Advances in simulation (London, England)最新文献

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.

Simulation-based education in healthcare has advanced significantly, yet a persistent gap remains between educational science and healthcare simulation research. The late Jeroen van Merriënboer's extensive work in educational science provides valuable guidance for bridging this gap. Four key insights from his research can serve as a strong theoretical bedrock for educators and researchers aiming to design more effective and cohesive simulation-based learning experiences: (1) integrating learning in both simulated and real environments to improve transfer, (2) offering targeted learner support that evolves with expertise, (3) embracing the complexity of educational practice and avoiding one-size-fits-all solutions, and (4) embedding domain-general skills within specific disciplines. Championing these insights may catalyze more theory-informed practice and research in healthcare simulation. Nevertheless, applying these principles in practice remains a challenge, highlighting the need for further research into the "how"-specifically how to interconnect learning environments, adapt instruction to diverse needs, integrate theory with practice, and combine the teaching of domain-general and domain-specific skills.

Background: The use of virtual patients enables learning medical history taking in a safe environment without endangering patients' safety. The use of a chatbot embedded in serious games provides one way to interact with virtual patients. In this sense, the chatbot can be understood as a game design element, whose implementation should be theory driven and evidence based. Since not all game design elements are already connected to theories, this study aimed to evaluate whether the game design element chatbot addresses the need for autonomy rooted in the self-determination theory.

Method: A cross-sectional study was conducted to compare two distinct chat systems integrated in serious games with one system being an open chatbot and the other system being a constrained chat system. Two randomized groups of medical students at a German medical school played one of two serious games each representing an emergency ward. The data collected included both objective data in terms of students' question entries and subjective data on perceived autonomy.

Results: Students using the open chatbot generally asked significantly more questions and diagnosed significantly more patient cases correctly compared to students using a constrained chat system. However, they also asked more questions not directly related to the specific patient case. Subjective autonomy did not significantly differ between both chat systems.

Conclusion: The results suggest that an open chatbot encourages students' free exploration. Increased exploration aligns with the need for autonomy, as students experience freedom of choice during the activity in terms of posing their own questions. Nevertheless, the students did not necessarily interpret the opportunity to explore freely as autonomy since their subjectively experienced autonomy did not differ between both systems.

Background: The notion that debriefing quality is highly reliant on the skills and expertise of the facilitator is being increasingly challenged. There is therefore emerging interest in self-led debriefings (SLDs), whereby following a simulated learning event, individuals or groups of learners conduct a debriefing amongst themselves, without the immediate presence of a trained facilitator. The interest in this approach to debriefing is multifactorial but is, in part, driven by a desire to reduce costs associated with resource-intensive faculty presence. The debate regarding the role of SLDs in simulation-based education (SBE) therefore has important implications for the simulation community.

Main body: We comprehensively explore the role of SLDs by contextualising their application across the spectrum of SBE, both in terms of contrasting simulation factors, namely (i) simulation modality, (ii) debriefing forum, and (iii) debriefing adjuncts, as well as different learner characteristics, namely (i) learners' previous simulation experience, (ii) learner numbers, and (iii) learners' professional and cultural backgrounds. These factors inherently shape the conduct and format of SLDs, and thus impact their effectiveness in influencing learning. We have synthesised and critically analysed the available literature to illuminate this discussion.

Conclusions: The current evidence suggests that SLDs can, in the right circumstances, form part of an effective debriefing strategy and support learners to reach appropriate levels of critical self-reflection and learning. Careful consideration and due diligence must go into the design and implementation of SLDs to augment the advantages of this debriefing format, such as enhancing flexibility and learner autonomy, whilst mitigating potential risks, such as reinforcing errors and biases or causing psychological harm. In situations where resources for facilitator-led debriefings (FLDs) are limited, simulation educators should recognise SLDs as a potential avenue to explore in their local contexts. By leveraging the strengths of both formats, balancing learner autonomy and expert guidance, a combined SLD and FLD approach may yet prove to be the optimal debriefing strategy to maximise learning. Whilst more research is needed to deepen our understanding of the nuances of SLDs to assess their true applicability across the spectrum of SBE, the time may now have arrived to consider challenging the status quo.

