Simulation in Healthcare-Journal of the Society for Simulation in Healthcare最新文献

{"title":"Stress During Virtual Reality and High-Fidelity Simulation in Anesthesia Trainees: A Randomized Controlled Trial.","authors":"Gianluca Bertolizio, Catherine Paquet, Natalie Buu, Thomas Engelhardt, Danielle Sophia Shafiepour, Milene Alice Azzam, Marta Garbin, Caroline White, Samuel Wasserman, Yuqi Gu, Simone Crooks, Curtis Nickel, Raman Sohi, Daniel Power, Vicki LeBlanc, Dan Poenaru","doi":"10.1097/SIH.0000000000000946","DOIUrl":"https://doi.org/10.1097/SIH.0000000000000946","url":null,"abstract":"<p><strong>Introduction: </strong>Manikin-based high-fidelity simulation (HFS) is critical in anesthesia for teaching crisis resource management skills in a safe environment. However, HFS is known to result in significant stress, potentially affecting learning. Virtual reality (VR) has emerged as a promising alternative to HFS, but the impact on stress remains unknown. This study compares perceived and physiological stress in anesthesia trainees during VR and HFS, and in high- and low-performing subjects after HFS.</p><p><strong>Methods: </strong>This secondary analysis from a prospective, sequential, randomized controlled trial compares anesthesia trainee volunteers who undergo either VR or HFS scenarios. Perceived stress was measured using the State-Trait Anxiety Inventory (STAI), the Medical Emotion Scale (MES), and the NASA Task Load Index (NASA-TLX). Physiological stress was assessed via heart rate variability standard deviation between successive N-N intervals (SDNN) and the low-frequency/high-frequency (LF/HF) ratio. Trainees' performance was assessed with the Ottawa Global Rating Scale.</p><p><strong>Results: </strong>Among the 34 volunteers enrolled, both the VR and HFS groups demonstrated similar STAI, MES, and NASA-TLX scores following the scenarios. However, VR elicited lower SDNN values (mean difference, -12, 95% CI, -23 to -1.0, P=0.034), but not the LF/HF ratio. No difference was observed in stress indicators between high-performing and low-performing trainees.</p><p><strong>Conclusions: </strong>Anesthesia trainees experience comparable levels of perceived stress in the form of anxiety, emotional responses, and task load in VR and HFS scenarios. A lower heart rate variability during VR scenarios may indicate greater physiological stress. The relevance and implications of these findings in simulation require further clarification.</p><p><strong>Study registration: </strong>ClinicalTrials.gov (NCT05041049).</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the METRICS Framework to Build Programs of Healthcare Simulation Research.","authors":"Adam Cheng, Walter Eppich, Aaron Calhoun, Michaela Kolbe, David Kessler, Ryan Brydges, Janice Palaganas, Marc Auerbach, Gabriel Reedy","doi":"10.1097/SIH.0000000000000876","DOIUrl":"10.1097/SIH.0000000000000876","url":null,"abstract":"<p><p>The evidence base supporting the adoption of simulation in health care has not kept pace with the rapid growth of the field. Although there is a growing body of research in health care simulation, many published studies describe small-scaled, underpowered projects with insufficient methodological rigor to inform our understanding of simulation. This problem is indicative of a larger challenge: the lack of focused, cohesive programs of research designed to advance the science of simulation. The METRICS framework is a model of scholarship that categorizes scholarship into 7 intersecting domains: Metascholarship, Evaluation, Translation, Research, Innovation, Conceptual, and Synthesis. In this article, we aim to explore how the METRICS framework can serve as a roadmap for researchers to develop cohesive simulation research programs. We also describe how the METRICS framework applies to existing institutional and network-based programs of health care simulation research and discuss future implications for the global health care simulation community.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"188-196"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Simulation-Based Learning for Direct and Indirect Ophthalmoscopy: A Systematic Review and Meta-analysis.","authors":"Mohammad Karam, Moath Baeshen, Tsz Hin Alexander Lau, Lojain Jamal, Khaldon Abbas, Marcele Falcao, Guillermo Rocha","doi":"10.1097/SIH.0000000000000868","DOIUrl":"10.1097/SIH.0000000000000868","url":null,"abstract":"<p><p>This systematic review and meta-analysis evaluated the efficacy of simulation-based training for direct and indirect ophthalmoscopy. The primary outcome was successful fundus identification rate. Secondary outcomes included the simulation favorability rate, posttest results, and perceived benefits. Of the 955 studies identified, 11 studies were included, comprising a total sample of 772 participants. Simulation training improved fundus identification success, with 63.1% of participants correctly identifying fundus structures and demonstrated a high favorability rate, with 75.6% of participants preferring simulation over traditional training methods. Participants also demonstrated improvements in posttest knowledge and technical skills, with enhanced confidence, realism, and ease of learning, underscoring simulation's role in effectively advancing practical ophthalmic skills. Overall, simulation-based training seems effective in enhancing examination skills within simulated settings. These findings support its integration into ophthalmology curricula to enhance training outcomes. Interpretation of fundus identification outcomes should be cautious due to limited study numbers and assessment heterogeneity.