Friday 15 July 2016

To 10 Simulation Papers June - July 2016

 by Tate Skinner and Adam Dubrowski






  1. Eur J Anaesthesiol. 2016 Aug;33(8):568-74. doi: 10.1097/EJA.0000000000000423.




Abstract
BACKGROUND:
Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion.
OBJECTIVE:
To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion.
DESIGN:
Before and after intervention study.
SETTING:
University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012.
PARTICIPANTS:
Residents in anaesthesiology aware of the Seldinger technique for vascular puncture.
INTERVENTION:
Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase).
MAIN OUTCOME MEASURES:
The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test.
RESULTS:
Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P < 0.001 for comparison with pretraining scores) and 26.5 (±5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (±1.0) points before training, 5.0 (±1.04) after training (P < 0.001 for comparison with pretraining scores) and 3.7 (±1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (±2.3) before training, 19.9 (±1.06) after training (P < 0.001 for comparison with pretraining scores) and 17.4 (±1.41) (P = 0.002 for comparison with pretraining scores). The percentage of correct answers in the multiple-choice questionnaire increased from 76.0% (±7.9) before training to 87.7% (±4.4) after training (P < 0.001).
CONCLUSION:
Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.

PMID: 27367432 [PubMed - in process]


  

2. Neurocrit Care. 2016 Jul 7. [Epub ahead of print]


Abstract
BACKGROUND:
Simulation is becoming a more common modality in medical education. The data regarding effectiveness of simulation in critical care neurology education are limited.
METHODS:
We administered a three-scenario simulation course to critical care fellowship trainees at a large academic medical center as a part of their core curriculum requirement. Pre- and posttests assessing medical knowledge and trainee confidence in managing neurologic disease were completed by all trainees. Overall satisfaction and effectiveness were evaluated following the course. Change in trainee knowledge and confidence before and after the course was assessed for improvement.
RESULTS:
Sixteen trainees completed the simulation course. Prior to completion, medical knowledge was 5.2 ± 0.9 (of 8 possible correct answers) and following the course was 6.4 ± 1.3 (p = 0.002). Overall confidence improved from 15.4 ± 4.9 (of 30 possible points) to 20.7 ± 3.3 (p = <0.0001). Confidence was significantly improved for neurologic diseases directly assessed during the course (p = <0.0001) as well as for those not directly assessed (p = 0.004).
CONCLUSIONS:
Simulation is an effective means of neurologic education for critical care trainees, with improvement in both medical knowledge and trainee confidence after completion of a three-scenario simulation experience. This course ensures the exposure of critical care trainees to neurologic diseases that are required curricular milestones to successfully complete the fellowship training program.

PMID: 27389006 [PubMed - as supplied by publisher]


  

3. Simul Healthc. 2016 Jul 6. [Epub ahead of print]



Abstract
INTRODUCTION:
Although simulation facilities are available at most teaching institutions, the number of qualified instructors and/or content experts that facilitate postsimulation debriefing is inadequate at many institutions. There remains a paucity of evidence-based data regarding several aspects of debriefing, including debriefing with a facilitator present versus teledebriefing, in which participants undergo debriefing with a facilitator providing instruction and direction from an off-site location while they observe the simulation in real-time. We conducted this study to identify the effectiveness and feasibility of teledebriefing as an alternative form of instruction.
METHODS:
This study was conducted with emergency medicine residents randomized into either a teledebriefing or on-site debriefing group during 11 simulation training sessions implemented for a 9-month period. The primary outcome of interest was resident perception of debriefing effectiveness, as measured by the Debriefing Assessment for Simulation in Healthcare-Student Version (See Appendix, Supplemental Digital Content 1, http://links.lww.com/SIH/A282) completed at the end of every simulation session.
RESULTS:
A total of 44 debriefings occurred during the study period with a total number of 246 Debriefing Assessment for Simulation in Healthcare-Student Version completed. The data revealed a statistically significant difference between the effectiveness of on-site debriefing [6.64 (0.45)] and teledebriefing [6.08 (0.57), P < 0.001]. Residents regularly evaluated both traditional debriefing and teledebriefing as "consistently effective/very good."
CONCLUSIONS:
Teledebriefing was found to be rated lower than in-person debriefing but was still consistently effective. Further research is necessary to evaluate the effectiveness of teledebriefing in comparison with other alternatives. Teledebriefing potentially provides an alternative form of instruction within simulation environments for programs lacking access to expert faculty.

