Pub Date : 2023-01-21DOI: 10.1186/s41077-023-00243-6
Susan Eller, Jenny Rudolph, Stephanie Barwick, Sarah Janssens, Komal Bajaj
In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter's change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a "longitudinal prebrief," a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.
{"title":"Leading change in practice: how \"longitudinal prebriefing\" nurtures and sustains in situ simulation programs.","authors":"Susan Eller, Jenny Rudolph, Stephanie Barwick, Sarah Janssens, Komal Bajaj","doi":"10.1186/s41077-023-00243-6","DOIUrl":"https://doi.org/10.1186/s41077-023-00243-6","url":null,"abstract":"<p><p>In situ simulation (ISS) programs deliver patient safety benefits to healthcare systems, however, face many challenges in both implementation and sustainability. Prebriefing is conducted immediately prior to a simulation activity to enhance engagement with the learning activity, but is not sufficient to embed and sustain an ISS program. Longer-term and broader change leadership is required to engage colleagues, secure time and resources, and sustain an in situ simulation program. No framework currently exists to describe this process for ISS programs. This manuscript presents a framework derived from the analysis of three successful ISS program implementations across different hospital systems. We describe eight change leadership steps adapted from Kotter's change management theory, used to sustainably implement the ISS programs analyzed. These steps include the following: (1) identifying goals of key stakeholders, (2) engaging a multi-professional team, (3) creating a shared vision, (4) communicating the vision effectively, (5) energizing participants and enabling program participation, (6) identifying and celebrating early success, (7) closing the loop on early program successes, and (8) embedding simulation in organizational culture and operations. We describe this process as a \"longitudinal prebrief,\" a framework which provides a step-by-step guide to engage colleagues and sustain successful implementation of ISS.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9130948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Teaching nursing management of diabetic ketoacidosis: a description of the development of a virtual patient simulation.","authors":"Fatimazahra Mahou, Saloua Elamari, Adesina Afeez Sulaiman, Oumnia Bouaddi, Omaima Changuiti, Mohammed Mouhaoui, Asmae Khattabi","doi":"10.1186/s41077-022-00241-0","DOIUrl":"https://doi.org/10.1186/s41077-022-00241-0","url":null,"abstract":"","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9831878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-09DOI: 10.1186/s41077-022-00240-1
Margrethe Duch Christensen, Doris Østergaard, Søren Stagelund, Leonie Watterson, Hyun Soo Chung, Peter Dieckmann
{"title":"Embracing multiple stakeholders' perspectives in defining competent simulation facilitators' characteristics and educational behaviours: a qualitative study from Denmark, Korea, and Australia.","authors":"Margrethe Duch Christensen, Doris Østergaard, Søren Stagelund, Leonie Watterson, Hyun Soo Chung, Peter Dieckmann","doi":"10.1186/s41077-022-00240-1","DOIUrl":"https://doi.org/10.1186/s41077-022-00240-1","url":null,"abstract":"","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10524828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-28DOI: 10.1186/s41077-022-00238-9
Clément Buléon, Laurent Mattatia, Rebecca D Minehart, Jenny W Rudolph, Fernande J Lois, Erwan Guillouet, Anne-Laure Philippon, Olivier Brissaud, Antoine Lefevre-Scelles, Dan Benhamou, François Lecomte, The SoFraSimS Assessment With Simulation Group, Anne Bellot, Isabelle Crublé, Guillaume Philippot, Thierry Vanderlinden, Sébastien Batrancourt, Claire Boithias-Guerot, Jean Bréaud, Philine de Vries, Louis Sibert, Thierry Sécheresse, Virginie Boulant, Louis Delamarre, Laurent Grillet, Marianne Jund, Christophe Mathurin, Jacques Berthod, Blaise Debien, Olivier Gacia, Guillaume Der Sahakian, Sylvain Boet, Denis Oriot, Jean-Michel Chabot
Background: Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, "the use of simulation for summative assessment" requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start.
Methods: First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee.