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"180-187"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Simulation With 3D-Printed Spine for Teaching Durotomy Repair: A Technique Guide and Validation Study.","authors":"Lainey G Bukowiec, Aaron Damon, Julia Todderud, Seung J Lee, Paul Huddleston","doi":"10.1097/SIH.0000000000000889","DOIUrl":"10.1097/SIH.0000000000000889","url":null,"abstract":"<p><strong>Introduction: </strong>Durotomies can lead to cerebrospinal fluid leakage, resulting in various complications. Repairing a durotomy is an essential skill for orthopedic and neurosurgical trainees, but the learning process can be challenging. Therefore, there is a need for effective simulators that allow surgical trainees to practice the technique in a controlled environment without endangering patient safety.</p><p><strong>Methods: </strong>This study describes the development of a novel 3-dimensional (3D) printed simulation model designed for teaching the repair of intraoperative durotomies to surgical trainees. Junior and senior residents, fellows, and attending spine surgeons used the simulation. Inter- and intragroup performance was examined.</p><p><strong>Results: </strong>A novel durotomy repair simulation model with lumbar and thoracic windows was developed using 3D-printed and repurposed components to create a lifelike representation of an in vivo intraoperative scenario. Senior residents, fellows, and attendings outperformed junior residents at the initial attempt. All groups improved with repeated exposure to the simulator.</p><p><strong>Conclusions: </strong>The model offers surgical trainees a controlled environment to practice technical skills without increasing risk for patients or prolonging surgical cases. The model demonstrated its validity by showing that more senior participants outperformed junior residents during their initial attempts. Performance improvement across all groups with repeated exposure indicates that the model not only tests a relevant and realistic skill set, but also facilitates skill development over time. Given the challenges associated with intraoperative training as well as the complications associated with durotomies, the proposed simulator has the potential to benefit surgical trainees and patients.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"203-208"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Barriers to Clinical Reasoning in High-Fidelity Simulation for Undergraduate Medical Students: A Phenomenological Study.","authors":"Leah Williams, Anastasia Trebacz, Michael Atkinson, Chris Tiplady","doi":"10.1097/SIH.0000000000000886","DOIUrl":"10.1097/SIH.0000000000000886","url":null,"abstract":"<p><strong>Introduction: </strong>There is a growing imperative to integrate clinical reasoning (CR) training more centrally into medical school curricula. As a pedagogical tool that facilitates explicit CR teaching, high-fidelity simulation (HFS) is perhaps uniquely situated to meet this need. While barriers to CR for medical students on clinical placement are well-documented, a comprehensive understanding of barriers specific to HFS was previously lacking.</p><p><strong>Methods: </strong>Fourth-year medical students at the University of Sunderland were purposively sampled. Data were gathered via semistructured videoconferencing interviews between April and May 2023. A reflexive, data-driven, inductive thematic analysis was undertaken, and a thematic framework was generated. Data collection ceased upon thematic saturation after 14 interviews.</p><p><strong>Results: </strong>Barriers to CR during HFS were identified across student and simulation domains. Students reported barriers to (1) information synthesis-due to inadequate knowledge and difficulty interpreting clinical findings-and (2) engaging in metacognition-due to procedural rigidity, stress, and cognitive bias. Simulation-related barriers arose from (3) case design-including excessive case complexity and cognitive overload-and (4) the simulation environment-such as inadequate prebriefing, technological limitations, and overreliance on facilitators. Some findings, such as the impact of cognitive bias, align with existing literature on barriers to CR in other contexts. Others, including the limitations of technology, appear unique to the HFS setting.