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A109 A simulation escape room: Does gameful training promote active learning and student engagement 模拟密室:游戏训练是否能促进学生的主动学习和参与
Lucy Morgan
Gamification of learning is becoming increasingly popular within higher education [1]. Student activities described as ‘gameful training’, including Escape Rooms, have reported additional learner benefits including improved teamwork, creative thinking and communication skills compared to traditional session designs [2]. There is a small number of existing case studies demonstrating their utilization within healthcare professional education and the reported additional benefits included pertinent skills such as task delegation and leadership, as well as being an engaging teaching strategy that promotes active learning [3]. A trial simulation escape room was created and implemented for level 5 adult and mental health branch nursing students within a Higher Education Institution. 12 different teams of students entered the escape room and worked together to ‘treat Arthur’, a patient presenting with acute anxiety and chest pain. Students were required to assess, escalate and manage Arthur effectively and would ‘escape the ward’, once he had received all of the required treatment. The learning outcomes for the scenario and subsequent puzzles and tasks were created based on recent curriculum teaching allowing students to apply prior learning within the escape room environment. Puzzles included coded locked boxes and students were required to apply relevant knowledge, such as answering pharmacology questions, to generate codes and progress throughout the scenario. Simulation equipment was utilized and students unlocked clinical treatments and medical devices which in turn had to be delivered to Arthur. The facilitator maintained an active role within the scenario and allowed students to practise communication skills such as escalating their concerns about Arthur via the telephone. It must be noted that the design time was significant for one scenario and required several pilots to ensure that all components were cohesive. Full support and creative input was required from the simulation technicians to ensure the activity’s success. Students fed back that they enjoyed the activity and were observed to work effectively together and prioritize and delegate throughout the task with minimal supervision. Students also stated the scenario context was helpful to apply their prior learning and were pleased that they had been able to manage this patient presentation together. Feedback from facilitators was also positive and both staff and students found it to be an engaging experience. Simulation escape rooms offer an innovative and engaging way for students to apply learning and vital practice technical and non-technical skills. For educators, clear learning outcomes and allowing sufficient design time is a necessity. 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.
学习游戏化在高等教育中越来越流行[1]。与传统的课程设计相比,被描述为“游戏训练”的学生活动,包括密室逃生,已经报告了额外的学习者好处,包括提高团队合作、创造性思维和沟通技巧[2]。现有的少数案例研究表明,它们在医疗保健专业教育中的应用,报告的额外好处包括相关技能,如任务授权和领导能力,以及作为一种促进主动学习的引人入胜的教学策略[3]。为某高等教育机构5级成人和心理健康科护理专业的学生创建并实施了一个试验模拟逃生室。12个不同的学生小组进入逃生室,共同“治疗亚瑟”,这是一个表现出急性焦虑和胸痛的病人。学生们被要求有效地评估、升级和管理亚瑟,一旦他接受了所有必要的治疗,就会“逃离病房”。场景的学习成果以及随后的谜题和任务是基于最近的课程教学创建的,允许学生在逃生室环境中应用先前的学习。谜题包括加密的锁盒,学生需要应用相关知识,如回答药理学问题,以生成代码并在整个场景中取得进展。利用模拟设备,学生们解锁了临床治疗和医疗设备,这些设备又必须交付给亚瑟。引导者在这个场景中保持积极的角色,并允许学生练习沟通技巧,例如通过电话升级他们对亚瑟的担忧。必须注意的是,设计时间对于一个场景来说是重要的,并且需要几个试点来确保所有组件都是内聚的。模拟技术人员的全力支持和创造性投入是确保活动成功的必要条件。学生们反馈说,他们喜欢这项活动,并且观察到他们在一起有效地工作,在最小的监督下优先考虑和分配任务。学生们还表示,场景背景有助于应用他们之前的知识,并且很高兴他们能够一起处理这个病人的演示。主持人的反馈也很积极,教师和学生都认为这是一次引人入胜的经历。模拟密室为学生提供了一种创新和吸引人的方式来应用学习和重要的实践技术和非技术技能。对于教育工作者来说,清晰的学习成果和充足的设计时间是必要的。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
A56 Using simulation to address staff wellbeing and retention in a global non-healthcare organization A56利用模拟解决一家全球性非医疗保健组织的员工福利和留任问题
Carrie Hamilton, Anna Thame
Stress, anxiety and depression affect one-fifth of the working age population and are a leading cause of staff attrition and loss of productivity [1]. Conversations between colleagues can help reduce stress, increase job satisfaction and productivity, build stronger relationships, and create a more positive work environment [2]. In spite of numerous policy initiatives in large organizations and fewer in small [3], it is reported, by colleagues, that hands on ‘practice’ in having conversations would be beneficial. We were approached to create a remote live four-hour workshop with authentic simulated scenarios, appropriate for a cross cultural global reach, aiming to enable staff to feel ‘at ease’ with having proactive conversations with their colleagues on a daily basis. In 2021-2022, 120 hours were spent developing a live module for managers working in non-healthcare environments. This module was preceded by three online eLearning modules, ‘being aware, being proactive and being responsive’. After eight pilots, content and delivery was scrutinized, analysing feedback from participating