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A63 The use of simulation based education (SBE) to improve recognition and management of patients in the transition from acute to end of life care 使用模拟教育(SBE)来提高患者从急性到临终关怀过渡的认识和管理
Jane Brundish, Genevieve Russell
Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3]. To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients. Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario. Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning. SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
在任何情况下,识别和管理病情恶化的患者对卫生保健提供者(HCPs)来说都是一件具有挑战性和痛苦的事情。临终关怀是护理和医学教育的核心组成部分,但历史上却很少受到关注。基于模拟的教育(SBE)已被证明是一种有效的工具,可以在涉及复杂的临床场景和倡导以患者为中心的护理时提高医护人员的能力和信心[1]。国家对及时、个性化的临终关怀的认识和提供正在推动对多学科团队教育的需求[2][3]。设计、实施和修改SBE计划,以提高病人病情恶化时的护理质量。SBE将被用来实现这一目标,通过提高一个有凝聚力的多学科团队在护理病情恶化的病人时的信心和能力。每年举办三个SBE学习日,通过在线门户网站预订。会议由重症监护、姑息医学和实践发展团队的医护人员提供便利。一份概述SBE情景和学习目标的手册会提前分发,这份预简介可以让学习者准备和理解当天的形式。教学日由三个临床场景组成,跟随患者经历他们疾病的不同阶段:最初是急性评估和升级,导致考虑个人治疗升级计划,最终是他们的临终关怀。通过基于证据的角色扮演,通过模拟学习是多方面的,观察者作为学习者,在每个场景之后通过促进反馈进行集体汇报。所有学习者提供的在线反馈在整个四年的课程开发过程中得到整理。评价揭示了三个主要主题;学习者看重SBE,因为它可以复制实践,简报讨论巩固了学习,并使学习者有机会了解它将如何改善他们的实践,并且重视多学科团队学习。SBE是一种有效的方法,可以在任何情况下提高HCPs对病情恶化患者的个性化和协调护理的质量。作为一种有效的工具,它也与国家的努力保持一致,即通过积极主动的预先护理计划讨论和对临终者及其家属的整体护理,提高对临终患者的认识。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A68 Remote Simulation in Cardiothoracic Surgery A68远程模拟在心胸外科
Abdul Badran, Aiman Alzetani
Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1]. We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis. We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience. Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
在COVID大流行之后,模拟是英国外科培训恢复不可或缺的一部分。传统模拟训练的物理限制会影响访问。我们试图了解心脏和胸部远程模拟训练是否可行和有效。它已在其他环境中得到证实,在外科环境中具有潜力[1]。我们利用Teams和Zoom在线平台进行了一对一和分组模拟培训,内容包括视频胸腔镜手术楔形切除和肺叶切除以及冠状动脉吻合。我们在胸椎组有15名参与者在心脏组有5名参与者在4个疗程中。所有参与者都发现远程模拟训练很有用,提高了他们对手术技能的信心。我们在会议期间没有任何技术连接困难,但这种格式的模拟挑战包括标准化设备和设置会前。参与者发现,在89%的情况下,对表现的反馈优于面对面的模拟和/或手术室体验。在我们的试点研究中,远程模拟在心胸外科手术中是可行和有效的。需要进一步研究以更好地澄清这种资源应针对哪些人,包括受训人员的经验和能力水平。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A16 ‘Not being afraid of saying dying’: sharing key vocabulary for palliative care discussions through simulation debrief A16“不怕说死”:通过模拟汇报分享姑息治疗讨论的关键词汇
Amy Huggin, Deepta Churm, Lucy Robinson, Laura Massey, Owain Leng
Simulation as a learning platform is recognized internationally as beneficial in terms of education, training and assessment of doctors [1,2]. This study aimed to introduce and evaluate a novel Palliative Medicine simulation session as a tool for Foundation Year 2 (FY2) doctors to gain competency and confidence in the assessment and management of life-limiting illness. We designed the palliative care (PC) simulation session based on the FY2 curriculum. The three scenarios involved management of opioid toxicity, breaking bad news and shared decision-making with a role-play patient with a gastrointestinal bleed. Session faculty included a mix of healthcare professionals, but always included a PC specialist. We evaluated the session using a pre- and post-session questionnaire collecting data using 5-point Likert scales and free-text comments. We analysed qualitative data using content analysis. Researcher and methodological triangulation increased the credibility of the findings. The three prevalent themes noted from the pre-content analysis were Communication, Prognostication and the Process of complex decision-making. Comments such as ‘Senior colleagues hesitant to have escalation discussions’ and ‘I find it difficult when the patient has a very different idea of how poorly they are’ were examples of quotes given by candidates as pre-session challenges. 