BMJ Simulation & Technology Enhanced Learning最新文献

{"title":"Engaging young people as simulated patients: a qualitative description of health professional educators’ perspectives","authors":"A. Gamble, M. Bearman, D. Nestel","doi":"10.1136/bmjstel-2020-000807","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000807","url":null,"abstract":"Background Real patients in clinical placements are important for learning and may well be the ‘gold standard’. However, simulated patients (SPs) are a viable alternative in the absence of this opportunity. While adult SPs contribute to health professions education, child and adolescent simulated patients (CASPs) are less common. This research aims to explore the perspectives of healthcare educators regarding the engagement of young SPs, specifically the identification of barriers and enablers to involving CASPs. Methods We used an interpretive paradigm of qualitative description. Thirteen interviewees, all educators involved in SP programmes, participated in semistructured interviews. Data were transcribed verbatim and analysed using an inductive thematic approach. Findings Not all participants saw value in engaging CASPs. A number of barriers and enablers to involving them were acknowledged in six themes: challenges and concerns; logistical barriers; benefits of CASPs; overcoming challenges; an ethical minefield; and child safety. Opinions differed with respect to feasibility and necessity for involving CASPs, particularly in the hospital setting where real patients are accessible. All participants articulated the critical importance of ensuring adequate support and adherence to ethical principles if CASPs were involved. Conclusions The involvement of CASPs in health professions education is a divisive issue. CASPs’ ability to provide a realistic option for supporting learning is recognised yet perhaps not wholly perceived as a feasible alternative to real patients. Their engagement raises critical ethical, practical, logistical and financial challenges.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78268890","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":"SP safety, autonomy and healthcare simulation practice in the COVID-19 era.","authors":"Lou Clark, Anne Woll, Tamara L Owens, Deltonia Shropshire, Bob Kiser, Grace Gephardt, Christine S Park","doi":"10.1136/bmjstel-2020-000835","DOIUrl":"10.1136/bmjstel-2020-000835","url":null,"abstract":"<p><p>This letter expands upon the three tenets of the Healthcare Simulation Manifesto-comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: 'essential' and 'autonomy' in relation to safety for standardized/simulated patients (SPs). In this time of crisis, simulationists must move the boundary of skills training previously accepted as safe for human beings, and leverage technology to ensure the highest level of safety achievable for our SPs.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81951141","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":"Orotracheal intubation incorporating aerosol-mitigating strategies by anaesthesiologists, intensivists and emergency physicians: a simulation study","authors":"Saullo Queiroz Silveira, Leopoldo Muniz da Silva, A. Ho, C. M. Kakuda, Daniel Wagner de Castro Lima Santos, R. S. Nersessian, Arthur de Campos Vieira Abib, Marcella Pellicciotti de Sousa, G. Mizubuti","doi":"10.1136/bmjstel-2020-000757","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000757","url":null,"abstract":"Background Orotracheal intubation (OTI) can result in aerosolisation leading to an increased risk of infection for healthcare providers, a key concern during the COVID-19 pandemic. Objective This study aimed to evaluate the OTI time and success rate of two aerosol-mitigating strategies under direct laryngoscopy and videolaryngoscopy performed by anaesthesiologists, intensive care physicians and emergency physicians who were voluntarily recruited for OTI in an airway simulation model. Methodology The outcomes were successful OTI, degree of airway visualisation and time required for OTI. Not using a stylet during OTI reduced the success rate among non-anaesthesiologists and increased the time required for intubation, regardless of the laryngoscopy device used. Results Success rates were similar among physicians from different specialties during OTI using videolaryngoscopy with a stylet. The time required for successful OTI by intensive care and emergency physicians using videolaryngoscopy with a stylet was longer compared with anaesthesiologists using the same technique. Videolaryngoscopy increased the time required for OTI among intensive care physicians compared with direct laryngoscopy. The aerosol-mitigating strategy under direct laryngoscopy with stylet did not increase the time required for intubation, nor did it interfere with OTI success, regardless of the specialty of the performing physician. Conclusions The use of a stylet within the endotracheal tube, especially for non-anaesthesiologists, had an impact on OTI success rates and decreased procedural time.