managers, facilitators, and actors. In 2023, a further 24 workshops are underway, using the refined content and delivery structure; 144 actors, 24 facilitators and 24 simulation advisers are involved. Participants are global managers, clustered into geographical regions; module timings are amended to suit time zones and in total 192 participants are able to take part in small groups of eight. A 90 minute follow up a month later enables participants to discuss the personal areas of identified focus. Creating a safe space has been essential, with ongoing facilitator alertness. Participants have immersed themselves in the six scenarios covering loneliness, disillusion, over-work, depression, crisis and acute anxiety. Participants key areas of focus have included: being sensitive to situations, being a better observer, sharing values with staff, spending time with colleagues, scheduling time to look after oneself. Timekeeping to ensure equity of discussion and involvement, and arrival and integration of the six actors have both been challenging, although mitigated by the pilot experience. This programme, incorporates online eLearning modules, a remote ‘live’ simulated module, and follow-up group sessions. By practising through simulated scenarios, there is significant potential to improve the support, retention and wellbeing of employees within this non-healthcare organization. The programme’s global scope, with five regions, highlights its relevance and applicability to a diverse range of workplaces. There is potential for replication in other organizations facing similar challenges, ultimately impacting on our society as a whole. 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.
压力、焦虑和抑郁影响着五分之一的工作年龄人口,是导致员工流失和生产力下降的主要原因[1]。同事之间的对话有助于减轻压力,提高工作满意度和生产力,建立更牢固的关系,创造更积极的工作环境[2]。尽管在大型组织中有许多政策倡议,而在小型组织中则较少[3],但据同事们报道,在进行对话时动手“练习”将是有益的。我们被邀请创建一个远程的四小时现场研讨会,其中有真实的模拟场景,适合跨文化的全球影响,旨在使员工在日常工作中与同事进行积极的对话时感到“轻松”。在2021-2022年期间,我们花了120个小时为在非医疗保健环境中工作的管理人员开发一个实时模块。在这个模块之前,有三个在线电子学习模块,“意识到,积极主动和响应”。在八个试点项目之后,对内容和交付进行了仔细审查,分析了参与项目的管理者、促进者和参与者的反馈。2023年,另外24个工作坊正在进行中,使用精炼的内容和交付结构;共涉及144名演员、24名辅导员和24名模拟顾问。参与者是分布在不同地理区域的全球管理者;模块时间被修改以适应时区,总共有192名参与者可以参加8人一组的小组。一个月后进行90分钟的跟进,让参与者讨论确定的个人重点领域。创造一个安全的空间是至关重要的,要时刻保持协调人的警觉。参与者将自己沉浸在六个场景中,分别是孤独、幻灭、过度工作、抑郁、危机和急性焦虑。参与者关注的主要领域包括:对情况敏感,成为更好的观察者,与员工分享价值观,与同事共度时光,安排时间照顾自己。确保公平讨论和参与的时间安排,以及六个参与者的到来和整合都是具有挑战性的,尽管试点经验减轻了这一挑战。该课程包括在线电子学习模块、远程“现场”模拟模块和后续小组会议。通过模拟场景的练习,在这个非医疗保健组织中,有很大的潜力可以改善员工的支持、留任和福利。该方案的全球范围,五个地区,突出了其相关性和适用性,以各种工作场所。在其他面临类似挑战的组织中也有可能复制,最终影响到我们整个社会。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
A59 Midlands Simulation and Immersive Learning Census 2023: A Cross-sectional study to inform regional TEL strategy A59中部模拟和沉浸式学习普查2023:为区域TEL战略提供信息的横断面研究
Joshua Whittaker, Alexander Crichton, Usman Ahmed
National Health Service England (NHSE) is committed to providing the highest quality, evidence-based and sustainable Technology Enhanced Learning (TEL) to the workforce of tomorrow [1]. Over the past 20 years, simulation-based education (SBE) facilities have developed across many NHS trusts, universities, and training programmes using different models of delivery and funding to match their local needs. More recently, technological advances and a pandemic-driven need for remote and supplementary training experiences has expanded the remit of TEL. Our objective was to complete a wide-ranging census to map simulation and immersive learning (SimImm) resources across an entire NHSE region and how these are delivered. Most importantly, we aim to gather stakeholder opinions on the perceived challenges faced by the SimImm community in the coming 3-5 years. In December 2022, we launched a multi-phased regional online survey of SimImm providers. Phase one distribution included members of the two regional simulation networks. Phase two was distributed to simulation leads for postgraduate schools, training programmes and higher education institutions. Throughout, other stakeholders in the SimImm community had the opportunity to complete the ‘future challenges’ section only. 35 organizations had completed the full census, with a further 47 stakeholders completing the ‘future challenges’ section. Of the full census, 14 were secondary care simulation centres, 18 training programmes and 3 universities. The most common resources used were High-fidelity simulation ( Thematic analysis of the ‘future challenges’ section, revealed 5 primary areas of perceived challenges: Faculty development, maintenance, and retention; resources funding; collaborative working; strategy and equitable opportunities and adoption of new technology. Provisional results already demonstrate a huge variety of resources which are distributed widely across the region. Many of these are not necessarily in contact with regional simulation networks, particularly individual training programmes. The stakeholder opinions collated through this exercise will form the bedrock on which regional SimImm strategy and decision-making can be based. 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.
