BMJ Simulation & Technology Enhanced Learning最新文献

{"title":"Developing a simulation programme to train airway management during the COVID-19 pandemic in a tertiary-level hospital.","authors":"Heung Yan Wong, Craig Johnstone, Gunjeet Dua","doi":"10.1136/bmjstel-2020-000755","DOIUrl":"10.1136/bmjstel-2020-000755","url":null,"abstract":"<p><p>Tracheal intubation of a patient with COVID-19 is a high-risk procedure for not only the patient, but all healthcare workers involved, leading to an understandable degree of staff anxiety. We used simulation to help train airway managers to intubate patients with COVID-19. Based on action cards developed by our department, we designed a series of scenarios to simulate airway management during the COVID-19 pandemic. Teams were asked to perform a rapid sequence induction with tracheal intubation. We designed in situ scenarios with low-fidelity manikins that could be set up in operating theatres across multiple sites. Over a period of 4 weeks, 101 consultant anaesthetists, 58 anaesthetic trainees and 30 operating department practitioners received intubation training. These members made up the airway response team of our hospital. 30 emergency department doctors also received training in anticipation of further COVID-19 surges leading to the possibility of overwhelmed services. Simulation-based training was an invaluable tool for our hospital to rapidly upskill medical professionals during the first wave of the COVID-19 pandemic. We have used feedback and additional guidelines to improve our scenarios to retrain staff during subsequent waves.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/82/bmjstel-2020-000755.PMC8445193.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Simulation-based Training on Reflective Practice.","authors":"John A Aitken, Elisa M Torres, Seth A Kaplan, Deborah DiazGranados, Lillian Su, Sarah Henrickson Parker","doi":"10.1136/bmjstel-2021-000870","DOIUrl":"10.1136/bmjstel-2021-000870","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based training (SBT) is often evaluated based on the transfer of specific knowledge and skills. In contrast, the degree to which reflective practice is inculcated by SBT is rarely considered. Because reflection is a pillar of adult learning theories, we sought to examine the degree to which participation in SBT was associated with increased reflective practice.</p><p><strong>Method: </strong>Eighty one healthcare professionals completed a survey which included the number of SBTs they participated in during the past two years, content- and administrative-related features of those SBTs, and a key aspect of reflective practice (i.e., self-appraisal).</p><p><strong>Results: </strong>The number of SBTs healthcare professionals participated in during the past two years was positively associated with reflective self-appraisal. This relationship was not moderated by the inclusion of reflection components in SBTs nor by the voluntary/mandatory nature of participation in SBTs. Furthermore, the facilitator was ranked as the most important feature of the overall learning experience in SBTs. Also, no significant differences were found between the number of technical skills-based and non-technical skills-based SBTs.</p><p><strong>Conclusion: </strong>These findings demonstrate the importance (of evaluating) SBTs for facilitating reflective learning mindsets that healthcare practitioners can apply beyond the specific skills trained by SBTs.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411838/pdf/bmjstel-2021-000870.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9975866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice?","authors":"Mary Lavelle, Gabriel B Reedy, Thomas Simpson, Anita Banerjee, Janet E Anderson","doi":"10.1136/bmjstel-2020-000700","DOIUrl":"10.1136/bmjstel-2020-000700","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice.</p><p><strong>Design: </strong>Exploratory observational cohort study.</p><p><strong>Setting: </strong>Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women.</p><p><strong>Participants: </strong>Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)).</p><p><strong>Main outcome measures: </strong>Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance.</p><p><strong>Results: </strong>Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time.</p><p><strong>Conclusions: </strong>Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/1d/bmjstel-2020-000700.PMC8445203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual tabletop simulations for primary care pandemic preparedness and response.","authors":"Marlot Johanna Blaak,&nbsp;Raad Fadaak,&nbsp;Jan M Davies,&nbsp;Nicole Pinto,&nbsp;John Conly,&nbsp;Myles Leslie","doi":"10.1136/bmjstel-2020-000854","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000854","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic prompted widescale use of clinical simulations to improve procedures and practices. We outline our deployment of a virtual tabletop simulation (TTS) method in primary care (PC) clinics across Alberta, Canada. We summarise the quality and safety improvements from this method and report end users' perspectives on key elements.</p><p><strong>Methods: </strong>Our virtual TTS used teleconferencing software alongside digital whiteboards to walk clinic stakeholders through patient scenarios. Participants reviewed and rehearsed their workflows and care practices. The goal was for staff to take ownership over gaps and codesigned solutions. After simulation sessions, follow-up interviews were conducted to collect feedback.</p><p><strong>Results: </strong>These sessions helped PC staff identify and codesign solutions for clinical hazards and threats. These included the flow of patients through clinics, communications, redesignation of physical spaces, and adaptation of guidance for cleaning and personal protective equipment use. End users reported sessions provided neutral spaces to discuss practice changes and built confidence in delivering safe care during the pandemic.