Results: Seven topics were selected by the task force: "What can be assessed in simulation?", "Assessment tools for SBSA", "Consequences of undergoing the SBSA process", "Scenarios for SBSA", "Debriefing, video, and research for SBSA", "Trainers for SBSA", and "Implementation of SBSA in healthcare". Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted.
Conclusion: Our results identified among the seven topics one area with robust evidence in the literature ("What can be assessed in simulation?"), three areas with evidence that require guidance by expert opinion ("Assessment tools for SBSA", "Scenarios for SBSA", "Implementation of SBSA in healthcare"), and three areas with weak or emerging evidence ("Consequences of undergoing the SBSA process", "Debriefing for SBSA", "Trainers for SBSA"). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.
{"title":"Simulation-based summative assessment in healthcare: an overview of key principles for practice.","authors":"Clément Buléon, Laurent Mattatia, Rebecca D Minehart, Jenny W Rudolph, Fernande J Lois, Erwan Guillouet, Anne-Laure Philippon, Olivier Brissaud, Antoine Lefevre-Scelles, Dan Benhamou, François Lecomte, The SoFraSimS Assessment With Simulation Group, Anne Bellot, Isabelle Crublé, Guillaume Philippot, Thierry Vanderlinden, Sébastien Batrancourt, Claire Boithias-Guerot, Jean Bréaud, Philine de Vries, Louis Sibert, Thierry Sécheresse, Virginie Boulant, Louis Delamarre, Laurent Grillet, Marianne Jund, Christophe Mathurin, Jacques Berthod, Blaise Debien, Olivier Gacia, Guillaume Der Sahakian, Sylvain Boet, Denis Oriot, Jean-Michel Chabot","doi":"10.1186/s41077-022-00238-9","DOIUrl":"https://doi.org/10.1186/s41077-022-00238-9","url":null,"abstract":"<p><strong>Background: </strong>Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, \"the use of simulation for summative assessment\" requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start.</p><p><strong>Methods: </strong>First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee.</p><p><strong>Results: </strong>Seven topics were selected by the task force: \"What can be assessed in simulation?\", \"Assessment tools for SBSA\", \"Consequences of undergoing the SBSA process\", \"Scenarios for SBSA\", \"Debriefing, video, and research for SBSA\", \"Trainers for SBSA\", and \"Implementation of SBSA in healthcare\". Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted.</p><p><strong>Conclusion: </strong>Our results identified among the seven topics one area with robust evidence in the literature (\"What can be assessed in simulation?\"), three areas with evidence that require guidance by expert opinion (\"Assessment tools for SBSA\", \"Scenarios for SBSA\", \"Implementation of SBSA in healthcare\"), and three areas with weak or emerging evidence (\"Consequences of undergoing the SBSA process\", \"Debriefing for SBSA\", \"Trainers for SBSA\"). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9795938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10819099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-28DOI: 10.1186/s41077-022-00239-8
Leandro Teixeira de Castro, Andreia Melo Coriolano, Karina Burckart, Mislane Bezerra Soares, Tarso Augusto Duenhas Accorsi, Vitor Emer Egypto Rosa, Antônio Sérgio de Santis Andrade Lopes, Thomaz Bittencourt Couto
Introduction: Rapid-cycle deliberate practice (RCDP) is a simulation-based educational strategy that consists of repeating a simulation scenario a number of times to acquire a planned competency. When the objective of a cycle is achieved, a new cycle initiates with increased skill complexity. There have been no previous randomized studies comparing after-event debriefing clinical manikin-based simulation to RCDP in adult cardiopulmonary resuscitation (CPR).
Methods: We invited physicians from the post-graduate program on Emergency Medicine of the Hospital Israelita Albert Einstein. Groups were randomized 1:1 to RCDP or after-event debriefing simulation prior to the first station of CPR training. During the first 5 min of the pre-intervention scenario, both groups participated in a simulated case of an out-of-hospital cardiac arrest without facilitator interference; after the first 5 min, each scenario was then facilitated according to group allocation (RCDP or after-event debriefing). In a second scenario of CPR later in the day with the same participants, there was no facilitator intervention, and the planned outcomes were evaluated. The primary outcome was the chest compression fraction during CPR in the post-intervention scenario. Secondary outcomes comprised time for recognition of the cardiac arrest, time for first verbalization of the cardiac arrest initial rhythm, time for first defibrillation, and mean pre-defibrillation pause.