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80709599","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":"Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students.","authors":"John T Paige, Deborah D Garbee, Qingzhao Yu, John Zahmjahn, Raquel Baroni de Carvalho, Lin Zhu, Vadym Rusnak, Vladimir J Kiselov","doi":"10.1136/bmjstel-2020-000685","DOIUrl":"10.1136/bmjstel-2020-000685","url":null,"abstract":"<p><strong>Background: </strong>The evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.</p><p><strong>Methods: </strong>Forty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.</p><p><strong>Results: </strong>Statistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores <math><mo>≥</mo></math> 3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.</p><p><strong>Conclusions: </strong>Quality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74109233","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":"From manifestos to praxis: developing criticality in healthcare simulation.","authors":"Nancy McNaughton, Gerard Gormley","doi":"10.1136/bmjstel-2020-000821","DOIUrl":"10.1136/bmjstel-2020-000821","url":null,"abstract":"","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72488924","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":"Online objective structured clinical examination overview","authors":"Vivienne Mak","doi":"10.1136/bmjstel-2020-000781","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000781","url":null,"abstract":"Correspondence to Dr Vivienne Mak, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia;Vivienne.Mak@monash.edu Objective structured clinical examinations (OSCEs) are used as summative assessments in the pharmacy programme to assess students’ clinical knowledge and oral communication skills. [...]some learning outcomes were modified depending on adaptations required for online OSCE stations. In addition to medical devices, if there are any further props required for the OSCE station, these are provided and made available as PowerPoint presentations that are designed to be managed by the simulated patient/examiner.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81198213","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":"TeamSTEPPS online simulation: expanding access to teamwork training for medical students","authors":"Rebekah Burns, M. Gray, Dana Peralta, Andrew Scheets, R. Umoren","doi":"10.1136/bmjstel-2020-000649","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000649","url":null,"abstract":"Background The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) programme is an evidence-based approach to teamwork training. In-person education is not always feasible for medical student education. The aim of this study was to evaluate the impact of online, interactive TeamSTEPPS simulation versus an in-person simulation on medical students’ TeamSTEPPS knowledge and attitudes. Methods Fourth-year medical students self-selected into an in-person or online training designed to teach and evaluate teamwork skills. In-person participants received didactic sessions, team-based medical simulations and facilitated debriefing sessions. The online group received an equivalent online didactic session and participated in an interactive software-based simulation with immediate, personalised performance-based feedback and scripted debriefing. Both trainings used three iterations of a case of septic shock, each with increasing medical complexity. Participants completed a demographic survey, a preintervention/postintervention TeamSTEPPS Benchmarks test and a retrospective preintervention/postintervention TeamSTEPPS teamwork attitudes questionnaire. Data were analysed using descriptive statistics and repeated measures analysis of variance. Results Thirty-one students (18 in-person, 13 online) completed preintervention/postintervention surveys, tests and questionnaires. Gender, age and exposure to interprofessional education, teamwork training and games were similar between groups. There were no statistical differences in preintervention knowledge or teamwork attitude scores between in-person and online groups. Postintervention knowledge scores increased significantly from baseline (+2.0% p=0.047), and these gains did not differ significantly based on whether participants received in-person versus online training (+1.5% vs +2.9%; p=0.49). Teamwork attitudes scores also showed a statistically significant increase with training (+0.9, p<0.01) with no difference in the effect of training by group (+0.8 vs +1.0; p=0.64). Conclusions Graduating medical students who received in-person and online teamwork training showed similar increases in TeamSTEPPS knowledge and attitudes. Online simulations may be used to teach and reinforce team communication skills when in-person, interprofessional simulations are not feasible.