</p><p><strong>Discussion: </strong>TTS has not been extensively deployed to improve clinical practice in outpatient environments. We show how virtual TTS can bridge gaps between knowledge and practice by offering a guided space to rehearse clinical changes. We show that virtual TTS can be used in multiple contexts to help identify hazards, improve safety and build confidence in professional teams adapting to rapid changes in both policies and practices. While our sessions were conducted in Alberta, our results suggest this method may be deployed in other contexts, including low-resource settings.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjstel-2020-000854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39337165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immersive technology in ophthalmology education: a systematic review.","authors":"Shakeel Lowe, Kathryn Mares, Zarnie Khadjesari","doi":"10.1136/bmjstel-2021-000906","DOIUrl":"10.1136/bmjstel-2021-000906","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing use of immersive technology (IT) in ophthalmology, the effectiveness of this approach compared to other teaching practices is unclear. This systematic review aimed to determine the value of IT to teach students ophthalmic skills and whether it can supplement or replace conventional teaching practices.</p><p><strong>Methods: </strong>A systematic search was performed of CENTRAL, MEDLINE, EMBASE, ERIC and PsychINFO databases. Randomised controlled trials comparing IT interventions versus (1) no training, (2) standard training, (3) different types of IT interventions, (4) different doses of IT interventions were eligible for inclusion.</p><p><strong>Results: </strong>Seven trials involving 177 participants were included. IT offered some benefit compared to standard training as most trials demonstrated evidence of learning represented by composite performance score and performance time. Repetitive training with IT displayed similar results.</p><p><strong>Conclusion: </strong>IT appears to improve the ophthalmic skill of healthcare trainees and should be considered as a supplement to training.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85957859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age suit simulation replicates in healthy young adults the functional challenges to balance experienced by older adults: an observational study","authors":"Carole Anne Watkins, E. Higham, M. Gilfoyle, C. Townley, Sue Hunter","doi":"10.1136/bmjstel-2021-000867","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000867","url":null,"abstract":"Background Age simulation can have a positive effect on empathic understanding and perception of ageing. However, there is limited evidence for its ability to replicate objectively the physical and functional challenges of ageing. Objective To observe whether age suit simulation can replicate in healthy young adults the physical and physiological balance disturbance and falls risk experienced by older adults. Methodology Healthy young adults aged 20–40 years (16 male) were recruited to the study using convenience sampling from a student population. Participants performed three validated balance tests—Functional Reach Test (FRT), Timed Up and Go (TUG) and Berg Balance Scale (BBS)—first without the age suit and then with the age suit, using a standardised protocol, following the same sequence. Results 30 participants completed all tests. Statistically significant differences between without-age-suit and with-age-suit performance were recorded for FRT distance (p<0.000005), time taken to complete the TUG (p<0.0005) and BBS score (p<0.001). A comparison of participant scores with normative FRT and TUG scores identified that the suit had ‘aged’ the majority of participants to the normative values for older adults (60+), with some reaching the values for individuals aged 70–89. However, no scores achieved the values indicative of increased falls risk. Conclusions The age suit is a valid educational tool that extends the value of age simulation beyond a more general empathising role, enabling those working with an older population to experience and understand the functional challenges to balance experienced by older adults as part of their training.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73097030","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}

{"title":"Conception and design of novel lumbar drain insertion simulator","authors":"N. Murthy, Ellen K. O’Brien, N. Dahdaleh","doi":"10.1136/bmjstel-2021-000873","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000873","url":null,"abstract":"Lumbar drain insertion is a common procedure that is performed by anaesthesiologists, radiologists and neurosurgeons that is generally taught through supervised learning that can place patients at risk. We describe in detail the creation and considerations of a novel lumbar drain simulator designed to allow learners to rehearse the complete lumbar drain insertion procedure from start to finish. A lumbar drain simulator was designed with the goal of simulating drain placement on a patient including identifying physical landmarks, sterile field preparation, technical steps of the procedure, troubleshooting and securing and connecting the drainage system. Emphasis was placed on simulating the structural components of the anatomic compartments encountered during needle insertion and accurate reproduction of the tactile aspects of the procedure. The simulator is able to reproduce the critical aspects of drain placement, allowing for learners to practice a complete lumbar drain placement from start to finish. A complete simulation of lumbar drain placement can be created that allows learners to practise all aspects of the lumbar drain procedure. Learners can rehearse all steps of the procedure allowing them to be more confident and facile with the procedure, which can lead to improved patient safety and satisfaction.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89167080","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}