Background: While many nursing programs in developed countries have implemented simulation-based education as a pedagogic method of teaching, implementation of simulation in developing countries like Tanzania is rare. Traditional methods of auditorium lectures are widely conducted in low-income nursing and midwifery education institutions. Such pedagogy provides students with theoretical knowledge yet with limited hands-on exposure for clinical skills, which might affect the professional integration of students and quality care delivery. This study explored perceptions of simulation-based education among diploma nursing students and midwifery students in one of the urban nursing schools in Tanzania.

Method: An exploratory qualitative study design was employed. Thirty-four nursing and midwifery students who had experience with simulation-based education were selected purposively to participate in focus group interviews. Data was collected in July 2023. Data analysis was conducted based on Graneheim and Lundman's content analysis approach.

Results: Two major themes emerged from the analysis: (1) Strengthened confidence through practice in a safe teaching environment. This theme included three sub-themes: (i) Increased overall confidence, (ii) reduced fear through practice in a safe environment, and (iii) enhanced knowledge and skills in procedures and equipment. The second theme was as follows: (2) Enhanced critical thinking and reasoning in debriefing and included two sub-themes: (i) Integrating theory into practice, (ii) communication in neonatal emergency management.

Conclusion: Nursing and midwifery students perceived simulation-based education as an effective method to prepare for clinical practice and quality neonatal care. Introducing simulation-based education in nursing education may benefit students' learning and strengthen the sustainability of skilled healthcare providers in low-income contexts where resources are scarce. Further research is needed to assess whether students can transfer knowledge into clinical skills practice.

Aim/objective: This study aims to explore the perceptions of nursing students on virtual reality (VR) technology, focusing on its utility, relevance, user-friendliness, and potential for broader integration into nursing education and other educational domains.

Background: VR is increasingly utilized in education, providing immersive and interactive learning experiences. Despite its potential, there are concerns regarding its practical application and alignment with educational objectives across various disciplines.

Design: The study employed an exploratory descriptive design using focus group interviews to gather qualitative data from nursing students.

Methods: Semi-structured interviews were conducted with 15 nursing students across three focus groups. The discussions centered on their experiences with VR in medication management training, focusing on perceived utility, user-friendliness, and motivation for future use. Data were analyzed using thematic analysis to identify key themes and insights relevant to educational technology adoption.

Results: Students acknowledged VR's potential for providing a safe and enhanced learning environment. They appreciated the opportunity to practice without real-world consequences but expressed concerns about technical complexity, lack of user-friendliness, and the absence of realistic clinical scenarios. The need for better alignment of VR content with actual educational needs and more user-friendly interfaces was emphasized.

Conclusion: The findings highlight the importance of aligning VR technology with the specific needs and learning objectives of students in various educational settings. Continuous dialogue with end-users is crucial for enhancing the educational effectiveness of VR. This study provides valuable insights for educators and developers to refine VR applications, contributing to the development of solutions that meet practical and educational requirements across different disciplines.

Introduction: For researchers and medical simulation trainers, measuring team dynamics is vital for providing targeted feedback that can lead to improved patient outcomes. It is also valuable for research, such as investigating which dynamics benefit team performance. Traditional assessment methods, such as questionnaires and observations, are often subjective and static, lacking the ability to capture team dynamics. To address these shortcomings, this study explores the use of physiological synchrony (PS) measured through electrocardiogram (ECG) data to evaluate team dynamics automated and in high-resolution.

Methods: A multicentre observational field study was conducted involving 214 medical first responders during mixed reality (MR) mass casualty training sessions. Participants were equipped with electrocardiogram (ECG) sensors and MR gear. The study measured dyadic PS using heart rate (HR), root mean square of successive differences (RMSSD), and standard deviation of NN intervals (SDNN). Data were collected at high frequency and analysed using dynamic time warping (dtw) to assess fluctuations in PS.

Results: Findings indicate that PS varies significantly by task nature, with higher synchrony during cooperative tasks compared to baseline. Different ECG metrics offered unique insights into team dynamics. Proximity and scenario conditions influenced PS, with closer teamwork leading to higher PS. Smaller sampling intervals (e.g. 5 s) provided a detailed view of PS fluctuations over time.

