Advances in simulation (London, England)最新文献

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.

Background: Simulation-based education has expanded across Latin America, creating demand for contextually relevant faculty development. Meta-debriefing, defined as a facilitated conversation following a debriefing, can strengthen debriefer performance. However, its implementation and effectiveness in Spanish-speaking settings remain underexplored. The CORE model (context, observation, reflection, and enhanced practice) provides structural guidance, but its adaptation to regional cultures has not been studied.

Methods: We conducted a concurrent mixed-methods study of one experienced meta-debriefer interacting and facilitating 15 remote meta-debriefing sessions with interprofessional novice debriefers. Quantitative data were derived from audio-recorded sessions using DASH, SET-M, a CORE-aligned checklist, and a meta-debriefing pillars tool. Qualitative data consisted of written observer reports, analyzed using inductive content analysis, and triangulated across sources.

Results: Quantitative analysis revealed high adherence to the CORE model and consistent demonstration of the four meta-debriefing pillars. Peer-assessed DASH scores ranged from 6.8 to 7.0, while SET-M items were consistently marked as achieved. Qualitatively, the meta-debriefer demonstrated behaviors aligned with psychologically safe, context-dependent, theoretically grounded, and formative facilitation. The meta-debriefer used cultural metaphors (e.g., "boli," "cazuelas," and a prisoner's song) to clarify structure and normalize reflection. Five reflection strategies emerged as central to generating debriefer insight: (1) Structured reorientation, (2) constructivist linkage to clinical identity, (3) metaphorical framing, (4) strategic questioning (e.g., advocacy & inquiry, circular inquiry), and (5) emotional normalization.

Conclusion: This study demonstrates how meta-debriefing, when implemented through culturally sensitive and structured approaches like CORE, supports transformative learning among simulation debriefers. Meta-debriefer's relational style, use of shared narratives, and context-sensitive scaffolding activated learner-centered reflection. As meta-debriefing models gain traction in Latin America and beyond, this study highlights the value of culturally responsive faculty development strategies that integrate local language, values, and pedagogical traditions into simulation-based education.

Background: Simulation-based training for endovascular thrombectomy (EVT) may improve care for patients with acute ischaemic stroke. This study investigated whether engaging anaesthesia professionals as co-faculty in an established in situ simulation programme influenced EVT care and patient outcomes.

Methods: This single centre pre-post interventional study (2017-2023) evaluated the impact of revising an EVT simulation training programme by engaging anaesthesia professionals in its design, delivery, and debriefing. Outcomes were measured by changes in: (1) anaesthetic management (relative and absolute time systolic blood pressure was outside protocol thresholds, hypoxic time, and protocol adherence), (2) workflow process (time metrics, successful revascularisation rates, and intraprocedural complications), and (3) patient outcomes (intracerebral haemorrhage, National Institute of Health Stroke Scale scores and modified Rankin Scale scores).

Results: A total of 275 stroke patients were treated with EVT during the study period (189 pre- and 86 postintervention). Anaesthetic management improved significantly in the postintervention group, with a decrease in the proportion of time that systolic blood pressure remained outside thresholds (37.0% to 27.7%, p = 0.02), increased compliance with recommended anaesthetics (27.5% to 100.0%, p < 0.001), and a reduction in hypoxia (5 to 0 min, p < 0.001). Time from suite arrival to groin puncture increased from 15 to 20 min in the postintervention group (p = 0.003). No significant differences were observed between the groups in the remaining workflow time metrics, reperfusion rates, or procedural complications. The proportion of patients with an excellent outcome (modified Rankin Scale 0-1) improved significantly from 23.4% to 42.6% in the postintervention group (p = 0.01).

Conclusions: The engagement of anaesthesia professionals in the EVT simulation training faculty was associated with improved EVT anaesthesia care and improved patient outcomes. The multidisciplinary nature of the EVT team should be reflected in faculty composition for EVT simulation training.

