Advances in simulation (London, England)最新文献

Background: Patient safety science and debriefing approaches have historically tended to focus most heavily on Safety-I or "why things go wrong" and learning from unfavorable performance, root cause of adverse outcomes, and improvement opportunities learned from failures. Consequently, rich opportunities for analysis and learning from "why things go right," successful performance, and exploration of how systems succeed, adapt, and perform effectively regardless of outcome-Safety-II-are often underrepresented.

Methods: Open-access videos of healthcare debriefing were sought by searching Google and YouTube via search terms "healthcare debriefing," "healthcare debrief," "healthcare debriefing video," "healthcare debrief video," "healthcare debriefing example," "healthcare debrief example," "simulation debriefing," and "simulation debrief." Additionally, a search of major professional organization websites was utilized. Included videos were reviewed to score all utterances on the following: (1) phase of debriefing; (2) question or statement; (3) by facilitator or participant; (4) if utterance was neutral, related to positive performance/ "what went well" or negative performance/"what could be improved"; (5) if facilitator utterance was general or a follow-up, reflective utterance building upon previous discussion; (6) if participant utterances were general or specific reflective, insight offering comments; (7) all facilitator follow-up/ specific reflective type utterances were further analyzed and coded as exploration into Safety-I (e.g., exploration of why error occurred) or Safety-II (e.g., adaptability, variation, reproducing success) concepts.

Results: A review of open-access video examples of healthcare debriefing demonstrates disproportionate emphasis on Safety-I and highlights the opportunity for open-access examples of healthcare debriefing to include additional language and techniques that promote and role model inclusion of Safety-II discussion.

Conclusions: While there is always room for improvement and we must all strive to do the best we can, we are missing a major opportunity to build resilience by Safety-II exploration into analyzing why things go positively. Those designing such instructional videos should intentionally include debriefing focused on both Safety-I and Safety-II aspects of performance, regardless of outcome, as they are both important, complimentary, and result in a more holistic understanding of improvement opportunities and success. Future study on the impact of Safety-II debriefing should focus on context-specific promotion of quality and patient safety, as well as impact on participant wellbeing and overall safety culture.

Background: Creating Brave Spaces (CBS) workshops are designed by an interprofessional team of health professions educators to empower faculty members to disrupt microaggressions in the clinical teaching environment using simulation-based education design, where actors were trained to portray sources of microaggressions.

Methods: The CBS team delivered eleven workshops addressing five categories of biases in various contexts during 2020-2024 engaging hundreds of participants. The team recruited participants to conduct semi-structured interviews. Records from team meetings and facilitator focus groups were collected and reviewed. The dataset was subjected to thematic analysis focusing on the participants' experience in the workshop. Themes were presented in Context-Mechanism-Outcome statements informed by the realist evaluation framework. Subsequently, the results were verified with participants.

Results: Nine participants volunteered to be interviewed 2 to 12 weeks after attending the workshop. The interview scripts, totaling about 60,000 words, provided a rich picture of faculty members' backgrounds and experiences. Thematic analysis yielded the following results. Simulation-based education design empowered faculty members to overcome barriers and progress in their skills. During the immersive experience, participants benefited from a rare opportunity to practice aligning their values with their actions. Those who experienced microaggressions as victims or passive bystanders in their past experienced heightened emotions. Faculty members agreed that disrupting microaggressions is an important part of their work. They navigated the tension between "calling in" the source of the microaggression, being mindful of power dynamics in the simulated cases, and "calling out" the harm of microaggressions by holding the source accountable. Some recounted successes in managing subsequent incidences of microaggressions in their clinical teaching environment. The results were validated by a member-checking process, and further supported by recorded conversations during team meetings and facilitator focus groups.

Conclusions: Health sciences institutions' stated strategic goals in inclusive excellence, although widely accepted by faculty members, are challenging to operationalize in the moment of a microaggression. Participants practiced this skill using simulation-based education design and reported significant and positive impacts.