英国国家卫生服务(NHSE)致力于为未来的劳动力提供最高质量、以证据为基础和可持续的技术增强学习(TEL)。在过去的20年里,模拟教育(SBE)设施已经在许多NHS信托基金、大学和培训项目中发展起来,使用不同的交付模式和资金来满足当地的需求。最近,技术进步和流行病对远程和补充培训经验的需求扩大了TEL的职权范围。我们的目标是完成一项广泛的普查,以绘制整个NHSE区域的模拟和沉浸式学习(SimImm)资源及其交付方式。最重要的是,我们的目标是收集利益相关者对simim社区在未来3-5年内所面临的挑战的看法。在2022年12月,我们对simim供应商发起了一项多阶段的区域性在线调查。第一阶段的分配包括两个区域模拟网络的成员。第二阶段分配给研究生院、培训方案和高等教育机构的模拟领导。在整个过程中,SimImm社区的其他利益相关者只有机会完成“未来挑战”部分。35个组织完成了全面普查,另有47个利益相关者完成了“未来挑战”部分。在全面普查中,有14个是二级保健模拟中心、18个培训课程和3所大学。最常用的资源是高保真模拟(“未来挑战”部分的专题分析,揭示了感知挑战的5个主要领域:教师发展,维护和保留;资源资金;协作工作;战略、公平机会和采用新技术。临时结果已经表明,在整个区域广泛分布着种类繁多的资源。其中许多不一定与区域模拟网络接触,特别是个别训练方案。通过此练习整理的利益相关者意见将形成区域simim战略和决策的基础。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
A50 The SEIPS game: An interprofessional teaching aid to promote understanding of human factors in healthcare A50 SEIPS游戏:一个跨专业的教学辅助工具,以促进对医疗保健中的人为因素的理解
Ruth Millett, Eloise van Vuren, Jessica Wadsworth, Jennifer Blair
As a human-factors focused simulation centre, we begin all our simulation courses with a human factors workshop introducing participants to the SEIPS model of human factors [1]. This enables them to explore systems-based impacts on clinical practice during post-scenario debriefs. However, we have noticed that some participants struggle to identify and discuss human factor themes which impact on them in their workplace. We aimed to develop an innovative teaching aid which would promote participant understanding and engagement. Previous experience has provided evidence that participants enjoy simulation games. Therefore, we chose to develop a table-top game to play with participants based on the SEIPS work system. We worked with interprofessional colleagues to identify factors that help and hinder processes in the work system and categorized them under SEIPS headings. We made a series of cards based on these factors which participants collect. The winner was the person who collected a helpful card for each SEIPS heading first. We have piloted our SEIPS game with interprofessional faculty, including those with specialist expertise in human factors in healthcare. We surveyed participants to obtain feedback. Survey results so far include data contained in ‘Play’ is a kinaesthetic way of learning and helps embed ideas and thinking. It also can create opportunities for discussion on different headings for human factors and systems thinking. The examples are fun but are also realistic so helps you see how HF is relevant. With the examples of human factors in the game it could be useful for staff with little clinical experience. Liked the competitive element and the examples helped expand on what SEIPS was and how it could be relevant to lots of areas. SEIPS game participant survey results We have developed a SEIPS game to facilitate discussion of human factors in healthcare. This novel approach has received positive initial feedback following our pilot. We are confident we can now move forward to integrate our SEIPS game into our Foundation Doctor’s simulation programme from August 2023. Following this, we intend to continue the process of data collection and analysis, with the intention of incorporating our SEIPS game more widely across simulation courses within various clinical specialties in future. 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.