Results: We analyzed data of three courses conducted between June 2018 and July 2019, with 76 participants divided into 9 teams. Each team had a median of 8 participants. In the post-intervention scenario, the RCDP teams had a significantly higher chest compression fraction than the after-event debriefing group (80.0% vs 63.6%; p = 0.036). The RCDP group also demonstrated a significantly lower time between recognition of the rhythm and defibrillation (6 vs 25 s; p value = 0.036).
Conclusion: RCDP simulation strategy is associated with significantly higher manikin chest compression fraction during CPR when compared to an after-event debriefing simulation.
简介:快速循环刻意练习(RCDP)是一种基于模拟的教育策略,包括多次重复模拟场景以获得计划的能力。当一个循环的目标实现时,一个新的循环开始,技能的复杂性增加。在成人心肺复苏术(CPR)中,尚无随机对照研究比较基于人体模型的事后报告临床模拟与RCDP。方法:我们邀请了来自以色列阿尔伯特·爱因斯坦医院急诊医学研究生项目的医生。各组在第一站CPR训练前按1:1随机分为RCDP或事后汇报模拟。在干预前情景的前5分钟,两组都参与了一个没有助听器干扰的院外心脏骤停的模拟案例;在前5分钟后,根据小组分配(RCDP或事后汇报)促进每个场景。在当天晚些时候对同样的参与者进行CPR的第二个场景中,没有辅助干预,并对计划的结果进行评估。主要结局是干预后情况下CPR期间的胸部压缩分数。次要结果包括识别心脏骤停的时间,心脏骤停初始节律的首次言语化时间,首次除颤时间和平均除颤前暂停时间。结果:我们分析了2018年6月至2019年7月期间进行的三个课程的数据,76名参与者分为9个小组。每个小组的参与者中位数为8人。在干预后的情况下,RCDP组的胸压分数明显高于事后述诉组(80.0% vs 63.6%;p = 0.036)。RCDP组也表现出节律识别和除颤之间的时间显著缩短(6 vs 25 s;P值= 0.036)。结论:与事后汇报模拟相比,RCDP模拟策略与心肺复苏术中较高的假人胸部压缩率相关。
{"title":"Rapid-cycle deliberate practice versus after-event debriefing clinical simulation in cardiopulmonary resuscitation: a cluster randomized trial.","authors":"Leandro Teixeira de Castro, Andreia Melo Coriolano, Karina Burckart, Mislane Bezerra Soares, Tarso Augusto Duenhas Accorsi, Vitor Emer Egypto Rosa, Antônio Sérgio de Santis Andrade Lopes, Thomaz Bittencourt Couto","doi":"10.1186/s41077-022-00239-8","DOIUrl":"https://doi.org/10.1186/s41077-022-00239-8","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid-cycle deliberate practice (RCDP) is a simulation-based educational strategy that consists of repeating a simulation scenario a number of times to acquire a planned competency. When the objective of a cycle is achieved, a new cycle initiates with increased skill complexity. There have been no previous randomized studies comparing after-event debriefing clinical manikin-based simulation to RCDP in adult cardiopulmonary resuscitation (CPR).</p><p><strong>Methods: </strong>We invited physicians from the post-graduate program on Emergency Medicine of the Hospital Israelita Albert Einstein. Groups were randomized 1:1 to RCDP or after-event debriefing simulation prior to the first station of CPR training. During the first 5 min of the pre-intervention scenario, both groups participated in a simulated case of an out-of-hospital cardiac arrest without facilitator interference; after the first 5 min, each scenario was then facilitated according to group allocation (RCDP or after-event debriefing). In a second scenario of CPR later in the day with the same participants, there was no facilitator intervention, and the planned outcomes were evaluated. The primary outcome was the chest compression fraction during CPR in the post-intervention scenario. Secondary outcomes comprised time for recognition of the cardiac arrest, time for first verbalization of the cardiac arrest initial rhythm, time for first defibrillation, and mean pre-defibrillation pause.</p><p><strong>Results: </strong>We analyzed data of three courses conducted between June 2018 and July 2019, with 76 participants divided into 9 teams. Each team had a median of 8 participants. In the post-intervention scenario, the RCDP teams had a significantly higher chest compression fraction than the after-event debriefing group (80.0% vs 63.6%; p = 0.036). The RCDP group also demonstrated a significantly lower time between recognition of the rhythm and defibrillation (6 vs 25 s; p value = 0.036).</p><p><strong>Conclusion: </strong>RCDP simulation strategy is associated with significantly higher manikin chest compression fraction during CPR when compared to an after-event debriefing simulation.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9798613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10455169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-16DOI: 10.1186/s41077-022-00237-w
Anders Lund Schram, Morten Søndergaard Lindhard, Magnus Bie, Maria Louise Gamborg, Neel Toxvig, Gitte Skov, Rune Dall Jensen
Background: During hospital relocations, it is important to support healthcare professionals becoming familiar with new settings. Simulation-based training seems promising and in situ simulation has been suggested as a beneficial educational tool to prepare healthcare professionals for relocation. This study aimed to investigate the impact of a simulation-based training intervention on health professionals´ readiness to work in their new environment, as well as investigate sick leave before and after relocation.