Background: Training in invasive procedures like pericardiocentesis is a critical component of medical education but poses significant challenges due to its complexity and infrequent clinical application. Pericardiocentesis is an invasive procedure used to remove excess pericardial fluid from the pericardial sac, typically performed to relieve cardiac tamponade. It requires precise anatomical knowledge, ultrasound guidance, and dexterous needle placement to minimize complications. Simulation-based training, particularly with innovative technologies such as 3D printing and virtual reality (VR), offers accessible and cost-effective solutions. This study compared the effectiveness of 3D-printed mannequins and VR simulations in pericardiocentesis training, focusing on learning outcomes, stress responses, and cognitive load.

Methods: Thirty-five final-year medical students participated in this quasi-experimental study, receiving training with both models in separate sessions under the supervision of two experienced instructors. Learning outcomes were evaluated using the objective structured clinical examination (OSCE), while stress responses were assessed via heart rate variability (HRV), a measure of fluctuations in heart rate that reflect stress levels. Perceived cognitive load was measured with the NASA Task Load Index (NASA-TLX). Wilcoxon signed-rank and Friedman tests were used for statistical analysis.

Results: The 3D-printed mannequin outperformed VR in tasks requiring fine motor skills, such as material handling and drainage placement (Z = - 2.56, p < 0.05; Z = - 2.34, p < 0.05). VR training, however, was associated with lower mental demand and effort (Z = - 2.147, p < 0.05; Z = - 2.356, p < 0.05). Biometric analysis indicated higher stress levels during mannequin-based training (SD1/SD2, chi-square = 14.157, p < 0.01), reflecting its closer replication of real-life clinical conditions.

Conclusions: Both 3D-printed mannequins and VR simulations serve as effective tools for pericardiocentesis training, each offering unique advantages. The 3D-printed mannequin supports tactile skill acquisition, while VR enhances cognitive engagement in a low-stress environment. A hybrid approach-beginning with VR and progressing to 3D-printed models-maximizes training outcomes, particularly in resource-limited settings, where affordable simulation tools can improve access to medical education.

Introduction: With the rapid evolution of healthcare environments, effective and accessible experiential learning has become an integral part of health education. Virtual reality (VR) poses the advantage of providing users with a virtual, immersive experience, to allow them to interact with elements of a simulated environment. This scoping review aims to evaluate the use of virtual reality (VR)-based simulation for the training of situational awareness (SA) and decision-making (DM) for undergraduate healthcare education.

Methods: A search was carried out across eight databases, namely: MEDLINE, Embase + Embase Classic, Scopus, Google Scholar, PubMed, CINAHL, ERIC, and PsycINFO. Studies evaluating the use of VR and its extended interfaces (i.e., augmented reality (AR) and mixed reality (MR)) for training SA and DM in undergraduate healthcare education were included.

Results: Of 3932 studies retrieved from the database search, 35 studies were included within the review. VR-based interventions were used across a range of healthcare profession trainees, including nursing, medical, paramedical, midwifery, and healthcare assistant students. Seventeen studies used screen-based VR interventions, and 16 studies used head-mounted devices (HMD). One study used both screen-based and HMD interventions and one further augmented reality. Twenty-nine studies assessed the role of the intervention in DM training, and 6 studies assessed its role in SA training. Eighteen studies used validated assessment tools, and 17 studies used educational theories to underpin their learning techniques.

Conclusions: The role of VR in training of SA and DM for healthcare professions has been well recognized, as demonstrated by the increasing number of studies. There is need for consensus of reporting for such studies to ensure a high-quality body of evidence with standardized outcome assessment.

Background: Effective information sharing is crucial for emergency care teams to maintain an accurate shared mental model. This study describes the design, simulation-based testing and implementation of a team reflexivity aid to facilitate in-action information sharing during resuscitations.

Methods: A five-phase team-centred iterative design process was employed. Phase 1 involved a literature review to identify in-action cognitive aids. Phase 2 focused on conceptual design, followed by simulation-based testing and modifications in phase 3. Implementation through simulation-based user training occurred in phase 4 at a large non-university teaching hospital. Phase 5 evaluated the aid among resuscitation team members in the emergency department after one year.