Background: Simulation-based testing (SBT) is increasingly recognised as a strategic tool for enhancing healthcare safety, efficiency, and system readiness. Despite its growing use, the perspectives of healthcare leaders-key stakeholders in sustaining simulation services-remain underexplored. This study aimed to understand how healthcare leaders perceive the value of SBT, identify drivers for engagement, and explore how simulation activities can be aligned with leadership priorities to support quality improvement.

Methods: A qualitative, phenomenological approach was used, involving semi-structured interviews with nine healthcare leaders from executive, clinical, and infrastructure roles within a large Australian health service. Thematic analysis was conducted to identify key themes from the interview data.

Results: Three major themes emerged: Optimising operations-Leaders valued SBT for its ability to test real-world workflows, uncover latent safety threats, and ensure regulatory and licensing readiness. SBT was seen as a diagnostic tool that supports operational assurance and futureproofing. Collaborative design-Leaders emphasised the importance of engaging end users in simulation activities to ensure relevance, foster shared understanding, and support implementation. SBT was also valued for its role in experiential orientation and team cohesion. Reporting and recommendations-Timely, structured, and risk-stratified reporting was critical for decision-making. Leaders preferred concise executive summaries and actionable recommendations aligned with project goals and resource constraints.

Conclusion: Healthcare leaders demonstrated a sophisticated understanding of SBT's strategic applications beyond education. They recognised its value in improving routine operations, supporting compliance, and informing high-stakes decisions. Simulation faculty can enhance the impact and sustainability of SBT by aligning activities with leadership priorities, ensuring timely communication, and delivering focused, actionable insights. These findings offer guidance for embedding SBT into broader quality improvement and organisational strategies. Future research should explore the generalisability of these findings across less mature simulation services and further investigate SBT's role in regulatory compliance.

Background: Non-technical skills (NTS) play a crucial role in reducing patient harm. In light of this, medical schools are now integrating NTS into their undergraduate curricula to encourage efficiency and reduce human errors, particularly during highly stressful scenarios. Utilising medical simulations has become prevalent for honing these skills in a controlled environment. However, a lack of guidance on how best to design and deliver effective NTS training leads to inconsistencies in quality and outcomes. Therefore, this review aims to examine current practices in simulation-based NTS training for medical students to collate evidence-informed strategies for enhancing its effectiveness.

Methods: A scoping review was carried out according to PRISMA-ScR guidelines. A search strategy was performed on PubMed, Scopus and Web of Science databases from inception to 17th June 2025. A thematic analysis of eligible studies identified recurring themes, leading to a conceptual model for the current delivery of NTS training.

Results: The screening process yielded 51 articles and commonly occurring themes were synthesised: Simulation setup, simulation modality, post-simulation activity, observational tools for NTS and learning environment. We identified several key practice points that are essential for the successful implementation of NTS training. These include pre-simulation briefings, appropriate fidelity, and debriefing sessions which collectively form the foundation for effective training outcomes.

Conclusion: The resulting themes highlight the effective strategies currently employed for NTS training in undergraduate medical simulation. Educators will be able to use these to design and implement consistent, effective NTS training.

Background: Simulation modalities have been increasingly used within programmatic assessment systems, yet educators typically have not collected and appraised validity evidence to justify such uses. Kane's validity framework offers a contemporary approach to conducting validation studies of assessment practices. Under the framework, educators collect and appraise validity evidence according to four inferences: the scoring of performance, the generalization of scores to other assessment contexts, the extrapolation of assessment performance to real-world contexts, and the implications or consequences of assessment decisions for learners, educators, programs, patients, and society. We developed a simulation-based echocardiography competence assessment tool (ECAT) and collected validity evidence to evaluate its use as an assessment for learning. We applied Kane's validity framework to evaluate the utility of the ECAT, with a focus on the implications of the assessment for promoting trainees' learning.

Methods: We implemented the ECAT in 2017, collecting simulation-based performance data and subsequent interview data. Fourteen cardiology trainees were assessed using the ECAT by four raters, and their performance was video-recorded. After trainees reviewed their performance videos and feedback, we conducted individual interviews with them and the raters who provided feedback. Directed content analysis generated implications and scoring evidence, and quantitative analyses generated scoring and extrapolation evidence. All evidence was critically appraised to form a validity argument about using ECAT as an assessment for learning.

