BMJ Simulation & Technology Enhanced Learning最新文献

{"title":"High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences","authors":"A. F. Macnamara, K. Bird, Alana Rigby, T. Sathyapalan, David Hepburn","doi":"10.1136/bmjstel-2020-000625","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000625","url":null,"abstract":"Background Simulation technology is widely used in medical education, providing an environment in which students can develop and practise a multitude of skills that are relevant to clinical practice, without the risk of harm to patients. Methods We conducted a mixed methods cross-over study with quantitative and qualitative outcomes. This analysed students’ perceptions of two simulation technologies: a high-fidelity patient simulator and virtual reality. Twenty final year medical students completed a questionnaire after having experienced both simulation modalities. Results Students scored the patient simulator higher in domains such as developing team working and ‘ABCDE assessment skills’, whereas the virtual reality simulation was more immersive and fun. Participants found the patient simulator more useful in preparing them for clinical practice. Conclusion Medical students in this study expressed that a high-fidelity patient simulator, in a simulated clinical environment, was of greater value to their preparation for clinical practice than virtual reality simulation of a similar environment. However, the virtual reality simulation offered a near comparable experience, and was found to be was enjoyable, immersive and easily portable.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"102 1","pages":"528 - 535"},"PeriodicalIF":1.1,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86534442","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":"Impact of simulation training on decision to delivery interval in cord prolapse","authors":"G. Gallagher, Alison Griffin, Sharon Clipperton, S. Janssens","doi":"10.1136/bmjstel-2021-000860","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000860","url":null,"abstract":"Background Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance. Aim To assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia. Method A retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours). Results After the introduction of simulation training, mean DDI decreased by 4.1 min (difference −4.1, 95% CI −6.2 to −1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH. Conclusions The introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"266 1","pages":"543 - 547"},"PeriodicalIF":1.1,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82992742","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":"Examining novice anaesthesia trainee simulation performance: a tale of two clusters","authors":"R. D. Daly Guris, Christina R Miller, A. Schiavi, S. Toy","doi":"10.1136/bmjstel-2020-000812","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000812","url":null,"abstract":"Introduction Understanding performance differences between learners may provide useful context for optimising medical education. This pilot study aimed to explore a technique to contextualise performance differences through retrospective secondary analyses of two randomised controlled simulation studies. One study focused on speaking up (non-technical skill); the other focused on oxygen desaturation management (technical skill). Methods We retrospectively analysed data from two independent simulation studies conducted in 2017 and 2018. We used multivariate hierarchical cluster analysis to explore whether participants in each study formed homogenous performance clusters. We then used mixed-design analyses of variance and χ2 analyses to examine whether reported task load differences or demographic variables were associated with cluster membership. Results In both instances, a two-cluster solution emerged; one cluster represented trainees exhibiting higher performance relative to peers in the second cluster. Cluster membership was independent of experimental allocation in each of the original studies. There were no discernible demographic differences between cluster members. Performance differences between clusters persisted for at least 8 months for the non-technical skill but quickly disappeared following simulation training for the technical skill. High performers in speaking up initially reported lower task load than standard performers, a difference that disappeared over time. There was no association between performance and task load during desaturation management. Conclusion This pilot study suggests that cluster analysis can be used to objectively identify high-performing trainees for both a technical and a non-technical skill as observed in a simulated clinical setting. Non-technical skills may be more difficult to teach and retain than purely technical ones, and there may be an association between task load and initial non-technical performance. Further study is needed to understand what factors may confer inherent performance advantages, whether these advantages translate to clinical performance and how curricula can best be designed to drive targeted improvement for individual trainees.