</p><p><strong>Conclusions: </strong>Barriers to CR identified within this context contribute novel findings to the existing body of educational research. We advocate that educators should carefully consider these barriers when designing HFS sessions, and when optimizing students for learning through simulation, to enhance CR training.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"143-150"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-based Longitudinal Ultrasound Training for Critical Care Physicians: A Prospective Single-center Evaluation.","authors":"Hui Wang, Shanshan Zhai, Yongyi Chen, Jun Duan","doi":"10.1097/SIH.0000000000000931","DOIUrl":"10.1097/SIH.0000000000000931","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the training outcomes and early transfer of ultrasound to the clinical environment of a simulation-based longitudinal ultrasound training program for critical care physicians in a single-center intensive care unit.</p><p><strong>Materials and methods: </strong>We designed a simulation-based longitudinal ultrasound training for emergency and intensive care residents. The course lasts for 6 months per session, including theoretical classes, practice with simulators and real human models, learning of critical care ultrasound processes and protocols, and finally clinical application. A total of 164 physicians have received training through this program. We evaluated learner satisfaction, theoretical knowledge and practical performance both before and after training, as well as process-based indicators of clinical application and transfer of ultrasound skills into the clinical environment.</p><p><strong>Results: </strong>Across all 10 survey items, 81.3% to 100% of trainees responded \"agree\" or \"strongly agree,\" with the highest ratings observed for the usefulness of theoretical courses and the relevance of content to clinical work. Post-training assessments showed significant improvements in theoretical examination (median difference=24, 95% CI [23.3, 26.6], W=13,366), abnormal image interpretation (median difference=36, 95% CI [32.7, 36.7], W=13,041), and operational skills (median difference=30, 95% CI [28.7, 31.3], W=13,366) (all P <0.05). Median scores significantly improved post-training compared with baseline: clinical case assessment scores increased from 48 (IQR: 38, 55) to 76 (IQR: 72 to 84); case analysis from 11 (IQR: 8 to 15) to 21 (IQR: 17 to 26); and image interpretation from 4 (IQR: 2 to 7) to 16 (IQR 13 to 18) (all P <0.05). During clinical practice, a total of 956 critical care ultrasound examinations were performed. Of these, 415 examinations (43.41%) provided additional diagnostic clarification. Overall, 789 examinations (82.53%) generated ultrasound findings that supported, refined, or contextualized ongoing diagnostic assessment or clinical decision-making.</p><p><strong>Conclusions: </strong>Our longitudinal ultrasound training program strengthens foundational knowledge and enhances clinical application of critical care ultrasound. However, this single-center study lacks a comparator arm and long-term patient outcome evaluation. Future multicenter studies should validate these findings, compare training methodologies, and assess the impact of critical care ultrasound on patient morbidity and mortality.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"164-171"},"PeriodicalIF":2.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on Confronting a Capacity Challenge With an AI-Powered Patient Simulator (SimPatient).","authors":"Andrew O'Malley","doi":"10.1097/SIH.0000000000000890","DOIUrl":"10.1097/SIH.0000000000000890","url":null,"abstract":"","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"209-210"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open to Interpretation: Design Thinking, Role-Reversal Simulation, Building Empathy in Language-Discordant Care.","authors":"Jason G Langenfeld, Heather K Nichols, Wesley G Zeger, Elizabeth R Lyden, Abigail M Meier, Clare F Euteneuer, Isabelle S Weber, Esther R Samuel, Kaitlyn K Baysa, Tedd J Welniak","doi":"10.1097/SIH.0000000000000896","DOIUrl":"10.1097/SIH.0000000000000896","url":null,"abstract":"<p><p>Linguistic barriers create challenges in delivering effective healthcare, particularly in emergency medicine (EM) where miscommunication has dire consequences. A unique partnership of undergraduate students and EM faculty used design thinking to identify innovative solutions to improve provider understanding of the effects of those barriers on patient care. Empathy interviews with patients and providers evaluated contrasts in patient care between language concordant and discordant encounters, directing development and implementation of a preferred-language role-reversal simulation exercise. This novel exercise was an effective tool to provide education and experience on the care of language-discordant patients. Evaluation exposed lack of confidence in available options and need for technology and resources to help alleviate barriers when traditional avenues for communication fail. Easily adaptable, simulation is useful to explore the impact of language on patient experience. This study highlights the need for further efforts to address quality of patient care when language barriers are present.