Introduction

Simulation is a mandatory component of surgical training; the challenge remains to develop ‘close-to-real’ training. Management of paediatric elbow fractures is an obligatory competence for completion of training in Trauma and Orthopaedics. Current methods use dry bone simulation to teach wire configuration, but intra-operative radiographic interpretation is not possible.

Pleuroscopy is a safe and sensitive alternative to video-assisted thoracic surgery for the diagnosis and management of malignant pleural effusion. Pleuroscopy requires fewer resources and can be offered to patients with reduced surgical fitness. A healthcare re-design project was required to establish pleuroscopy in our hospital system. These projects improve the quality and accessibility of care for patients and often result in multiple changes occurring simultaneously within a complex system. The Systems Engineering Initiative for Patient Safety model highlights the system elements that may be impacted when considering system redesign such as the environment, people/roles, tools/technology, tasks and organization. The resulting impact to our processes, patient/staff safety and desired outcomes is not always predictable when changing one or several elements.

Methods

Simulation is a key method to integrate into redesign projects to ensure the preparedness of staff, systems and processes involved, although it isn’t always utilized. This redesign involved relocating pleuroscopy procedures from the operating room (OR) suites to an outpatient bronchoscopy suite. Short skills-based simulation sessions (i.e. sub-sections of the workflow) were included for learning specific skills, followed by team simulation events as a final implementation step to ensure readiness. Based on this approach, restructuring of process, team roles, the environment, equipment and more was evaluated using simulation to test each system element undergoing change.

Results

Simulation provided an essential means to evaluate staffing and roles (i.e. expanded scope of practice for respiratory therapists and nurses); the development of cognitive/visual aids and checklists; policy changes; initial staffing modifications, standardization; environmental changes; process changes and more. During the first year since implementation, 25 pleuroscopy procedures have been successfully completed without any safety events reported.

Discussion

Systems testing and education using simulation was required to ensure an effective implementation and reinforce the many redesigned elements. Simulation was able to proactively test how this procedure could be achieved safely in the new environment. This article serves to demonstrate the utility of simulation for systems testing and staff training for a large system redesign project moving a diagnostic procedure from the OR to an outpatient bronchoscopy suite.

Transgender and gender non-binary (TGNB) patient care is not routinely taught in medical training. As a result, clinicians frequently lack knowledge regarding gender-affirming practices, surgeries and medications. TGNB-specific health knowledge and care delivery are further negatively impacted by pervasive societal transphobia. Virtual reality (VR)-based instruction may provide learners with opportunities for perspective taking, empathy building and attitudinal shifting to improve care delivery to TGNB patients.

Methods

This was a feasibility trial that compared passive VR and webinar in changing learner attitudes, knowledge and medical decision-making (MDM). Residents were recruited from five US emergency medicine (EM) residencies and were randomized to either VR or webinar educational intervention arm. Pre- and post-intervention assessments were matched using a unique identifier. Participants provided feedback about platform usability.

Results

From August 2020 to October 2021, 206 resident participants were randomized into a case-based VR experience or webinar intervention on TGNB-specific EM medicine; 52 residents completed all three steps of the study. Webinar participants demonstrated more changes in attitudinal statements than VR participants. No improvements in knowledge or MDM were appreciated in either intervention arm. Participants in both arms shared positive and critical feedback about the intervention they accessed, with convenience and ease of use being valued for asynchronous webinar learning.

Discussion

The webinar arm demonstrated a higher increase in empathy or change in attitude compared to VR learners. As VR becomes more technologically agile, accessible and reliable, more work is needed to see if this novel format is an educational tool that closely approximates the standardized patient encounter.

Development of the undergraduate simulation experience is needed to continue developing aspiring clinicians’ ability to assess and manage unwell patients. However, its heavy resource demand and ‘Generation Z’s’ desire for technologically enhanced learning means novel simulation modalities must now be considered. Mixed reality (MR) provides a platform to deliver such simulation; however, it is yet to be studied in this context. We conducted an observational cohort study with the aim to assess ift MR simulation improves students’ perceived ability to assess and manage unwell patients.

Methods:

We recruited 32 undergraduate medical students and asked them to rate their ability to assess and manage acutely unwell patients, out of 10. An MR simulation was then delivered using the Microsoft HoloLens and HoloScenario software produced by GigXR. Students then rated their assessment and management ability again, alongside their experience of the system and its usability. Data analysis used paired t-tests to assess for significant differences.

Results:

By attending the simulation, students showed a significant improvement in perceived ability to assess (p < 0.001) and manage (p < 0.001) acutely unwell patients. Mean assessment scores improved by 1.09/10 (95% confidence interval [CI 0.67, 1.52]) with 89% of students feeling more confident. Mean management scores improved by 1.63/10 (95% CI [1.15, 2.10]) with 84% of students reporting increased confidence levels. When considering usability, 69% of students did not find the MR system easy to use, with 75% of students having technical issues and 38% experiencing side effects. Overall, 88% of students believed the experience was beneficial to their learning.

Conclusions:

MR shows promise in its ability to deliver simulation training and improve students’ perceived ability to assess and manage unwell patients. Advances in software availability and content are required for integration into undergraduate medical curricula. Further research is required to assess if these results are replicated objectively.

Learning through simulation requires psychological safety where participants feel comfortable engaging to their fullest extent, speaking up or asking questions without fear of embarrassment. While professional simulation organizations provide recommendations on fostering psychological safety, anecdotal stories from newly graduated nurses demonstrated variability in their experiences. The study explored nurses’ experience with psychological safety in their prelicensure curricula.

Methods

Using constructivist grounded theory methodology, the researchers conducted 17 semi-structured interviews with nurses who had experienced simulation in their prelicensure curriculum. They collected and analysed data iteratively using constant comparison to identify categories and explore their relationships. They used theoretical sampling in later stages until data sufficiency was achieved.

Results

The constructed theory, Simulation Psychological Safety Ecosystem, expresses the variability of nurses’ experiences. Psychological safety is a dynamic, complex process with a spectrum of outcomes from feeling psychologically safe to suffering psychological harm. Factors that influence this outcome include clarification of Expectations, Facilitation from the instructor during scenarios, experience with Observation, and structure and quality of Debriefing/Feedback. Psychological safety is also influenced by nurses’ existing relationships with faculty and peers, and their desire to achieve meaningful clinical learning.

Discussion

Implications for nursing education reinforce clarifying expectations for equipment and roles, instructor presence, and observation. The findings suggest the benefits of establishing peer and faculty relationships prior to simulation-based education implementation and providing guidelines for faculty and peer feedback. Potential areas for future research include clarifying the ecosystem model and exploring the impact of faculty and peer relationships on psychological safety.

The nursing team is crucial in emergency care (EC) settings, serving as patients’ first point of contact. However, gaps in their training have been hindering the effectiveness of care and patient survival. In situ simulation (ISS) has been recognized as a valuable tool in EC education, uncovering hidden risks in clinical care areas. This study aimed to analyse how an ISS educational intervention in the EC department impacted participants’ clinical and transferable skills.

Methods:

To assess the effectiveness of an educational intervention on the 37 EC nursing professionals, a 12-month study quasi-experimental study was conducted. The study consisted of a survey to identify participants’ learning needs and four workshops tailored to meet the team’s specific needs, culminating in an ISS session. Knowledge levels were evaluated using pre- and post-tests administered before (T0) and after (T1) the workshops, along with a formative assessment with an Objective Structured Clinical Examination (OSCE) holistic marking guide to measure the clinical and transferable skills acquired during the ISS.

Results:

The primary participant’s learning needs centred around cardiopulmonary arrest caused by acute myocardial infarction, including interpreting electrocardiogram and teamwork. These topics were used to develop the workshop and the simulation scenario. A significant difference (p < 0.001) was observed in the levels of learning between T0 and T1, indicating a marked improvement in the participants’ performance. The nursing professionals displayed proficient clinical and transferable skills during the ISS, successfully completing over 80% of the OSCE items.

Discussion:

These findings suggested that a customized educational intervention incorporating participatory learning and ISS effectively enhances clinical and transferable skills among nursing professionals. The positive outcomes observed in post-tests and OSCE holistic assessment highlighted the effectiveness of this intervention for the EC nursing team. The results of this study demonstrate that active participation in workshops facilitates knowledge acquisition. Furthermore, the OSCE results illustrate the practical application of clinical and transferable skills during the ISS.

High-fidelity medical simulations can help students successfully navigate the stressors of medical training and practice. Because sufficiently high stress levels can interfere with learning, the balance of stress and resilience factors during simulation training should be carefully curated. However, student experiences of stress and resilience during high-fidelity simulations are seldom well characterized, especially in military medical training. With this in mind, the authors investigated students’ lived experiences of stress and resilience during a well-established high-fidelity simulation at a military medical school.

Methods

Fourth-year active-duty military medical students (n = 23) from the United States Air Force, Army, and Navy who were attending Operation Bushmaster – a 5-day, high-fidelity military medical simulation – were interviewed during and after the simulation. Data were analyzed via a hermeneutic phenomenological qualitative approach. Another 21 students reported their stress levels and trait mindfulness. Experts rated their performance at Operation Bushmaster.

Results

Participant narratives pointed towards major internal stressors, including chronic uncertainty and fluctuating motivation, and external stressors, such as weather and equipment-related challenges. Narratives also identified multiple factors that mitigated stress, including the use of mindfulness skills (especially mindful/tactical breathing), giving/receiving social support, shifting perspectives to centre connections between Operation Bushmaster and students’ professional purpose, and positive self-talk that gave participants permission to make mistakes and learn from them. There was a moderate positive correlation between mindfulness and performance at Operation Bushmaster.

Conclusions

These stress and resilience factors are critical leverage points for educators seeking to optimize learning during Operation Bushmaster and other high-fidelity simulation trainings. Future research should continue to examine how the balance of these factors impacts medical students’ immediate learning (e.g. regarding medical decision-making, skill and leadership) and longer-term ability to successfully navigate the stressors of the medical profession.

The EyeSi (Haag-Streit, Manheim, Germany) cataract surgery simulator is the most commonly used virtual reality simulator internationally to train Ophthalmology registrars. It consists of a Cataract Challenge Course (CCC), which is a virtual reality simulation (VRS) of cataract surgery. In this study, we aimed to determine any correlation between the parameters measured on the EyeSi virtual reality cataract surgery simulator and if they can predict the progression of microsurgical skill acquisition and development amongst ophthalmology trainees.

Methods

Data on the performance of 56 Ophthalmology trainees (training ophthalmic surgeons) at the Royal Victorian Eye and Ear Hospital were analysed from 2018 to 2022. The trainees ranged from first to fourth year of training. Analysed parameters included Initial Task Performance, Time to Gate (the time to reach a threshold score – 50% in this case), and Peak Performance. Relationships between the parameters were analysed with Pearson r, and the significance of the difference between correlations was analysed with the psych package in R.

Results

The strongest correlation was found between initial and peak performance (r = 0.810), which was significantly greater than the correlation between Initial Task Performance and Time-to-Gate (r = 0.553, p = 0.03). Time-to-Gate was weakly correlated with Peak Performance (r = 0.475). The average total training time was 1123 minutes, ranging from 252 to 2039, and the mean peak CCC score was 442, ranging from 166 to 496.

Conclusions

Time-to-Gate, Initial Task Performance and Peak Performance are interlinked, indicating that trainees with the highest initial performance remain ahead in ability and can progress through VRS training more rapidly. Data also indicated that the EyeSi platform ultimately prioritizes a wide range of skills over mastery of a few – as participants who spend longer on ‘perfecting’ each stage of the simulator are not truly rewarded points-wise in comparison to those who rush through stages, as rushing through stages grants trainees a far higher overall score for each section (with one’s score ideally being a numeric representation of one’s ‘ability’). Consequently, the authors believe that virtual reality systems play a crucial role in training surgical registrars. However, their scoring systems should focus on skill mastery to facilitate maximal acquisition of skills.

Multidisciplinary teamwork addresses the demands of the modern healthcare system. It enables collaboration between medical, nursing and allied health practitioners to deliver high-quality, patient-centred care. In a rural Australian setting, an interprofessional training programme, developed over the past decade, used healthcare simulation to deliver immersive student learning experiences. A three-part, half-day simulation programme allowed students to experience and learn from phases of care through, ‘Stroke – the patient journey’, including emergency management, allied health assessments and discharge planning.

Methods

Twenty students from six different disciplines participated in the programme. Three assessments were used. Knowledge of participants’ health disciplines was assessed pre- and post-training. A focus group was used to elicit student reflections on their learning experience. The individual Teamwork and Observational Feedback Tool was used by peers and tutors alike to assess in-exercise observable behaviours.

Results

No increase in discipline-specific knowledge was demonstrated following the training. The focus group identified five key themes: (1) Understanding patient priorities; (2)Enhancing patient autonomy; (3) Observation of discipline-specific contributions to care; (4) Understanding the role of multidisciplinary team discussions and (5) Value of leadership in team-based care. The average scores were 70% for ‘Shared decision-making’ and 75% for ‘Working in a team’. ‘Leadership’ was demonstrated by 70% of students and ‘Patient safety’ by 55%.

Discussion

This study has demonstrated the value of the use of sequential healthcare simulation episodes to increase student understanding of acute and chronic management of a patient with a stroke. Learners understood that effective multidisciplinary communication and teamwork are essential in the care of a complex patient.

The need for interprofessional education (IPE) has been recognized on the basis of compromised patient care due to ineffective communication and teamwork among healthcare providers. Using Simulation to enhance IPE has been advocated to achieve the competencies required for effective interprofessional collaborative practice. However, the implementation of this powerful tool and its integration into Indian medical education are a relatively recent development, gradually gaining momentum in recent years.

Purpose

This study was undertaken to assess the attitudes and perceptions of a group of Indian medical and nursing undergraduates and faculty towards simulation-enhanced interprofessional education (Sim-IPE) before introducing this module at the institute.

Methods

A descriptive correlational design was conducted using the KidSIM^TM ATTITUDES scale on a convenient sample of 82 students and faculty of medical and nursing colleges.

Results

The total scores for the 30-item questionnaire revealed an overall positive attitude towards IPE and Simulation as a learning modality. Analysis of variance tests revealed lesser scores for students when compared to faculty.

Conclusions

A positive attitude towards Sim-IPE by students and faculty is promising, and it is the first step towards integrating Sim-IPE into the undergraduate curriculum in India.

In healthcare simulation, the appropriate level of stress produced through physiological and psychological arousal is necessary for effective experiential learning. While beneficial stress promotes learning, excessive stress inhibits learning. Animal Assisted Interventions may be a viable method to support learners experiencing excessive stress post-simulation. Animal Assisted Interventions have been used therapeutically with positive effects though there is an absence of research on Animal Assisted Interventions in healthcare simulation. This study investigates the efficacy of an Animal Assisted Intervention compared to an intervention control to reduce negative affective arousal post-simulation.

Methods

Primary Care Paramedic, Animal Health, and Respiratory Therapy students were recruited for the study. The study utilized an experimental design. After a simulation, known to induce stress and potentially negative affective arousal, participants were randomly assigned to an Animal Assisted Activity with a Canine or to Diaphragmatic Breathing. Negative affective arousal was measured post-simulation and post-intervention using a Visual Analogue Scale.

Results

Forty-five students participated in the study. Pre-intervention scores showed moderate levels of anxiety, stress and confusion. Both interventions led to a significant decrease in emotional affect. Participants in the Canine condition reported significantly lower levels of Anxiety compared to the Breathing Condition. Participants and facilitators expressed positive emotions related to the canine’s presence.

Conclusions

The presence of a canine was well received by all, and Animal Assisted Interventions can fit seamlessly into the post-simulation period to reduce anxiety after a simulation. Animal Assisted Activities may be best utilized for simulations known to be emotionally distressing and intensive.