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"297 1","pages":"548 - 554"},"PeriodicalIF":1.1,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79626874","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":"Systematic literature search, review and dissemination methodology for the COVID-19 pandemic","authors":"C. Reynard, D. Darbyshire, G. Prager, A. Jafar, M. Naguib, Govind Oliver, Patricia van den Berg, R. Body, Harriet Ambroziak, S. Carley","doi":"10.1136/bmjstel-2020-000817","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000817","url":null,"abstract":"Purpose of the study SARS-CoV-2 has caused healthcare systems globally to reorganise. A pandemic paradox emerged; while clinicians were desperate for information on a new disease, they had less time to find and evaluate the vast volume of publications at times of significant strain on healthcare systems. A multidisciplinary team undertook a weekly literature search capturing all COVID-19 publications. We also monitored free open access medical education (FOAMed) sources for emerging themes. Title and abstract screening pooled the most relevant papers for emergency medicine. Three summary types were created, a ‘Top 5 Flash Update’, a journal club and a rapid response to emerging FOAMed themes. From these summaries, three modes of dissemination were used: short written summaries, blogs and podcasts. These were amplified through social media. Study design A retrospective review was conducted assessing the impact of this knowledge dissemination strategy for the period of March to September 2020. Results In total, 64 687 papers were identified and screened. Of the papers included in the ‘Top 5’, 28.3% were on epidemiology, 23.6% treatment, 16.7% diagnostics, 12% prognosis, 8.7% pathophysiology with the remaining 10.7% consisting of PPE, public health, well-being and ‘other’. We published 37 blogs, 17 podcasts and 18 Top 5 Flash Updates. The blogs were read 138 343 times, the Top 5 Flash Updates 68 610 times and the podcasts had 72 501 listens. Conclusion A combination of traditional academic and novel social media approaches can address the pandemic paradox clinicians are facing.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"217 1","pages":"524 - 527"},"PeriodicalIF":1.1,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75813480","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":"In situ simulation improves perceived self-efficacy of OR nurses and anaesthesiologists during COVID-19 pandemic","authors":"F. Lois, C. Hallet, N. Samalea Suarez, A. Ghuysen, J. Brichant","doi":"10.1136/bmjstel-2020-000840","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000840","url":null,"abstract":"Introduction Self-efficacy is defined as people’s internal beliefs about their ability to have an impact on events that affect their lives. As part of the COVID-19 pandemic, we carried out in situ simulation for anaesthesiologists and operating room (OR) nurses. Simulation was focused on the recommendations on the use of specific personal protective equipment (PPE) as well as on airway management and intubation. We hypothesised that in situ procedural simulation should increase their perceived self-efficacy. Methods Between 16 March and 20 March 2020, 208 healthcare workers took part in in situ procedural simulation. A questionnaire was sent to participants on 21 April 2020. Six self-efficacy items related to PPE and airway manoeuvres were assessed before and after training on a Numeric Rating Scale from 0 to 10. Results Sixty-seven participants (32%) replied to the questionnaire. The before–after comparison of the six items revealed an increase in perceived self-efficacy for each of them. A before training difference was observed between nurses, board-certified anaesthetists and trainees in anaesthesia in perceived self-efficacy for putting on (6 (3–8) vs 4.5 (2.25–6) vs 2 (0–6), p=0.007) and remove PPE (8 (5–8) vs 4.5 (3.25–6) vs 4 (1–6), p=0.009). No difference in perceived self-efficacy after training was observed between nurses, board-certified anaesthetists and trainees in anaesthesia. Conclusions In situ simulation improves the perceived self-efficacy of OR nurses and anaesthesiologists on specific skills related to the care of patients with COVID-19.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"26 1","pages":"555 - 560"},"PeriodicalIF":1.1,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87948643","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":"Multiperspective simulations for implementing a change in service: stroke telethrombolysis","authors":"C. Brown, P. Elofuke","doi":"10.1136/bmjstel-2020-000848","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000848","url":null,"abstract":"Simulation-based training has been used in a variety of ways to demonstrate and improve process elements of patient care. One example of this is in improving door-to-needle times in hyperacute stroke care. Changes in service by one team which affect another bring difference of opinions between service providers involved and can lead to interdepartmental conflict. In this report, we use Kurt Lewin’s model for change to describe how a series of multiperspective simulation-based exercises were used in implementing a change in practice with the introduction of telethrombolysis within a large tertiary stroke referral hospital. The use of multiperspective or bidirectional simulation allowed a ‘meeting of minds’ with each service able to illustrate key themes to the other service. This was demonstrated through a series of simulation-based exercises. Following successful simulation-based exercises and subsequent interdepartmental agreement, a telethrombolysis pilot has been conducted within our centre. Ongoing audit of practice continues as this method of treatment delivery is continued. Further simulation work is planned as a national thrombectomy service is instigated.