Becky Allan, Andreas Day, Yvonne Moulds, Linda Bell
In a number of medical schools, students often feel unprepared to manage acutely unwell trauma patients, with a majority of students reporting they had received less than five hours of trauma-based teaching and clinical skills exposure [1]. Despite the lack of previous training, newly graduated doctors are often one of the first professionals to initiate assessment and management of trauma patients on arrival to hospital [2]. Our scenario design aims to help both medical and nursing students gain experience of multiple trauma patients in a simulated environment. We wished to incorporate the skills of prioritization, leadership, role allocation and delegation whilst also covering some technical skills of trauma management. This scenario aims to simulate a high-pressure, busy clinical environment where students can practise the management of patients requiring immediate care in a resuscitation room setting. The students were briefed collectively for the multiple trauma simulation, as if there were a ‘stand-by call’ as a pre-alert from the ambulance crew. The students were informed that there was a nearby road traffic accident and there would be three casualties arriving: a patient with a head injury who was on an anticoagulant, a patient who had a chest wall injury and a patient who had suffered burns at the scene. They were allocated 5-10 minutes to assist with assigning roles and identifying how they planned to divide up tasks before starting the simulation. The initial assessment and management plans were commenced by the students, and a member of the faculty team would come in around half-way through as a ‘senior emergency physician’, who could offer advice and guidance. Verbal and written feedback collected from both medical and nursing students was positive, with many stating that they felt their teamwork and leadership abilities had been enhanced. Multiple people commented on the impact of clear communication, task delegation and leadership on the outcome of the scenario. Several students also commented on the positive impact of multidisciplinary working by combining both medical and nursing students for simulation training, and felt they had a greater appreciation and understanding of each other’s roles. Students felt that their confidence in both technical and non-technical skills had improved as a result of participating in the scenario, and many felt they had learnt valuable leadership and teamwork abilities. 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.
{"title":"A114 Multiple Trauma Simulation - An Introduction for Medical and Nursing Students","authors":"Becky Allan, Andreas Day, Yvonne Moulds, Linda Bell","doi":"10.54531/veai3540","DOIUrl":"https://doi.org/10.54531/veai3540","url":null,"abstract":"In a number of medical schools, students often feel unprepared to manage acutely unwell trauma patients, with a majority of students reporting they had received less than five hours of trauma-based teaching and clinical skills exposure [1]. Despite the lack of previous training, newly graduated doctors are often one of the first professionals to initiate assessment and management of trauma patients on arrival to hospital [2]. Our scenario design aims to help both medical and nursing students gain experience of multiple trauma patients in a simulated environment. We wished to incorporate the skills of prioritization, leadership, role allocation and delegation whilst also covering some technical skills of trauma management. This scenario aims to simulate a high-pressure, busy clinical environment where students can practise the management of patients requiring immediate care in a resuscitation room setting. The students were briefed collectively for the multiple trauma simulation, as if there were a ‘stand-by call’ as a pre-alert from the ambulance crew. The students were informed that there was a nearby road traffic accident and there would be three casualties arriving: a patient with a head injury who was on an anticoagulant, a patient who had a chest wall injury and a patient who had suffered burns at the scene. They were allocated 5-10 minutes to assist with assigning roles and identifying how they planned to divide up tasks before starting the simulation. The initial assessment and management plans were commenced by the students, and a member of the faculty team would come in around half-way through as a ‘senior emergency physician’, who could offer advice and guidance. Verbal and written feedback collected from both medical and nursing students was positive, with many stating that they felt their teamwork and leadership abilities had been enhanced. Multiple people commented on the impact of clear communication, task delegation and leadership on the outcome of the scenario. Several students also commented on the positive impact of multidisciplinary working by combining both medical and nursing students for simulation training, and felt they had a greater appreciation and understanding of each other’s roles. Students felt that their confidence in both technical and non-technical skills had improved as a result of participating in the scenario, and many felt they had learnt valuable leadership and teamwork abilities. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"178 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debriefing after simulation practice offers a crucial opportunity for guided reflection and learning. However, there are many structures and models available [1]. Health Education and Improvement Wales (HEIW) holds regular simulation webinars, workshops and conferences. During these events, the simulation community in Wales expressed their willingness to standardize debriefing in order to facilitate faculty sharing and to support interprofessional simulation. National debriefing experts carried out a review of the relevant literature and devised the Triangular Approach to Debriefing, incorporating agreed debriefing principles, a simple structure and recommended strategies with links to relevant key articles. This approach was shared and piloted by simulation faculty at a national workshop in September 2022. The feedback received was excellent. Comments received guided a document review. The final version was incorporated in the Essential Faculty Development Course and is currently in available in Welsh and English. The triangular approach embraces a set of collaboratively identified principles, an easy to use structure and a summary of well referenced strategies: Principles adopted include facilitating safe and constructive discussions, with Inclusion of all participants and respect for different learner needs, aiming to guide reflective practice and sharing of mental models with the highest level of facilitation possible. A four-step structure (see Recommended strategies cover psychological safety (such as ground rules, time management, authenticity and validation of contributions), how to focus the discussion, facilitation techniques, closing and meta-debriefing. Debriefing structure in the Triangular Approach to debriefing The Triangular Approach to debriefing has been welcomed by the simulation community in Wales. It is not expected to be the only way that facilitators debrief, but a gateway into good quality debriefing for new faculty, supporting the development of national expertise and encouraging to explore other available models as well as key debriefing 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 applicable.