Cultural competence is one component of effective communication between patients, families and healthcare professionals. Tools to assess physicians’ clinical cultural competencies need validity evidence. This paper describes Lawshe’s method for determining the Content Validity Index (CVI) for the Clinical Cultural Competence Questionnaire (CCCQ) for North America (NA), Pakistan (PK) and an international group (IG) using physician simulation educators (PSEs) for diverse cultures.

Methods

Five simulation educators pilot-tested the CCCQ, and initial changes were made based on their feedback. A total of 10 PSEs experts from NA, 11 PSEs from PK and 10 PSEs from IG completed two rounds of validation testing using Lawshe’s CVI survey for the CCCQ. The PSEs rated each item of the CCCQ as ‘essential’, useful but not essential’ or ‘not useful’. Lawshe’s CVI was calculated for the initial CCCQ; the CCCQ was then modified for individual items, separately for each group, NA, PK and IG. The IG comprised PSEs from Bahrain, Oman, Qatar, KSA, UAE, Australia, Argentina, India and Israel.

Results

The survey response rate was 83.33% for NA and IG and 91.6% for PK, respectively. The CVI of the CCCQ in round 1 was 0.689 for NA, 0.545 for PK and 0.691 for IG. In the second round of the CCCQ, with modified items, the CVI was 0.89 for NA, 0.802 for PK and 0.862 for IG. The major modifications suggested by the PSEs were to remove the unnecessary items, e.g. demographic information and last medical school attended, as they were deemed unnecessary or reword them for better understanding and combine related items to reduce the length of the CCCQ survey. We also evaluated the comments of PSEs from NA, PK and IG to explore the similarities and differences in their opinions regarding the CCCQ tool items.

Conclusion

Our research emphasizes the need to thoroughly examine questionnaire content in tools like the CCCQ to accurately capture the cultural competence knowledge, attitudes and skills crucial for healthcare providers in diverse settings.

Interprofessional simulation-based learning provides collegiate students with safe, realistic scenarios to learn and refine vital health related skills. This article describes an innovative project that engages college students from various disciplines in simulation-based activities to enhance health and professional knowledge, promote safety awareness, and improve cultural sensitivity. Additionally, the theme of traveling domestically and/or abroad during spring break provided a true-to-life backdrop.

Methods

The Activity Theory provides the framework for this study emphasizing collaborative learning toward shared goals. Six spring break themed simulation scenarios were created and evaluated using a mix-methods design. Pre-posttest measures were conducted using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, and open-ended responses.

Results

Twenty-eight students completed the survey showing statistically significant change scores from pre-post. Qualitative findings identified three overarching themes of participants’ gains: 1) knowledge of other healthcare professionals’ roles, 2) healthcare professions’ contributions to patient care, 3) being respectful of other cultures, being prepared when traveling, and knowing how to improvise while traveling abroad.

Discussion

Students enjoyed a meaningful and engaging interprofessional activity while learning about one another’s professions, appreciating other healthcare professions’ roles, developing awareness and respect for other cultures, and practicing skills that may be needed during challenging encounters while traveling.

Few studies have examined the value of dedicated simulation-based point-of-care ultrasound (POCUS) training in improving Internal Medicine residents’ knowledge and comfort with cardiac POCUS to diagnose acute decompensated systolic heart failure and large pericardial effusion.

Methods

This mixed-methods research included all 48 first-year Internal Medicine Residents receiving POCUS training at an urban academic centre. Participants were queried about their self-appraised cardiac POCUS knowledge, objectively tested on their cardiac POCUS knowledge, and surveyed about their comfort with cardiac POCUS tasks before and immediately after their training session, as well as 3 months later.

Results

Participants’ self-appraised knowledge regarding cardiac POCUS increased significantly from pre- to immediately post-intervention (31%–83%, p < 0.001), and from pre- to 3 months post-intervention (31%–73%, p < 0.001). The percentage of participants who felt comfortable identifying major cardiac structures in the four core cardiac POCUS views increased significantly from pre- to immediately post-intervention (31.0%–93.8%, p < 0.001), as did the percentage of participants who felt comfortable identifying decompensated systolic heart failure POCUS findings (16.7%–91.7%, p < 0.001) and those who felt comfortable identifying a large pericardial effusion with POCUS (38.1%–97.9%, p < 0.001). These comfort gains proved durable at 3 months post-intervention as well.

Conclusion

Simulation-based training can be beneficial for teaching Internal Medicine residents the fundamental skills of cardiac POCUS as well as how to utilize the modality to diagnose acute decompensated systolic heart failure and large pericardial effusion.

Access to and inclusion in simulation-based education (SBE) for remote and rural (RR) healthcare practitioners, irrespective of geographic setting, professional background and workplace context, is challenging. This challenge is compounded because simulation in healthcare education is acknowledged as a complex intervention, and healthcare systems are in and of themselves complex.

Methods

A realist review of published and grey literature was conducted, seeking to identify programme theories and to explore what works, how and why, in respect of mobile and distance SBE for healthcare practitioners in RR and harder-to-reach communities.

Results

There is limited rigorous research in this field. Mobile and distance simulation programmes exist in physical, digital and hybrid forms. This makes simulation more accessible and inclusive for RR healthcare professionals in respect of facilitating simulation. It allows for clinical and simulation centres of expertise to collaborate with harder-to-reach communities enabling the contextualizing of learning with, from and about the needs of a target population. However, the challenges of implementing and sustaining mobile and distance simulation interventions are underexplored.

Discussion

Mobile and distance programmes of SBE are introduced into and are subject to dynamic and heterogeneous social contexts. The intended outcomes of such programmes are dependent on building relationships, trust and networks between geographically distanced communities of practice. These social connections are the key mechanisms which support accessibility, inclusivity and sustainability. Further explorations of mobile and distance simulation innovations are critical to building capacity, sustainable solutions and enhancing future use.

We aimed to gain insight into student experiences of simulation-based education (SBE), particularly in regards to (1) current provision of SBE, (2) learning opportunities and (3) areas for improvements, innovation and focused initiatives. This was to create focussed initiatives that can assess and address specific needs to improve SBE for learners and educators alike.

Methods

Medical students were surveyed with 41 questions on their experiences of SBE using an 11-point Likert scale (0 – strongly disagree, 10 – strongly agree). Results were analysed by individual questions and presented as median (interquartile range) or percentage (n/N respondents). Data were analysed using Mann–Whitney U or Kruskal–Wallis tests (p < 0.05 for significance). Likert scales were analysed for internal consistency using Cronbach’s alpha.

Results

246 students participated, with 76.0% (187/246) completing all questions. 99.2% of students (235/237) had participated in SBE. The most valuable elements of SBE were learning a new skill under supervision (90.3%, 187/207), applying prior knowledge to a clinical scenario (73.4%, 152/187) and identifying gaps in knowledge/skill (73.4%, 152/187). Simulation was thought to improve medical knowledge (95.2%, 218/229) and technical skills (87.3%, 200/229). Twenty-one per cent (41/197) of students reported a negative experience and 23.5% (48/204) felt anxious. Students strongly agreed that simulation was beneficial to their training (9 [8–10]) and that there should be more SBE (8.5 [8–10]).

Conclusions

Medical students find SBE accessible and valuable to their education. By analysing student perspectives (such as self-reported negative experience), targeted areas for further research and focussed initiatives can be implemented.

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box.

Methods

This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios.

Results

50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes.

Discussion

The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.

Reduced clinical placement capacity, the COVID-19 pandemic and growing training place numbers have resulted in the development of innovative placement design in healthcare education. Simulation is widely used in healthcare education; however, its use as a placement model is in its infancy. The experiences and perceptions of students and educators are important to shape simulated placements moving forward.

Methods

A systematic search of the literature was conducted on eight databases to identify qualitative and mixed-methods studies exploring the experiences of students or educators in the nursing and allied health professions. Eight studies met the inclusion criteria and were assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. A meta-aggregative approach, in accordance with JBI guidelines for reviews of qualitative evidence, was used to synthesize the results.

Results

From the eight studies, a total of 69 findings were extracted. These were grouped into nine categories to form three synthesized findings of overall low quality. These findings were related to (1) reality of the simulated placement, (2) emotions evoked during the simulated placement, and (3) opportunities and challenges associated with implementing simulated placements.

Conclusion

Simulated placements were considered a useful tool for the enhancement of communication skills, clinical reasoning skills, new knowledge generation, enhancing reflection and for preparation for clinical practice by students as well as educators.

This article describes introduction of a comprehensive laparoscopic simulation education program to enhance operative efficiency in gynaecological procedures. We describe our approach to educational design, clinical integration and evaluation using an outcome logic model.

Methods

The study was conducted at Gold Coast Hospital Health Service (GCHHS) following the purchase of a laparoscopic virtual reality (VR) laparoscopic simulator (LAPSIM® VR), and development of a training program for obstetrics and gynaecology (O&G) trainees. In 2021, a surgical laparoscopic credentialling simulation program was introduced, requiring trainees to achieve a ‘pass’ on the LAPSIM® VR simulator prior to operating on patients. The evaluation approach used an outcome logic model to document program objectives and outcomes. Data analysis involved multivariate linear regression to ascertain the impact of the laparoscopic simulation program on procedure length in the operating theatre.

Results

Inputs included faculty and trainee time, space, LAPSIM® VR equipment and take-home laparoscopic box trainers. Activities involved online instructional modules, training and surgical learning sessions. Outputs included trainee utilization of LAPSIM® VR and credentialling. Outcomes included surveys, retrospective reviews of patient laparoscopic salpingectomies and primary surgeon operator rates. LAPSIM® VR credentialling was performed by 81% of the GCHHS gynaecology registrar cohort in 2021. Trainees completed 234 VR salpingectomies. Introduction of the LAPSIM® VR program was associated with a significant reduction in mean operative time for all ectopic pregnancies in all primary surgeon groups. For uncomplicated ectopic procedures, there was a reduction in operative time of 14 minutes between 2020 and 2021 (p = 0.001, 95% CI: 9–19 minutes) after adjusting for instrument and surgeon level. Credentialled trainees were no more likely to be a primary operator than those who were not credentialled. Survey results revealed that trainees felt the LAPSIM® VR program improved their technical skills, but that other factors influenced their likelihood of being primary operator.

Discussion

Introduction of a laparoscopic simulation VR credentialling program resulted in a significant reduction in operative time for laparoscopic salpingectomies in our institution. Educational programs should aspire to translational, patient-focused outcomes in their design and delivery.

Simulation-based teaching is an integral feature within medical education and following the emergence of virtual simulation, an array of possibilities exists for educators to choose between. However, evidence informing their use is scarce, particularly regarding outcomes assessing user experience and knowledge acquisition, and experimental studies comparing different approaches to virtual simulation. Therefore, this study compared immersive virtual reality (VR) simulation to computerized virtual patient (VP) simulation measuring their effect on knowledge acquisition and retention, as well as user experience, in fifth-year medical students.

Methods

This pilot study, of a randomized crossover design, comprised 18 participants independently completing an immersive VR simulation and a computerized VP simulation. All participants completed the same two scenarios and received an induction to both modalities. Multiple-choice questions were employed to assess knowledge acquisition and retention, with participants completing the questions immediately before and after the simulation and following a 12-week interval. User experience questionnaires were completed after the simulation, utilizing both Likert scale and open-ended questions. Statistical analysis comprised a Student’s t-test, whilst free-form responses were thematically analysed.

Results

Both interventions achieved statistically significant levels of knowledge acquisition and retention. However, VR simulation achieved higher levels of acquisition (2.11; 95% CI = 0.89, 3.32, p = 0.0019) and retention (1.22; 95% CI = 0.16, 2.28, p = 0.026), when compared to VP simulation. Participants reacted positively to both interventions, though VR simulation was significantly preferred compared to VP simulation. Thematic analysis of free-form responses revealed themes of ‘education’ and ‘technology’, divided into subthemes of ‘application’, ‘knowledge and skills’, ‘value’, ‘software’ and ‘fidelity’.

Discussion

The findings indicated that both interventions are effective and acceptable educational tools. However, learning does not appear to be uniform across different virtual simulators, with participants achieving higher levels of learning following immersive VR simulation. Moreover, participants reacted significantly more positively to VR simulation, though potential applications were identified for both interventions. This study highlights the importance of an evidence-based approach to the implementation of novel simulation technologies. The findings contribute to an underexplored area of the literature and offer a step towards enabling medical educators to make an informed decision regarding the application of virtual simulation in their context.

Embracing innovative pedagogies and structured pre-simulation activities in healthcare simulation enhances learning and clinical performance. The Society for Simulation in Healthcare (SSH) and the International Nursing Association for Clinical Simulation and Learning (INACSL) propose a three-phase approach of prebriefing, simulation-based experiences and debriefing. This scoping review explored the impact of prebriefing pedagogies, aiming to enhance nursing students’ chances of success in simulation-based learning experiences.

Methods

This scoping review encompassed the existing literature on simulation in nursing education, specifically focusing on prebriefing strategies.

Results

The existing literature revealed variations in the contexts, educational concepts, prebriefing pedagogy and outcome measures employed in simulation-based experiences. None of the studies established a correlation between dependent variables and prebriefing pedagogy strategies. Instead, most studies utilized a combination of dependent variables to measure the correlated aspects of prebriefing, namely personal development and engagement.

Discussion

The recognized prebriefing strategies serve as valuable resources for nurse educators when designing the prebriefing phase of a simulation-based experience.

Simulation is a crucial part of health professions education that provides essential experiential learning. Simulation training is also a solution to logistical constraints around clinical placement time and is likely to expand in the future. Large language models, most specifically ChatGPT, are stirring debate about the nature of work, knowledge and human relationships with technology. For simulation, ChatGPT may present a solution to help expand the use of simulation by saving time and costs for simulation development. To understand if ChatGPT can be used to write health care simulations effectively and efficiently, simulations written by a subject matter expert (SME) not using ChatGPT and a non-SME writer using ChatGPT were compared.

Methods

Simulations generated by each group were submitted to a blinded Expert Review. Simulations were evaluated holistically for preference, overall quality, flaws and time to produce.

Results

The SME simulations were selected more frequently for implementation and were of higher quality, though the quality for multiple simulations was comparable. Preferences and flaws were identified for each set of simulations. The SME simulations tended to be preferred based on technical accuracy while the structure and flow of the ChatGPT simulations were preferred. Using ChatGPT, it was possible to write simulations substantially faster.

Conclusions

Health Profession Educators can make use of ChatGPT to write simulations faster and potentially create better simulations. More high-quality simulations produced in a shorter amount of time can lead to time and cost savings while expanding the use of simulation.

Undergraduate health sciences and health professional degree programmes introduce students to common heart diseases and associated treatments, including atrial fibrillation (AF). Our students, second-year biomedical science and pharmacy students, through formal and informal feedback on their learning experience with cardiology, noted AF as the most difficult to comprehend. The learning challenges include electrophysiology and pharmacology aspects of AF. This study, therefore, aims to investigate the potential use of augmented reality (AR) to enhance students’ engagement and understanding of AF.

Methods

Based upon students’ feedback, and guided by the learning outcomes of our degree programmes, we developed an AR application (App) to teach AF, covering general as well as discipline-specific learning content. The development was done through an iterative process, grounded in the constructivist learning theories. A survey consisting of 13 Likert-scale questions and an open-ended question formulated around user interface principles was conducted to gather students’ feedback of the App.

Results

Thirteen per cent of pharmacy students (n = 21) and 22% of biomedical science students (n = 27) responded to the anonymous and voluntary survey. Student responses to the survey were largely positive, including the areas related to engagement, novelty, realism, learning and enjoyment.

Discussion

This study shows that AR technology has enhanced students’ engagement as well as perception of understanding of AF, specifically in the areas that students find difficult. This authentic learning tool has successfully addressed some of the learning challenges raised by students of both disciplines. Students’ positive feedback suggests that a carefully designed AR App, guided by learning theories, is a suitable and viable option to improve students’ understanding of complex subjects, apart from making learning immersive and engaging.