Methods: The study was a controlled intervention study implemented at a university hospital in Denmark. Simulation was used to prepare employees for workflows prior to relocation. Before relocation, 1199 healthcare professionals participated in the in situ simulation-based training program. Questionnaires on readiness to perform were distributed to participants at pre-, post-, and follow-up (6 months) measurement. In addition, data on participants' sick leave was gathered from a business intelligence portal. To compare dependent and independent groups, paired and unpaired t tests were performed on mean score of readiness to perform and sick leave.
Results: Compared to the control group, healthcare professionals participating in the intervention felt significantly more ready to work in a new hospital environment. As a measure of psychological wellbeing, register data indicated no difference in sick leave, when comparing intervention and control groups before and after participating in the in situ simulation-based training program.
Conclusions: Healthcare professionals felt significantly more ready to work in a new environment, after participating in the in situ simulation-based training program, indicating that the intervention supported healthcare professionals during relocations. This may mitigate feelings of uncertainty; however, further research is needed to explore such effects.
Trial registration: The study was approved by The Regional Ethics Committee (no. 1-16-02-222-22).
{"title":"Using simulation-based training during hospital relocation: a controlled intervention study.","authors":"Anders Lund Schram, Morten Søndergaard Lindhard, Magnus Bie, Maria Louise Gamborg, Neel Toxvig, Gitte Skov, Rune Dall Jensen","doi":"10.1186/s41077-022-00237-w","DOIUrl":"https://doi.org/10.1186/s41077-022-00237-w","url":null,"abstract":"<p><strong>Background: </strong>During hospital relocations, it is important to support healthcare professionals becoming familiar with new settings. Simulation-based training seems promising and in situ simulation has been suggested as a beneficial educational tool to prepare healthcare professionals for relocation. This study aimed to investigate the impact of a simulation-based training intervention on health professionals´ readiness to work in their new environment, as well as investigate sick leave before and after relocation.</p><p><strong>Methods: </strong>The study was a controlled intervention study implemented at a university hospital in Denmark. Simulation was used to prepare employees for workflows prior to relocation. Before relocation, 1199 healthcare professionals participated in the in situ simulation-based training program. Questionnaires on readiness to perform were distributed to participants at pre-, post-, and follow-up (6 months) measurement. In addition, data on participants' sick leave was gathered from a business intelligence portal. To compare dependent and independent groups, paired and unpaired t tests were performed on mean score of readiness to perform and sick leave.</p><p><strong>Results: </strong>Compared to the control group, healthcare professionals participating in the intervention felt significantly more ready to work in a new hospital environment. As a measure of psychological wellbeing, register data indicated no difference in sick leave, when comparing intervention and control groups before and after participating in the in situ simulation-based training program.</p><p><strong>Conclusions: </strong>Healthcare professionals felt significantly more ready to work in a new environment, after participating in the in situ simulation-based training program, indicating that the intervention supported healthcare professionals during relocations. This may mitigate feelings of uncertainty; however, further research is needed to explore such effects.</p><p><strong>Trial registration: </strong>The study was approved by The Regional Ethics Committee (no. 1-16-02-222-22).</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9758894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10403876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-12DOI: 10.1186/s41077-022-00236-x
Michael Meguerdichian, Komal Bajaj, Rachel Ivanhoe, Yiqun Lin, Audrey Sloma, Ariel de Roche, Brian Altonen, Suzanne Bentley, Adam Cheng, Katie Walker
Background: The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator's ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator's debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators' cognitive load, workload, and debriefing quality.