{"title":"A66 Standardizing debriefing in Wales: the Triangular Approach","authors":"Cristina Diaz-Navarro, Bridie Jones, Jody Stafford, Suman Mitra, Sara Catrin Cook, Clare Hawker","doi":"10.54531/kzwg5509","DOIUrl":"https://doi.org/10.54531/kzwg5509","url":null,"abstract":"Debriefing after simulation practice offers a crucial opportunity for guided reflection and learning. However, there are many structures and models available [1]. Health Education and Improvement Wales (HEIW) holds regular simulation webinars, workshops and conferences. During these events, the simulation community in Wales expressed their willingness to standardize debriefing in order to facilitate faculty sharing and to support interprofessional simulation. National debriefing experts carried out a review of the relevant literature and devised the Triangular Approach to Debriefing, incorporating agreed debriefing principles, a simple structure and recommended strategies with links to relevant key articles. This approach was shared and piloted by simulation faculty at a national workshop in September 2022. The feedback received was excellent. Comments received guided a document review. The final version was incorporated in the Essential Faculty Development Course and is currently in available in Welsh and English. The triangular approach embraces a set of collaboratively identified principles, an easy to use structure and a summary of well referenced strategies: Principles adopted include facilitating safe and constructive discussions, with Inclusion of all participants and respect for different learner needs, aiming to guide reflective practice and sharing of mental models with the highest level of facilitation possible. A four-step structure (see Recommended strategies cover psychological safety (such as ground rules, time management, authenticity and validation of contributions), how to focus the discussion, facilitation techniques, closing and meta-debriefing. Debriefing structure in the Triangular Approach to debriefing The Triangular Approach to debriefing has been welcomed by the simulation community in Wales. It is not expected to be the only way that facilitators debrief, but a gateway into good quality debriefing for new faculty, supporting the development of national expertise and encouraging to explore other available models as well as key debriefing 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 applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"90 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samuel Jones, Divya Premchandran, Benjamin Smalley
International medical graduates (IMGs) are doctors that have graduated from a medical university outside of the UK and subsequently employed by the NHS. The transition to working within the NHS presents them with many new challenges including communication, cultural differences, healthcare system differences, NHS policies and UK legal frameworks, and the expectations attributed to a doctor practicing in the UK. They often commence work with little training about these practical challenges and as a result encounter a steep learning curve. IMGs are significantly more likely to receive complaints and face fitness to practice investigation [1]. Therefore, developing educational opportunities to help them adapt to working in the NHS is a necessity. Simulation has been shown to improve the confidence, knowledge and provides an ethically and educationally safe setting for doctors to develop their practice [2,3]. We therefore created an IMG oriented simulation programme that focussed on some of the key challenges they face. We delivered simulation sessions on four separate days with 6-8 IMG candidates at each. Sessions consisted of two clinical scenarios divided into sections, approximately 20 minutes long, each targeting a key educational outcome. We used a combination of a computerized simulation manikin (SimMan Essential) and live actors. Key educational outcomes included managing an acutely deteriorating patient, escalating to a senior, obtaining a collateral history, breaking bad news and duty of candour. Each candidate had the opportunity to participate in a part of the simulation whilst the others observed. The candidates were then debriefed and learning objectives explored by a trained faculty member. The candidates were asked to complete pre-simulation, immediate post-simulation and 3-month post-simulation feedback forms using a nominal Likert scale. They scored 1-10 (10 being ‘strongly agree’) on their confidence around each component of the educational outcomes. We had 21 candidates complete the simulation day, with 19 responses to the immediate post simulation survey and 9 responses to the 3-month post simulation survey. The results showed a significant increase in the confidence of the candidates for each educational outcome, with mean scores increasing from 6-7 to >9. We also demonstrated that the candidate’s confidence remained and they were still using the skills they had learned 3 months later. We have demonstrated that IMG oriented simulation is a valuable educational tool for doctors transitioning into working within the NHS. Confidence around a variety of difficult topics increases and the lessons learned have a lasting impact. 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.