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"67 1","pages":"624 - 626"},"PeriodicalIF":1.1,"publicationDate":"2021-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74811182","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":"Development and clinical implementation of a structured, simulation-based training programme in laparoscopic appendectomy: description, validation and evaluation","authors":"Benedicte Skjold-Odegaard, H. Ersdal, J. Assmus, B. Nedrebø, O. Sjo, K. Søreide","doi":"10.1136/bmjstel-2020-000728","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000728","url":null,"abstract":"Background Laparoscopic appendectomy is a common procedure in general surgery but is likely underused in structured and real-life teaching. This study describes the development, validation and evaluation of implementing a structured training programme for laparoscopic appendectomy. Study design A structured curriculum and simulation-based programme for trainees and trainers was developed. All general surgery trainees and trainers were involved in laparoscopic appendectomies. All trainees and trainers underwent the structured preprocedure training programme before real-life surgery evaluation. A standardised form evaluated eight technical steps (skills) of the procedure as well as an overall assessment, and nine elements of communication (feedback), and was used for bilateral evaluation by each trainee and trainer. A consecutive, observational cohort over a 12-month period was used to gauge real-life implementation. Results During 277 eligible real-life appendectomies, structured evaluation was performed in 173 (62%) laparoscopic appendectomies, for which 165 forms were completed by 19 trainees. Construct validity was found satisfactory. Inter-rater reliability demonstrated good correlation between trainee and trainer. The trainees’ and trainers’ stepwise and overall assessments of technical skills had an overall good reliability (intraclass correlation coefficient of 0.88). The vast majority (92.2%) of the trainees either agreed or strongly agreed that the training met their expectations. Conclusion Structured training for general surgery residents can be implemented for laparoscopic appendectomy. Skills assessment by trainees and trainers indicated reliable self-assessment. Overall, the trainees were satisfied with the training, including the feedback from the trainers.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"2016 1","pages":"517 - 523"},"PeriodicalIF":1.1,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86332059","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":"Does simulation training in final year make new graduates feel more prepared for the realities of professional practice?","authors":"Ciara Carpenter, Tom Keegan, Gill Vince, L. Brewster","doi":"10.1136/bmjstel-2020-000836","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000836","url":null,"abstract":"Introduction The transition from medical student to doctor has long been a source of concern, with widespread reporting of new graduates’ lack of preparedness for medical practice. Simulation has been suggested as a way to improve preparedness, particularly due to the difficulties in allowing full autonomy for patient care for undergraduate medical students. Few studies look at simulation alone for this purpose, and no studies have compared different simulation formats to assess their impact on preparedness. Methods This mixed-method study looked at two different simulation courses in two UK universities. Data were collected in two phases: immediately after the simulation and 3–4 months into the same students’ postgraduate training. Questionnaires provided quantitative data measuring preparedness and interviews provided a more in-depth analysis of experiential learning across final year and how this contributed to preparedness. Results There were no significant differences between the two courses for overall preparedness, stress or views on simulation, and no significant differences in opinions longitudinally. Although the study initially set out to look at simulation alone, emergent qualitative findings emphasised experiential learning as key in both clinical and simulated settings. This inter-relationship between simulation and the student assistantship prepared students for practice. Longitudinally, the emphasis on experiential learning in simulation was maintained and participants demonstrated using skills they had practised in simulation in their daily practice as doctors. Nevertheless, there was evidence that although students felt prepared, they were still scared about facing certain scenarios as foundation doctors. Discussion The results of this study suggest that simulation may positively affect students’ preparedness for practice as doctors. Simulation will never be a replacement for real clinical experience. However, when used prior to and alongside clinical experience, it may have positive effects on new doctors’ confidence and competence, and, therefore, positively impact patient care.