95.6% of our candidates felt that the session addressed these challenges, mainly through the debrief process. The main learning points articulated were in relation to prescribing and communication skills. Candidates expressed the importance of ‘picking up communication techniques and phrases’. The debrief was the most highly valued, and frequently mentioned positive element of the content analysis. ‘Open discussions’ was mentioned on numerous occasions, ‘I felt comfortable asking questions’ and ‘Discussion after SIM was very useful’, all support the importance of skilled debrief. FY2 doctors identified communication as their biggest concern when managing Palliative Care patients. Our session addressed this through open and frank debrief discussion. This allowed reflection on previous experience and peer-to-peer learning of key vocabulary when talking to patients with a limited prognosis. Further qualitative evaluation of the impact of this session on clinical practice and how peer learning could be incorporated into day-to-day skills development on the wards would be of value. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
模拟作为一种学习平台,在医生的教育、培训和评估方面被国际公认为是有益的[1,2]。本研究旨在介绍和评估一种新的姑息医学模拟课程,作为基础二年级(FY2)医生获得评估和管理限制生命疾病的能力和信心的工具。我们根据FY2课程设计了姑息治疗(PC)模拟课程。这三种场景涉及阿片类药物毒性的管理,突发坏消息以及与患有胃肠道出血的角色扮演患者共同决策。会议教师包括医疗保健专业人员,但总是包括一个个人电脑专家。我们使用5点李克特量表和自由文本评论收集数据的会前和会后问卷来评估会议。我们使用内容分析来分析定性数据。研究者和方法论三角测量增加了研究结果的可信度。从内容前分析中指出的三个普遍主题是沟通、预测和复杂决策过程。面试者在面试前提出的挑战中引用了一些例子,比如“资深同事在讨论升级问题时犹豫不决”,“当病人对自己的情况有完全不同的看法时,我觉得很难做到”。95.6%的候选人认为会议主要通过汇报过程解决了这些挑战。所阐述的主要学习要点与处方和沟通技巧有关。求职者表示“学习沟通技巧和表达方式”的重要性。汇报是内容分析中最受重视、最常被提及的积极因素。“公开讨论”在很多场合被提到,“我觉得提问很舒服”和“SIM后的讨论非常有用”,这些都证明了熟练汇报的重要性。FY2医生认为沟通是他们在管理姑息治疗患者时最关心的问题。我们的会议通过公开和坦率的汇报讨论解决了这个问题。这允许在与预后有限的患者交谈时反思以前的经验和对等学习关键词汇。进一步对本次会议对临床实践的影响进行定性评估,以及如何将同行学习纳入病房的日常技能发展,将是有价值的。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A28 Developing and delivering a telephone skills simulation training for non-registered NHS mental health call-handlers A28为未注册的国民保健制度心理健康电话接线员制定和提供电话技能模拟培训
Anna Thame, Carrie Hamilton
Registered healthcare professionals undertake a wide range of mental health work, sometimes with little preparation and training [1]. Increasingly non-registered staff take on mental health call-handler roles, having conversations with vulnerable individuals over the phone; these staff often lack the training to effectively communicate with callers. The aim of this initiative was to design and deliver a telephone skills training program for non-registered NHS mental health call-handlers, with the hypothesis that such training would improve their communication skills and overall job performance. Studies have shown that receiving training in having supportive mental health conversations over the phone increases staff confidence and changes their attitudes [2] and has the