Results: The phase 1 literature review identified 58 cognitive aids, with only 10 designed as 'team aid'. Studies using team information screens found increase team and task performance in simulation-based environments, with no evaluations in authentic workplaces. Phase 2 resulted in a three-section team reflexivity aid, iteratively modified in three rounds of simulation-based testing (N = 30 groups) phase 3 resulted in a team reflexivity aid containing five sections: resuscitation times and intervals, patient history, interventions on a longitudinal timeline, differential diagnosis and a quick review section. Phase 4 consisted of reflexivity aid user training with simulation-based education (N = 60 sessions) and the creation of a digital entry form to store data in the patient's electronic medical record. Evaluation after one year in phase 5, (N = 84) showed perceived improvements in communication (3.82 ± 0.77), documentation (4.25 ± 0.66), cognitive load (3.94 ± 0.68), and team performance (3.80 ± 0.76) on a 5-point Likert scale. Thematic analysis of user feedback identified improvements in both teamwork and taskwork. Teamwork enhancements included better situation awareness, communication and team participation. Taskwork improvements were seen in drug administration and clinical reasoning.

Conclusions: This study demonstrated the successful development and implementation of a Team Reflexivity Aid for Cardiac arrests using simulation methodology. This task-focused team tool improved perceived team situation awareness, communication, and overall performance. The research highlights the interplay between task- and teamwork in healthcare settings, underscoring the potential for taskwork-oriented tools to benefit team dynamics. These findings warrant further investigation into team-supportive interventions and their impact on resuscitation outcomes.

We designed, developed, and constructed a reusable, durable, low-cost resuscitative hysterotomy (RH) task trainer with functional and structural fidelity for repetitive practice and education for emergency medicine trainees. The availability of commercial caesarean task trainers is limited, and their high cost often poses a barrier to training. Although similar procedures, RH and traditional caesarean section are unique, and to the authors' knowledge there are currently no commercial task trainers specifically designed for RH. Current RH literature recommends completing the procedure within five minutes to improve the survival chances of both the fetus and the mother during active or imminent cardiac arrest. While RH is not a technically complex procedure relative to other procedures, it involves specific technical steps and requires clinicians to act decisively. Our RH task trainer was created using low-cost expired materials sourced from our hospital system and additional items purchased online. The RH task trainer was designed to be easily assembled, have minimal recurring material costs, and with quick set-up and clean-up for repetitive practice. When used within a simulation-based scenario, learners are also challenged with the decision to proceed with an RH; thus, providing experiential development of this decision-making step which is unparalleled in comparison to most traditional training formats. Overall, our RH trainer can be built for approximately 230 US dollars. The ability to create low-cost and easily accessible opportunities for repetitive practice of RH contributes to the limited pool of non-commercial RH task trainers, offering valuable experiential instruction for this unique, high-acuity, low-occurrence procedure. Brief description We developed a reusable, durable, low-cost resuscitative hysterotomy (RH) task trainer with functional and structural fidelity for repetitive practice and education for emergency medicine trainees at a tertiary care training hospital. Further, we aimed to create a task trainer that enhanced the cognitive and procedural skills required for performing RH within a high-stress clinical environment.

Background: 360° video and virtual reality (VR) simulation may offer innovative opportunities as portable simulation-based technologies to enhance Neonatal Resuscitation Program (NRP) training, updates, and refreshers. The purpose of this study was to compare the use of 360° video with VR simulation in NRP training and the effect on NRP learning outcomes.

Methods: Thirty (N = 30) NRP providers were randomly assigned to either VR simulation or 360° video study groups (n = 15 each) with pre and posttests of confidence, posttests of user satisfaction, usefulness, presence, and simulator sickness, and a performance demonstration of positive pressure ventilation (PPV) on a manikin-simulator. Participants were then exposed to the other condition and again post-tested.

Results: Both systems were positively viewed. However, participants reported significantly higher perceptions of usefulness in enhancing learning and increased sense of presence with the VR simulation. VR simulation participants gained more confidence in certain NRP skills, such as proper mask placement (adjusted p-value 0.038) and newborn response evaluation (adjusted p-value 0.017). A blinded assessment of PPV skills showed participants exposed to VR performed significantly better in providing effective PPV (adjusted p-value 0.005).

Conclusions: NRP providers found both systems useful; however, VR simulation was more helpful in improving learning performance and enhancing learning. Participants reported an increased feeling of presence and confidence in certain areas with VR and performed better on a crucial NRP skill, providing effective PPV. VR technologies may offer an alternative modality for increasing access to standardized and portable refresher learning opportunities on NRP.