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85689758","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":"Rapid cycle system improvement for COVID-19 readiness: integrating deliberate practice, psychological safety and vicarious learning.","authors":"Albert Kam Ming Chan,&nbsp;Jenny W Rudolph,&nbsp;Vivian Nga Man Lau,&nbsp;Henry Man Kin Wong,&nbsp;Rosinni Si Ling Wong,&nbsp;Thomas S F Lo,&nbsp;Gordon Y S Choi,&nbsp;Gavin Matthew Joynt","doi":"10.1136/bmjstel-2020-000635","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000635","url":null,"abstract":"<p><strong>Introduction: </strong>In the face of a rapidly advancing pandemic with uncertain pathophysiology, pop-up healthcare units, ad hoc teams and unpredictable personal protective equipment supply, it is difficult for healthcare institutions and front-line teams to invent and test robust and safe clinical care pathways for patients and clinicians. Conventional simulation-based education was not designed for the time-pressured and emergent needs of readiness in a pandemic. We used 'rapid cycle system improvement' to create a psychologically safe learning oasis in the midst of a pandemic. This oasis provided a context to build staff technical and teamwork capacity and improve clinical workflows simultaneously.</p><p><strong>Methods: </strong>At the Department of Anaesthesia and Intensive Care in Prince of Wales Hospital, a tertiary institution, in situ simulations were carried out in the operating theatres and intensive care unit (ICU). The translational simulation design leveraged principles of psychological safety, rapid cycle deliberate practice, direct and vicarious learning to ready over 200 staff with 51 sessions and achieve iterative system improvement all within 7 days. Staff evaluations and system improvements were documented postsimulation.</p><p><strong>Results/findings: </strong>Staff in both operating theatres and ICU were significantly more comfortable and confident in managing patients with COVID-19 postsimulation. Teamwork, communication and collective ability to manage infectious cases were enhanced. Key system issues were also identified and improved.</p><p><strong>Discussion: </strong>To develop readiness in the rapidly progressing COVID-19 pandemic, we demonstrated that 'rapid cycle system improvement' can efficiently help achieve three intertwined goals: (1) ready staff for new clinical processes, (2) build team competence and confidence and (3) improve workflows and procedures.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjstel-2020-000635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290524","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":"Workload of learners during simulated paediatric cardiopulmonary resuscitation.","authors":"Ann L Young,&nbsp;Cara B Doughty,&nbsp;Kaitlin C Williamson,&nbsp;Sharon K Won,&nbsp;Marideth C Rus,&nbsp;Nadia N Villarreal,&nbsp;Elizabeth A Camp,&nbsp;Daniel S Lemke","doi":"10.1136/bmjstel-2020-000652","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000652","url":null,"abstract":"<p><strong>Introduction: </strong>Learner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.</p><p><strong>Methods: </strong>Paediatric emergency nurses and paediatric and emergency medicine residents formed teams of four to eight and randomised into roles to participate in simulation-based, paediatric resuscitation. Participant workload was measured using the NASA Task Load Index, which provides an average workload score (from 0 to 100) across six subscores: mental demand, physical demand, temporal demand, performance, frustration and mental effort. Workload is considered low if less than 40, moderate if between 40 and 60 and high if greater than 60.</p><p><strong>Results: </strong>There were 210 participants representing 40 simulation teams. 138 residents (66%) and 72 nurses (34%) participated. Team lead reported the highest workload at 65.2±10.0 (p=0.001), while the airway reported the lowest at 53.9±10.8 (p=0.001); team lead had higher scores for all subscores except physical demand. Team lead reported the highest mental demand (p<0.001), while airway reported the lowest. Cardiopulmonary resuscitation coach and first responder reported the highest physical demands (p<0.001), while team lead and nurse recorder reported the lowest (p<0.001).</p><p><strong>Conclusions: </strong>Workload for learners in paediatric simulated resuscitation teams was moderate to high and varied significantly based on team role. Composition of workload varied significantly by team role. Measuring learner workload during simulated resuscitations allows improved processes and choreography to optimise workload distribution.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936742/pdf/bmjstel-2020-000652.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9283004","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":"Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice.","authors":"Sharon Griswold,&nbsp;Toshiko Uchida,&nbsp;S Barry Issenberg,&nbsp;Ivette Motola,&nbsp;William C McGaghie,&nbsp;Michael A Gisondi,&nbsp;Amelia Lorenz,&nbsp;Jeffrey H Barsuk","doi":"10.1136/bmjstel-2021-000889","DOIUrl":"https://doi.org/10.1136/bmjstel-2021-000889","url":null,"abstract":"<p><p>Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team's voice and safety are important. <i>Calls for personal, physical or patient safety should never be disregarded or met with retaliation</i>.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936733/pdf/bmjstel-2021-000889.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9180468","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}