potential to benefit staff retention. A mixed-methods approach was used in the design, incorporating both qualitative and quantitative data collection and based on the needs and feedback of the call-handlers themselves. Evidence shows that involving simulated patients (SPs) can be effective in telephone studies [3]; leading us to train experienced SPs in their roles as members of the community phoning the help line. All was face to face, although conducted over the phone with the SP hidden. Active participants, the SP and the observing participants all became involved in the debrief. The content covered active listening, empathy, signposting and options in handling the challenging situations. Developed over a month, the programme was delivered as part of an overall training for their roles. The evaluation of the session indicated significant self-rated confidence in having calls with members of the public. The scenarios increased in intensity, covering topics ranging from bullying, domestic violence, gambling addiction and intent to take life. Qualitative feedback from the call-handlers showed that they felt more confident and prepared in their roles, and were better equipped to handle challenging situations. The involvement of SPs was also found to be authentic and highly beneficial by the call-handlers. Participants requested frequent practice sessions, face to face or online. Investing in providing targeted training and support for non-registered NHS mental health call-handlers, can have a positive impact on their communication skills, overall job performance and likely staff retention. This can ultimately lead to improved quality of care and patient outcomes in the mental health sector. The involvement of SPs can provide a valuable learning experience, both in role and in the debrief, for call-handlers, and help to prepare them for real-life scenarios. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
注册医疗保健专业人员承担广泛的心理健康工作,有时几乎没有准备和培训[1]。越来越多的非注册工作人员承担起心理健康电话接线员的角色,通过电话与脆弱的个人交谈;这些员工往往缺乏与呼叫者有效沟通的培训。这一倡议的目的是为未注册的国民保健制度心理健康电话接线员设计和提供电话技能培训方案,假设这种培训将提高他们的沟通技巧和整体工作表现。研究表明,接受关于通过电话进行支持性心理健康对话的培训可增加工作人员的信心,改变他们的态度[2],并有可能有利于留住工作人员。在设计中使用了混合方法,结合定性和定量数据收集,并基于调用处理程序本身的需求和反馈。有证据表明,让模拟患者(SPs)参与电话研究是有效的[3];引导我们培训经验丰富的sp,让他们成为拨打帮助热线的社区成员。所有的一切都是面对面的,尽管是在电话里进行的,警察是隐藏的。主动参与者、SP和观察参与者都参与了汇报。课程内容包括积极倾听、同理心、指引以及应对挑战的方法。该计划经过一个多月的发展,作为对他们的角色进行全面培训的一部分。对会议的评估表明,在与公众成员进行电话交谈时,有很大的自我评价的信心。这些场景的强度越来越大,涵盖了欺凌、家庭暴力、赌博成瘾和自杀意图等话题。从电话接线员那里得到的定性反馈表明,他们对自己的角色更有信心,准备得更充分,也能更好地处理具有挑战性的情况。呼叫处理人员也发现SPs的参与是真实的和非常有益的。参与者要求经常进行面对面或在线的练习。投资为未注册的NHS心理健康呼叫处理人员提供有针对性的培训和支持,可以对他们的沟通技巧、整体工作绩效和可能的员工保留产生积极影响。这最终可以改善精神卫生部门的护理质量和病人的治疗结果。服务提供者的参与可以为呼叫处理人员提供宝贵的学习经验,无论是在角色中还是在汇报中,并帮助他们为现实生活中的情况做好准备。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A104 A virtual musculoskeletal case history simulation with service users for pre-registration physiotherapy students A104为注册前理疗学生提供的虚拟肌肉骨骼病例史模拟服务
Carol McNally, Katy Baines