{"title":"A80 Simulation: a tool to improve the confidence of International Medical Graduates transitioning into working in the NHS","authors":"Samuel Jones, Divya Premchandran, Benjamin Smalley","doi":"10.54531/jjto2612","DOIUrl":"https://doi.org/10.54531/jjto2612","url":null,"abstract":"International medical graduates (IMGs) are doctors that have graduated from a medical university outside of the UK and subsequently employed by the NHS. The transition to working within the NHS presents them with many new challenges including communication, cultural differences, healthcare system differences, NHS policies and UK legal frameworks, and the expectations attributed to a doctor practicing in the UK. They often commence work with little training about these practical challenges and as a result encounter a steep learning curve. IMGs are significantly more likely to receive complaints and face fitness to practice investigation [1]. Therefore, developing educational opportunities to help them adapt to working in the NHS is a necessity. Simulation has been shown to improve the confidence, knowledge and provides an ethically and educationally safe setting for doctors to develop their practice [2,3]. We therefore created an IMG oriented simulation programme that focussed on some of the key challenges they face. We delivered simulation sessions on four separate days with 6-8 IMG candidates at each. Sessions consisted of two clinical scenarios divided into sections, approximately 20 minutes long, each targeting a key educational outcome. We used a combination of a computerized simulation manikin (SimMan Essential) and live actors. Key educational outcomes included managing an acutely deteriorating patient, escalating to a senior, obtaining a collateral history, breaking bad news and duty of candour. Each candidate had the opportunity to participate in a part of the simulation whilst the others observed. The candidates were then debriefed and learning objectives explored by a trained faculty member. The candidates were asked to complete pre-simulation, immediate post-simulation and 3-month post-simulation feedback forms using a nominal Likert scale. They scored 1-10 (10 being ‘strongly agree’) on their confidence around each component of the educational outcomes. We had 21 candidates complete the simulation day, with 19 responses to the immediate post simulation survey and 9 responses to the 3-month post simulation survey. The results showed a significant increase in the confidence of the candidates for each educational outcome, with mean scores increasing from 6-7 to >9. We also demonstrated that the candidate’s confidence remained and they were still using the skills they had learned 3 months later. We have demonstrated that IMG oriented simulation is a valuable educational tool for doctors transitioning into working within the NHS. Confidence around a variety of difficult topics increases and the lessons learned have a lasting impact. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"322 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Jacobs, Kriti Vaidya, Tim Old, Lauren Medwell
A scoping review identified a significant growth in research with immersive technology in healthcare education. However, there are few validated measures that capture the user experience of participants [1]. This study aims to investigate the use of an immersive virtual reality (VR) simulation on sepsis management and measure user experience using a validated tool, the Immersive Technology Evaluation Measure (ITEM) [2]. ITEM was formulated on a learning theory called Model for Immersive Technology in Healthcare Education (MITHE), which borrows cognitive and behavioural theories to help explain our level of immersion and enjoyment that can be facilitated by technology (see Model of immersive technology in healthcare education (MITHE) This single-study quasi-experimental investigation was conducted at a single site. Nine participants were recruited, consisting of medical students and healthcare professionals. Participants were trained on varied immersive devices: sepsis management using an immersive VR simulation developed by Gogglemind, and augmented reality (AR) holographic patient with respiratory distress, which included realistic patient scenarios and interactive decision-making. User experience was measured using the ITEM, which assesses user; immersion, cognitive load, intrinsic motivation, debrief and technology usability. Nine participants had high levels of immersion (mean 39.6, total 50), high levels of intrinsic motivation (mean 39.6, total 50), high technology score (mean 79.4, total 100), optimum cognitive load (average 59.5, optimum 39–61) and moderate score on debrief (mean 18.1, total 25). ITEM subscores indicated an enjoyable and immersive experience with good technology interface on usability scores. Self-directed debrief in VR had lower scores with emotional considerations and identifying domains of performance and learning. The use of the ITEM provided valuable insights into the user experience of the VR simulation, which can be used to improve the design and implementation of future simulations. This contributes to an ongoing ITEM validation process. This study highlights the importance of training in healthcare and the potential benefits of using immersive technologies such as VR and AR simulations. 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.
