follow-ups, both groups significantly improved on self-assessed competence. At the second follow-up, the PL-trained group scored significantly higher than the SA group on the performance assessment.

Conclusions: All learners demonstrated significant improvements in knowledge, skills performance, and feelings of competence. The PL group demonstrated significantly higher skills performance during the second follow-up after training. This finding suggests that structured practice alone is an effective learning strategy for balloon tamponade placement without needing the resources of accompanying adjuncts within a simulation scenario, and that education with additional adjuncts may contribute to skills decay over time.