Within health care provision many case history assessments are now performed online [1], with students expected to utilize a variety of virtual platforms in a safe, effective and professional manner. Aim: To approximate a real environment for students to practice virtual skills of case history assessment with service users. Objectives: Student development of: 1. Virtual communication skills (verbal, non-verbal, active listening, respect), 2. Clinical reasoning and interpretation, and 3. Reflective skills facilitated by debrief. Simulation preparation including revision of musculoskeletal assessment and familiarization with virtual ground rules linked to HCPC Guidance on Conduct and Ethics [2]. 42 students participated, split into groups of 14 for each virtual simulation session with a total of 5 service users briefed beforehand. Initial warm-up activities in breakout rooms were used to familiarize students with use of the online platform and to facilitate virtual communication skills. Groups of 4 students planned and undertook a virtual musculoskeletal case history with a service user. The Diamond structure for simulation debrief [3] was facilitated by Faculty staff involving the service users and peers; enabling further development of the students’ clinical reasoning and interpretation. Students reflected on their own performance using a simulation checklist as a resource, closing the loop by creating an action plan prior to their first practice placement. 25 students voluntarily completed an anonymous questionnaire linked to their virtual experiential learning activity. 75% strongly agreed and 21% agreed that the simulation was helpful in their development for placements (see Graph to show student response that virtual musculoskeletal simulation with service users was helpful in their development for placements Thematic analysis of good aspects of the activity identified 4 main themes: Benefits and realism of service user involvement compared to actors or peers Development of virtual communication and assessment skills Richness of involvement of service users in the debrief Usefulness of warm up activities using virtual technology Suggestions for improvement showed 2 main themes around increasing planning time and more opportunities for simulation with service users. Findings demonstrated the simulation aims and objectives were met with students positively reporting that the activity was helpful in their learning ahead of practice placements - enabling development of virtual communication, clinical reasoning/ interpretation and reflection through debrief. Approximation of a real environment for students to practice virtual case history assessment incorporating service users offers a rich educational example that aligns well with practice and sustainability in the current healthcare environment and is highly valued by students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submittin
在医疗保健服务中,许多病例史评估现在都是在线进行的[1],学生希望以安全、有效和专业的方式利用各种虚拟平台。目的:为学生提供一个近似真实的环境,让学生与服务使用者一起练习个案史评估的虚拟技能。目标:学生的发展:2.虚拟沟通技巧(口头、非口头、积极倾听、尊重)2 .临床推理与解释;汇报促进了反思技能。模拟准备包括修订肌肉骨骼评估和熟悉与HCPC行为和道德指南相关的虚拟基本规则[2]。42名学生参加了这次虚拟模拟活动,他们被分成14人一组,并事先向5名服务用户进行了简要介绍。在分组讨论室进行的初始热身活动是为了让学生熟悉在线平台的使用,并促进虚拟交流技能。每组4名学生与一名服务用户一起计划并进行了一项虚拟的肌肉骨骼病例记录。模拟汇报的菱形结构[3]是由涉及服务用户和同行的教职员工促成的;促进学生临床推理和解释能力的进一步发展。学生们用模拟清单作为资源来反思自己的表现,在他们第一次实习之前通过制定行动计划来完成这个循环。25名学生自愿完成了一份与他们的虚拟体验式学习活动相关的匿名问卷。75%的人强烈同意,21%的人同意模拟对他们的实习发展有帮助(见图表,显示学生对服务用户的虚拟肌肉骨骼模拟有助于他们的实习发展的反应)与演员或同伴相比服务用户参与的好处和现实性虚拟沟通和评估技能的发展服务用户在汇报中的参与度丰富使用虚拟技术预热活动的有用性改进建议显示了两个主要主题围绕增加规划时间和与服务用户进行模拟的更多机会。研究结果表明,模拟的目的和目标得到了满足,学生们积极地报告说,该活动有助于他们在实习前的学习——通过汇报促进虚拟交流、临床推理/解释和反思的发展。为学生提供一个近似真实的环境来实践包含服务用户的虚拟病例历史评估,提供了一个丰富的教育示例,它与当前医疗保健环境中的实践和可持续性很好地结合在一起,并且受到学生的高度重视。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A81 Advance Choice Documents: a Simulation for Service Users, Carers and Clinicians A81预先选择文件:服务用户、护理人员和临床医生的模拟