{"title":"A9 Immersive Technology Experience Measure (ITEM): pilot study on participant experience using novel questionnaire and VR scenario","authors":"Chris Jacobs, Kriti Vaidya, Tim Old, Lauren Medwell","doi":"10.54531/rwxn3896","DOIUrl":"https://doi.org/10.54531/rwxn3896","url":null,"abstract":"A scoping review identified a significant growth in research with immersive technology in healthcare education. However, there are few validated measures that capture the user experience of participants [1]. This study aims to investigate the use of an immersive virtual reality (VR) simulation on sepsis management and measure user experience using a validated tool, the Immersive Technology Evaluation Measure (ITEM) [2]. ITEM was formulated on a learning theory called Model for Immersive Technology in Healthcare Education (MITHE), which borrows cognitive and behavioural theories to help explain our level of immersion and enjoyment that can be facilitated by technology (see Model of immersive technology in healthcare education (MITHE) This single-study quasi-experimental investigation was conducted at a single site. Nine participants were recruited, consisting of medical students and healthcare professionals. Participants were trained on varied immersive devices: sepsis management using an immersive VR simulation developed by Gogglemind, and augmented reality (AR) holographic patient with respiratory distress, which included realistic patient scenarios and interactive decision-making. User experience was measured using the ITEM, which assesses user; immersion, cognitive load, intrinsic motivation, debrief and technology usability. Nine participants had high levels of immersion (mean 39.6, total 50), high levels of intrinsic motivation (mean 39.6, total 50), high technology score (mean 79.4, total 100), optimum cognitive load (average 59.5, optimum 39–61) and moderate score on debrief (mean 18.1, total 25). ITEM subscores indicated an enjoyable and immersive experience with good technology interface on usability scores. Self-directed debrief in VR had lower scores with emotional considerations and identifying domains of performance and learning. The use of the ITEM provided valuable insights into the user experience of the VR simulation, which can be used to improve the design and implementation of future simulations. This contributes to an ongoing ITEM validation process. This study highlights the importance of training in healthcare and the potential benefits of using immersive technologies such as VR and AR simulations. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"101 19","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An NHS provider had no established simulation education opportunities for community based allied health professionals (AHP). Urgent Community Response (UCR) teams are interdisciplinary teams, comprised of nurses, paramedics, physiotherapists and occupational therapists, who provide care to adults in their home to avoid hospital admission [1]. Older people experience effective high-quality care when a multi-skilled clinician, working across the usual professional boundaries, can effectively address their needs rather than requiring numerous other professionals to visit them at home. In this NHS Trust, intermediate care teams were required to include UCR referrals as part of their usual work. The physiotherapists and occupational therapists from these teams required upskilling to be able to safely support patients requiring this more acute and urgent level of care. Clinicians working in the community have limited opportunity to observe and learn from each other. Simulation is an evidenced based educational activity to support the development of new knowledge and skills required in interdisciplinary teams working in clinical settings [2]. It was hypothesized that interprofessional simulation would be an effective educational intervention to support this upskilling. A faculty was established which included a simulation educator; simulation technician; a practice development AHP; and a physiotherapist with clinical experience of working within this setting. Simulation scenarios were developed to reflect common referral presentations; the Skills for Health UCR Capability Framework [3]; and learning outcomes identified as priorities by the clinicians and service managers. The learning outcomes included applying an A to E assessment; the use of NEWS2 and the SBAR escalation tool when assessing an adult patient in their own home. A modified Kirkpatrick evaluation form was used to evaluate the training. Three simulation training events were offered. There were 26 participants overall with representation from physiotherapy, occupational therapy, nursing and healthcare support workers. There were fourteen evaluation responses to a modified Kirkpatrick evaluation form. The evaluation identified that simulation provided an opportunity to learn from other professions; supported the practical application of learning; debriefing provided a safe learning environment; and that the learning would lead to changes in their current practice (see Evaluation themes with supporting examples Simulation training events were evaluated by participants from an interprofessional community team as a safe, practical and effective way to support their upskilling to provide an UCR service. Simulation should be considered as part of an education package to support interprofessional teams upskilling to provide new services in a community setting. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms th