Nottinghamshire Healthcare Medical Education delivers simulation-based learning to over 500 medical students and junior doctors each year. The scenarios for these sessions are co-produced and delivered with a simulated patient actor. In January 2023, we introduced a new type of simulation allowing participants to interact with a digital patient. The AVATr digital patient received good feedback delivered remotely [1], but we intended to use it face to face. Our aim was to find out whether participants found the digital patient more or less useful than the patient actor. A secondary aim was to explore if the digital patient was helpful in preparing for simulation with a patient actor.

Methods:

The digital patient simulation was delivered in the morning of a full-day session to a cohort of F2 doctors. Participants sat on a chair in front of a green screen with a go-pro filming them. Participants were able to see themselves in a third-person perspective on a TV screen and interact with a digital patient. The digital patient was controlled by a facilitator who chose responses from a grid depending on what had been asked and how it had been asked. The participants experienced two scenarios – one around assessing psychosis and one on adult self-harm. The participants also had a simulation later that day with a patient actor. We collected qualitative and quantitative feedback via digital forms and analysed the results.

Results:

Ninety-two participants attended the sessions between January 2023 and March 2023. 70% of participants Agreed or Strongly agreed that the virtual patient was useful, compared to 100% for the patient actor. If facilitator familiarity with technology was adjusted for 68% of participants, Agreed or Strongly agreed the digital patient was useful. Eighty-six per cent of participants believed that digital patient simulation helped them prepare for the patient actor simulation. Total numbers in Figure 1-A17. Reasons participants gave for not finding the digital patient useful fell into four main themes: the limited nature of the responses the patient could give, the artificiality of the arrangement, the awkwardness of the technology and the relevance of being able to see yourself in the third person.

Figure 1-A17:

Clustered bar graph comparing Likert-scale responses to the statements The Virtual Patient was useful and The Patient Actor was useful

Conclusion:

We found that whilst participants overwhelming preferred simulation with a patient actor to simulation with a digital patient, the digital patient played a role in helping prepare participants for simulation with a patient actor.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation as a learning platform is recognized internationally as beneficial in terms of education, training and assessment of doctors [1,2]. This study aimed to introduce and evaluate a novel Palliative Medicine simulation session as a tool for Foundation Year 2 (FY2) doctors to gain competency and confidence in the assessment and management of life-limiting illness.

Methods:

We designed the palliative care (PC) simulation session based on the FY2 curriculum. The three scenarios involved management of opioid toxicity, breaking bad news and shared decision-making with a role-play patient with a gastrointestinal bleed. Session faculty included a mix of healthcare professionals, but always included a PC specialist.

We evaluated the session using a pre- and post-session questionnaire collecting data using 5-point Likert scales and free-text comments. We analysed qualitative data using content analysis. Researcher and methodological triangulation increased the credibility of the findings.

Results:

The three prevalent themes noted from the pre-content analysis were Communication, Prognostication and the Process of complex decision-making. Comments such as ‘Senior colleagues hesitant to have escalation discussions’ and ‘I find it difficult when the patient has a very different idea of how poorly they are’ were examples of quotes given by candidates as pre-session challenges. 95.6% of our candidates felt that the session addressed these challenges, mainly through the debrief process. The main learning points articulated were in relation to prescribing and communication skills. Candidates expressed the importance of ‘picking up communication techniques and phrases’. The debrief was the most highly valued, and frequently mentioned positive element of the content analysis. ‘Open discussions’ was mentioned on numerous occasions, ‘I felt comfortable asking questions’ and ‘Discussion after SIM was very useful’, all support the importance of skilled debrief.

Conclusion:

FY2 doctors identified communication as their biggest concern when managing Palliative Care patients. Our session addressed this through open and frank debrief discussion. This allowed reflection on previous experience and peer-to-peer learning of key vocabulary when talking to patients with a limited prognosis. Further qualitative evaluation of the impact of this session on clinical practice and how peer learning could be incorporated into day-to-day skills development on the wards would be of value.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation debriefing plays an important role in knowledge synthesis [1]. Although there is evidence to suggest that video-assisted debriefing improves outcomes, at least in nursing simulations, there is a wide variability in the practice and perceived effectiveness of video-assisted debriefing [2,3]. There is a paucity of literature about participants’ perspectives on the use of video review for simulation debriefing. The aim of this study is to explore participants’ perceptions and experience of the use of video review post-simulation.

Methods:

The study received ethical approval from the ethics committee at Anglia Ruskin University. We used qualitative research methodology to answer our research question. Foundation year trainees attending simulation as part of the curriculum were included in the study. This study involved focus group interviews with simulation participants prior to their simulation-based education. Post-simulation training, participants reviewed their simulation video clip in their own time and filled in a structured qualitative questionnaire about their video review experience.

Results:

This is an ongoing research and initial results are presented here. Data were collected from 13 participants over a period of 3 months from February 2023 to April 2023 in the simulation centre of a tertiary teaching hospital in the UK. The audio recording and the questionnaire were pseudonymized and analysed using inductive thematic content analysis. Important themes identified were the emotional aspects of watching their video, the learning opportunities available with video review, level of support needed for video review and ideal time to review the video. Unexpected emergent themes included foundation doctors’ views about simulation education, reflective practice post-simulation and peer pressure during simulation.

Conclusion:

This study explored foundation trainees’ perceptions (cognitive, kinetic and affective) about video review after simulation and several interesting themes were identified. We believe this study adds value to simulation-based medical education in helping to understand foundation doctors’ views about simulation and video-assisted debriefing.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In the aftermath of the COVID-19 pandemic, where access to traditional simulation environments and experiences was necessarily restricted, increasing focus has been placed on the use of technology in simulation. The use of virtual patient simulations has been shown in literature to increase interest as well as provide opportunities to practice clinical reasoning [1]. Opportunities to develop clinical reasoning are of notable importance in undergraduate pharmacy education currently owing to ongoing changes in pharmacy education, where newly qualified pharmacists will be annotated as independent prescribers from 2026 [2]. Evidence on the extent to which views on the perceived uses and benefits of virtual simulation align between different user groups is limited. In a UK university, a programme of virtual simulation has been utilized since 2020 as a part of the undergraduate pharmacy curriculum. A mixed-methods study was run which aimed to evaluate the alignment of views of students, faculty and stakeholders (who were individuals involved in the design or implementation of virtual simulation products) on the potential uses, intended learning outcomes, and perceived benefits and weaknesses of virtual simulation.

Methods:

Following approval by the school research ethics committee, an electronic questionnaire was sent to final-year undergraduate pharmacy students who had experienced a programme of virtual simulation including a mixture of qualitative and quantitative questions relating to student perceptions of the use of virtual simulation in the curriculum. Semi-structured interviews were conducted with faculty members and stakeholders exploring their views on virtual simulation. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes.

Results:

A total of 25 responses to student questionnaires were received. A total of seven interviews were performed, including three members of academic staff familiar with virtual simulation and four stakeholders responsible for the design or implementation of virtual simulation products. Students most commonly believed that virtual simulation could benefit their development of consultation skills, clinical history taking and physical assessment. Significant alignment between the perceptions of stakeholders and students on the uses and benefits of virtual simulation was demonstrated, but faculty members articulated a more limited list of perceived uses and benefits.

Conclusion:

The views of final-year undergraduate pharmacy students aligned strongly with stakeholders involved in the design or implementation of virtual simulation. The more limited views of faculty may represent a barrier to the full implementation of virtual simulation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Development and enrichment of the undergraduate simulation experience is needed due to its utility in developing the aspiring clinician and their ability to assess and manage acutely unwell patients. However, with its heavy resource demand, and the desire for technologically enhanced learning by ‘Generation Z’, novel simulation modalities must now be considered [1]. Mixed reality (MR) technology provides a platform to deliver such simulation training; however, it is yet to be studied in this context. To evaluate this, we conducted an observational cohort study to assess if MR simulation improves students’ perceived ability to assess and manage acutely unwell patients.

Methods:

We recruited 32 undergraduate medical students and asked them to rate their ability to assess and manage acutely unwell patients out of 10, before delivering a 2-hour MR simulation teaching session using the Microsoft HoloLens head-mounted device and HoloScenario software produced by GigXR [2]. They were then asked again to rate their assessment and management ability alongside their experience of the MR system and its usability. Data were analysed using paired t-tests to assess for significant improvement.

Results:

Analysis of the MR teaching session showed a statistically significant improvement of student scores in their perceived ability in assessment (p = .00) and management (p = .00) of the acutely unwell patient. In self-rated ability to assess the unwell patient, mean scores improved by 1.09 on the 10-point scale (95% CI [0.67, 1.52]) with 89% of students feeling more confident in assessment. In self-rated ability to manage the unwell patient, mean scores improved by 1.63 (95% CI [1.15, 2.10]) with 84% of students feeling more confident in management. Sixty-nine per cent of the students did not find the MR system easy to use, with 75% of students having technical issues and 38% experiencing side effects. Eighty-eight per cent of students believed the teaching experience to be beneficial to their learning.

Conclusion:

MR shows promise in its ability to deliver simulation training and improve students’ perceived ability to assess and manage acutely unwell patients. Advances in software availability and simulation exercises are required for complete integration into undergraduate medical curricula. Further research is required to assess if MR simulation objectively improves student performance in this area.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Collaborative learning is recognized as essential in ensuring the delivery of safe and effective healthcare. It is fundamental to creating the healthcare teams of the future [1,3]. Central to this, is the early exposure of healthcare students to multiple, healthcare professions to begin the process of thinking and practising in a more interprofessional way. Importantly, how the interprofessional experience is assessed is crucial to the success of collaborative learning. This was the background to the development of an interprofessional module within the School of Nursing & Midwifery at Queens’ University Belfast.

Aims:

(1) To collaborate on the development of additional IPE workshops to supplement an established interprofessional simulation model. (2) To develop an assessment component for the interprofessional activities, including interprofessional simulation. (3) To evaluate the process.

Methods:

Drawing upon the expertise associated with the implementation of a highly successful interprofessional simulation programme, an interprofessional education (IPE) group was established with representation across the Faculty. From the outset, there was a need to have a shared understanding of the module and its complexities, and to work together to collectively support the pedagogy, shaping student learning and assessment, and providing the best educational experience [2]. The team collaborated on sourcing and establishing IPE workshops, developing reflective questions, as well as working on designing and integrating an online video within a digital platform, and streaming all students to one interprofessional workshop. An evaluation questionnaire was created using Microsoft Forms. The 17-item questionnaire incorporated three Likert scales, plus two either/or answers and two questions on digital device/browser. The questionnaire had 10 qualitative ‘free response’ questions to allow candidates to elaborate, expand, clarify or illustrate their answers.

Results:

The collaboration with staff across the Faculty of Medicine Health & Life Sciences resulted in the establishment of four additional IPE workshops to complement an established six. Total number of IPE workshops, n = 10. These workshops were positively evaluated by both students and staff and one workshop contributed to a national IPE award. Importantly, the video-based, reflective, summative assessments submitted following participation in the IPE workshops were of a high standard with students reflecting on the importance and value of having the opportunity to engage with other professions and on how the IPE simulated workshops adding to their learning.

Conclusion:

Interprofessional opportunities that utilize a reflective video-based assessment contribute positively to the student experience and are a welcome addition to the undergraduate nursing curriculum.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In part due motivated by a lack of in-person placement opportunities for undergraduate pharmacy students during the COVID-19 pandemic, a UK university teaching team developed a programme of virtual simulated placement-style events to support undergraduate pharmacy students in developing skills and experience to support them in engaging with their foundation training. These experiences were developed at a time of significant change for undergraduate pharmacy training, as all new pharmacists being annotated as independent prescribers at the point of registration from 2026 onwards [1]. It has been reported that in medical students, the use of virtual patient simulation could improve clinical reasoning skills [2] but evidence of student views on the acceptability and implementation of virtual simulation in the target audience is limited and frequently not reflective of the style of self-directed simulation being utilized. This work aimed to evaluate final-year undergraduate pharmacy student views of the impact of the introduction of a programme of student-led virtual simulation on their education.

Methods:

In academic years 2020–2021 and 2021–2022, an electronic questionnaire was distributed to final-year students who had recently been introduced to and given access to a range of student-led virtual placement experiences in academic years. Prior to administering questionnaires to students, the study was approved by the relevant school research ethics committee. Questionnaires were formed of a mixture of qualitative and quantitative questions, and asked students about their experiences of engagement with virtual simulation and views on the potential applications of virtual simulation in the curriculum. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes.

Results:

A total of 43 student questionnaires were collected, with 18 responses (41.9%) being received in the academic year 2020–2021 and 25 responses (58.1%) received in the academic year 2022. 88.4% of respondents agreed that the introduction of virtual simulation would enhance their educational experience. Four key themes emerged from qualitative data analysis: individuality and autonomy, convenience, immediacy, and control. Students most commonly believed that the second year of the 4-year Master of Pharmacy programme is the optimal time for the introduction of placement-style virtually simulated experiences.

Conclusion:

Final-year undergraduate pharmacy students believed that the introduction of a programme of student-led virtual simulation would enhance their educational experience. Students were found to value the convenience, control and autonomy of the introduction of student-led virtual simulation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation.

Methods:

As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software.

Results:

Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus.

Conclusion:

VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A scoping review identified a significant growth in research with immersive technology in healthcare education. However, there are few validated measures that capture the user experience of participants [1]. This study aims to investigate the use of an immersive virtual reality (VR) simulation on sepsis management and measure user experience using a validated tool, the Immersive Technology Evaluation Measure (ITEM) [2]. ITEM was formulated on a learning theory called Model for Immersive Technology in Healthcare Education (MITHE), which borrows cognitive and behavioural theories to help explain our level of immersion and enjoyment that can be facilitated by technology (see Figure 1-A9).

Figure 1-A9:

Model of immersive technology in healthcare education (MITHE)

Methods:

This single-study quasi-experimental investigation was conducted at a single site. Nine participants were recruited, consisting of medical students and healthcare professionals. Participants were trained on varied immersive devices: sepsis management using an immersive VR simulation developed by Gogglemind, and augmented reality (AR) holographic patient with respiratory distress, which included realistic patient scenarios and interactive decision-making. User experience was measured using the ITEM, which assesses user; immersion, cognitive load, intrinsic motivation, debrief and technology usability.

Results:

Nine participants had high levels of immersion (mean 39.6, total 50), high levels of intrinsic motivation (mean 39.6, total 50), high technology score (mean 79.4, total 100), optimum cognitive load (average 59.5, optimum 39–61) and moderate score on debrief (mean 18.1, total 25). ITEM subscores indicated an enjoyable and immersive experience with good technology interface on usability scores. Self-directed debrief in VR had lower scores with emotional considerations and identifying domains of performance and learning.

Conclusion:

The use of the ITEM provided valuable insights into the user experience of the VR simulation, which can be used to improve the design and implementation of future simulations. This contributes to an ongoing ITEM validation process. This study highlights the importance of training in healthcare and the potential benefits of using immersive technologies such as VR and AR simulations.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Ligature and death by hanging represent critical issues in nursing practice that necessitate ongoing vigilance and assessment from healthcare practitioners [1–3]. This study delves into the lived experiences of healthcare professionals participating in a simulated ligature training and management workshop at a London university. The phenomenological research aims to offer an in-depth comprehension of the benefits and challenges associated with employing a simulation-based approach to ligature management training for mental health care professionals.

Methods:

A purposive sample of 10 healthcare professionals working in in-patient settings were invited to partake in a 2-day simulation-based ligature management workshop. Participants were aged 18 years or older and were able to provide written informed consent. Qualitative data were gathered following the 2-day simulation workshop through audio recordings and verbatim transcriptions, which were subsequently thematically analysed and interpreted by the research team.