Megan Fisher, Anita Bignell, Marcela Schilderman, Claire Henderson, Shubulade Smith, Abigail Babatunde, Selena Galloway, Mariola Ruiz
Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process. Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs. ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience. The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios. There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well. The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved. Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course. This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
提前选择文件(Advance Choice Documents, ACDs)是英国《精神卫生法》即将进行的重要改革之一[1]。该文件的目的是允许服务用户在身体健康时拥有更大的自主权,以便在将来身体不适时做出决定和指导。它是由服务用户和临床医生在共同决策过程中创建的。莫兹利学习(ML)与精神病学、心理学和神经科学研究所的一个研究小组合作,为服务用户、护理人员和临床医生提供了一个共同制作的模拟日。其目的是使与会者能够更好地了解如何共同制定和实施亚洲发展议程。ML运行了两个独立的模拟日,以及研究团队的成员,包括一名律师和具有生活经验的调解人。一天的开始部分包括说教式教学;让参与者更多地了解ACDs,并有空间向有实际经验的人、临床医生和律师提问。这确保了参与者获得了承担场景的基线知识水平。写了四个模拟场景,但由于时间有限,两天只发生了三个。这些都围绕着一个病人;参与者跟随患者完成他们的ACD旅程。病人由一位演员扮演。所有场景的设计都涉及临床医生,通常还有护理人员和服务用户在场。汇报包括一个改进的彭德尔顿模型,其中包括来自服务用户、护理人员和临床医生的反馈,以允许所有参与者提供反馈和学习。参与者被要求完成课前和课后问卷调查。配对样本t检验分析课程前后问卷的差异。结果显示,治疗前(M = 3.17, SD = 0.81)和治疗后(M = 4.21, SD = 0.20)的课程问题得分存在显著差异,t(5) = -5.26, p <0.05, 95% CI[-1.55, -0.53],大效应量d = -2.15。100%的参与者会推荐这门课程。这是ML首次与混合学习者进行模拟,其中不仅包括临床医生,还包括参与模拟和汇报的服务用户和护理人员。反馈是积极的,有助于提高对ACD的认识。同样值得注意的是,它使临床医生、服务使用者和护理人员相互学习产生了积极的影响。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A67 Advanced cardiothoracic Simulation -how to do it and who is it for? A67高级心胸模拟-如何做到这一点,谁是它?
Abdul Badran, Aiman Alzetani
There is a large backlog in surgery due to covid as well as surgical training [1]. We explored the feasibility of a dry lab simulation environment to teach advanced surgical specialty skills to learners with different levels of experience. Session description: We ran 5 cardiothoracic surgical simulation courses over 2021-2022 with a total of 61 delegates. We covered coronary anastomosis, aortic valve replacement, video-assisted-thoracoscopic-surgery (VATS) lung wedge resection and pulmonary vessel dissection. Each skill station ran for 40 minutes including a 15-minute description and real-time demo. Target audience: Participants included 36 medical students, 14 specialty doctors and 11 foundation doctors. We used synthetic plastinated and resin printed models with modular metal frames to help with retraction and suspension of the area of interest for the cardiac models. For the VATS models a laptop with connected angled endoscopic camera was utilized. The lung models were 3D printed. 88% of all participants were able to complete all procedures successfully under supervision. 