Discussion: The results demonstrate the potential of PS as an indicator of team performance and cohesion. High-resolution monitoring provides detailed insights into team dynamics, offering high-resolution feedback that traditional methods cannot provide. The integration of physiological measures into training programmes can enhance team performance by providing objective, high-resolution data.

Conclusion: This study shows that PS, measured by ECG data, is sensitive to medical team activities, offering insights into team dynamics. Different ECG metrics highlight various aspects of team performance, and high-resolution monitoring captures detailed dynamics. Further research is needed to validate these findings across diverse scenarios. This approach could improve training methodologies, resulting in better-prepared medical teams and improved patient care outcomes.

Introduction: Neonatal mortality is high in middle- and low-income countries, including Tanzania. Most of these deaths are preventable and linked to suboptimal quality of care. In this study, we assessed neonatal resuscitation skills acquisition after a 1-day Helping Babies Breathe (HBB) simulation training using improved tools and associated factors among healthcare providers in 12 facilities in Tanzania.

Methods: A cross-sectional study was conducted among healthcare providers working in the labor wards in selected health facilities. The training was conducted in situ using the HBB second edition curriculum with improved simulation tools (Neonatalie Live simulator, NeoBeat heart rate meter, and Upright resuscitator). After training, skills acquisition was evaluated using Objectively Structured Clinical Evaluation. Participants who scored an average of 75% or above were considered passing. Descriptive statistics were used to determine the proportion of staff who passed the evaluation by different demographic categories. One-way analysis of variance was used to compare mean scores among demographic categories. Factors associated with neonatal resuscitation skills acquisition were analyzed using modified Poisson regression.

Results: A total of 481 participants were enrolled in the study. Among these, 420 (87.3%) passed the skills evaluation on the first attempt. The overall mean skills score was 92.4%. In bivariable analysis, health facility level, region, age, and experience working in the labor ward were associated with passing skills evaluation on the first attempt. However, after controlling other variables in a multivariable model, none of the factors showed a statistically significant association.

Conclusion: In-situ, HBB simulation training using improved training tools effectively imparts neonatal resuscitation skills among healthcare providers. Participants learned skills similarly regardless of their different demographic characteristics, including level of education and working experience. Due to its potential to impart skills, frequent simulation training using improved tools may be considered for scaling up in other health facilities.

Background: Simulation educators are typically passionate advocates for simulation as a training modality; however, we frequently encounter participants who do not share our enthusiasm. The voice of the highly engaged participant is well publicised; however, the experience of those who do not readily engage in simulation has not been extensively studied and may offer valuable insights for educators. This qualitative study will explore factors which influence learner engagement in paediatric simulation training, informing the practice and approach of simulation educators to optimise learning experiences.

Methods: We conducted a reflexive thematic analysis of 12 semi-structured interviews with medical and nursing professionals from a large paediatric teaching hospital in New Zealand who self-identified as reluctant participants in simulation-based education. Interviews explored factors which have influenced their engagement in simulation-based education over the course of their careers.

Results: Three overarching themes were developed which describe the factors influencing adult-learner engagement in simulation-based education. The first, participant anxiety, explores the participants' narratives related to anxiety before, during and even following simulation which can impact on their ability to engage in current and subsequent simulation-based education. The second, protective behaviours, relates to the defensive mechanisms employed by participants in response to vulnerability experienced during simulation activities. The third theme, perception of the facilitator, examines the impact of simulation facilitator characteristics and behaviours on learner engagement.

Conclusions: These narratives highlighted that regular simulation activities with transparent learning objectives in which facilitators demonstrate vulnerability and adopt a co-learner attitude act to reduce participant anxiety. Emergent defensive behaviours, particularly "group shielding", interfere with collective learner engagement and should be both recognised and addressed by facilitators. Finally, there are potential discrepancies in the perceptions of facilitators and learners regarding what constitutes psychologically safe education environments. A collaborative and iterative approach to simulation-based education design may act to improve psychological safety for reluctant participants.