Methods: Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models.
Results: Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX -4.5, 95%CI -16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI -3.4 to 8.1, p=0.436).
Conclusions: The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.
背景:在模拟中促进卓越和反思性学习(PEARLS)医疗保健报告工具是一种认知辅助工具,旨在以结构化的方式部署报告。通过分解汇报的复杂性,从而提高新手调解人汇报的质量,该工具有可能增加调解人获得汇报技能的能力。在这项初步研究中,我们旨在评估该工具对引导者认知负荷、工作量和述职质量的影响。方法:来自纽约市卫生+医院模拟奖学金的14名研究人员,是珍珠医疗报告工具的新手,随机分为两组,每组7人。干预组配备认知辅助工具,对照组不使用认知辅助工具。两组都进行了8小时的汇报课程。两组分别对3个视频模拟事件进行了情况介绍,并分别使用Paas-Merriënboer量表和原始的美国国家航空航天局任务负荷指数(NASA-TLX)对他们的经历的认知负荷和工作量进行了评分。然后使用医疗保健模拟汇报评估(DASH)对汇报质量进行评估。认知负荷测量以Paas-Merriënboer量表测量,并使用Wilcoxon秩和检验进行比较。使用混合效应线性回归模型分析工作量和汇报质量的度量。结果:使用工具的患者在3次述评中有2次的认知负荷中位数得分显著降低(使用工具与不使用工具的中位数得分:情景A 6 vs 6, p=0.1331;情景B: 5 vs 6, p=0.043;情境C: 5 vs 7, p=0.031)。工具在降低工作量需求综合评分(NASA-TLX平均差值为-4.5,95%CI为-16.5至7.0,p=0.456)或提高汇报质量综合评分(DASH平均差值为2.4,95%CI为-3.4至8.1,p=0.436)方面的有效性无差异。结论:珍珠保健报告工具可作为报告技能习得的教育辅助工具。使用述职认知辅助工具可能会减少述职的认知负荷,但对新手述职的工作量或质量没有影响。建议进一步研究认知辅助的效果。然而,本研究的设计可以作为未来探索述职报告质量的模型。
{"title":"Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: a pilot study.","authors":"Michael Meguerdichian, Komal Bajaj, Rachel Ivanhoe, Yiqun Lin, Audrey Sloma, Ariel de Roche, Brian Altonen, Suzanne Bentley, Adam Cheng, Katie Walker","doi":"10.1186/s41077-022-00236-x","DOIUrl":"https://doi.org/10.1186/s41077-022-00236-x","url":null,"abstract":"<p><strong>Background: </strong>The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator's ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator's debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators' cognitive load, workload, and debriefing quality.</p><p><strong>Methods: </strong>Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models.</p><p><strong>Results: </strong>Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX -4.5, 95%CI -16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI -3.4 to 8.1, p=0.436).</p><p><strong>Conclusions: </strong>The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10704900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-26DOI: 10.1186/s41077-022-00235-y
Mary K Fey, Christopher J Roussin, Jenny W Rudolph, Kate J Morse, Janice C Palaganas, Demian Szyld
Simulation-based learning occurs in multiple contexts, and one teaching style cannot adequately cover the needs at each learning level. For example, reflective debriefing, often used following a complex simulation case, is not what is needed when learning new skills. When to use which facilitation style is a question that educators often overlook or struggle to determine. SimZones is a framework used to clarify the multiple contexts in simulation. This framework, combined with elements of Debriefing With Good Judgment, can help educators match the appropriate facilitation style with learner needs and learning context. We have distilled the core elements of the "with good judgment" approach to debriefing and applied them to the SimZones framework to guide educators with (1) what type of learning can be expected with each learning context, (2) what behaviors and activities can be expected of the learners in each learning context, (3) what instructional strategies are most effectively used at each stage, and (4) what are the implications for the teacher-learner relationship.