96% of all participants increased in confidence with the procedure following simulation compared to before. Interestingly only 44% of specialty trainees described themselves as confident in some procedures prior to simulation. Of the medical student cohort 95% had not had any previous simulation or surgical experience prior. We have demonstrated the feasibility of a dry lab simulation programme for candidates of all experiences in cardiothoracic surgery. Confidence in surgical technique is low during the COVID era. Simulation improved confidence in surgical technique and must be offered more widely to enhance training experiences. No experience is necessary for successful simulation. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
由于新冠肺炎疫情,外科手术和外科培训都存在大量积压[1]。我们探索了在干实验室模拟环境下,对不同经验水平的学习者进行高级外科专业技能教学的可行性。会议描述:我们在2021-2022年期间开设了5门心胸外科模拟课程,共有61名代表。我们涵盖了冠状动脉吻合,主动脉瓣置换术,视频辅助胸腔镜手术(VATS)肺楔形切除和肺血管剥离。每个技能站运行40分钟,包括15分钟的描述和实时演示。对象:参会者包括36名医学生、14名专科医生和11名基础医生。我们使用合成塑化和树脂打印模型与模块化的金属框架,以帮助缩回和悬浮感兴趣的区域的心脏模型。对于VATS模型,使用了连接有角度的内窥镜相机的笔记本电脑。肺模型是3D打印的。88%的参与者能够在监督下成功完成所有程序。与之前相比,96%的参与者对模拟后的程序增加了信心。有趣的是,在模拟之前,只有44%的专业受训者表示自己对某些程序有信心。在医学生队列中,95%之前没有任何模拟或手术经验。我们已经证明了干实验室模拟程序的可行性,适用于所有心胸外科经验的候选人。在COVID时代,对手术技术的信心很低。模拟提高了对手术技术的信心,必须更广泛地提供以提高培训经验。成功的模拟不需要经验。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A36 Supporting clinical and non-clinical staff to have challenging conversations with patients, relatives and colleagues: online simulation with live actors A36支持临床和非临床工作人员与患者、亲属和同事进行具有挑战性的对话:与真人演员进行在线模拟
Anna Thame, Carrie Hamilton
Whether clinical or non-clinical, patient facing or not, staff working in a healthcare environment will need to initiate or manage challenging conversations in the workplace, with colleagues, patients or relatives/carers. How well and how compassionately these more difficult interactions are handled is critical to whether the conversation is effective, and leaves all parties feel respected and heard, even if the issue itself cannot be resolved. If there is negative escalation of the situation, trust is undermined, leading to further complications, distress and potential error. This can have a significant impact on team working, and ultimately on the patient or their relative’s experience [1]. Evidence was gathered from a large NHS Trust during the two-month long design of the workshop. The aim was to enable participants to learn communication strategies and techniques helping them to effectively manage challenging conversations with kindness and compassion. In 2020, five standalone sessions were delivered online (a result of the geographical size of the Trust rather than a result of the pandemic); there has been a further six online deliveries per year to date, with constant review and revision. Content includes: Active listening, empathy, communication strategies, appreciative enquiry, an exploration of values, and opportunities for reflection. The scenarios cover colleague to colleague interactions (Teams meeting), frustrated relatives (phone call), isolated patient (video consultation) and unsafe colleague (face to face). All are effective in an online environment, and are authentic and relatable. Over 300 NHS staff have participated over three years. Evaluation shows they agree or strongly agree that their skills and knowledge has improved, the scenarios were relevant and authentic, and the mode of participation provided a valuable opportunity to practice new skills in a safe environment. All felt more