{"title":"Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic.","authors":"Sinead Campbell, Sarah Corbett, Crina L Burlacu","doi":"10.1136/bmjstel-2021-000894","DOIUrl":"10.1136/bmjstel-2021-000894","url":null,"abstract":"<p><strong>Background: </strong>With the introduction of strict public health measures due to the coronavirus pandemic, we have had to change how we deliver simulation training. In order to reinstate the College of Anaesthesiologists Simulation Training (CAST) programme safely, we have had to make significant logistical changes. We discuss the process of reopening a national simulation anaesthesiology programme during a pandemic.</p><p><strong>Methods: </strong>We approached how to reinstate the programme with three distinct but intertwined projects, as in the following: (1) a survey of effects of the pandemic on training opportunities for anaesthesiology trainees, (2) proposals for methods of reinstating simulation were developed under the headings <i>avoidance, compromise, accommodation</i> and <i>collaboration</i>. A small online video-assisted simulation pilot was carried out to test the <i>compromise</i> method, (3) having opted for combined <i>accommodation</i> (onsite with smaller participant numbers and safety measures) and <i>collaboration</i> (with other regional centres), a postreinstatement evaluation during a 4-month period was carried out.</p><p><strong>Results: </strong>(1) Eighty-five per cent of 64 trainees surveyed felt that they had missed out not only just on simulation-based education (43%) but also on other training opportunities, (2) when five trainees were asked to state on a 1 to 5 Likert scale (strongly disagree, disagree, undecided, agree and strongly agree) whether online video-assisted simulation was similar to face-to-face simulation in four categories (realism, immersion, sense of crisis and stress), only 9 (45%) of the 20 answers agreed they were similar, (3) When onsite simulation was reinstated, the majority of trainees felt that training was similar to prepandemic and were happy to continue with this format.</p><p><strong>Conclusion: </strong>In order to reinstate simulation, we have identified that <i>accommodation</i> and <i>collaboration</i> best suited the CAST while <i>compromise</i> failed to rank high among trainees' preferences. Onsite courses will continue to be delivered safely while meeting the high standards our trainees have come to expect.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245283/pdf/bmjstel-2021-000894.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10097289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study","authors":"Joseph Sleiman, D. J. Savage, Benjamin Switzer, Colleen Y. Colbert, Cory Chevalier, K. Neuendorf, David Harris","doi":"10.1136/bmjstel-2021-000897","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000897","url":null,"abstract":"Background Breaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback. Purpose of study The goal of this educational innovation was to improve internal medicine residents’ communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project. Study design Internal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges. Results 148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results. Conclusions A trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents’ interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83491928","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}

{"title":"3D printed ascending aortic simulators with physiological fidelity for surgical simulation","authors":"Ali Alakhtar, A. Emmott, C. Hart, R. Mongrain, R. Leask, K. Lachapelle","doi":"10.1136/bmjstel-2021-000868","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000868","url":null,"abstract":"Introduction Three-dimensional (3D) printed multimaterial ascending aortic simulators were created to evaluate the ability of polyjet technology to replicate the distensibility of human aortic tissue when perfused at physiological pressures. Methods Simulators were developed by computer-aided design and 3D printed with a Connex3 Objet500 printer. Two geometries were compared (straight tube and idealised aortic aneurysm) with two different material variants (TangoPlus pure elastic and TangoPlus with VeroWhite embedded fibres). Under physiological pressure, β Stiffness Index was calculated comparing stiffness between our simulators and human ascending aortas. The simulators’ material properties were verified by tensile testing to measure the stiffness and energy loss of the printed geometries and composition. Results The simulators’ geometry had no effect on measured β Stiffness Index (p>0.05); however, β Stiffness Index increased significantly in both geometries with the addition of embedded fibres (p<0.001). The simulators with rigid embedded fibres were significantly stiffer than average patient values (41.8±17.0, p<0.001); however, exhibited values that overlapped with the top quartile range of human tissue data suggesting embedding fibres can help replicate pathological human aortic tissue. Biaxial tensile testing showed that fiber-embedded models had significantly higher stiffness and energy loss as compared with models with only elastic material for both tubular and aneurysmal geometries (stiffness: p<0.001; energy loss: p<0.001). The geometry of the aortic simulator did not statistically affect the tensile tested stiffness or energy loss (stiffness: p=0.221; energy loss: p=0.713). Conclusion We developed dynamic ultrasound-compatible aortic simulators capable of reproducing distensibility of real aortas under physiological pressures. Using 3D printed composites, we are able to tune the stiffness of our simulators which allows us to better represent the stiffness variation seen in human tissue. These models are a step towards achieving better simulator fidelity and have the potential to be effective tools for surgical training.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79908755","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}