{"title":"A74 The use of simulation to support the upskilling of interprofessional teams providing an Urgent Community Response service (UCR)","authors":"Belinda Twissell, Kate Olsen, Deryn Creasy","doi":"10.54531/kxgl5220","DOIUrl":"https://doi.org/10.54531/kxgl5220","url":null,"abstract":"An NHS provider had no established simulation education opportunities for community based allied health professionals (AHP). Urgent Community Response (UCR) teams are interdisciplinary teams, comprised of nurses, paramedics, physiotherapists and occupational therapists, who provide care to adults in their home to avoid hospital admission [1]. Older people experience effective high-quality care when a multi-skilled clinician, working across the usual professional boundaries, can effectively address their needs rather than requiring numerous other professionals to visit them at home. In this NHS Trust, intermediate care teams were required to include UCR referrals as part of their usual work. The physiotherapists and occupational therapists from these teams required upskilling to be able to safely support patients requiring this more acute and urgent level of care. Clinicians working in the community have limited opportunity to observe and learn from each other. Simulation is an evidenced based educational activity to support the development of new knowledge and skills required in interdisciplinary teams working in clinical settings [2]. It was hypothesized that interprofessional simulation would be an effective educational intervention to support this upskilling. A faculty was established which included a simulation educator; simulation technician; a practice development AHP; and a physiotherapist with clinical experience of working within this setting. Simulation scenarios were developed to reflect common referral presentations; the Skills for Health UCR Capability Framework [3]; and learning outcomes identified as priorities by the clinicians and service managers. The learning outcomes included applying an A to E assessment; the use of NEWS2 and the SBAR escalation tool when assessing an adult patient in their own home. A modified Kirkpatrick evaluation form was used to evaluate the training. Three simulation training events were offered. There were 26 participants overall with representation from physiotherapy, occupational therapy, nursing and healthcare support workers. There were fourteen evaluation responses to a modified Kirkpatrick evaluation form. The evaluation identified that simulation provided an opportunity to learn from other professions; supported the practical application of learning; debriefing provided a safe learning environment; and that the learning would lead to changes in their current practice (see Evaluation themes with supporting examples Simulation training events were evaluated by participants from an interprofessional community team as a safe, practical and effective way to support their upskilling to provide an UCR service. Simulation should be considered as part of an education package to support interprofessional teams upskilling to provide new services in a community setting. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms th","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"59 37","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debbie Thackray, Laura Rossiter, Emma Cowley, Ruth Turk, Belinda Judd, Jennie Brentnall
In 2021, a diverse international and inter-professional team designed and implemented an intensive in-person simulation week and an interactive online learning programme to enhance student preparation for clinical placement (the Clinical Placement Enhancement Project) supported with funding from Health Education England. The simulation programme aimed for students to develop their patient-centred communication skills, assessment and therapeutic management by attending three simulation scenarios and inter-professional understanding through participation in a multi-disciplinary team (MDT) meeting. The bespoke online programme was designed with similar learning outcomes and utilized various learning materials, including 360° images of clinical environments linked to case studies. The study design was an integrative mixed-methods feasibility study, with 29 AHP students participating in the simulation and 24 students taking part in the online arm of the study. Students from physiotherapy, occupational therapy and podiatry self-selected their preferred delivery mode for placement preparation. The evaluation explored the experiences of both domestic and international students attending the simulation and using the online learning. In addition, perspectives of the clinical educators and actor role players were explored. Data were inductively analysed using a reflexive thematic approach and integrated with the quantitative data. The key findings from the pilot study showed the value of the simulation programme in allowing students to apply their learning, particularly helping them to develop their confidence in communication, rapport building and interventions. By contrast, the online learning programme was most effective at developing students’ clinical reasoning and proficiency with documentation [1]. We have built on these findings this year, to upscale the simulation programme to include all first-year AHP students ( By combining the immersive simulation with the online learning, we have created a sustainable and achievable approach to better prepare AHP students for clinical placement, and this combined approach may help to reduce the burden for our clinical educators. 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.