confident to hold challenging conversations that would be more mutually positive and avoid escalation. Consistently, participants have commented on the positivity of receiving feedback from each other and the involvement of actors was found to be highly beneficial, with feedback from them, from their perspective, uniquely insightful. For the last three years, staff from a large NHS Trust have been able to learn and practice challenging conversations, through online, live simulation, with ‘real’ patients, relatives/carers and colleagues. They have explored why conflict occurs and practised strategies, stopping and restarting, rehearsing and debriefing. Participants have requested further sessions and stated they would highly recommend all colleagues to undertake this training. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
无论是临床还是非临床、是否面对患者,在医疗保健环境中工作的员工都需要在工作场所与同事、患者或亲属/护理人员发起或管理具有挑战性的对话。处理这些更困难的互动的好坏和同情程度,对于对话是否有效至关重要,即使问题本身无法解决,也要让各方都感到受到尊重和倾听。如果局势出现负面升级,信任就会受到破坏,导致进一步的复杂情况、痛苦和潜在的错误。这可能会对团队合作产生重大影响,并最终影响患者或其亲属的体验[1]。在为期两个月的研讨会设计期间,从一家大型NHS信托机构收集了证据。目的是让参与者学习沟通策略和技巧,帮助他们以善意和同情心有效地管理具有挑战性的对话。2020年,在线举办了五次独立会议(这是信托基金地理规模大的结果,而不是大流行的结果);到目前为止,每年还有6次在线交付,并不断进行审查和修订。内容包括:积极倾听、共情、沟通策略、欣赏式询问、价值观探索和反思的机会。这些场景包括同事之间的互动(团队会议)、沮丧的亲属(电话)、孤立的病人(视频咨询)和不安全的同事(面对面)。这些都是有效的在线环境,是真实的和相关的。三年来,300多名NHS工作人员参与了这项活动。评估表明,他们同意或强烈同意他们的技能和知识得到了提高,场景是相关的和真实的,参与模式提供了一个在安全环境中练习新技能的宝贵机会。所有人都感到更有信心进行具有挑战性的对话,这将使双方更加积极,避免升级。参与者一致认为,从彼此那里得到反馈是积极的,参与者的参与被发现是非常有益的,从他们的角度来看,他们的反馈是独特的洞察力。在过去的三年里,一家大型NHS信托基金的员工已经能够通过在线实时模拟,与“真实”的病人、亲属/护理人员和同事学习和练习具有挑战性的对话。他们探讨了冲突发生的原因,并练习了策略,停止和重新开始,排练和汇报。与会者要求举行进一步的培训,并表示他们强烈建议所有同事参加这一培训。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A6 Virtual reality simulation as a tool for ENT training: an autoethnographic study 作为耳鼻喉科训练工具的虚拟现实模拟:一项自我民族志研究
Thomas Binnersley, C. Lucy Dalton
Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice. The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression. Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period ( This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if
自我民族志是一种新兴的定性研究类别,它试图将传统科学的严格分析与人类经验不可否认的影响联系起来。尽管在外科和基于模拟的教育研究中仍未得到充分利用,但自我民族志在与更广泛的读者分享系统的个人反思方面具有巨大的潜力,特别是与依赖体验式学习作为其培训基石的外科学员。本研究从外科新手的角度研究了使用自体人种志来研究虚拟现实(VR)颞骨(TB)钻孔模拟作为耳鼻喉(ENT)训练的学习工具。从2021年10月到2022年7月,首席研究员进行了16次3小时的学习,学习在Voxel-Man TempoSurg (VMT)结核病模拟器上进行虚拟皮质乳突切除术。使用模板收集定性数据,包括现场记录和反思日志。使用NVivo12对这些数据进行编码,并使用归纳主题分析进行分析。修改的韦林量表和修改的斯坦福评估获得的手术模拟性能的其他定量数据使用Microsoft Excel绘制,并使用简单线性回归进行统计分析。最终产生了与学习经验相关的六个主题:(1)VMT作为手术学习工具,(2)导致不准确的内部和外部匆忙原因,(3)克服VMT技术问题,(4)反思反思和反馈的重要性,(5)手术对操作者的身体影响,(6)克服动机。作者对每个主题的思考随后进行了详细的讨论,并在当前文献的背景下进行了分析,以满足研究目标。定量数据的统计分析表明,在16个疗程期间,程序技能和能力在统计上有显著提高(本研究展示了一种新的自我民族志应用,表明虚拟现实结核病模拟与自我民族志的有组织反思和反馈相结合,是一种有效的耳鼻喉科培训工具,用于学习解剖学和技术技能。)我们发现,由评估驱动的行为和饥饿引起的匆忙导致了错误。这些错误导致手术医生失去动力和压力,这是外科医生经常经历的情绪。因此,我们也证明了VR结核病模拟可以成功地模拟手术室中常见的几个人为因素,这些因素必须自我识别并及时寻求高级支持,以防止患者受到伤害。这一证据应该为未来在外科和基于模拟的文献领域的自我民族志研究提供一个跳板。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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引用次数: 0
A107 Mental Health Simulation for Foundation Doctors: Bridging the gap of placement variation A107基础医生心理健康模拟:弥合安置差异的差距
Lisa Stevens, John Sterling