作为一个以人为因素为重点的模拟中心,我们以人为因素研讨会开始所有的模拟课程,向参与者介绍人为因素的SEIPS模型[1]。这使他们能够在场景后汇报中探索基于系统的临床实践影响。然而,我们注意到,一些参与者很难识别和讨论在工作场所影响他们的人为因素主题。我们的目标是开发一种创新的教学辅助工具,以促进参与者的理解和参与。以往的经验证明,参与者喜欢模拟游戏。因此,我们选择在SEIPS工作系统的基础上开发一个桌面游戏供参与者一起玩。我们与跨专业的同事合作,确定工作系统中有助于和阻碍流程的因素,并将其归类为SEIPS标题。我们根据参与者收集的这些因素制作了一系列卡片。获胜者是首先为每个SEIPS标题收集有用卡片的人。我们已经与跨专业的教师进行了SEIPS游戏的试点,包括那些在医疗保健中的人为因素方面具有专业知识的教师。我们调查了参与者以获得反馈。到目前为止的调查结果包括“游戏”是一种动觉的学习方式,有助于嵌入想法和思考。它还可以为讨论人为因素和系统思维的不同标题创造机会。这些例子很有趣,但也很现实,可以帮助你了解HF是如何相关的。以游戏中的人为因素为例,它可能对缺乏临床经验的工作人员有用。我喜欢其中的竞争元素,这些例子也帮助我扩展了SEIPS是什么,以及它是如何与许多领域相关的。SEIPS游戏参与者调查结果我们开发了一个SEIPS游戏,以促进对医疗保健中的人为因素的讨论。在我们的试点之后,这种新颖的方法得到了积极的初步反馈。从2023年8月起,我们有信心将SEIPS游戏整合到基金会博士的模拟课程中。在此之后,我们打算继续进行数据收集和分析,以便在未来将我们的SEIPS游戏更广泛地整合到各种临床专业的模拟课程中。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
A97 Applying the Mental Capacity Act through multi-disciplinary simulation - A successful pilot 通过多学科模拟应用心理能力法案-一个成功的试点
Sebastian Gonzalez, Jennie Wood, Lisa Stevens, Christiane Plaum, Sini John, Eric Opoku
An assessment of mental capacity involves determining if a person can make a decision, or whether this needs to be done in their best interests [1]. The Mental Capacity Act (MCA) 2005, provides a legal framework that protects people who might not be able to make decisions for themselves and guides professionals during their practice. Research has shown inconsistencies on how the Mental Capacity Act is applied in health and social care settings [2], therefore ensuring that professionals have are provided with the right support to confidently apply the act should be a priority. Simulation has been effectively used in healthcare education [3] and could also be implemented to support this area of practice. The Homerton Healthcare NHS Foundation Trust’s Simulation Team and Adult Safeguarding Team, jointly worked in developing a simulation-based session which focused on mental capacity assessments in different situations. The aim of these sessions was to increase participants’ confidence to assess mental capacity and to manage challenging conversations during assessment. Scenarios were designed for hospital and community settings, the topics covered included consent to treatment, self-discharge, compliance with treatment, substance misuse, mental health problems, dementia and learning disability. The target audience was senior healthcare professionals that are regularly involved in making decisions related to mental capacity. Scenarios were designed to be flexible and adaptable according to the attendants’ needs, for example the learning disability scenarios involved the use of easy read information that was specifically provided or created. Actors were used for the role of patients or relatives, and members of the adult safeguarding team were part of the faculty to support or lead the debrief process. Between January 2023 and February 2023, the faculty delivered 3 sessions, with a total of 20 participants from different professional groups including doctors, nurses and allied health professionals. Anonymous feedback was collected at the end of each session, with 84.62% ( Studies have shown that healthcare professionals’ confidence in applying the mental capacity act can vary [2]. Solely focusing on traditional forms of education might not be enough to prepare our workforce, in this case simulation-based training has provided a valuable tool to enhance participant’s abilities in relation to the mental capacity act and its application in healthcare 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.
