Advances in simulation (London, England)最新文献

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.

Background: Traumatic injuries are a significant contributor to pediatric morbidity and mortality, and trauma care necessitates that providers from different specialties and backgrounds be prepared to work together in high acuity settings to provide optimal care. Simulation-based trauma education consistently demonstrates improved knowledge, skill acquisition, teamwork, and task performance among providers, but relatively few studies assess provider performance during real resuscitations. The objective of this study is to develop an interdisciplinary pediatric trauma curriculum to improve trauma bay teamwork and adherence to ATLS ideals in the clinical environment.

Methods: We developed a simulation-based pediatric trauma curriculum (Pediatric Trauma Boot Camp) incorporating learners from multiple departments and divisions all of whom care for pediatric trauma patients at our institution. To determine the impact of the curriculum on trauma team clinical performance, videos of trauma activations throughout the multi-year implementation period were reviewed and data abstracted. Teamwork was assessed using the Trauma NOTECHS scale and ATLS compliance by the presence or omission of eight items of the primary and secondary survey. Eighty-six total trainees participated during 2 years of curriculum implementation with faculty from General Pediatric Surgery, Pediatric Emergency Medicine, and Pediatric Critical Care serving as facilitators.

Results: Out of a maximum of 25, the mean total Trauma NOTECHS score for the pre-pilot videos (n = 29) was 14.0. Post-pilot (n = 26), the mean total score improved to 16.8 (p = 0.001). Mean secondary survey completion improved from 4.1/8 pre-pilot to 5.4/8 post-pilot (p = 0.039). No significant difference was observed in primary survey completion between the first two cohorts. Following the second year of curriculum implementation, primary survey completion improved to 6.1/8 in the third cohort (n = 27) from 5.5/8 (p = 0.079). Continued improvement in total Trauma NOTECHS scores was observed (mean = 17.7), and improvements demonstrated in secondary survey completion were preserved.

Conclusion: An interdisciplinary simulation-based pediatric trauma curriculum incorporating learners across specialties has the ability to positively impact provider behavior and direct patient care at a level 1 pediatric trauma center as evidenced by improved teamwork scores and secondary survey completion on video review of live trauma activations.

Background: Ensuring equitable access to education is a fundamental goal in health professions training, particularly in simulation-based learning, where realistic clinical scenarios prepare learners for real-world practice. Universal Design for Learning (UDL) offers a robust framework for creating instructional strategies, materials, and environments that are accessible and effective for all learners.

Main body: In this article, we provide practical guidance and actionable strategies for incorporating UDL principles into simulation-based activities. Engaging in simulation-based education requires a leap of faith and a willingness to embrace vulnerability, as learners must immerse themselves in authentic scenarios. By integrating UDL principles, educators can create a supportive environment that reduces barriers, fosters psychological safety, and ensures that all participants feel empowered to take these risks and fully engage in the learning process. This framework supports opportunities for every learner to partake in meaningful and challenging experiential learning, ultimately preparing them for successful clinical practice.

Conclusion: From scenario design to debriefing techniques, this article offers insights and recommendations grounded in evidence-based practices, thereby empowering educators to optimize the effectiveness and accessibility of their simulation programs. By embracing UDL principles, educators in health professions education can create simulation experiences that cater to the diverse needs of learners, ensuring that all participants have the opportunity to thrive and succeed in their learning journeys.