Results:

Thematic analysis of in-depth interviews unveiled three principal themes: (1) transformative experience, (2) altered perspectives on ligature training, and (3) patient-centred risk management and empowerment. The study offers valuable insights into the lived experiences of healthcare professionals within a simulated learning environment, contributing to a more profound understanding of effective training strategies for handling ligature-related situations in clinical practice.

Conclusion:

The findings indicate that simulation-based training can bolster the competence, resilience and preparedness of mental health professionals in managing ligature-related situations. Moreover, involving patients in devising their own risk management plans and delivering individualized care can result in improved patient outcomes and diminished staff burnout. This study sheds light on effective training strategies for mental health professionals in tackling complex and challenging circumstances in mental health care.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

There is a plethora of research on the benefit of a collaborative learning amongst participants in inter-professional education and simulation-based education [1,2]. It would be insightful to explore how this concept of shared learning extends to the faculty members facilitating these educational sessions. From the perspective of the clinical nurse educator, this research study offers a unique insight into the nature of the collaborative teaching experience, processes of knowledge acquisition, and transferability of learning and their influence on both clinical and teaching practice.

Aim:

To illuminate the lived experiences of clinical nurse educators facilitating inter-professional simulation-based education (IPSBE) to gain deeper insight into how this approach can influence their future practice.

Methods:

An interpretative phenomenology analysis (IPA) was chosen as the qualitative research approach for this study as it sought to illuminate the experiences of clinical nurse educators through the interpretation and validation of their unique ‘first-hand’ experiences. A small purposive sample of clinical nurse educators who facilitated IPSBE was recruited to take part in semi-structured interviews. Data were inductively analysed using a systematic, step-by-step approach, generating meaningful themes and concepts that can be applied to the context of practice [3].

Results:

Four master concepts were derived from the interpretative analysis of the interviews: ‘looking at things through a different lens’; the centrality of the debrief; ‘we are actually learning all the time’ and personal and professional growth. It was evident from the interviews that the clinical nurse educators learned from the participants and fellow faculty members when facilitating IPSBE. There was a recognition of the significance and importance of working, learning and teaching together. IPSBE creates a safe space for learning that promotes an opportunity for shared learning to occur which can positively influence inter-professional relationships and practices, which can influence patient care and safety. In addition, the clinical nurse educators expressed that their experiences had enabled them to develop a deeper insight, understanding and respect for educational theory that underpins adult learning which has been transformational to their teaching practices.

Conclusion:

IPSBE creates a safe space for learning that promotes an opportunity for shared learning amongst faculty to occur which can positively influence inter-professional relationships and practices. These positive team-based behaviours are transferable to educational and clinical practice. The detailed analysis and interpretation of the research findings led to recommendations for practice, education, policy and research.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice.

Methods:

The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression.

Results:

Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period (p < .001).

Conclusion:

This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In 2021, a diverse international and inter-professional team designed and implemented an intensive in-person simulation week and an interactive online learning programme to enhance student preparation for clinical placement (the Clinical Placement Enhancement Project) supported with funding from Health Education England. The simulation programme aimed for students to develop their patient-centred communication skills, assessment and therapeutic management by attending three simulation scenarios and inter-professional understanding through participation in a multi-disciplinary team (MDT) meeting. The bespoke online programme was designed with similar learning outcomes and utilized various learning materials, including 360° images of clinical environments linked to case studies.

Methods:

The study design was an integrative mixed-methods feasibility study, with 29 AHP students participating in the simulation and 24 students taking part in the online arm of the study. Students from physiotherapy, occupational therapy and podiatry self-selected their preferred delivery mode for placement preparation. The evaluation explored the experiences of both domestic and international students attending the simulation and using the online learning. In addition, perspectives of the clinical educators and actor role players were explored. Data were inductively analysed using a reflexive thematic approach and integrated with the quantitative data.

Results:

The key findings from the pilot study showed the value of the simulation programme in allowing students to apply their learning, particularly helping them to develop their confidence in communication, rapport building and interventions. By contrast, the online learning programme was most effective at developing students’ clinical reasoning and proficiency with documentation [1]. We have built on these findings this year, to upscale the simulation programme to include all first-year AHP students (n = 130). We have reduced the number of scenarios from three to one, choosing the frailty scenario as this meets the generic outcomes for the programme and the profession-specific learning outcomes. We have retained the MDT simulation as an inter-professional simulation but modified the delivery from a ‘fishbowl style’ to a theatre forum to increase capacity. We have updated the online learning programme to be used as a supplementary learning resource before and during the simulation week. The content has been organized into inter-professional and profession-specific learning materials so that the site is easily navigated and accessible.

Conclusion:

By combining the immersive simulation with the online learning, we have created a sustainable and achievable approach to better prepare AHP students for clinical placement, and this combined approach may help to reduce the burden for our clinical educators.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Surgical chest drain insertion is indicated in pneumothorax or haemothorax secondary to thoracic trauma. It is a mandatory emergency procedure that is incorporated as a part of the core medical training curriculum [1]. However, sparse training opportunities result in low clinician competency and increased risk of complications. While simulation training can offer a solution, the affordability of commercial models and hygiene and ethical implications of animal carcasses are significant limiting factors. The aim of this project is to build a reusable, high-fidelity, low-cost human chest cavity model excluding animal use for simulation-based teaching of surgical chest drain insertion.

Methods:

To construct the model, plaster gauze, metal wires and u-channel rubber trims were used to build a ribcage. Soy-protein-based sausage casing was used to create the pleural layers, and the muscles and subcutaneous fat were represented with ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel), a novel material with tactility and dissection sensation similar to human soft tissue [2]. Synthetic chamois leather was used to represent skin. The resulting model allowed locating the safe triangle using anatomical landmarks, blunt dissection of muscles, pleural puncturing and advancement and suturing of the chest tube. The model cost less than £130, and it could be repaired after over 20 uses with less than £15. Verbal consent on study participation was obtained from all participants who performed chest drain insertion on the model and evaluated its fidelity and educational value using an anonymized Likert scale questionnaire. All questionnaire responses were converted to numerical values for data quantification, as shown in Table 1-A4.

Table 1-A4:

Median and range of questionnaire responses collected from study participants

Questionnaire item	Experienced clinicians	Inexperienced clinicians
	Median [range]	Median [range]
Model in general allowed learning of chest drainage techniques.	4 [1–5]	5 [4–5]
Model in general adequately resembles real-life patients.	4 [3–5]	3 [2–5]
If you have experience with other models: this model resembles real-life patients better than other simulation models.	4 [2–5]	3 [2–5]
Model is appropriate as simulation-based teaching material for inexperienced trainees.	4 [4–5]	4 [4–5]
I would recommend this learning tool to others.	4 [4–5]	5 [4–5]
I would use this model for teaching purposes.	4 [3–5]	N/A
Overall, I am satisfied with the training model.	4 [3–5]	5 [4–5]

Results:

Sixteen senior clinicians with multiple experience on chest drain insertion and 11 junior clinicians with limited experience took part in the study. Anatomical and haptic fidelity of the model was evaluated very highly amongst experienced clinicians. Junior doctors stated increased confidence in performing the procedure, overall assessing the model as an appropriate learning tool. Twenty participants with previous training experience compared the quality of this model to other commercial or animal-based models, and 18 rated this model to be of the same or superior quality.

Conclusion:

This chest cavity model is suitable for simulation training of chest drain insertion. Importantly, the model excluded the use of animals under the principle of replacing, refining and reducing animal use in research [3]. Further training opportunities that utilize this model can increase clinician competence in the procedure, which can improve clinical practice and reduce patient mortality.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Healthcare delivery is a major contributor to the climate crisis, producing 4.4% of net carbon global emissions today [1]. The campaign ‘For a Greener NHS’ launched in 2020 set a road map for the National Health Service (NHS) in the UK to reach net-zero emissions for patient care by 2040 [2]. However, to achieve this, staff must be carbon literate and start by understanding the impact of their own professional practice. It follows, therefore, that carbon literacy education must be a priority for healthcare educators. There is to date no research on educating student nurses on carbon literacy or the personal carbon footprints of their practice. Using simulation could provide an innovative solution providing a system-thinking environment that could connect carbon emissions theory to actual practice and develop carbon literacy.

The aim of the study was to explore student nurses’ reflections on their carbon footprint of resources used in simulation and identify the potential role of simulation in developing carbon literacy.

Methods:

This study used qualitative phenomenographic methodology, underpinned by transformational learning theory to explore student nurses’ awareness and attitudes towards their carbon emissions from simulation. Ten participants were asked to log the clinical resources used during a venepuncture and cannulation simulation skills station. Carbon emissions were then calculated for each participant using the Centre for Sustainable Healthcare [3] carbon emissions calculation and were shown to students during one-to-one semi-structured interviews. Data analysis was conducted, discovering the different ways participants conceptualized their carbon footprint.

Results:

Students were unaware and shocked by their carbon emissions from resource use in simulation and wanted to be better educated to enable them to make an informed choice to practise sustainably. Students highlighted the crucial role of simulation educators to educate students using simulation but to role model sustainable practice and design low resource-use simulation. Finally, students were able to connect the impact of their personal clinical practice to the global climate crisis.

Conclusion:

Simulation is a powerful teaching approach to develop carbon literacy, challenging students’ pre-existing knowledge, and enabling them to link their personal practice to the global climate-change crisis.

Ethics statement:

The authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Over the last decade, there has been increasing awareness of the prevalence of gender-based violence with increasing recognition of its disproportionate impact on vulnerable adults and children [1]. When these vulnerable adults and children may present to services, healthcare professionals have an opportune position to recognize this and act as an agent to signpost these individuals to relevant services. Individuals suffering from gender-based violence prefer practitioners to ask about the possibility of violence as it is easier for them to disclose this in response to the question than to offer the information unprompted [2]. While communication skills are taught to various degrees in medical schools around the country, the authors of this project recognized that many medical schools did not address these issues in these sessions. Consequently, a communication-based skills day was developed that addressed this and offered an opportunity for training and simulation of scenarios.

Aims:

These sessions aimed to improve students’ confidence in recognizing indicators of abuse and asking individuals if they were subject to forms of violence or abuse.

Methods:

A half-day teaching programme was produced for final year medical students. This comprised of a talk on the indicators of gender-based violence, suggestions on how to approach enquiring about gender-based violence and simulation scenarios incorporating gender-based violence. The scenarios were designed to include indicators of violence aforementioned in the talk to enable students to practise question asking.

Pre- and post-session questionnaires were used, and students were to rate their confidence on a scale of 1–5 of how confident they felt asking these questions and recognizing indicators of violence.

Results:

Twenty-three students partook in the two sessions delivered. Pre-session data suggested that students had received minimal teaching on the indicators of violence. After completion of the sessions, there was a 57% increase in the students’ confidence in recognizing a victim of violence and a 51% increase in confidence in asking whether an individual had been subject to violence. Qualitative data suggested that students valued simulation incorporating indicators of violence and opportunity to sensitively enquire if someone had experienced violence. Overall, students felt better equipped to address future scenarios where an individual may have been subject to violence.

Conclusion:

Our teaching session increased the confidence of final-year medical students in recognizing the indicators of violence and their ability to sensitively enquire about any violence that an individual may be subject to.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Research suggests that eating disorders (ED) in children and adolescents are on the rise [1]. One study found that the incidence of anorexia nervosa in young girls aged 10–14 years increased by 50% between 1980 and 2000 [2]. Another study reported a 119% increase in the number of hospitalizations for eating disorders in children aged 12 and under between 1999 and 2006 [3]. These statistics highlight the urgent need for improved prevention, early intervention and treatment of eating disorders in young people. This 1-day interactive simulation training course is designed to enhance the knowledge, confidence and skills of medical doctors, psychiatrists, RMNs, physical health nurses, dieticians, general practitioners and family therapists who are working with children and young people (CYP) with eating disorders.

Methods:

This 1-day simulation course was delivered online. The course focuses on the assessment and management of CYP with ED, understanding the challenges faced by professionals in engaging CYP with ED in different settings, thinking about dynamics within family systems and in wider systems, and gaining a better understanding of capacity, consent and other conundrums. The course includes simulated scenarios played by trained actors to support the development of effective communication skills and Maudsley debrief model is employed to give participants feedback on their contributions and assist them in learning positively and constructively from their experience. Participants completed a pre- and post-course questionnaire measuring their confidence in course-specific skills and human factors skills, as well as collecting qualitative feedback on their experience of the course and intention to apply the learning.

Results:

Participants were asked to complete a pre-course and post-course questionnaire rating their knowledge, confidence and skills related to working with patients with eating disorders. Paired samples t-tests were conducted to analyse the difference in ratings between the pre- and post-course questionnaires. Results demonstrated a significant difference in the scores for course-specific questions between the pre-course (M =25.48, SD = 4.50) and post-course (M = 32.44, SD = 3.53), t(12) = 46 p < .001, 95% CI [−8.11, −5.80]. 100% of the participants reported that they would recommend the course.

Conclusion:

The course was effective at improving participants’ knowledge, confidence and skills in working with CYP with ED. The participants found the course useful for their clinical practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

First, to determine the feasibility of providing a simple educational intervention using the HEEAL (Honesty, Empathy, Educate, Apology/awareness, Lessen the chance for future errors) mnemonic. Second, to assess the intervention’s ability to improve communication self-efficacy, knowledge and objective measures of error disclosure competence among providers.

Methods

A 1-day (6-hour) pilot medical error curriculum was created to teach the HEEAL method of medical error disclosure to both patients and peers who have committed errors. The four-part curriculum consists of pre-intervention evaluation, HEEAL content lecture, rapid cycle deliberate practice (RCDP) with debriefing and post-intervention evaluation. This curriculum was repeated twice. The first training focused on medical error disclosure to patients’ families and the second on medical error disclosure to involved peers. Participating faculty developed, adapted and piloted simulation cases, skills checklists and knowledge questionnaires. The barriers to error disclosure assessment (BEDA) tool served as our confidence survey. Five additional questions developed and piloted by the research team were administered with the BEDA to assess learner confidence with peer–peer disclosure. Pre- and post-intervention written measures of knowledge and confidence (BEDA) were obtained for both iterations of the curriculum. Assessment of observed clinical skills was scored by the involved SP (standardized patient) immediately following the RCDP. An a priori Kappa coefficient of <0.9 was used to measure SP scoring reliability.

Results

Fourteen learners completed all curricular components. Learners demonstrated statistically significant improvement in their confidence in medical error disclosure (p = <0.0001), knowledge (p = 0.0087) and performance of peer-disclosure skills (p = 0.001). Participants demonstrated improvement in (p = 0.05) patient-disclosure skills, yet this skill did not meet statistical significance.

Conclusions

This pilot data suggest that the HEEAL intervention provides an effective and efficient way for medical educators to teach senior medical students how to provide competent error disclosure to both patients and peers.

Gender minorities experience extensive health inequities. Discrimination and bias in healthcare are contributing factors. Increasingly, medical educators are utilizing patient simulation to teach gender-affirming clinical skills. However, institutional practices vary widely in case authoring, casting and training. To date, no guidance for ethical practice has been established. Gender minority healthcare providers offer an important perspective on this due to their patient simulation experience and embodied knowledge.

Methods

Transgender and non-binary healthcare providers and trainees (n = 21) took part in semi-structured interviews that focused on their experiences with, and perceptions of, simulation and gender-affirming care. Participants were asked to consider several casting scenarios. Data were analysed using inductive thematic discourse analysis.

Results

Casting gender minorities in gender minority roles is the gold standard. In situations where this is not possible, participant opinion diverged on whether it is preferable to cast cisgender simulated patients or cancel the case. Participants described gender-affirming patient simulation as impactful. They noted the potential for harm to gender minority simulated patients due to repeated learner errors.