对精神能力的评估包括确定一个人是否能够做出决定,或者是否需要为了他们的最大利益而做出决定[1]。《2005年精神能力法》(MCA)提供了一个法律框架,保护那些可能无法自己做决定的人,并在他们的实践中指导专业人士。研究表明,《精神能力法》在健康和社会护理环境中的应用存在不一致之处[2],因此,确保专业人员得到正确的支持,以自信地应用该法案应该是一个优先事项。模拟已经在医疗保健教育中得到了有效的应用[3],也可以用于支持这一领域的实践。霍默顿医疗保健NHS基金会信托的模拟小组和成人保护小组共同开发了一个基于模拟的会议,重点关注不同情况下的心理能力评估。这些课程的目的是增加参与者评估心理能力的信心,并在评估过程中管理具有挑战性的对话。为医院和社区环境设计了情景,涵盖的主题包括同意治疗、自我出院、遵守治疗、药物滥用、精神健康问题、痴呆和学习障碍。目标受众是经常参与与心理能力有关的决策的高级医疗保健专业人员。根据服务人员的需求,设计的场景是灵活的和可适应的,例如,学习障碍场景涉及使用专门提供或创建的易于阅读的信息。演员被用来扮演病人或亲属的角色,成人保护小组的成员是教员的一部分,以支持或领导汇报过程。在2023年1月至2023年2月期间,该学院共举办了3次课程,共有20名来自不同专业群体的参与者,包括医生、护士和专职卫生专业人员。在每次会议结束时收集匿名反馈,84.62%(研究表明,医疗保健专业人员对应用心理能力法案的信心可能会有所不同[2])。仅仅关注传统形式的教育可能不足以让我们的员工做好准备,在这种情况下,基于模拟的培训提供了一个有价值的工具,可以提高参与者在心理能力法案及其在医疗保健实践中的应用方面的能力。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
A111 Undergraduate nursing programme entry: Encouraging offer holders to select their university offer, based on an informed overview of programme content A111本科护理课程入学:鼓励录取通知书持有人在了解课程内容的基础上选择大学录取通知书
Carrie Hamilton, Julie Cairns, Jim Bird, Caroline Tomkins
Choosing the right university and programme is crucial for aspiring nursing students and their families. With so many options available, it can be challenging to make an informed decision [1-3]. The aim of this initiative was to provide student nurse offer-holders and their parents/partners with an overview of the undergraduate nursing programme’s content, in an effort to encourage them to select the right university. The initiative was developed and conducted over six months (Dec 2022 - May 2023). It consisted of five Saturday morning sessions, each included taster lectures, clinical skills sessions, and simulations with actor role players. Offer-holders attended one rotation, while the parents/partners of offer-holders attended another rotation. The facilitated simulations were collaboratively designed by the University branch specialists and the education provider, and involved actor role players. In order to cover child, adult and mental health branches, for aspiring students, the scenario content was broad based and applicable to all. Scenario 1: Communication with relatives of a baby failing to thrive Scenario 2: Communication with an adult patient and her husband Both simulations were conducted as forum theatre and aligned with NHS values. Evaluation forms completed by potential nursing students and their parents/partners were overwhelmingly positive. Attendees reported that the sessions were informative and enjoyable, with the simulations being a particular highlight. The use of actor role players helped to make the simulations more realistic and engaging. Attendees felt that the sessions assisted them to better understand what to expect from the nursing programme, which would aid them in making a more informed decision about which university to choose. Offer holders and their families need to make an informed decision when choosing a nursing programme. The study showed that providing a comprehensive overview of the programme’s content through taster lectures, clinical skills sessions, and simulations can be an effective way to encourage students to select the right university. The use of actor role players in the simulations helped to create a realistic and engaging learning experience for attendees. Overall, this initiative highlights the importance of providing potential nursing students with the necessary information to make a decision about their education. By making an informed decision, the fit is likely to be right and the chances of attrition reduced. Further studies will be conducted by the university admissions teams to establish if these tasters assist with retention. 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.
选择合适的大学和课程对有抱负的护理专业学生和他们的家庭至关重要。面对如此多的选择,做出明智的决定是一项挑战[1-3]。这一举措的目的是为持有护理offer的学生及其父母/伴侣提供本科护理课程内容的概述,以鼓励他们选择合适的大学。该倡议的制定和实施历时6个月(2022年12月至2023年5月)。它包括五个星期六上午的课程,每个课程包括品酒师讲座,临床技能课程和演员角色扮演的模拟。要约持有人参加一次轮转,而要约持有人的父母/合伙人参加另一次轮转。促进模拟是由大学分院专家和教育提供者合作设计的,并涉及演员角色扮演。为了涵盖儿童、成人和心理健康部门,对于有抱负的学生,情景内容基础广泛,适用于所有人。场景1:与未能茁壮成长的婴儿的亲属沟通场景2:与成年患者及其丈夫沟通这两个模拟都是作为论坛剧院进行的,并与NHS价值观一致。潜在护理学生及其父母/伴侣填写的评估表格绝大多数是积极的。与会者报告说,会议内容丰富,令人愉快,模拟是一个特别的亮点。演员角色扮演者的使用有助于使模拟更加逼真和引人入胜。与会者认为,这些课程帮助他们更好地了解护理课程的期望,这将有助于他们在选择哪所大学时做出更明智的决定。Offer持有者和他们的家庭在选择护理项目时需要做出明智的决定。研究表明,通过品尝讲座、临床技能课程和模拟课程,对课程内容进行全面概述,可以有效地鼓励学生选择合适的大学。在模拟中使用演员角色扮演者有助于为与会者创造一个真实而引人入胜的学习体验。总的来说,这一举措强调了为潜在的护理学生提供必要信息以决定他们的教育的重要性。通过做出明智的决定,合适的人选很可能是正确的,员工流失的几率也会降低。大学招生团队将进行进一步的研究,以确定这些品酒师是否有助于记忆。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
A46 SPEED: an emergency department simulation training model which does not affect patient waiting times A46 SPEED:不影响病人等待时间的急诊科模拟训练模型
Sebastian Chong, Michael Phillips, Salwa Malik