{"title":"Teaching, coaching, or debriefing With Good Judgment: a roadmap for implementing \"With Good Judgment\" across the SimZones.","authors":"Mary K Fey, Christopher J Roussin, Jenny W Rudolph, Kate J Morse, Janice C Palaganas, Demian Szyld","doi":"10.1186/s41077-022-00235-y","DOIUrl":"10.1186/s41077-022-00235-y","url":null,"abstract":"<p><p>Simulation-based learning occurs in multiple contexts, and one teaching style cannot adequately cover the needs at each learning level. For example, reflective debriefing, often used following a complex simulation case, is not what is needed when learning new skills. When to use which facilitation style is a question that educators often overlook or struggle to determine. SimZones is a framework used to clarify the multiple contexts in simulation. This framework, combined with elements of Debriefing With Good Judgment, can help educators match the appropriate facilitation style with learner needs and learning context. We have distilled the core elements of the \"with good judgment\" approach to debriefing and applied them to the SimZones framework to guide educators with (1) what type of learning can be expected with each learning context, (2) what behaviors and activities can be expected of the learners in each learning context, (3) what instructional strategies are most effectively used at each stage, and (4) what are the implications for the teacher-learner relationship.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2022-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40487140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-05DOI: 10.1186/s41077-022-00234-z
May Sissel Vadla, Robert Moshiro, Paschal Mdoe, Joar Eilevstjønn, Jan Terje Kvaløy, Barikiel Hhando Hhoki, Hege Ersdal
Background: Annually, 1.5 million intrapartum-related deaths occur; fresh stillbirths and early newborn deaths. Most of these deaths are preventable with skilled ventilation starting within the first minute of life. Helping Babies Breathe is an educational program shown to improve simulated skills in newborn resuscitation. However, translation into clinical practice remains a challenge. The aim was to describe changes in clinical resuscitation and perinatal outcomes (i.e., fresh stillbirths and 24-h newborn deaths) after introducing a novel simulator (phase 1) and then local champions (phase 2) to facilitate ongoing Helping Babies Breathe skill and scenario simulation training.
Methods: This is a 3-year prospective before/after (2 phases) clinical observational study in Tanzania. Research assistants observed all deliveries from September 2015 through August 2018 and recorded labor/newborn information and perinatal outcomes. A novel simulator with automatic feedback to stimulate self-guided skill training was introduced in September 2016. Local champions were introduced in October 2017 to motivate midwives for weekly training, also team simulations.
Results: The study included 10,481 births. Midwives had practiced self-guided skill training during the last week prior to a real newborn resuscitation in 34% of cases during baseline, 30% in phase 1, and 71% in phase 2. Most real resuscitations were provided by midwives, increasing from 66% in the baseline, to 77% in phase 1, and further to 83% in phase 2. The median time from birth to first ventilation decreased between baseline and phase 2 from 118 (85-165) to 101 (72-150) s, and time pauses during ventilation decreased from 28 to 16%. Ventilations initiated within the first minute did not change significantly (13-16%). The proportion of high-risk deliveries increased during the study period, while perinatal mortality remained unchanged.