Introduction: Simulated patients, participants and persons (SPs) are valued members of simulation teams. For people new to working as SPs, there are unique orientation requirements. This project sought to co-produce a resource package with SPs to facilitate orientation to the philosophy and foundations of health simulation, the type of work SPs do and to the structures and environments in which health simulation may be undertaken.

Aims: To explore and describe SPs' perceptions of their role in health simulation, the things that inform and influence their work, and SP recommendations for orienting new people to health simulation and this type of work.

Methods: Focus group discussions were hosted to construct a narrative with and from people who work as SPs, for the purpose of informing an online resource for new SPs. Data were analysed using Braun and Clark's Experiential Thematic Analysis methods to address project aims.

Results: Twenty-three SPs participated, contributing their thoughts, experiences and ideas. Data from transcripts were analysed thematically, resulting in three themes, and 11 sub-themes. The broad themes describe (1) The Purpose (why the SP role is valued); (2) The Job (what we do as an SP) and (3) The Craft (how we work as an SP) from the perspective of participants. Specific recommendations for course content were described and integrated into a new non-award, open-access resource for new SPs.

Conclusion: Findings from this study contribute to the ongoing and expanding understanding of the SP role and the perspectives of people who work in the social practice of health simulation.

Introduction: Team mental models and team situational awareness are key components of healthcare team simulation. Human factors and organizational psychology researchers have developed clear definitions and theories about these concepts that are at times 'lost in translation' within the prevailing forms of measurement and training utilized in healthcare. Simulation research to date has often relied upon indirect and imprecise measures and a conceptualization of team cognition that ill equips simulation educators as they endeavour to optimize healthcare team performance.

Methods: We present a narrative review that examines how team cognition is assessed in healthcare team simulation, critically consider assessment strategies described in key studies, and contrast them to advances in human factors and organizational psychology.

Results: This study presents a framework that reconceptualizes how we measure team cognition in healthcare simulation along the matrices of directness and timing of evaluation. We pair this framework with a table that exemplifies extant measurement techniques and highlight how simulation educators may decide between different 'types' of assessment based upon their needs.

Discussion: We offer recommendations for educators to consider capturing team cognition before, during, and after simulation. We also offer recommendations for researchers to develop tools that may be more readily applied across key settings.

Conclusion: Here, we present a framework of team cognition for healthcare action teams that advances healthcare simulation to better align with human factors and organizational psychology literature. This work will guide healthcare simulation educators and researchers on their quest to optimize team performance through improved team cognition.

Trial registration: None.

Background: When medical students enter their first psychiatry rotation, they often feel under-prepared for the complex milieu of psychopathology, emotional distress, and complex psychosocial issues. Simulation is valued for its ability to orient learners to new environments. In this project, a hybrid simulation workshop was designed and delivered for fourth-year medical students. This study aimed to examine students' experience of this workshop and to explore participant attitudes towards people who experience mental distress.

Methods: Fourth-year undergraduate medical students were invited to complete pre- and post-workshop questionnaires that contained a series of previously developed scales, including the Stigma of Suicide Scale, the Literacy of Suicide Scale, the General Help-Seeking Behaviour Scale, the Attitudes and Confidence in the Integration of Psychiatry Scale, and the Satisfaction with Simulation Experience Scale.

Results: From a cohort of 172, 118 students participated (68.8%). The mean percentage of suicide literacy rose from 65.8 to 70.1%, with the highest literacy in the "treatment and management" domain (pre-workshop mean 92.9%, post-mean 95.0%) and lowest in the "signs and symptoms" domain (pre-workshop mean 38.0%; post-mean 44.5%). Suicide stigma was low both pre- and post-workshop. In both pre- and post-workshop, participants identified feeling most confident about screening for depression and least confident about managing symptoms of anxiety for patients and their relatives. Concerningly, 11% of the cohort stated they would not seek help themselves if they experienced thoughts of self-harm or suicide.

Conclusion: Using a combination of simulation modalities, students were oriented to their psychiatry placements. Importantly, this orientation focused on the experiences of people with lived experience of mental illness and how health professionals impact patient journeys through health and mental health services. Findings suggest this type of simulation workshop can support students in their dispositional readiness for placement in psychiatry units.