There is a well-recognized tension between clinical service provision and participation in learning events for junior doctors (JDs) in the UK [1]. JDs frequently report that they are unable to attend regular teaching due to departmental clinical pressures, representing lost opportunities for their training and development. Therefore, there is need for development of training methods which minimize impact on clinical service delivery. To develop a simulation training model for Emergency Department (ED) JDs which would a) deliver tailored learning objectives according to the participants’ level of training and b) have minimal impact upon ED service provision. The ‘Simulation and Personalised Education in the Emergency Department’ (SPEED) model was developed. On SPEED days, JDs and advanced clinical practitioners (ACPs) who were undertaking clinical duties in ED on that day were invited on an individual basis to participate in a twenty-minute clinical simulation. Upon completion, the participant underwent a ten-minute debrief to reinforce predetermined learning objectives and supply feedback to simulation tutors before returning to their clinical duties in ED. Pre- and post-session questionnaires were conducted to assess acquisition of learning objectives. Training days were conducted in EDs of a UK Major Trauma Centre (MTC) and an associated small teaching hospital (TH). Departmental data on time to be seen by an ED clinician were collected retrospectively for SPEED days and comparable non-SPEED days, with differentiation between the majors and urgent care (UC) MTC sub-departments. A total of 7 SPEED days were conducted over 6 months between September 2022 and March 2023 – 5 in the MTC ED and 2 in the TH ED. 65 JDs and ACPs participated across the seven days. On asking about the usefulness of the SPEED session for day-to-day practice, 41 participants responded ‘strongly agree’ and 18 participants responded ‘agree’. 6 of the 7 SPEED days demonstrated a positive mean difference in post-session questionnaire score when compared to pre-test questionnaire. There was no statistically significant difference in time to see clinician between SPEED days and comparable non-SPEED days in MTC majors (1h11m vs. 48m), MTC UC (2h41m vs. 2h25m), or TH (1h15m vs. 1h8m) (Kruskal-Wallis test, The SPEED model demonstrates acquisition of learning objectives which are relevant to day-to-day practice. There is no evidence that delivery of this model significantly affects waiting times in either a small or large ED. Adoption of this training strategy may improve training opportunities for other ED clinicians. 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.
在英国,初级医生(JDs)的临床服务提供和学习活动的参与之间存在着公认的紧张关系[1]。jd经常报告说,由于部门的临床压力,他们无法参加常规教学,这意味着他们失去了培训和发展的机会。因此,有必要开发培训方法,以尽量减少对临床服务提供的影响。为急诊科专科医生发展模拟训练模式,以达致a)根据参加者的训练水平提供量身订定的学习目标,以及b)尽量减少对急诊科服务的影响。开发了“急诊室模拟和个性化教育”(SPEED)模型。在速成日,当日在急诊科执行临床工作的jd和高级临床医生(acp)被个别邀请参加一个20分钟的临床模拟。完成后,参与者进行了10分钟的汇报,以加强预定的学习目标,并向模拟导师提供反馈,然后返回他们在急诊科的临床职责。进行了课前和课后问卷调查,以评估学习目标的获得情况。培训日在联合王国重大创伤中心(MTC)和附属小型教学医院(TH)的急诊科进行。回顾性收集急诊科临床医生在SPEED日和可比较的非SPEED日的部门数据,并区分专业和紧急护理(UC) MTC子部门。在2022年9月至2023年3月的6个月内,共进行了7天的SPEED测试,其中5天在MTC ED, 2天在TH ED。在7天内,65名jd和acp参与了测试。当被问及SPEED会议对日常实践的有用性时,41名参与者回答“非常同意”,18名参与者回答“同意”。与测试前问卷相比,7天中的6天在测试后问卷得分上表现出正的平均差异。在MTC专业(1h11m vs. 48m)、MTC UC (2h41m vs. 2h25m)或TH (1h15m vs. 1h8m)中,SPEED天数与非SPEED天数在见临床医生的时间上没有统计学上的显著差异(kruskl - wallis检验)。SPEED模型表明与日常实践相关的学习目标的习得。没有证据表明这种模式的实施会显著影响小型或大型急诊科的等待时间。采用这种培训策略可能会改善其他急诊科临床医生的培训机会。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
A89 Paramedic placements: Let’s not forget the non-technical skills A89护理人员实习:不要忘记非技术技能
Jess Spencer, Carrie Hamilton, Jess Rimmer, Channine Clarke
Simulated placements for paramedics are increasing, with some organizations approaching these placements innovatively, focussing on combining undergraduate paramedic facilitation skills with peer reviewing skills [1]. Other HEIs focus on clinical skills with manikin scenario-simulations and on virtual reality driven learning. Effective communication skills are crucial for paramedics and simulated placements provide an opportunity to practice these skills. There is a heavy focus on communication skills in the HCPC Standards of Proficiency for Paramedics [2]; this, combined with our responsibilities to patients and their relatives means that rehearsal of these skills, are not overlooked in preference to technical skill acquisition. A simulation-based education provider and an HEI, co-created a two-day simulated placement for 60 paramedic undergraduates. The scenario content was developed to reflect the broad client base paramedics interact with: patients, relatives, by-standers, other healthcare, and emergency service professionals, all from across the life span and from different cultural and social backgrounds. The scenario focus was: care, kindness and compassion, confidentiality and candour, supporting colleagues, de-escalation, safeguarding, inclusivity, and transgender and gender diversity. Scenario development was undertaken by a range of healthcare professionals, and co-produced with lay developers, people who had experienced paramedic intervention. Actors were coached in role depiction and escalation, briefed regarding the