Discussion

The study provides a point of reference for educators designing simulation activities. Developing gender minority case content is important and should be undertaken with care. If recruiting gender minority simulated patients proves difficult, programs should engage their local transgender and non-binary community for input on recruitment and next steps. Increasing the simulated patient-to-learner ratio, engaging gender minority simulated patients remotely and/or involving gender minorities in case development and training may be viable alternatives.

Research shows inequity of access and provision of Simulation-Based Education (SBE) globally, perhaps especially for Simulation for Mental Health (S4MH). Integrated approaches to education improve outcomes, despite this, there is a lack of multi-agency education and service user/carer involvement. This innovative work involves service users and carers in the design, delivery and evaluation of an experiential, mental health, SBE programme for health and social care professionals, and multi-agencies. Highlighting important areas of inclusivity, equality and diversity provides valuable insight into the unique patient perspective and experience of their interactions with services and professionals, and knowledge, perspective, and role of the practitioner, considering the transition of the service user between services.

Methods

In a mixed approach, data was collected between November 2021 and March 2022 by pre- and post-participation survey of participants’ thoughts, beliefs, attitudes, behaviours and experiences of the programme. A thematic method was used for qualitative data analysis.

Results

Completed survey response rate = 64%. Analyses constructed themes around safety, responsiveness, empathy, stigma and experience. Findings show increased confidence and understanding of roles following participation in the programme. Positive changes in empathy and respondents’ perspectives and behaviours were also reported.

Conclusions

Findings inform better integrated, co-ordinated systems and practices, demonstrating mutual benefits of service user and carer involvement, and value of multi-agency learning; increased knowledge, safety, empathy, mutual appreciation of roles and recognition in the value of lived experience integrated into learning. Implications for practice and mental health care are relevant to multi-agency professionals, service providers, service users, carers and families.

Keywords

Simulation, Hybrid, Mental Health, Co-Production, Multi-Agency, Psychosis, Depression, Personality Disorder

Simulation educator onboarding and longitudinal professional development is a challenge for most healthcare simulation programmes. The Simulation Educator Needs Assessment Tool (SENAT) was created for self-assessing individuals’ knowledge and perceived competency in simulation-based education.

Methods

Messick’s unified validity framework was used as a validity framework. First, this tool underwent two rounds of content validity studies following the Lawshe’s method. Participants at both rounds (N = 22) were experienced simulation educators who had achieved Certified Healthcare Simulation Educator – Advanced status. Second, the internal structure validity (scale reliability) was reported following SENAT completion by 147 simulationists.

Results

The final SENAT contained 29 items with a satisfactory content validity index for each item (>0.455). Two subscales were found with good to excellent reliability: Self-assessment of Learning Needs (α = 0.90; excellent) and Competence with Simulation Modalities (α = 0.81; good).

Discussion

The SENAT can impact simulation quality by providing a professional development roadmap for individuals, as well as provide data needed to develop mentoring conversations. Aggregate data from groups of educators can support planning for programmatic professional development.

Caregivers of persons with dementia (PWD) frequently face physical assault and emotional abuse when providing care. Providing experiential opportunities for caregivers to develop skills that maximize safe, compassionate care is a priority. Human simulation has demonstrated greater effectiveness than didactic activities in developing clinical skills. However, this requires consideration of physical safety for both learners and simulated participants (SPs), limiting the full expression of behaviours. To address this limitation, we conducted a proof-of-concept study engaging SPs on a synchronous, facilitated VR platform responding realistically, but safely, to learners’ communication approaches. Learners negotiated online with potential threats of violence from the SPs.

Methods

This study used a pre/post mixed-method research design. Both qualitative and quantitative approaches were used to explore the impact of this training on participants’ knowledge, confidence and comfort when providing care to PWD.

Results

Overall, participant ratings of knowledge, confidence and comfort increased post-training, as compared to pre-training (p = 0.28, p = 0.26 and p = 0.70, respectively). Although these increases were not statistically significant, the results were consistent with qualitative data related to these outcomes. However, after adjusting for participants’ prior training in working with PWD, significant increases were associated with the subgroup of novice learners but not for the subgroup who had previous experience (interaction p = 0.004, p = 0.03 and p = 0.02, respectively).

Discussion

Our findings provide insights into the implications of VR-based training for managing responsive behaviours of PWD. VR training has the ability to increase caregiver knowledge, confidence and comfort working with PWD who are exhibiting responsive behaviours, as shown by participants.

Medical training is an immersive process requiring the application of knowledge in practice. Training programmes can also be challenged by addressing cultural differences such as language barriers. This study examined learners’ perceived effectiveness of a traditional Spanish didactic training programme and an integrated Spanish-simulation training programme during their first month of training in an Emergency Medicine (EM) residency programme on the United States–Mexico border.

Methods

This study employed two groups of participants: (1) Post-graduate Year 2 (PGY2), PGY3 and immediate post-graduates from an EM residency programme and (2) incoming PGY1 residents over 4 years. Group 1 received traditional Spanish language training which was purely didactic. Group 2 received traditional classroom Spanish language training in addition to 25 simulation scenarios (integrated Spanish training). This training included five 1-hour didactic sessions specific to five patient complaints commonly seen in EM prior to the simulation. Participants completed pre- and post-surveys regarding their perceived Spanish language proficiency and training effectiveness.

Results

Forty per cent of Group 1 participants (n = 11) agreed that the traditional Spanish language training was effective; however, 71% (n = 20) believed that the clinical use of Spanish was a more effective method of learning. Prior to participating in the integrated Spanish training programme, 47% of Group 2 (n = 27) reported little to no Spanish language proficiency. Eighty-one per cent (n = 47) of Group 2 participants agreed that the training was effective, and that simulation exposure assisted with learning Spanish.

Conclusions

Overall, study findings suggest that clinically applied Spanish training during simulation was seen as more effective than traditional didactic instruction and led to increased perceived proficiency across all levels of Spanish-speaking ability.

Professional development in simulation-based education (SBE) is a complex process. Individual components have overlapping boundaries and relationships, rendering them suitable for Complex Adaptive Systems (CAS). This complexity is multifold in low-resource settings, unfamiliar with simulation, and augmented by hierarchical culture and linguistic diversity. This study aimed to conduct a professional development course through SBE using principles of CAS for faculty in a Pakistani medical college.

Methods

A simulation educator team (six on-site, three online) from Pakistan and North America constructed and facilitated a 6-hour-long hybrid course following CAS in three phases. Planning phase consisted of needs assessment and inclusion of stakeholders in decision-making. Implementation phase involved remote facilitators joining the in-person team using Zoom and demonstrating evidence-based practices in case design, pre-briefing, facilitation and debriefing. In the evaluation phase, participants completed an immediate Post-workshop Survey and a Follow-up Survey after 4 weeks.

Results

Twenty-three faculty members from basic medical (n = 9) and clinical sciences (n = 14) participated in the course and completed the evaluations. All five outcomes intended for this program, i.e., level of acceptance for simulation, simulation knowledge, self-efficacy, simulation application in the learner’s setting and performance of workshop facilitators, were met. The unexpected positive outcome was smooth delivery of the program from an administrative perspective and enthusiastic response from learners towards simulation.

Discussion

We suggest using CAS as a framework for professional development programs to train faculty in simulation. A CAS framework can help the organizers to integrate systems thinking into educational interventions.

Simulation for non-pedagogical purposes has begun to emerge. Examples include quality improvement initiatives, testing and evaluating of new interventions, the co-designing of new models of care, the exploration of human and organizational behaviour, comparing of different sectors and the identification of latent safety threats. However, the literature related to these types of simulation is scattered across different disciplines and has many different associated terms, thus making it difficult to advance the field in both recognition and understanding. This paper, therefore, aims to enhance and formalize this growing field by generating a clear set of terms and definitions through a concept taxonomy of the literature.

Methods

Due to the lack of alignment in terminology, a combination of pearl growing, snowballing and citation searching approach was taken. The search was conducted between November 2020 and March 2023. Data were extracted and coded from the included papers according to seven Simulation-Based I’s (SBIs; Innovation, Improvement, Intervention, Involvement, Identification, Inclusion and Influence).

Results

Eighty-three papers were identified from around the world, published from 2008 to 2023. Just over half were published in healthcare simulation journals. There were 68 different terms used to describe this form of simulation. Papers were categorized according to a primary and secondary Simulation-Based ‘I’. The most common primary SBI was Simulation-Based Identification. Selected categorized papers formed a descriptive narrative for each SBI.

Discussion

This review and taxonomy has revealed the breadth of an emerging and distinct field within healthcare simulation. It has identified the rate at which this field is growing, and how widespread it is geographically. It has highlighted confusion in terminology used to describe it, as well as a lack of consistency in how it is presented throughout the literature. This taxonomy has created a grounding and step change for this work which is embedded in the literature, providing a rich and varied resource of how it is being utilized globally.

In-hospital cardiac arrests that occur outside of the intensive care unit may require transportation during active cardiopulmonary resuscitation. Studies have shown that high-quality cardiopulmonary resuscitation is imperative for survival with preserved neurologic function. We sought to determine if high-quality cardiopulmonary resuscitation is maintained during simulated transportation of paediatric in-hospital cardiac arrest.

Methods

Randomized crossover simulated study of paediatric in-hospital cardiac arrest with 10 teams composed of five providers (physicians, advanced practice providers, nurses and respiratory therapists). Teams remained in a simulation room or transported the mannequin between two rooms. The primary analysis compared chest compression fraction in stationary versus transport simulations. Secondary analyses included additional cardiopulmonary resuscitation quality metrics with comparison to the 2015 American Heart Association standards.

Results

There was no significant difference in chest compression fraction or rate between the transport and stationary groups. 92%, 72% and 26% of epochs met American Heart Association criteria for compression fraction, rate and depth, respectively. Stationary simulations were more likely to meet recommendations for combined quality metrics, including compression fraction and rate (77 vs. 53; p < 0.001) and compression fraction, rate and depth (25 vs. 7; p < 0.001).

Conclusion

Chest compression fraction was preserved during simulated in-hospital cardiac arrest with transport. However, the transport simulation was less likely to meet American Heart Association recommendations for combined metrics. Similar to previous cardiopulmonary resuscitation quality studies, both teams failed to meet depth requirements in the majority of simulations.

Between 2013 and 2017, the Association of SP Educators (ASPE), a global organization of educators dedicated to the work of human simulation, developed Standards of Best Practice (SOBP) for working with human role players in simulation. These individuals are known by diverse terms, including simulated or standardized patients or participants (SPs). This study had two aims: (1) to understand the ways in which the ASPE SOBP are relevant to the practices of SP educators around the world, and (2) to identify improvements to the ASPE SOBP from a global perspective.

Methods

This qualitative study was undertaken between January 2020 and July 2022. Subjects consented to audio-recorded interviews. A collaborative, inductive coding approach was adopted, followed by thematic analysis, aligned with the methods described by Braun and Clarke. Themes were further updated following reflexive conversations amongst the investigators at meetings over the course of several months and were aligned with the study aims.

Results

Twelve SP educators from six continents participated. Four primary themes were identified (each with multiple subthemes): influencing SP educator practices; advancing professionalization; identifying challenges to implementation; and bridging gaps in the ASPE SOBP.

Discussion

A diverse group of SP educators from around the world identified the ASPE SOBP in general as relevant and applicable to their practice. The standards provided both guidance and flexibility for working with SPs in a safe, effective and quality-based way. At the same time there were challenges noted and recommendations made that can help to inform future iterations of the standards.

Simulated participants (SPs) can support development of competencies associated with person-centred care of older adults. There is limited information and understanding about working with older adult SPs and those who support them to create authentic, safe and effective simulations. This review aimed to review simulation literature focused on the care of older adults to explore and summarize what is known about working with older adults as SPs in healthcare providers’ education.

Methods

This scoping review followed Arksey and O’Malley’s five-stage approach, involving identification, selection, charting, collating, summarizing and reporting on results. Databases searched included MEDLINE, PsychINFO and EBSCO. To capture additional articles, we hand-searched the reference lists of articles selected for inclusion, MedEdPORTAL and Google Scholar.

Results

From the initial 816 citations identified, 12 articles were in scope. Articles were either research or educational guides. Findings related to general characteristics of articles, description of SPs, conceptualization of SP role/scenario, SP preparation and scenario implementation.

Discussion

Older adult SPs contribute to healthcare provider training in authentic, engaging, safe and effective ways. This scoping review provides a foundation on which to further develop older adult SP practices by highlighting their well-being and safety (both physical and psychological), promoting ways to increase diversity and inclusion, and emphasizing that the words we use matter. Improved reporting details of articles involving older adult SPs will facilitate the identification of effective practices.

Our study aimed to examine the communication behaviours of receivers responding to a speaking up message from a nurse. Specifically, what behaviours receivers of the speaking up message used to understand and address their concerns, and whether observed receiver communication behaviours differed between the health disciplines (receiver groups).

Methods

Deductive content analysis, through the application of Communication Accommodation Theory, was used to analyse observed receiver behaviour.

We used simulation to directly observe speaking up interactions. Data collection occurred between May and November 2019 within a large metropolitan health organization. Twenty-two simulations were conducted and analysed, involving participants (n = 138) from varying (N = 3) clinical discipline groups.

Results

Nurses/midwives frequently utilized task-based questioning, which inhibited their ability to promptly recognize the speaker’s concern. In contrast, medical officers more readily provided reassurance and support to the speaker and sought clearer understanding of the situation through using more open-ended questioning techniques.

Discussion

Simulation was an effective means to study receiver behaviour. Results demonstrated the receiver’s clinical discipline influenced not only what behaviour strategies were deployed, but the effectiveness of the strategies in accurately interpreting and effectively resolving the raised concern. This study has important implications for clinical practice and how receivers of a speaking up message are trained. As different disciplines approached the same conversation in very different ways, understanding these differences is key to increasing the efficacy of healthcare speaking up training.

COVID restrictions saw the migration of the entire teaching–learning process to online mode. Medical educators faced challenges in the execution of skills teaching via online platforms. This study was conducted to evaluate the process and outcome of online skills teaching compared with historical in-person training.

Methods

Participants were undergraduate medical students during clinical skills training (n = 150). Interventional group students attended online teaching of cardiac and respiratory auscultation via virtual and video demonstrations. The control group was a student cohort from the previous academic year taught face-to-face. Students’ performance was assessed by Objective Structured Practical Examination (OSPE) and compared by the Mann–Whitney U-test. Qualitative data were collected through student surveys and faculty focus groups.

Results

OSPE scores of the interventional group were lower compared to controls (2.93 vs. 3.75 and 2.76 vs. 3.90) with statistical significance (p < 0.0001*). Positive findings were faculty expression of a sense of accomplishment and students’ satisfaction with staff preparedness, preliminary instructions and time allotment. Faculty expressed a lack of opportunity to provide hands-on training, lesser learner participation and technical issues. Students expressed a lack of confidence, dissatisfaction with interactions and inability to correlate sequences.

Discussion

We could infer that outcome of online teaching was lower compared to the control reasons that were evident from subjective feedback. The control group had better avenues for interaction, error correction and repetition. Strategies to improve outcomes are small group size, hybrid teaching, faculty training in digital technology and a supportive technical team.

Continuing education for cancer care providers is essential for promoting high-quality patient care. Simulation-based education can be an effective strategy to educate healthcare professionals; however, there is a lack of synthesized evidence available to inform the delivery of simulation-based education for nurses and physicians across the cancer care continuum.

Aim

This scoping review aimed to collate and synthesize the literature regarding how simulation has been reported to educate nurses and physicians about cancer care.

Methods

Scoping review following the JBI methodology. Medline, CINAHL, EMBASE and PsycINFO were searched until July 2021. Unpublished literature was searched using ResearchGate, OpenGrey and open access theses and dissertation databases. Articles were eligible if they discussed how simulation has been utilized to educate nurses and physicians about any aspect of cancer care. Two independent reviewers screened the references, extracted and analysed the data.