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"89 1","pages":"510 - 516"},"PeriodicalIF":1.1,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84083666","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":"Creating an intramuscular injection pad for the SimMan 3G","authors":"R. Sinclair, Alan Inglis","doi":"10.1136/bmjstel-2021-000874","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000874","url":null,"abstract":"This short report outlines the rationale, design and method of production for a thigh-mounted intramuscular (IM) pad in the thigh of a SimMan 3G manikin. The aim of this project was to create an IM injection site in the manikin’s thigh to allow simulation participants to practise administering IM injections in a safe, supported environment. After creating a prototype from a plastic bottle, a module was designed to use with the SimMan 3G. A mould of SimMan’s leg was created using plaster of Paris, and then a relief was added to this mould to create the shape required to hold the sponge. Once the mould was completed, glass reinforced plastic (GRP) was applied to create the final module. Using an electric rotary tool, a hole was cut in the SimMan’s thigh to enable the module to be fitted. The final product was waterproof, lightweight and strong. It sits discretely beneath the SimMan 3G’s leg skin enabling students to practise high-fidelity IM injections on the manikin’s leg without faculty intervention. This module is a cost-effective solution for allowing participants to practise IM injections on a manikin during healthcare simulation.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"2 1","pages":"617 - 619"},"PeriodicalIF":1.1,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73160667","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":"COVID-19 challenges in organising teaching at a faculty of pharmacy","authors":"O. Rahić, M. Sirbubalo, A. Tucak, J. Hadžiabdić, A. Elezovic, E. Vranić","doi":"10.1136/bmjstel-2021-000896","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000896","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. We come from Bosnia and Herzegovina, a small country in western Balkans. Our Faculty of Pharmacy at the University of Sarajevo was opened in 1973, but from then on there was no kind of online teaching. So when the COVID-19 pandemic broke out, and when the university decided to stop all kinds of ‘inclass’ teaching (12 March 2020), we were faced with something new. We work at the Department of Pharmaceutical Technology, where we teach regular courses on ‘Drug Formulation’ and ‘Industrial Pharmacy’. Students take classes in these subjects in the seventh, eighth and ninth semesters. The exercises are practical and last several hours. On 25 March 2020, classes in the lecture hall were suspended until further notice by the decision of the Senate of the University of Sarajevo, and then we realised that we must embark on the adventure of organising online classes. We carried out short research on available online teaching platforms to find basic information on the platform’s capabilities, identify their advantages and disadvantages, and check their commercial prices. We studied the following platforms for online courses: Google Meet, Adobe Connect, Zoom and BigBlueButton, and the following platforms for online examinations: Exam. net, Virtualx, Google Forms, Skillsbook, Papershala, Edbase, Kaldin and TCExam. After examining the possibilities of the available online teaching platforms, we agreed that Zoom and Google Meet provide the best results for running online courses. Adobe Connect, Blackboard Collaborate and BigBlueButton work on the same principle, but professional versions of these platforms were quite unaffordable to us. The results for the online examination platforms are summarised in table 1. Given the security and price of the platforms, we concluded that Exam. net currently meets our criteria, but that it would be necessary to use two platforms simultaneously during the examination, one of which would allow an established video connection with students during the examination (eg, a combination of Exam. net and Zoom). Students accessed the examination platform from their laptop while simultaneously established a video connection with the teacher on their mobile device. At the end of the semester, we conducted an online survey in which 60 (70.93%) of 86 students participated, and for 98.4% of the students this was their first online learning experience. Although it is assumed that current students (digital natives) have adequate information and communications technology competence, they differ in their computer and information literacy as they come from different socioeconomic backgrounds. Of the students, 21.3% had technical difficulties (ie, unstable connection). One of them said she/he has problems with misunderstanding from parents who required help with housework at the time of the lecture because she/he comes from the countryside. ","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"2 1","pages":"646 - 647"},"PeriodicalIF":1.1,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89458603","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}