learning outcomes, and had the pre-requisite experience in debriefing and feedback skills. Each learning outcome was scored by the students, for confidence and ability, in a pre-post evaluation. Overall students evaluated the placement as a meaningful learning opportunity. They felt able to consider their existing knowledge, then practice their skills and reflect on their attitudes. They described feeling better prepared for ‘real’ situations. Students reported the usefulness of being able to stop, discuss and restart/resume the simulation. Feedback from actors, peers and facilitators was described as an enhancement, and crucially, the co-production of the scenarios with lay developers, translating their ‘real’ experiences resonated with the students creating genuine, authentic learning opportunities. Communicating is a vital paramedic skill; evidence demonstrates that these vital skills, done well, lead to improved patient outcomes and satisfaction, and a reduction of medical errors [3]. Simulated placements are an essential ingredient in developing these skills and the involvement of actors and experienced facilitators provides a safe environment for students to practice. This initiative provides valuable insights into the co-production of scenarios (with users) and partnerships between HEIs and external simulation-based education providers. Authors confirm that all relevant ethical standards for research conduct and d
护理人员的模拟实习正在增加,一些组织以创新的方式进行这些实习,重点是将本科护理人员促进技能与同行评议技能相结合[1]。其他高等教育机构则侧重于通过模拟人体场景和虚拟现实驱动的学习来培养临床技能。有效的沟通技巧对护理人员来说是至关重要的,模拟实习为实践这些技能提供了机会。HCPC护理人员熟练程度标准非常注重沟通技巧[2];这一点,再加上我们对患者及其家属的责任,意味着这些技能的演练,不会被忽视,而不是技术技能的习得。一家基于模拟的教育提供商和一家高等教育机构共同为60名护理本科生创建了为期两天的模拟实习。制定情景内容是为了反映护理人员与之互动的广泛客户群:患者、亲属、旁观者、其他医疗保健和紧急服务专业人员,他们都来自不同的生命周期和不同的文化和社会背景。情景重点是:关怀、善良和同情、保密和坦率、支持同事、降级、保护、包容性、跨性别和性别多样性。场景开发由一系列医疗保健专业人员承担,并与经历过护理人员干预的非专业开发人员共同制作。演员在角色描述和升级方面接受了指导,简要介绍了学习成果,并在汇报和反馈技能方面具有必要的经验。每个学习成果都由学生在前后评估中对信心和能力进行评分。总的来说,学生们认为这次实习是一次有意义的学习机会。他们觉得能够考虑他们现有的知识,然后练习他们的技能,反思他们的态度。他们说自己对“真实”情况准备得更好了。学生们报告了能够停止、讨论和重新开始/恢复模拟的有用性。来自演员、同伴和辅导员的反馈被认为是一种增强,至关重要的是,与非专业开发人员共同制作场景,将他们的“真实”经验转化为学生的共鸣,创造了真正的学习机会。沟通是一项重要的急救技能;有证据表明,这些重要的技能,做得好,导致改善病人的结果和满意度,并减少医疗事故[3]。模拟实习是培养这些技能的重要组成部分,演员和经验丰富的辅导员的参与为学生的实践提供了一个安全的环境。这一举措为(与用户)共同制作场景以及高等教育机构与外部基于模拟的教育提供商之间的伙伴关系提供了有价值的见解。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
A60 A Simulation Based Quality Improvement Project to improve patient care in the Urgent Care Environment a60a基于模拟的质量改进项目,以改善紧急护理环境中的患者护理
Claire Cree, Marta Soares-Preece
In the two years prior to commencement of the project, data suggested that incidents related to patient safety were high on one Urgent Care Ward. Evidence also suggested that staff turnover and the number of junior staff in post were also higher than usual with little support available. A series of monthly, clinical Simulation Based Education, (SBE) Sessions were held over eight months with the aim of allowing staff to practice, in a safe space, the specific clinical skills required to work in that environment ultimately resulting in safer patient care by increasing knowledge, skills and confidence, [1]. Training consisted of monthly 3-hour sessions, 3 scenarios per session, each followed by a structured debriefing cementing understanding and learning. Scenarios were relevant to Urgent Care and as realistic as possible using High Fidelity Simulators. A mixed methodology was used to collect qualitive and quantitative data over 11 months allowing for robust analysis, [2]. Pre and Post session Confidence Scales were completed by candidates as well as a feedback form to identify key learning points and to advise on the suitability. A comparison study was made, collecting patient safety data at the beginning and end of the project. 26 candidates attended. 3 attended twice. Candidates were qualified and student Nurses and Health Care Assistants with varying levels of Urgent Care experience. Following sessions all candidates reported that they felt more confident managing deteriorating patients and that they felt more confident to summon assistance. They all reported that scenarios were relevant to practice. 65 learning points were identified with 7 common themes. The most useful part of sessions was realism and relevance. Patient Safety Data indicates some improvement in the number of reported incidents. Some variables could have influenced data and further study is required. Results were positive and the project has been adopted throughout Urgent Care across the Trust to improve patient safety and retain staff The project aimed to improve patient safety by providing SBE to staff on one Urgent Care Ward. Analysis of data suggests there was some benefit to patient care and demonstrated a positive impact on staff confidence. It also identified key learning themes. The educational program will be offered across the Trust and further study will enable more persuasive data. 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.