{"title":"A5 Sustainable healthcare placement preparation: enhancing AHP student preparation through immersive simulation and online learning","authors":"Debbie Thackray, Laura Rossiter, Emma Cowley, Ruth Turk, Belinda Judd, Jennie Brentnall","doi":"10.54531/dity4030","DOIUrl":"https://doi.org/10.54531/dity4030","url":null,"abstract":"In 2021, a diverse international and inter-professional team designed and implemented an intensive in-person simulation week and an interactive online learning programme to enhance student preparation for clinical placement (the Clinical Placement Enhancement Project) supported with funding from Health Education England. The simulation programme aimed for students to develop their patient-centred communication skills, assessment and therapeutic management by attending three simulation scenarios and inter-professional understanding through participation in a multi-disciplinary team (MDT) meeting. The bespoke online programme was designed with similar learning outcomes and utilized various learning materials, including 360° images of clinical environments linked to case studies. The study design was an integrative mixed-methods feasibility study, with 29 AHP students participating in the simulation and 24 students taking part in the online arm of the study. Students from physiotherapy, occupational therapy and podiatry self-selected their preferred delivery mode for placement preparation. The evaluation explored the experiences of both domestic and international students attending the simulation and using the online learning. In addition, perspectives of the clinical educators and actor role players were explored. Data were inductively analysed using a reflexive thematic approach and integrated with the quantitative data. The key findings from the pilot study showed the value of the simulation programme in allowing students to apply their learning, particularly helping them to develop their confidence in communication, rapport building and interventions. By contrast, the online learning programme was most effective at developing students’ clinical reasoning and proficiency with documentation [1]. We have built on these findings this year, to upscale the simulation programme to include all first-year AHP students ( By combining the immersive simulation with the online learning, we have created a sustainable and achievable approach to better prepare AHP students for clinical placement, and this combined approach may help to reduce the burden for our clinical educators. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"18 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last decade, there has been increasing awareness of the prevalence of gender-based violence with increasing recognition of its disproportionate impact on vulnerable adults and children [1]. When these vulnerable adults and children may present to services, healthcare professionals have an opportune position to recognize this and act as an agent to signpost these individuals to relevant services. Individuals suffering from gender-based violence prefer practitioners to ask about the possibility of violence as it is easier for them to disclose this in response to the question than to offer the information unprompted [2]. While communication skills are taught to various degrees in medical schools around the country, the authors of this project recognized that many medical schools did not address these issues in these sessions. Consequently, a communication-based skills day was developed that addressed this and offered an opportunity for training and simulation of scenarios. These sessions aimed to improve students’ confidence in recognizing indicators of abuse and asking individuals if they were subject to forms of violence or abuse. A half-day teaching programme was produced for final year medical students. This comprised of a talk on the indicators of gender-based violence, suggestions on how to approach enquiring about gender-based violence and simulation scenarios incorporating gender-based violence. The scenarios were designed to include indicators of violence aforementioned in the talk to enable students to practise question asking. Pre- and post-session questionnaires were used, and students were to rate their confidence on a scale of 1–5 of how confident they felt asking these questions and recognizing indicators of violence. Twenty-three students partook in the two sessions delivered. Pre-session data suggested that students had received minimal teaching on the indicators of violence. After completion of the sessions, there was a 57% increase in the students’ confidence in recognizing a victim of violence and a 51% increase in confidence in asking whether an individual had been subject to violence. Qualitative data suggested that students valued simulation incorporating indicators of violence and opportunity to sensitively enquire if someone had experienced violence. Overall, students felt better equipped to address future scenarios where an individual may have been subject to violence. Our teaching session increased the confidence of final-year medical students in recognizing the indicators of violence and their ability to sensitively enquire about any violence that an individual may be subject to. 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.