There is significant variation of foundation programme tracks across the United Kingdom, giving a range of clinical exposure to newly qualified doctors [1]. Common themes in tracks can be identified to include acute/emergency, community, general medicine, surgery and psychiatry components. In the deanery, many Foundation Trainees (FTs) on psychiatry will have up to 3 additional simulation days devoted to psychiatry themes and this is felt to be an especially effective way to supplement education on psychiatry consultation skills [2]. FTs who do not have psychiatry posts will not have the opportunity to attend this training. Typically, mandatory foundation simulation training focuses on human factors related to acute medical and surgical problems [3]. Our education department has developed a pilot programme to support simulation training on key mental health consultations to support well rounded training of FTs. Half day sessions have been delivered to small groups of FTs who do not have psychiatry posts. Faculty has included experienced simulation faculty and psychiatry doctors and the scenarios conducted in a small group format with professional actors playing patients for increased realism of scenarios. The participants rotated between 3 key scenarios covering essential themes of mental state examination, psychiatry team liaison, patient risk assessment and explaining mental health presentations. 2 sessions have been delivered for a total of 18 FTs. FTs showed insight to a number of challenges related to mental health presentations they had experienced outside of psychiatric settings and this formed the outline of the learning objectives for the session. The participants further reflected on discussions in their feedback from the session and portfolio. The sessions were well received, with improvement in confidence in managing these consultations demonstrated in pre and post course survey comparison from the majority of participants. Given the initial success of the session, the team is building a database of local faculty for continuity of the course and looking to secure relevant funding from HEE to provide further sessions for the FTs in the next academic year. This simulation pilot has shown promise to be a useful addition to supplement the education of FTs for mental health consultations applicable in all areas of their clinical practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
英国各地的基础课程有很大的差异,为新合格的医生提供了一系列的临床接触[1]。可确定各轨道的共同主题包括急症/急诊、社区、普通医学、外科和精神病学组成部分。在院长院,许多精神病学的基础学员(FTs)将有多达3个额外的模拟日专门用于精神病学主题,这被认为是补充精神病学咨询技能教育的特别有效的方式[2]。没有精神病学职位的FTs将没有机会参加此培训。通常,强制性基础模拟训练侧重于与急性医疗和外科问题相关的人为因素[3]。我们的教育部门制定了一项试点计划,支持主要心理健康咨询的模拟培训,以支持家庭医生的全面培训。对没有精神病学职位的家庭医生小组进行了半天的培训。教师包括经验丰富的模拟教师和精神病学医生,以及以小组形式进行的场景,由专业演员扮演患者,以增加场景的真实性。参加者在三个主要场景之间轮换,涵盖精神状态检查、精神科小组联络、病人风险评估和解释精神健康介绍等基本主题。已经为总共18个ft提供了2次会议。FTs对他们在精神科环境之外经历的与心理健康演讲相关的一些挑战表现出了洞察力,这形成了该课程学习目标的大纲。与会者在会议和作品集的反馈中进一步反思了讨论。这些课程受到了很好的欢迎,大多数参与者在课程前和课程后的调查比较中表明,他们对管理这些咨询的信心有所提高。鉴于该课程的初步成功,该团队正在建立一个本地教师的数据库,以确保课程的连续性,并希望从高等教育学院获得相关资金,以便在下一学年为FTs提供更多的课程。这一模拟试点已显示有希望成为一个有益的补充,以补充家庭医生的心理健康咨询教育,适用于其临床实践的所有领域。作者确认已符合研究行为和传播的所有相关伦理标准。提交作者确认已获得相关的伦理批准(如适用)。
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International journal of healthcare simulation : advances in theory and practice
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