在项目开始前的两年里,数据显示,在一个紧急护理病房,与患者安全有关的事件很高。也有证据表明,工作人员流动率和在职初级工作人员的人数也比平时高,而得到的支助很少。为期八个多月的一系列月度临床模拟教育(SBE)课程旨在让员工在安全的空间中练习在该环境中工作所需的特定临床技能,最终通过增加知识、技能和信心来实现更安全的患者护理,[1]。培训包括每月3个小时的课程,每个课程有3个场景,每个场景都有一个结构化的汇报,以巩固理解和学习。场景与紧急护理相关,并使用高保真模拟器尽可能真实。采用混合方法收集11个月的定性和定量数据,以便进行稳健分析,[2]。会议前和会议后,候选人完成了信心量表,并填写了一份反馈表格,以确定关键的学习点,并就其适用性提出建议。进行了一项比较研究,收集了项目开始和结束时的患者安全数据。26名候选人参加了面试。3人出席两次。候选人是具有不同程度紧急护理经验的合格和学生护士和卫生保健助理。在接下来的几次会议中,所有的候选人都报告说,他们对治疗病情恶化的病人更有信心了,他们对寻求帮助也更有信心了。他们都说场景与实践相关。在7个共同主题中确定了65个学习点。会议最有用的部分是现实主义和相关性。患者安全数据显示,报告的事故数量有所改善。一些变量可能会影响数据,需要进一步研究。结果是积极的,该项目已被整个信托基金会的紧急护理部门采用,以改善患者安全和留住员工。该项目旨在通过向一个紧急护理病房的员工提供SBE来改善患者安全。数据分析表明,这对病人护理有一些好处,并对员工信心产生了积极影响。它还确定了关键的学习主题。该教育项目将在整个信托基金范围内开展,进一步的研究将获得更有说服力的数据。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
A96 Whole System Transformed: Making Discharge Everyone’s Business A96全系统转型:排放人人有责
Lucy McNally, Julie Mardon
Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge. Empower any member of staff to have discharge conversations. Emphasis on early discharge conversations. Join up acute and community staff involved in the discharge process. The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families. To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session. The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants ( Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios. Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety. 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.
延迟出院在每家医院都是一个挑战。苏格兰政府“致力于大幅减少等待从医院病房转移到更合适场所的人数[1]。这种变革性模拟是为参与患者护理的所有多学科团队成员设计的,以参与出院计划;并响应卫生服务需求[2]。创建这个模拟是为了打破急性和社区护理之间的障碍,减少筒仓心态,并分享出院的决策和风险。授权任何员工进行解雇谈话。强调早期出院谈话。联合急症及社区人员参与出院程序。模拟包括三个小时的会议,有三个场景。该课程已在急症医院和社区医院开展。参与者是多学科的,包括医生、护士、联合卫生专业人员(AHP)、流动团队、护理人员代表、社会工作者、社会护理人员、家庭护理人员和苏格兰NHS教育(NES)工作人员。参与者两人一组,与病人的亲属就出院问题进行模拟对话。这些场景的学习目标围绕着现实医学、风险管理和处理焦虑的家庭。为了评估模拟的直接影响,参与者在到达时完成了模拟前问卷调查,并在会议结束时完成了模拟后问卷调查。结果来自2023年3月的试点会议前后模拟问卷调查。参与者(在模拟之前,参与者被问到“是什么让这些对话变得困难?”定性回答的主题是家庭期望和管理不确定性,这两者都是场景中的学习目标。我们的参与者反馈表明,这个无延迟放电模拟已经“让放电成为每个人的事情”。“这种模拟可以提供变革性的变化,帮助医疗保健专业人员进行早期出院对话。”这提供了更好的以患者为中心的护理,使患者回到家庭环境中,减少延迟出院,提高患者安全。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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