{"title":"A2 Pilot of communication skills simulation incorporating gender-based violence","authors":"Kate Jones, Emily Appadurai, Faris Hussain","doi":"10.54531/lnzn4606","DOIUrl":"https://doi.org/10.54531/lnzn4606","url":null,"abstract":"Over the last decade, there has been increasing awareness of the prevalence of gender-based violence with increasing recognition of its disproportionate impact on vulnerable adults and children [1]. When these vulnerable adults and children may present to services, healthcare professionals have an opportune position to recognize this and act as an agent to signpost these individuals to relevant services. Individuals suffering from gender-based violence prefer practitioners to ask about the possibility of violence as it is easier for them to disclose this in response to the question than to offer the information unprompted [2]. While communication skills are taught to various degrees in medical schools around the country, the authors of this project recognized that many medical schools did not address these issues in these sessions. Consequently, a communication-based skills day was developed that addressed this and offered an opportunity for training and simulation of scenarios. These sessions aimed to improve students’ confidence in recognizing indicators of abuse and asking individuals if they were subject to forms of violence or abuse. A half-day teaching programme was produced for final year medical students. This comprised of a talk on the indicators of gender-based violence, suggestions on how to approach enquiring about gender-based violence and simulation scenarios incorporating gender-based violence. The scenarios were designed to include indicators of violence aforementioned in the talk to enable students to practise question asking. Pre- and post-session questionnaires were used, and students were to rate their confidence on a scale of 1–5 of how confident they felt asking these questions and recognizing indicators of violence. Twenty-three students partook in the two sessions delivered. Pre-session data suggested that students had received minimal teaching on the indicators of violence. After completion of the sessions, there was a 57% increase in the students’ confidence in recognizing a victim of violence and a 51% increase in confidence in asking whether an individual had been subject to violence. Qualitative data suggested that students valued simulation incorporating indicators of violence and opportunity to sensitively enquire if someone had experienced violence. Overall, students felt better equipped to address future scenarios where an individual may have been subject to violence. Our teaching session increased the confidence of final-year medical students in recognizing the indicators of violence and their ability to sensitively enquire about any violence that an individual may be subject to. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation. As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software. Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus. VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation. 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.
模拟是医学教育的重要组成部分[1]。它需要很多资源才能成功运行[2]。最近，在COVID-19大流行之后，虚拟现实(VR)模拟的使用有所增加。现在使用虚拟现实的优势在于成本更合理，节省了场地面积和辅导员的时间。然而，人们对该软件对医师协会(PA)的有用程度、耳机的不利影响以及自主汇报是否有价值存在担忧[3]。本研究旨在利用虚拟现实模拟对问卷进行试点。作为2022年9月和2023年1月教学的一部分，VR模拟被纳入适当的研讨会。在会议结束时，一年级的PA学生被邀请完成一份基于模拟有效性工具的在线问卷，该工具针对VR进行了修改。在课程开始之前，所有学生都使用了Oculus Quest 2和Oxford Medical Simulation软件。25名学生中有21人完成了问卷。71.4%的人强烈同意，VR模拟帮助他们准备好应对患者病情的变化，并感到有能力做出临床决定。85.7%的人对提供促进患者安全的干预措施更有信心。66.7%的人对使用循证实践提供护理更有信心。当专注于自我导向的汇报时，66.7%的人强烈同意它有助于他们的学习，71.4%的人强烈同意它为他们的表现提供了自我反思的机会。关于耳机和软件的使用，28.6%的人认为登录耳机不容易，但65%的人认为加载场景很容易。57.1%的人有信心在虚拟环境中导航。这是在向学生介绍环境之后进行的。70.6%的人在虚拟世界中感到安全，11.1%的人在场景中感到恶心。这些场景也通过台式电脑运行。85.7%的人认为在虚拟世界中导航更容易，81%的人强烈同意他们感到沉浸在虚拟世界中。令人惊讶的是，52%的学生更喜欢桌面版，而14%的学生更喜欢通过Oculus观看。VR模拟是一种提供基于模拟的医学教育的有效方法，无需模拟套件或辅助设备。有趣的是，桌面版本可以提供学生喜欢的体验，但这需要进一步的研究。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)。
{"title":"A10 Pilot study looking at the benefits of Virtual Reality (VR) simulation for Physician Associates (PA)","authors":"Carl Heffernan, Ursula Rolfe","doi":"10.54531/zplj9321","DOIUrl":"https://doi.org/10.54531/zplj9321","url":null,"abstract":"Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation. As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software. Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus. VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"59 25","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team. Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems. Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups. Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course. 242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change. The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.