Conclusions: This study reports a gradual improvement in real newborn resuscitation skills after introducing a novel simulator and then local champions. The frequency of trainings increased first after the introduction of motivating champions. Time from birth to first ventilation decreased; still, merely 16% of newborns received ventilation within the first minute as recommended. This is a remaining challenge that may require more targeted team-scenario training and quality improvement efforts to improve.
{"title":"Newborn resuscitation simulation training and changes in clinical performance and perinatal outcomes: a clinical observational study of 10,481 births.","authors":"May Sissel Vadla, Robert Moshiro, Paschal Mdoe, Joar Eilevstjønn, Jan Terje Kvaløy, Barikiel Hhando Hhoki, Hege Ersdal","doi":"10.1186/s41077-022-00234-z","DOIUrl":"https://doi.org/10.1186/s41077-022-00234-z","url":null,"abstract":"<p><strong>Background: </strong>Annually, 1.5 million intrapartum-related deaths occur; fresh stillbirths and early newborn deaths. Most of these deaths are preventable with skilled ventilation starting within the first minute of life. Helping Babies Breathe is an educational program shown to improve simulated skills in newborn resuscitation. However, translation into clinical practice remains a challenge. The aim was to describe changes in clinical resuscitation and perinatal outcomes (i.e., fresh stillbirths and 24-h newborn deaths) after introducing a novel simulator (phase 1) and then local champions (phase 2) to facilitate ongoing Helping Babies Breathe skill and scenario simulation training.</p><p><strong>Methods: </strong>This is a 3-year prospective before/after (2 phases) clinical observational study in Tanzania. Research assistants observed all deliveries from September 2015 through August 2018 and recorded labor/newborn information and perinatal outcomes. A novel simulator with automatic feedback to stimulate self-guided skill training was introduced in September 2016. Local champions were introduced in October 2017 to motivate midwives for weekly training, also team simulations.</p><p><strong>Results: </strong>The study included 10,481 births. Midwives had practiced self-guided skill training during the last week prior to a real newborn resuscitation in 34% of cases during baseline, 30% in phase 1, and 71% in phase 2. Most real resuscitations were provided by midwives, increasing from 66% in the baseline, to 77% in phase 1, and further to 83% in phase 2. The median time from birth to first ventilation decreased between baseline and phase 2 from 118 (85-165) to 101 (72-150) s, and time pauses during ventilation decreased from 28 to 16%. Ventilations initiated within the first minute did not change significantly (13-16%). The proportion of high-risk deliveries increased during the study period, while perinatal mortality remained unchanged.</p><p><strong>Conclusions: </strong>This study reports a gradual improvement in real newborn resuscitation skills after introducing a novel simulator and then local champions. The frequency of trainings increased first after the introduction of motivating champions. Time from birth to first ventilation decreased; still, merely 16% of newborns received ventilation within the first minute as recommended. This is a remaining challenge that may require more targeted team-scenario training and quality improvement efforts to improve.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9636744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40446237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators' guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator's role during simulated scenarios.
Methods: A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.
Results: One main category, "Alternating between active and passive facilitation," emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students' understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator's presence in the simulation room during the simulated scenarios influenced students' emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.
Conclusions: The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.
{"title":"Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions.","authors":"Hilde Solli, Thor Arne Haukedal, Sissel Iren Eikeland Husebø, Inger Åse Reierson","doi":"10.1186/s41077-022-00233-0","DOIUrl":"https://doi.org/10.1186/s41077-022-00233-0","url":null,"abstract":"<p><strong>Background: </strong>High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators' guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator's role during simulated scenarios.</p><p><strong>Methods: </strong>A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.</p><p><strong>Results: </strong>One main category, \"Alternating between active and passive facilitation,\" emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students' understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator's presence in the simulation room during the simulated scenarios influenced students' emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.</p><p><strong>Conclusions: </strong>The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.</p>","PeriodicalId":72108,"journal":{"name":"Advances in simulation (London, England)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9618220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40442764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}