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"197-202"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability and Medication Error Rates of Pneumatic Versus Volumetric Pumps During a Perioperative Cardiac Surgery Simulation: A Prospective Pilot Study.","authors":"Steven B Greenberg, Nicholas B Clevenger, Andrew R Locke, John Cram, Kyle Petty, Chi Wang, Mohammed Minhaj","doi":"10.1097/SIH.0000000000000871","DOIUrl":"10.1097/SIH.0000000000000871","url":null,"abstract":"<p><strong>Introduction: </strong>This study compares 2 commercially available infusion pumps in a simulated cardiac surgical perioperative setting to assess differences in usability, medication errors, and programming workload among experienced and trainee healthcare professionals. Perioperative medications are frequently administered to patients via infusion pumps. Major issues in the perioperative period include medication errors, usability challenges, and workflow inefficiencies.</p><p><strong>Methods: </strong>Simulation of a cardiac perioperative setting was used to observe 24 trainee and experienced healthcare professionals. The primary outcome was time to correct completion of each drug infusion task. Participants completed usability and workload surveys after each simulation.</p><p><strong>Results: </strong>Participants were comparable with regard to demographics, prior work, and simulation experience. Results showed no significant difference with regard to time to correct completion of each drug infusion task. There was a significant increase in aggregate Systems Usability Scores among anesthesia professionals favoring use of the pneumatic pump. There were no significant differences in either cohort in aggregates score of the NASA Task Load Index.</p><p><strong>Conclusions: </strong>Aggregate System Usability Scoring among anesthesia professionals favored pneumatic pump use. However, there were no differences in time to complete infusion task or in medication errors in each pump group.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"158-163"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Workers' Experiences of Neonatal Mortality Prevention Education Using Digital Learning Platforms in Nigeria: A Qualitative Study.","authors":"Nnenna Mba-Oduwusi, Aloysius Odii, Bolaji Akala, Jess Littman, Naji Hattar, Beena D Kamath-Rayne, Susan Niermeyer, Petronila Tabansi, Mohammed Ashiru Garba, Mercy Poksireni, Abubakar Farouk","doi":"10.1097/SIH.0000000000000891","DOIUrl":"10.1097/SIH.0000000000000891","url":null,"abstract":"<p><strong>Introduction: </strong>Neonatal mortality remains a critical public health challenge in sub-Saharan Africa. This is due to numerous factors, including limitations in health worker education to provide essential care at birth. Improving the skills of available health workers could affect the quality of health care and reduce neonatal mortality. This qualitative study describes the experience of frontline health workers who participated in essential care education using digital learning platforms.</p><p><strong>Methods: </strong>Frontline health workers in 4 secondary healthcare institutions in Yobe, Gombe, and Borno states in Nigeria participated in focus group discussions and key informant interview after educational sessions delivered remotely and skills practice using a neonatal simulator providing digital feedback. Qualitative data collection sought both personal insights and group-level dynamics regarding the participants' educational and clinical experiences. Data were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>The study findings show that the participants learned essential newborn care practices like skin-to-skin contact and delaying cord clamping. They also reported that these new skills and practices improved how they care for newborns, including enabling timely and effective resuscitation at birth. However, challenges such as limited access to educational simulators and issues with internet connectivity acted as barriers to education; workload and equipment shortages limited implementation in the clinical setting.</p><p><strong>Conclusion: </strong>Health care workers were able to learn improved techniques for newborn care and resuscitation through digital technologies. However, further improved outcomes will require addressing technical and structural challenges that affect the implementation process.</p>","PeriodicalId":49517,"journal":{"name":"Simulation in Healthcare-Journal of the Society for Simulation in Healthcare","volume":" ","pages":"151-157"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}