Results

In total, 19 studies were included. When compared to previous reviews, our findings showed an increase in the use of virtual simulation; however, most interventions reported in-person simulation approaches and focused on improving skills (e.g. practical, communication), knowledge, confidence or decision-making for physicians and nurses caring for patients with a wide variety of cancers. Overall, simulation demonstrated positive results in educating nurses and physicians across the cancer care continuum through improved knowledge, skills and satisfaction. However, simulation interventions can be time-consuming and require significant resources for effective implementation.

Conclusions

Although simulation-based education demonstrated promise to educate nurses and physicians across the cancer continuum, it requires a significant allocation of resources to develop and implement these educational strategies. Educators and researchers should be aware of these challenges when planning and implementing simulation-based educational strategies.

Paediatric patients represent 5–15% of emergency medical services (EMS) transports in the US, yet true paediatric emergencies are rare. Management of these cases remains a common area of discomfort for pre-hospital providers. Previous studies have shown that simulation-based medical education is a useful tool to enhance patient safety in paediatrics. Simulation is an ideal modality to evaluate cognitive, technical and behavioural skills in low frequency, high-stakes events for healthcare providers. We hypothesize that using a deliberate practice model with simulation through a 6-month longitudinal curriculum will improve performance among pre-hospital providers treating paediatric seizure patients.

Methods

A prospective observational education study design of a 6-month longitudinal simulation curriculum was executed. The performance of each two-member fire-based crew was analysed during three separate simulation events. The in situ simulations were video recorded and conducted within an ambulance. Performance was reviewed and scored by three reviewers. A comparison analysis was reported.

Results

Thirty-nine pre-hospital providers completed at least some portion of the curriculum. There was an improvement in provider reported self-efficacy scores across all questions, as well as improvement in pre- and post-test knowledge scores. While the total number of critical actions completed did not vary significantly between simulations, there was improvement in several action items including end-tidal carbon dioxide use, application of oxygen, checking of medication dosage and administration of correct benzodiazepine dose.

Discussion

A simulation-based curriculum on the management of paediatric seizure for EMS providers improved self-efficacy, knowledge and performance of various critical actions in simulated settings.

Understanding health literacy is crucial to improve health and reduce disparities. Simulation is an effective active learning strategy to teach health literacy. Our aim was to perform a needs assessment of health literacy education using simulation, to guide faculty development for simulation educators.

Methods

Utilizing Kern’s curricular development process, problem identification, general and targeted needs assessments were performed. PubMed, CINAHL and PsycINFO searches were conducted using terms for health literacy and ‘prioritized health literacy competencies’ (PHLCs). Abstracts and full texts were screened. Simulation events that could feasibly incorporate health literacy were included. Data were collected regarding learners, type of event and incorporation of PHLCs. A targeted needs assessment used electronic survey to identify knowledge, attitudes and beliefs of local simulation educators regarding health literacy. Health literacy components of local simulation events (2018–2019) were assessed using a tool developed by the investigative team.

Results

Literature search identified 614 published articles, and 67 were included in analysis. ‘Avoidance of jargon’ (14/67) and ‘patient-centred approaches’ (11/67) were the most commonly cited PHLCs. No articles mentioned ‘delivery of information in 1–3 need-to-know elements’. Of the 57/881 local simulation events that could feasibly incorporate health literacy, 17/57 did so. ‘Jargon’ and ‘patient-centred’ care were the PHLCs most often present in learning objectives. Survey response rate was 77%. Only 18% (3/17) of local simulation educators demonstrated ‘comprehensive understanding’ of health literacy. Educators reported understanding ‘using universal precautions in written and oral communication’ (mean Likert 3.3) and ‘need-to-know/need-to-do concepts’ (3.4) least well. The majority felt including health literacy was important in simulation and believed they did this.

Discussion

There is a critical need to formalize and standardize language used when creating and studying simulations involving health literacy. An interprofessional faculty education program may assist faculty understanding of PHLCs when designing focused simulations for future healthcare providers.

Active observers can benefit vicariously from the experience of hands-on learners in simulation. Kolb’s experiential learning cycle and vicarious learning theory form the theoretical basis for directed observation during simulation teaching, although little is known about the impact of different simulation technologies on the observer experience.

Methods

This mixed-methods crossover study compared student experiences as observers using a high-fidelity manikin and immersive virtual reality (VR) software. Forty-nine final-year medical students were divided into two groups, undertaking and observing scenarios using either the manikin or VR before switching to the other form of simulation.

Results

Forty-eight questionnaires comprising Likert items were completed and analysed, with 11 students participating in focus groups. As observers, the students reported similar experiences with regards to engagement and reflection, with no statistically significant difference between the two technologies. However, the manikin scored higher in domains such as realism, enjoyment, clinical reasoning, usefulness and improved confidence. Students found that ‘participating’ is a more useful experience than ‘observing’ in both technologies. Thematic analysis revealed themes such as skills development, learning experience and technology.

Discussion

Students valued observing their colleagues completing scenarios within both technologies, highlighting the benefits of observation in focus groups. The high-fidelity manikin scored higher for several domains; however, there was no difference between VR and high-fidelity simulation on perceived observation experience regarding engagement and self-reflection. This suggests VR may have a useful role in observational learning, without the need for a simulation suite.

Virtual reality simulation (VRS) is an established technology for training cataract surgery. It has been validated for numerous ophthalmic surgical modules. The learner’s attitude towards its use has not been explored. This study has examined ophthalmology trainees’ attitudes towards VRS at the commencement of their training, before undergoing live surgery.

Methods

All Royal Australian and New Zealand College of Ophthalmology (RANZCO) trainees commencing in 2022 were invited to participate voluntarily in the research. Trainees completed an online mixed-methods questionnaire containing items on simulators, surgical experience and confidence levels in their surgical skills. Trainee attitudes were gathered utilizing Likert scale items, certainty-based and open-ended questions. The data were analysed by running basic descriptive statistics and frequencies utilizing SPSS.

Results and Discussion

Ophthalmology trainees believe that VRS can improve theatre skills, including reducing levels of complications in live surgery (91.7%), developing clinical decision-making (83.3%) and enhancing patient safety (87.5%). It was clear that the trainees felt that VRS training was helpful to increase pre-operative (91.7%) and intra-operative confidence (91.7%). The role of VRS in future training was unclear. Forty percent of trainees did not believe that VRS will be useful as they progress through their career.

Conclusion

Ophthalmology trainees value VRS training to develop microsurgical skills, though they are unclear about its benefit in the later stages of training. They possibly perceive VRS as a bridge to live surgery, not realizing its full potential to further enhance their skills. The authors recommend including in the VRS training curriculum standard a section highlighting its ongoing benefits for practice beyond commencing training.

Simulation in healthcare education enables learners to practice in a realistic and controlled environment without putting real patients at risk. Deception can be incorporated to generate a realistic learning experience. We aim to perform a systematic review of the literature to study the effect of deception in SBE in healthcare.

Methods

Online database search was performed from conception up to the date of search (December 2023). Qualitative descriptive analysis included all published and unpublished works as for the quantitative analysis, only randomized clinical trials with an objective measurement tool relating to learner’s performance were included. Forward citation tracking using SCOPUS to identify further eligible studies or reports was also applied.

Results

Twelve out of 9840 articles met the predefined inclusion criteria. Two randomized controlled trials were identified using deception for the intervention group and ten articles provided current knowledge about the use of deception in simulation-based education in healthcare. The aspects discussed in the latter articles related to the possible forms of deception, its benefits and risks, why and how to use deception appropriately, and the ethics related to deception.

Conclusion

Although this meta-analysis shows that using deception in SBE in healthcare by challenging authority negatively affects the trainees’ performance on the mAIS scale, this approach and other forms of deception in SBE, when used appropriately and with good intent, are generally accepted as a valuable approach to challenge learners and increase the level realism of SBE situations. Further randomized trials are needed to examine and confirm the effect of other deceptive methods and the true psychological effect of those interventions on validated scales.

Simulation-based education (SBE) supports early-stage psychiatric doctors to bridge educational and clinical practice while encouraging reflective practice. Research comparing the efficacy of in-person and online mental health SBE is limited. In a large-scale comparison study, we assessed for significant course evaluation measure differences between in-person and online participants attending an SBE course for early-stage psychiatric doctors.

Methods

A full-day in-person course was adapted for online delivery over a half-day. It focused on developing confidence and clinical skills relevant to early-stage psychiatric doctors. In-person (n = 228) and online (n = 90) participants were early-stage psychiatric doctors based in South London mental health trusts. Pre- and post-course quantitative data using the Human Factors Skills for Healthcare Instrument (HuFSHI) and Course Specific Questions (CSQ) measures were compared across the two delivery formats. Data collected from previous in-person deliveries were compared with online delivery data.

Results

Paired-samples t-tests comparing pre- and post-course HuFSHI and CSQ scores indicated significant improvements across both measures for the two delivery formats. Large and very large effect sizes, respectively, were observed for HuFSHI and CSQ scores in both delivery formats. Participants reported greater benefits from in-person delivery across CSQ measures and from digital delivery across HuFSHI measures. Independent-samples t-tests used to assess for significant differences between online and in-person delivery formats for HuFSHI and SCQ scores indicated no significant differences in scores favouring either in-person or online delivery.

Discussion

The data suggest online mental health SBE potentially represents an effective adjunct or alternative to in-person delivery. Further research is required to better understand these differences to support learners, educators, and commissioners.

During the perinatal phase many women experience suboptimal mental health. Effective care however, requires an educated and connected workforce who can provide integrated mental healthcare. Achieving interdisciplinary education related to perinatal mental health is often challenging, as professionals care for women at different points in time, in varying environments and with different focuses on what is paramount. To overcome this challenge, a motivational design model was applied in the development of immersive video-based simulations, that aimed to expose healthcare professionals to interdisciplinary care planning for women whose perinatal mental health deteriorated.

Methods

Three phases included conducting a learning needs analysis, implementing motivational tactics into the design of video-based simulations, and evaluating them for motivational and immersive impact. Students who experienced the simulations via 360° videos, flat screen and earphones versus virtual reality headsets were asked to complete a post-test measure of their level of motivation to learn and immersion into the learning experience.

Results

The evaluation demonstrated that all students experienced an optimal motivating and immersive learning experience. No significant differences were noted in the level of motivation or perceived immersion experienced whether using the flat screen 360° videos, or the VR headsets.

Discussion

Motivation and immersion are interconnected constructs that influence students’ experience of learning via simulation. Therefore, motivational design, immersive technologies, such as 360° videos and virtual reality, can equally result in optimal motivation for interdisciplinary students to learn about shared care plans and decision-making related to perinatal mental healthcare.

This paper presents comparisons of learner perceptions between an in-person and distance interprofessional educational activity.

Methods

A retrospective comparative analysis of data collected during post-activity evaluations following two versions (in-person; distance simulation-based) of a large-group simulated patient (SP) interprofessional education (IPE) simulation depicting a complex patient was used.

Results

The distance simulation-based encounter run in 2020 (the reformed event) was found to have more favourable opinions compared to the 2019 in-person one. The 2019 participants’ responses were more indicative of neutral and negative feelings of the activity compared to the participants from the 2020 distance simulation-based encounter.

Conclusions

This study demonstrates that large-group SP encounters can serve as appropriate platforms for IPE activities when in-person or at a distance. The findings of this study help to demonstrate how distance-simulation encounters used for IPE can be used to provide meaningful learning.

Patient profiles have changed from shifting demographics, globalization and immigration. Such changes highlight the need to educate and train healthcare trainees and healthcare providers (HCPs) on the provision of person-centred care through an equity, diversity and inclusion (EDI) approach. Simulation pedagogy has the potential to be a useful and impactful teaching and learning approach for EDI. The purpose of this review was to explore and summarize the current literature on the level of integration and state of EDI in clinical simulation within healthcare education, curricula and training.

Methods

An integrative literature review was conducted using Whittemore and Knafl’s (2005) method. Studies that met the selection criteria were assessed using the Johns Hopkins Nursing Evidence-Based Practice Model.

Results

A total of 64 studies were included in the review. Five themes emerged from EDI incorporation in clinical simulation education and training for HCPs and healthcare trainees: (1) increase in self-awareness; (2) enhanced communication; (3) enhanced insight and knowledge; (4) strengthened EDI-related self-efficacy; and (5) increase in EDI-related competence and skills.

Conclusions

Clinical simulation provides opportunities for EDI integration in healthcare education. Several implications were identified: (1) employing a more systematic process for EDI integration in healthcare education and programs; (2) developing a digital repository of EDI-focused clinical scenarios; (3) co-creating EDI-focused clinical simulations with persons of diverse background; (4) the importance of maintaining a safe learning environment for all involved persons – learners, staff, faculty and standardized/simulated patients in the EDI simulations; and (5) the need for more robust and rigorous research to advance the science of clinical simulation.

Since the beginning of the pandemic, the community spread of COVID-19 and the unavailability of clinical instructional sites led to heavy dependence on distance simulation to continue health professions education. The challenges faced by educators, combined with the lack of established parameters to prepare simulationists for distance simulation, prompted scholars to find a solution to fill this gap. In the absence of practical guidelines or parameters for healthcare educators to use emerging simulation technologies, this study explored the technological competencies of an ideal distance simulation educator at the basic and advanced level in light of the proposed Distance Simulation Educator Guidelines v3.0 (DSEG).

Methods

This qualitative descriptive study used deductive content analysis of interviews with distance simulation experts using the DSEG as a codebook for deductive analysis.

Results

Nine experts with a diverse healthcare professions background and distance simulation experience were interviewed. The identified main categories included a dual set of competencies, technological and non-technological. The non-technological competencies included professional values and applied principles of simulation and learning. Eight generic categories (competencies of the DSEG) emerged for basic- and advanced-level educators.

Discussion

Although several key findings were expected, this descriptive analysis study prioritized the competencies of basic- and advanced-level distance simulation educators. It also provided insight into how the DSEG could be applied in the real world. Further research is recommended for these preliminary findings.

There is a scarcity of simulation-based interprofessional (IP) programs in Portugal, with a notorious absence in undergraduate education. This paper describes the first step towards the development of an interprofessional education (IPE) undergraduate program, namely the implementation and preliminary assessment of the workshop LINKS – Lifting INterprofessional Knowledge through Simulation. The aim of this pilot study was to assess the educational effect of LINKS, in medical and nursing undergraduate students’ attitudes towards IP teamwork and collaborative practices, and their perception of roles and competencies within an IP team.

Methods

A total of 23 final-year students participated in the workshop. Teams of three or four elements (medical and nursing students) were exposed to two critical patient management simulation scenarios. To assess the impact of the workshop on students’ perception of IP collaborative practice, two surveys (ATTITUDES and IPEC) were applied before and after the workshop. Additionally, students’ opinion/satisfaction towards the workshop and its curricular integration was explored.

Results

Students’ awareness of the relevancy of IP learning and self-competency in IP practice improved. For all subdomains and overall scores, statistically significant differences were found when comparing the pre- and post-scores, for both medical and nursing students, in both surveys. All students agreed that the workshop added educational value to their training, and recommended its integration in the formal curriculum, with a first round in the penultimate year and repeated in the last year.

Discussion

Considering the pre–post test results and anecdotal comments shared during the session, we may infer that this single IPE event contributed to a clearer understanding of the team dynamic and individual role definition, increased the motivation to engage in collaborative practice between physicians and nurses and potentially challenged pre-existent stereotypes of each professional group. These findings corroborate the need for sustainable simulation-based IP programs, integrated in the undergraduate curricula, promoting early clinical interactions of different professional groups. We envision that the results of this study can help to inform future curriculum planning and provide useful insights that can be used within and between Portuguese institutions to develop a common IP undergraduate program.

Simulation-based activities (SBAs) research has explored the perceived and actual impact of SBAs on nursing education. The current study compares the perceived efficacy and transferability of nursing simulation to clinical practice from the point of view of simulation facilitators (SFs), course professors (CPs) and students.