{"title":"A71 Evaluation of a co-produced Simulation Based Perinatal Mental Health Programme","authors":"Labib Hussain, Maaz Malik, Jennifer Cooke","doi":"10.54531/scab6994","DOIUrl":"https://doi.org/10.54531/scab6994","url":null,"abstract":"NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team. Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems. Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups. Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course. 242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change. The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"130 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simulation Based Education (SBE) is well established across healthcare disciplines. However, the benefits can only be obtained in their entirety if simulation is embedded routinely in the healthcare system [1]. Aim: To create and embed SBE sessions targeted at Nursing and Allied Health Profession students within their placement learning. We collaborated with clinicians to create training sessions covering clinical and transferable skills alongside scenarios that are not covered in university teaching. Attendance of the sessions was voluntary, allocating places on a first come, first served basis. The session format consisted of an initial teaching presentation followed by a simulated scenario, debrief, topic specific activities and a final group discussion. We collated data from students immediately after the session via anonymous, online feedback forms. We have since sent follow up questionnaires to all students we had contact details for who attended a session in 2022. We created and delivered 18 simulation training sessions covering 13 topics, totalling 70 hours of training delivery. A total of 103 students from 6 professional groups participated. The students were in varying stages of their education, belonging to 8 HEIs. We received 74 responses out of the 103 students. Our results showed 99% of students felt the training session met their learning needs and 62.7% found the simulation and debrief the most beneficial part. Additionally, 87.5% found it beneficial working alongside other students and 81.3% reported the session allowed them to gain better understanding of differing professional roles. Students’ confidence levels relating to their ability to manage the clinical scenario significantly increased post simulation with 64.7% rating ‘Somewhat Confident’ and 27.5% rating ‘Extremely Confident’. We received 26 responses to the follow up questionnaire. In total 94% reported they have since applied the skills they learnt in practice. Furthermore, 42.9% stated their experience in our sessions had been influential in considering applying for posts in Trust. Simulation allows NHS students to learn essential clinical skills and collaborative working [2]. Our data proves our sessions are successful in increasing confidence scores, insight into other roles and provided invaluable networking time and peer support. We have created a catalogue of simulations that are sustainable and can be utilized in future student placements. We can also conclude we are not only developing our student NHS population but directly influencing our future workforce in Somerset. 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.
{"title":"A94 Starting from scratch, creating a sustainable multi-professional student simulation programme","authors":"Ben Hester, Shona Hill","doi":"10.54531/yeef6910","DOIUrl":"https://doi.org/10.54531/yeef6910","url":null,"abstract":"Simulation Based Education (SBE) is well established across healthcare disciplines. However, the benefits can only be obtained in their entirety if simulation is embedded routinely in the healthcare system [1]. Aim: To create and embed SBE sessions targeted at Nursing and Allied Health Profession students within their placement learning. We collaborated with clinicians to create training sessions covering clinical and transferable skills alongside scenarios that are not covered in university teaching. Attendance of the sessions was voluntary, allocating places on a first come, first served basis. The session format consisted of an initial teaching presentation followed by a simulated scenario, debrief, topic specific activities and a final group discussion. We collated data from students immediately after the session via anonymous, online feedback forms. We have since sent follow up questionnaires to all students we had contact details for who attended a session in 2022. We created and delivered 18 simulation training sessions covering 13 topics, totalling 70 hours of training delivery. A total of 103 students from 6 professional groups participated. The students were in varying stages of their education, belonging to 8 HEIs. We received 74 responses out of the 103 students. Our results showed 99% of students felt the training session met their learning needs and 62.7% found the simulation and debrief the most beneficial part. Additionally, 87.5% found it beneficial working alongside other students and 81.3% reported the session allowed them to gain better understanding of differing professional roles. Students’ confidence levels relating to their ability to manage the clinical scenario significantly increased post simulation with 64.7% rating ‘Somewhat Confident’ and 27.5% rating ‘Extremely Confident’. We received 26 responses to the follow up questionnaire. In total 94% reported they have since applied the skills they learnt in practice. Furthermore, 42.9% stated their experience in our sessions had been influential in considering applying for posts in Trust. Simulation allows NHS students to learn essential clinical skills and collaborative working [2]. Our data proves our sessions are successful in increasing confidence scores, insight into other roles and provided invaluable networking time and peer support. We have created a catalogue of simulations that are sustainable and can be utilized in future student placements. We can also conclude we are not only developing our student NHS population but directly influencing our future workforce in Somerset. 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.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"7 51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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