Results: Participants reported that ECAT scores accurately represented trainees'performance, and that the feedback helped identify learning opportunities. Inter-rater reliability was high at ICC = 0.913 (95% CI 0.81-0.97). Participants' ECAT scores correlated with their end-of-rotation cardiology exam scores (r = 0.66, p = 0.02) and had positive associations with raters' judgments of the diagnostic quality of their scans, and with their reported numbers of echocardiograms seen, performed, and interpreted.

Conclusions: Our integrated analysis produced a data-informed validity argument supporting the use of the ECAT as a simulation-based assessment for learning. The findings also highlighted multiple areas for further research to optimize the ECAT. Our illustrative example of Kane's validity framework aims to support simulation educators as they are increasingly called on to justify the use of simulation-based assessments in programmatic and competency-based assessment systems.

In situ simulation (ISS) has long been recognized as a powerful tool for identifying latent safety threats, enhancing teamwork, and ultimately improving patient safety in Emergency Departments (EDs). However, the challenges of operationalizing ISS training in the current clinical environment in Canadian EDs have become increasingly evident. While many EDs face hurdles in implementing ISS, some teams have proven resilient and successful in their ISS endeavors. This study aims to determine which factors are associated with the successful maintenance of ISS programs within Canadian EDs. Using a positive deviance approach, we conducted a qualitative study of ED teams engaged in ISS projects, using interviews as a data collection tool. We recruited 14 healthcare providers who had participated in successful ISS initiatives in Canadian EDs. Participants highlighted the importance of engaging interprofessional stakeholders, flexibility from the simulation team, and buy-in from participants and colleagues as key factors contributing to the success of ISS programs. Challenges identified included lack of buy-in, space constraints, high patient volume and acuity, and staff shortages. Strategies for managing these challenges included scheduling simulations during less busy times and having alternative spaces for simulations. ISS was found to have a significant impact on patient safety, improving teamwork, crisis resource management, and overall patient care. These findings provide valuable insights for EDs looking to start or improve their ISS programs, emphasizing the importance of collaboration and adaptability in overcoming challenges to ensure the success of ISS initiatives.

Background: Previous studies have focused on the role of simulated patient (SP) feedback on students' learning outcomes after an SP-student encounter, whereas more recent studies have aimed to unravel meaningful learning during the encounter. We gain a more detailed understanding of students' meaningful learning by examining the perspectives of students and SPs during the SP-student encounter. The research question was as follows: What are characteristics of meaningful learning moments for students during SP-student encounters and what are the perceptions of SPs during these moments?

Methods: Twelve second-year Technical Medicine students conducted a medical consultation with SP presenting the same patient case. Each consultation was followed by qualitative, video-stimulated recall (SR) sessions, first with the student and then with the SP. During these sessions, students were prompted to articulate the thoughts they had during the consultation to identify meaningful learning moments. Video-fragments of the meaningful learning moments identified by the student were subsequently shown to the SP to explore their perceptions. All verbatim-transcribed recall data were thematically analyzed.

Results: Student-identified meaningful learning moments were characterized by experiences that offered new insights, evoked emotions, and/or involved feedback-in-action from the SP. The SP's perspectives of the same moments were compared to those of the students, revealing that these perspectives aligned approximately as often as they differed. SP experienced the moments as if they were the actual patient, fully embodying the patient's role, while simultaneously maintaining an overview and being aware of the student's learning position.

Conclusions: This stimulated recall study enhanced our understanding of students' learning during SP-student encounters. For students, meaningful learning moments involved new insights, emotional responses, and feedback-in-action from the SP. When SP fully engage in their patient role while maintaining awareness of the student's learning context, they can respond authentically and supportively. Preparing SP to balance authentic role portrayal with educational awareness can enhance their contribution to students' learning.