Methods

A one-time online survey was administered to SFs, CPs and students regarding SBA effectiveness. Quantitative data were analysed using descriptive analysis.

Results

Student participants (especially those in years 2 and 3) perceived simulation to be a poorer (relative to course professors and SFs) reflection of their capabilities and means of developing clinical skills. Participants (including students, CPs and SFs) who reported that simulation group sizes as ideal were better prepared for SBAs, able to engage in clinical roles and to more effectively incorporate feedback. Qualitatively, CPs identified low-quality SBA facilitation as a barrier to learning effectiveness, and SFs described multiple approaches to simulation that influence transferability to clinical practice.

Conclusion

We conclude that a misalignment between the strengths and weaknesses of SBAs by CPs, SFs and students may challenge improvement efforts. Group size, less positive student attitudes and a lack of confidence in SFs should be specifically addressed.

Recently, simulation-based education (SBE) has been evidenced as an effective form of pedagogy in mental health and care settings, through consistent improvements in self-efficacy and technical and non-technical skills. A key component of SBE is post-simulation debriefing. Debriefing involves educators turning into facilitators and guiding participants through reflective discussions; however, there is no single debrief model used across simulation training. Debrief models have been previously evaluated, but not directly compared. This paper investigated whether there is a significant difference between self-efficacy scores of participants debriefed using the Diamond model and a modified Pendleton’s during SBE.

Methods:

Participants included 751 healthcare professionals who attended various simulation training courses between September 2017 and August 2019. Participants completed pre- and post-course questionnaires using the Human Factors Skills for Healthcare Instrument. Pre- and post-data were screened using Mahalanobis distance and Levene’s test and data were analysed using paired-samples t-tests.

Results:

Significant differences in human factors scores were found for the Diamond debrief model only. No significant improvements were found for the Pendleton’s model.

Discussion:

Results suggested a benefit to using the Diamond model over the Pendleton’s model during simulation debriefs, due to a significant improvement in self-efficacy scores. These findings contribute to the gap in literature around direct comparison of debrief models and support studies where the Diamond model has yielded significant improvements in human factors skills previously.

Physiotherapy students lack confidence when applying psychological strategies as part of interaction and assessment. Further research is required to establish consistent approaches to training in prequalifying programmes. The purpose of this study was (a) to document experiences of student physiotherapist to a Stroke-based simulation when applying the model of emotions, adaptation and hope (MEAH) tool, (b) consider if there are different experiences when the tool is applied online versus in-person and (c) provide recommendations for the use and application of the MEAH tool and training for future research and clinical practice.

Methods

An interpretative hermeneutic phenomenological study was undertaken. Two settings were selected in-person and online via zoom©. E-training focussing on the principles of the MEAH was delivered before a 10-minute simulation was undertaken by each student (online or in person). Semi-structured interview examining the experiences of the e-training were analysed using a reflexive thematic analysis. A conversation analysis was applied to 24 recorded in-person conversations.

Results

Twenty-five university final year physiotherapy students completed the in-person study and 13 second year physiotherapy student completed the online study. Thematic analysis: Four major themes across both groups were identified: (a) the content and value of the e-training, (b) the experience and perception of the simulation, (c) the application of the MEAH screening tool and (d) future training needs. Conversational analysis: Three types of interaction were identified. Type 1 interactions (15/24, 62.5%) followed the form in a very exacting way. Type 2 interactions (3/24, 12.5%) used the tool as an aid to their conversation. Type 3 interactions (6/24, 25%) deviated from the main focus of the tool. Factors which influenced the interaction were identified.

Conclusions

The current study demonstrated that the model of emotions, adaptation and hope can be used to enhance a brief therapeutic interaction for physiotherapy students. Further research and policy recommendations are provided.

We investigated the impact of a health sciences centre-wide, high-fidelity, simulation-based interprofessional team training program on participants’ knowledge, skills and attitudes towards teams and teamwork.

Methods

Senior medical, nurse anaesthesia and allied health profession students participated in dual-scenario, simulation-based, interprofessional team training sessions with immediate debriefings about team-based competencies (2015–2017). Pre- and post-intervention, students completed the Interprofessional Teamwork (IPT) questionnaire and the Readiness for Interprofessional Learning Scale (RIPLS). Observers and students rated team performance using the Teamwork Assessment Scales (TAS). Descriptive statistics were determined for IPT and RIPLS items and TAS subscales; student t-test or one-way ANOVA compared scores. Medical students completed the TeamSTEPPS™ Teamwork Attitudes Questionnaire (T-TAQ) at the beginning and end of senior year. Matched mean scores were calculated for T-TAQ subscales; paired t-tests and linear regression compared annual scores within and between years and, in 2015, trained and non-trained students.

Results

Students from five health professions participated (n = 659). Significant improvements occurred in matched scores across all 3 years for every IPT item and most RIPLS items. Significant improvements occurred annually for each matched observer-, peer- and self-rated TAS subscale score across scenarios. Significant changes in matched T-TAQ subscales included a decrease in mutual support in non-trained students in 2015 and an increase in situation monitoring for 2017 students. Between years, significant changes in matched T-TAQ subscales included an increase in leadership (2015–2017) and situation monitoring (2016–2017).

Discussion

A health sciences centre-wide high-fidelity, simulation-based, interprofessional team training program improves students’ team-based behaviours, teamwork attitudes and interprofessional learning attitudes. Widespread adoption of such large-scale team training programs has the potential to improve teamwork among healthcare providers over time.

Globally, practice education is a core component of physiotherapy training. Physiotherapy educators struggle to find sufficient workplace placements to ensure adequate clinical experience. Simulation-based learning (SBL) could complement clinical workplace experiences and bridge the gap between demand and provision. This study explores academic physiotherapy educators’ views and experiences of practice education and the potential contribution of SBL.

Methods

Representatives from all six Schools of Physiotherapy on the island of Ireland participated in focus groups. Interviews were audio-recorded and transcribed. Qualitative data were analysed using interpretive description methodology.

Results

We conducted seven focus groups with 29 academic educators (26 females and 3 males). Three core themes were identified: (i) challenges in practice education, (ii) the potential for SBL in practice education and (iii) barriers and enablers to integrating SBL in practice education. COVID-19 had dual impacts, both exacerbating challenges and precipitating innovations in practice education. Analysis revealed guidance for how to fit SBL within practice education although varied understanding and limited experience with using SBL remained. Barriers to SBL included cost, time, logistics and stakeholder buy-in, while collaboration represented a key facilitator. Perceived benefits of SBL included enhanced student capacity and experience.

Conclusions

A number of contributing factors threaten traditional workplace-based physiotherapy practice education in Ireland. SBL may reduce this threat and solicit ever better performances from students. Future research should examine the feasibility of proposed SBL deployment and foster buy-in from key stakeholders.

Medical malpractice trials improve understanding of law and healthcare intersection. Healthcare professional curricula rarely include interprofessional (IP) medical malpractice simulation learning. We describe a framework and student impressions for delivery of a large-scale interinstitutional IP mock trial.

Methods

An interinstitutional IP mock trial established in 2018 evolved from in-person to hybrid to virtual delivery formats. Healthcare and law students participated as trial attorneys, witnesses and jury members. Jurors heard the case (opening statements, Plaintiff/Defendant cases, closing statements) before IP juries convened to deliberate. A debriefing discussion followed verdict delivery. Student evaluations from in-person, hybrid and virtual offerings were compared.

Results

Learners from 19 professions across four institutions and 12 IP facilitators participated in in-person (n = 102), hybrid (n = 77) and virtual (n = 201) events. Similar improvement in perceived IP competency was seen across formats. Equivalent improvement in Interprofessional Education Collaborative (IPEC) competencies was seen for in-person, hybrid and virtual events. The vast majority of learners felt that all events, in-person, hybrid and virtual formats, respectively, provided a high level of psychological safety (93%, 95%, 96%), active engagement (93%, 96%, 91%), reduced anxiety about medical malpractice trials (93%, 90%, 93%). Benefits of the virtual approach included greater diversity of IP learners and facilitators due to elimination of the geographical distance barrier.

Discussion

A large-scale interinstitutional IP mock medical malpractice trial increased students’ perception of learning and IP skills, and supported healthcare and law students learning with, from and about each other. Virtual large-scale simulation events effectively increase accessibility for learners and expert faculty.

Bias potentially affects simulation-based training (SBT) for healthcare professions. The role bias plays in SBT design, presentations, and in the experiences of learners should be understood. Dual process theory is a well-accepted framework for understanding types of bias.

Methods

The authors performed a scoping review to map ‘bias’ in SBT of health professions in the literature. Search terms were developed for a query in the PubMed database. Researchers reviewed abstracts, met ten times to discuss which papers’ full texts to read, and then analysed and categorized the articles. Researchers used the Arksey and O’Malley framework for scoping reviews.

Results

Three thousand six hundred and twenty abstracts were identified by a detailed query in the PubMed database of which, 115 full-text articles were identified for inclusion.

Discussion

Articles published about bias in SBT cover a broad range of topics, from addressing how bias affects patient care, to bias in raters’ scoring of medical students on exams. Researchers found that the prevalence of articles on bias in SBT increased over time and focused primarily on implicit bias. Specific types of bias in some instances were difficult to identify, and several biases mentioned in papers were unique to this review. The results showed that many SBT methodologies (i.e. manikins, videos, etc.) were referenced in the papers. The type of simulation training most prevalent in the articles was simulated patient (SP) methodology. The results show that biases can be explored in any type of simulation method, indicating that simulationsists should be aware of bias in training during all types of training methodolgy.

The aim of this study was to develop an adequate tracking method for open surgical training, using tracking of the instrument or hand motions.

Methods

An open surgical training model and the SurgTrac application were used to track four separate suturing tasks. These tasks were performed with colour markings of either instruments or fingers, to find the most promising setting for reliable tracking.

Results

Four experiments were used to find the optimal settings for the tracking system. Tracking of instruments was not usable for knot tying by hand. Tracking of fingers seemed to be a more promising method. Tagging the fingers with a coloured balloon-tube, seemed to be a more promising method (1.2–3.0% right hand vs. 9.2–17.9% left hand off-screen) than covering the nails with coloured tape (1.5–3.5% right hand vs. 25.5–55.4% left hand off-screen). However, analysis of the videos showed that redness of the hand was seen as red tagging as well. To prevent misinterpreting of the red tag by redness of the hand, white surgical gloves were worn underneath in the last experiment. The off-screen percentage of the right side decreased from 1.0 to 1.2 without gloves to 0.8 with gloves and the off-screen percentage of the left side decreased from 16.9–17.9 to 6.6–7.2, with an adequate tracking mark on the video images.

Discussion

This study shows that tagging of the index fingers with a red (right) and blue (left) balloon-tube while wearing surgical gloves is a feasible method for tracking movements during basic open suturing tasks.

Simulated practice is an opportunity to transition nursing students from on-campus learning to clinical practice. There is limited evidence on simulated practice’s role in assisting this transition at the beginning of a nursing student’s education in terms of benefits, challenges, differences and affordances. This study aimed to research the impact of a simulated practice programme as a transitioning tool for first-year paediatric nursing students.

Methods

A participatory action research approach was used to address challenges in student’s transitioning to clinical practice and a lack of clinical placement capacity. A low-technological (physical), high-authenticity (emotional and environmental)-simulated practice programme for first-year paediatric nursing students was implemented. Forty students across two cohorts were recruited, and a qualitative survey was completed post-simulation/pre-clinical practice and post-clinical practice. Reflexive thematic analysis was used to develop the resulting themes.

Results

There was an initial 93% response rate after the simulated practice and 88% after clinical placement. Eight themes (‘bridging’ from simulation to practice and to enhance practice; ‘preparedness’ once on clinical placement; ‘applied learning’ reliably transferred to practice; ‘skill decay’ between simulation and practice; ‘same but different experiences’ between simulation and practice; simulation and clinical ‘practice pace’; ‘safety’ of simulation; and ‘unique affordances’ of simulated practice) were constructed from the data, and an additional nine sub-themes were identified (transference to practice; practice enhancement; slow-motion care; hectic; it is safe; it was safe; feedback and reassurance; practice and practice; and unpressured). Collectively, the themes indicated that simulated practice in this context is conveyed as a well-being tool in addition to having experiential learning and bridging benefits.

Conclusions

This study revealed that simulated practice can assist in transitioning paediatric student nurses to clinical practice. It identified its value in terms of fostering holistic learning, well-being and bridging theory to practice. To ensure long-term effectiveness, simulation maintenance training, booster training and refresher strategies should be included as part of the programme to prevent skill decay. Future studies should consider isolating these key findings for a more in-depth look at their meaning.

Managing difficult debriefing can be challenging for simulation facilitators. Debriefers may use eye contact as a strategy to build and maintain psychological safety during debriefing. Visual dominance ratio (VDR), a measure of social power, is defined as the percentage of time making eye contact while speaking divided by the percentage of time making eye contact while listening. Little is known about eye gaze patterns during difficult debriefings.

Aim

To demonstrate the feasibility of examining eye gaze patterns (i.e. VDR) among junior and senior facilitators during difficult debriefing.

Methods

We recruited 10 trained simulation facilitators (four seniors and six juniors) and observed them debriefing two actors. The actors were scripted to play the role of learners who were engaged in the first scenario, followed by upset (emotional) and confrontational in the second and third scenarios, respectively. The participant facilitators wore an eye-tracking device to record their eye movements and fixation duration. The fixation durations and VDRs were calculated and summarized with median and interquartile range. We explore the effect of scenarios and training level on VDRs using Friedman tests and Wilcoxon rank sum tests.

Results

All 10 participants completed all three scenarios. There were no statistically significant differences in VDRs between the junior and senior facilitators for all three scenarios (baseline: p = 0.17; confrontational: p = 0.76; and emotional: p = 0.61). The VDR did not change significantly between scenarios among junior (p = 0.85) and senior facilitators (p = 0.78). The senior group showed higher variability in VDR than the junior group.

Conclusion

The use of eye-tracking device to measure VDR during debriefings is feasible. We did not demonstrate a difference between junior and seniors in eye gaze patterns during difficult debriefings.

Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.

Methods

Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an ad hoc team in high-fidelity immersive simulation (shockable rhythm cardiac arrest). TTD was recorded. Video-recordings were scored by two researchers independently using the Team Emergency Assessment Measure (TEAM) tool. Differences between TEAM scores in the fast TTD versus slow TTD groups were compared using Student’s t-test.

Results

Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3, p = 0.004). When analysing the statistical significance of the differences in individual TEAM items, there was a statistically significant difference in the fast TTD and slow TTD groups for item 7 (adaptability).

Discussion

This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.

Simulation is an effective educational strategy to train those caring for older adults (persons over 60 years old). Working with simulated participants (SPs), well people trained to portray others, is an appropriate modality when learning objectives relate to behavioural skills. The COVID-19 pandemic has disrupted every aspect of society. At our simulation programme, we implemented a weekly, virtual, 1-hour meeting modelled on a framework that incorporates effective practices in simulation and working with older adults. In this paper, we explored older volunteer SPs’ perceptions of the shift from in-person to virtual meetings and its impact on their well-being and SP skill development.

Methods

This was a qualitative exploratory study of older adult SPs’ experiences within the virtual SP meetings. Thirteen volunteer older SPs consented to participate in audio recorded focus groups where they were asked to describe their experiences with the virtual SP meetings. A collaborative, inductive coding approach was adopted, followed by thematic analysis, aligned with the methods described by Braun and Clarke. Ethics approval was obtained.

Results

Four primary themes were identified: fostering meaningful and cohesive group connections; gaining personal benefits; enhancing SP skills and competence; and appreciating structure.

Discussion

A structured, regularly occurring virtual meeting is beneficial to the building and maintenance of SP skills for older adults and their well-being. This approach could be applied to other groups of SPs with the proviso that facilitators are skilled, and a framework is in place featuring the basic tenets of effective simulation.

Many healthcare professionals experience challenges when returning to practice after absence, potentially affecting their health and wellbeing outcomes as they might relapse and need to take another leave of absence. These challenges may also affect patients by impeding the quality of care provided by the professional. Research suggests that managerial support can ameliorate some challenges that professionals encounter when returning to work.

Objectives

This pilot study evaluates a simulation training intervention offered to multidisciplinary supervisors of returning doctors in order to improve doctors’ reintegration into the workplace

Methods

Participants (n = 38) were healthcare leaders who completed a 1-day training course consisting of didactic and experiential components.

Results

Thematic analysis identified that participants noticed changes in their social skills, management abilities, values in their managerial roles and implementation of structure in the workplace.

Conclusions

Simulation training might improve managerial competency when supervising doctors return to work. Future studies should address inconsistencies in feedback form completion and limitations of self-reporting questionnaires. Additional assessments of returning doctors’ outcomes following intervention delivery could also be beneficial, as these were not evaluated in the present study. A larger study is currently being conducted to evaluate impact and increase understanding of how simulation training can improve managers supporting doctors returning to practice.

Emergency departments can often be the first place to which people present when in mental health emergencies, although these departments and staff are not always adequately supported to meet the needs of these patients. This study aimed to evaluate the impact of simulation-based training for mental health crisis in the emergency department on knowledge, confidence and attitudes towards interprofessional collaboration.

Methods

Healthcare professionals (n = 85) from a range of professions participated in a multicentred simulation-based training activity. Questionnaires evaluating participant knowledge, confidence and interprofessional attitudes were administered pre- and post-activity, and analyses were conducted. Thematic analysis was conducted on free-form participation simulation training evaluation forms.

Results

Participants reported that the simulation training improved their communication skills, clinical practice, encouraged reflective practice and promoted interprofessional collaboration between emergency department and mental health professionals. Significant improvements were seen in participant knowledge and confidence in providing care to individuals presenting to emergency departments in mental health crises. Attitudes towards interprofessional collaboration in a variety of domains improved because of taking the simulation training.

Discussion

The pedagogical qualities of the in-situ simulation-based training presented fostered interprofessional collaboration and allowed participants to achieve challenging outcomes. It is suggested that further research should investigate the impact of simulation-based training on mental health related patient care outcomes in the emergency department.

Training is needed for staff who work with patients experiencing mental health issues. Self-efficacy, the belief that one is able to successfully perform a task, is a key part of transferring knowledge from training into the workplace. Without this transference, improvements on an occupational level are not thought to occur successfully. This paper investigates the impact of mental health care simulation training on self-efficacy. It further investigates the effect age and gender may have on self-efficacy outcomes in simulation training.

Methods

Participants were 829 healthcare staff attending simulation training courses from 2018–2019. Participants completed the Human Factors Skills for Healthcare Instrument pre- and post-course. Data were analysed using ANOVA, post-hoc tests and mediation analysis.

Results

Significant changes in self-efficacy were found across all participants. Individuals within the ages of 25–29 reported significantly less mean change than those between 35–45. Career stage did not seem to mediate this effect. No differences in self-efficacy were found across gender.

Conclusions

Mental health care simulation is a training method within the mental health professional field that is effective in increasing self-efficacy across a variety of courses and professions, suggesting that it can be an effective method of pedagogy.

The COVID-19 pandemic motivated simulation educators to attempt various forms of distance simulation in order to maintain physical distancing and to rapidly deliver training and ensure systems preparedness. However, the perceived psychological safety in distance simulation remains largely unknown. A psychologically unsafe environment can negatively impact team dynamics and learning outcomes; therefore, it merits careful consideration with the adoption of any new learning modality.

Methods

Between October 2020 and April 2021, 11 rural and remote hospitals in Alberta, Canada, were enrolled by convenience sampling in in-person-facilitated simulation (IPFS) (n = 82 participants) or remotely facilitated simulation (RFS) (n = 66 participants). Each interprofessional team was invited to attend two COVID-19-protected intubation simulation sessions. An abbreviated Edmondson Psychological Safety instrument compared pooled self-reported pre- and post-psychological safety scores of participants in both arms (n = 148 total participants). Secondary analysis included site champions’ self-matched pre- and post-complete Edmondson Psychological Safety instrument scores.

Results

There was no statistically significant difference between RFS and IPFS total scores on the abbreviated instrument at baseline (p = 0.52; Vargha and Delaney’s A [VD.A] = 0.53) or following simulations sessions (p = 0.36, VD.A = 0.54). There was a statistically significant increase in total scores on the complete instrument following simulation sessions for both RFS and IPFS site champions (p = 0.03, matched-pairs rank biserial correlation coefficient [r_rb] = 0.69).

Conclusions

Psychological safety can be established and maintained with RFS. Furthermore, in this study, RFS was shown to be comparable to IPFS in improving psychological safety among rural and remote interdisciplinary teams, providing simulation educators another modality for reaching any site or team.

Simulation-based medical education (SBME) is an evolving method of teaching cardiac examination skills to healthcare learners. It has been deliberated how effective this teaching modality is and whether high-fidelity methods are more effective than low-fidelity methods. This systematic review aimed to assess the effectiveness of high-fidelity SBME in teaching cardiac auscultation compared with no intervention or another active teaching intervention (low-fidelity SBME) using evidence from randomized controlled trials (RCTs).

Methods

Literature searches were performed on Medline, Embase, PsychInfo and Cinahl. RCTs that compared the effectiveness of high-fidelity simulation against no intervention or high-fidelity simulation against low-fidelity simulation in teaching cardiac auscultation to healthcare learners were included. Outcomes were knowledge, skills and satisfaction relating to cardiac auscultation education. Data were analyzed using Review Manager 5.3 software.

Results

Seventeen RCTs (n = 1055) were included. Twelve RCTs (n = 692) compared high-fidelity simulation with no intervention. The pooled effect sizes for knowledge and skills were 1.39 (95% confidence interval [CI], 0.39–2.38; p = 0.006; I² = 92%) and −0.28 (95% CI, −1.49 to 0.93; p = 0.65; I² = 94%), respectively. Five RCTs (n = 363) compared high-fidelity simulation with low-fidelity simulation. The pooled effect sizes for knowledge and skills were −0.73 (95% CI, −1.99 to 0.53; p = 0.26; I² = 86%) and 0.32 (95%CI −0.75 to 1.39; p = 0.56; I² = 89%), respectively.

Conclusions

This review’s findings suggest that high-fidelity SBME is an effective teaching method for cardiac auscultation education. Interestingly, there was no significant difference in knowledge or skills among learners when comparing high-fidelity simulation with low-fidelity simulation. Further research is needed to establish the effectiveness of different forms of SBME as educational interventions.

Previous research suggests that gender bias is pervasive in health care and has deleterious effects on treatment outcomes for patients. When developing and improving training on gender bias, we need to further our understanding of how such topics arise and are sustained in conversations between healthcare professionals (HCPs). The aim of this study is to analyze the influence of patient gender in HCP decision-making by analyzing how they surface, discuss and manage topics around gender.

Methods

An ethnomethodological qualitative study using discursive psychology and conversation analysis was implemented to examine 10 simulation debriefs in a specialized mental healthcare simulation centre in London. Video footage was obtained from mental health simulation training courses on bias in clinical decision-making, involving HCPs from mixed healthcare professions. Following transcription of selected segments, the debriefs were analyzed and repeated patterns of interaction were captured in distinct themes.

Results

Four main themes were identified from the data, indicating some of the ways in which conversations about gender are managed: collaboration (to encourage discussion), surprise (when unexpected topics arose), laughter (to diffuse tense situations) and silence (demonstrating careful thinking). Patients with mental health conditions were perceived differently in terms of treatment decisions due to existing gender biases.

Discussion

The persistence of gender bias that may result in discrimination in health care with negative consequences attests to the need for greater awareness and training development at various levels to include an intersectional approach.

Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.

Methods

We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.

Results

Small groups (n = 121) and survey ranking (n = 54) were used with distance, remote, and telesimulation as leading terms. Each was favored by a third of the participants without consensus.

Conclusion

This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of distance, remote and telesimulation is preferred.

Premature infant thermoregulation is a critical, yet challenging, component of neonatal resuscitation. Admission hypothermia is associated with multiple negative outcomes in very low birth weight (VLBW) infants. This study assessed the effect of a thermoregulation-focused simulation intervention on VLBW infant’s initial admission temperatures within a level 4 neonatal intensive care unit.

Methods

Seven multidisciplinary simulations were run in 2018 involving multiple members of the neonatal resuscitation team and led by neonatal fellows. Admission temperatures, gestational age, birth weight, maternal chorioamnionitis, antenatal steroids, caesarian section rate and need for intubation during the initial resuscitation were compared from 2019, the year following the simulation intervention, to 2017, the year preceding the simulation. Simulation participant data were collected.

Results

Admission temperatures in VLBW infants increased from 36.0°C in 2017 to 36.5°C in 2019 following the simulation intervention (p < 0.01). There was no significant difference in birth weight, gestation age, antenatal steroids, caesarian section rate, or need for intubation in the delivery room. There was an increased occurrence of maternal chorioamnionitis in 2019 compared with 2017 (p < 0.01).

Conclusions

This study demonstrated that the initiation of a thermoregulation simulation intervention has the potential to improve VLBW infant admission temperatures and supports the benefits of simulation-based training.

The global burden of disease from mental illness has been increasing, whilst the number of mental healthcare professionals has been decreasing at alarming rates. Recruitment to mental healthcare workforces is a key priority to efficiently tackle this imbalance, and recruitment efforts can be aided through educational experiences for school students that encourage career choices in mental health. This pilot study evaluates a novel simulation-based education programme to inform students about careers in mental health.

Methods:

94 school students aged 15–18 were opportunity sampled for this programme. Participants followed a simulated patient through four scenarios from hospital admission to returning home, whilst observing the roles of different mental health professions. Qualitative questionnaires were completed post-course, assessing the participants’ learning experience and perceptions of careers in mental health.

Results:

Thematic analysis of qualitative data revealed a greater understanding of mental healthcare roles, participants’ desire to challenge mental health stigma, and a positive regard for simulation-based education.

Discussion:

Simulation-based education serves as an innovative and applicable modality for career education. Moreover, it provides a novel approach to mental health literacy and stigma reduction in students, who could form the future workforces. Our findings act as a call to action for simulation educators, urging them to consider the application of simulation-based education in not just medical but also mental healthcare education. Large-scale deployment of this programme could have important implications for supporting mental healthcare recruitment.

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

Methods

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Results

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Discussion

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

Conclusion

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

Perspectives of simulated participants (SPs) as stakeholders in simulation education are under-represented. With rapid increase in virtual education and anticipation of post-pandemic continuation it is important to establish best practices. This work aims to determine SP perceptions of telesimulation.

Methods

In-depth semi-structured interviews determined SP opinions of participation in telesimulation. Thematic analysis utilizing an inductive and semantic iterative coding process was performed. SPs completed a survey of their demographics, experience and prior SP training, both virtual and in-person.

Results

Data sufficiency occurred after 16 interviews (10 females/6 males; 15 White/1 Black/African American). Median age was 56 years (range 37–72). Median number of in-person simulation experiences was 100 (range 6–300) and 27 telesimulations (range 3–100). Thematic analysis identified five themes: (1) students behave differently (distracted, less professional, less prepared for ‘real life’, less nervous), (2) my performance – some things are easier and some harder (increased cognitive load, coming out of role more, difficulties with non-verbal aspect, more standardized performance), (3) it’s harder to connect with learners (different cues, less of a personal connection), (4) safety for all in telesimulation (as psychologically safe as in-person, appreciate opportunity to continue to educate/work, personal safety), (5) future applications of telesimulation (telehealth training, better access to education for learners).

Conclusion

SP perceptions of telesimulation education revealed appreciation of the educational modality and identified potential benefit in telehealth education. SPs were concerned about learner participation, professionalism and resultant preparation for clinical practice. Incorporating SP feedback into telesimulation education may be important to ensure high quality.

Members of clinical teams can hold stereotyped views of one another that can form barriers to interprofessional cohesion and collaboration. Interprofessional education (IPE) is often championed as a way of teaching individuals to be better team players through the adoption of collaborative attitudes and behaviours. However, the potentially detrimental effects of IPE are not well understood. This study used the social identity approach (SIA) as a lens to explore the impact of interprofessional simulation on the identities and professional relationships of trainee pharmacists and medical students.

Methods

Across three different locations in Scotland, trainee pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Participants were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on SIA. Transcripts were analysed using template analysis, with sub-categorizations of SIA forming the initial coding template.

Results

Twenty-five interviews were undertaken across both groups. The interprofessional simulation session effectively challenged pre-existing stereotypes. For the trainee pharmacists, the alteration of self-stereotypes influenced motivation through self-enhancement and, in turn, altered group norms via the promotion of genuine collaboration and joint decision-making. However, social comparisons focussed on status remained prominent.

Discussion

This study has shown that interprofessional simulation can effectively challenge and alter stereotypes (including self-stereotypes), but social comparisons may be less easy to overcome in this context. As it continues to be embedded within healthcare education, the limitations of IPE must be better understood to ensure that the potential value of such opportunities is maximized.

Healthcare systems improvement using simulation and debriefing is an increasingly employed, yet underutilized quality improvement tool to enable user-centred design. This approach allows users to experience real-life systems and processes through simulation and then provide feedback on how a system supports them within their role. Understanding this interaction of people and their systems is critical to safe, quality, reliable and efficient care and bridges the gap between how we think a system is working and how it is working.

Methods

This novel project was collaboratively developed and led by simulation, human factors and patient safety experts and used existing organizational safety data to target further high-risk safety threats surrounding administering, cross-checking and labelling blood products for transfusion. A system-focused simulation-based approach was used to identify system issues for a large healthcare organization’s transfusion policy redesign. A Failure Mode and Effects Analysis (FMEA) was then used to apply a risk score to the findings from the simulation user feedback to inform a large high-risk policy redesign.

Results

Multiple recommendations were provided to the participating units and policy and procedure redesign teams surrounding environmental issues, standards, interpretation and usability of the policy.

Discussion

Our collaborative patient safety, simulation and human factors project was successful in proactively identifying both active and latent factors contributing to adverse events and identifying recommendations using FMEA methodology to improve patient safety, including revisions to the physical space within the lab, and the provincial blood transfusion policy and procedure.

Impostor phenomenon is the overwhelming feeling of intellectual phoniness and has been linked to decreased job satisfaction and increased levels of stress, depression and burnout. As education and healthcare institutions rely on simulation to train the current and future healthcare workforce, there is a need to improve our understanding of impostor phenomenon in the healthcare simulation context. This study investigated the prevalence of impostor phenomenon in simulation educators and examined the effect of work-related characteristics on impostor phenomenon in the simulation educator community.

Methods

In total, 148 simulation educators from nine countries participated in an online survey. Along with questions related to demographic characteristics, impostor phenomenon was measured using two scales, the Clance Impostor Phenomenon Scale (CIPS) and the Leary Impostorism Scale (LIS). Independent variables included gender, time spent on simulation activities per week, years working in simulation and team size.

Results

Impostorism was identified in 46.6% of simulation educators. A multivariate analysis of variance revealed no statistically significant interactions or main effects of gender, time spent on simulation activities per week, years working in simulation and team size on impostor phenomenon. Impostor phenomenon does not discriminate based on gender; it does not disappear with experience; and it is present regardless of the size of team.

Conclusions

Impostor phenomenon is prevalent across the healthcare simulation educator community. Given the negative impact impostor phenomenon has on well-being and career development, educators, employers and professional societies need to acknowledge the prevalence of impostor phenomenon and start a conversation to build awareness about impostor phenomenon in the healthcare simulation community. Bringing the conversation into the open is the first step to acknowledging feelings of impostorism and developing strategies to break the cycle.