PMID: 27388866 [PubMed - as supplied by publisher]


  

4. Simul Healthc. 2016 Jul 6. [Epub ahead of print]



Abstract
INTRODUCTION:
Our current understanding of what results in effective simulation-based training is restricted to the physical practice and debriefing stages, with little attention paid to the earliest stage: how learners are prepared for these experiences. This study explored the utility of Web-based observational practice (OP) featuring combinations of reading materials (RMs), OP, and collaboration to prepare novice medical students for a simulation-based mastery learning (SBML) workshop in central venous catheterization.
METHODS:
Thirty medical students were randomized into the following 3 groups differing in their preparatory materials for a SBML workshop in central venous catheterization: a control group with RMs only, a group with Web-based groups including individual OP, and collaborative OP (COP) groups in addition to RM. Preparation occurred 1 week before the SBML workshop, followed by a retention test 1-week afterward. The impact on the learning efficiency was measured by time to completion (TTC) of the SBML workshop. Web site preparation behavior data were also collected.
RESULTS:
Web-based groups demonstrated significantly lower TTC when compared with the RM group, (P = 0.038, d = 0.74). Although no differences were found between any group performances at retention, the COP group spent significantly more time and produced more elaborate answers, than the OP group on an OP activity during preparation.
DISCUSSION:
When preparing for SBML, Web-based OP is superior to reading materials alone; however, COP may be an important motivational factor to increase learner engagement with instructional materials. Taken together, Web-based preparation and, specifically, OP may be an important consideration in optimizing simulation instructional design.

PMID: 27388862 [PubMed - as supplied by publisher]


  

5. Pediatr Emerg Care. 2016 Jul 2. [Epub ahead of print]



Abstract
OBJECTIVES:
Opportunities to learn advanced airway management skills on pediatric patients in the emergency department are limited. Current strategies have focused largely on traditional didactics coupled with procedural skills training using simulation. However, these approaches are limited in their exposure to anatomic variation and realism. Here, we describe the development and assessment of an advanced airway curriculum that integrates videolaryngoscopic recordings obtained during actual patient intubations into a series of interactive educational sessions.
METHODS:
Trainees and attending physicians were surveyed anonymously to assess the impact of participation in the curriculum. A mixed methods approach to statistical analysis was used. Rating questions were used to evaluate the relative impact of this approach over other traditional strategies and recurrent themes within open-ended questions were identified.
RESULTS:
Participants reported this to be a highly effective means of learning about pediatric laryngoscopy and endotracheal intubation and regarded it more highly than other traditional educational approaches. Identified benefits included repetitive exposure, approaches to laryngoscopy, the realism of teaching using real and varied anatomy, and the opportunities to identify and troubleshoot difficulty in a learning environment.
CONCLUSIONS:
An advanced pediatric airway curriculum that integrates intubation videos obtained during videolaryngoscopy was highly regarded by pediatric emergency medicine providers. Content emphasis can be shifted to meet the needs of pediatric emergency medicine providers with all levels of skill and experience.

PMID: 27383403 [PubMed - as supplied by publisher]


  

6. Surg Endosc. 2016 Jun 29. [Epub ahead of print]




Abstract
BACKGROUND:
Simulators are useful tools in the development of laparoscopic skills. However, little is known about the effectiveness of short laparoscopic training sessions and how retention of skills occurs in surgical trainees who are naïve to laparoscopy. This study analyses the retention of laparoscopic surgical skills in medical students without prior surgical training.
METHODS:
A group of first- and second-year medical students (n = 68), without prior experience in surgery or laparoscopy, answered a demographic questionnaire and had their laparoscopic skills assessed by the Fundamentals of Laparoscopic Surgery (FLS) training protocol. Subsequently, they underwent a 150-minute training course after which they were re-tested. One year after the training, the medical students' performance in the simulator was re-evaluated in order to analyse retention.
RESULTS:
Of the initial 68 students, a total of 36 participated throughout the entire study, giving a final participation rate of 52 %. Thirty-six medical students with no gender predominance and an average age of 20 years were evaluated. One year after the short training programme, retention was 69.3 % in the peg transfer (p < 0.05) and 64.2 % in ligature (p < 0.05) compared with immediate post-training evaluation. There was no significant difference in suturing. The average sample score in the baseline test was 8.3, in the post-training test it was 89.7, and in the retention test it was 84.2, which corresponded to a skill retention equivalence of 93 %.
CONCLUSIONS:
There was a significant retention of the laparoscopic surgical skills developed. Even 1 year after a short training session, medical students without previous surgical experience showed that they have retained a great part of the skills acquired through training.

PMID: 27357929 [PubMed - as supplied by publisher]


  

7. J Surg Educ. 2016 Jun 21. pii: S1931-7204(16)30058-7. doi: 10.1016/j.jsurg.2016.05.012. [Epub ahead of print]



Abstract
OBJECTIVE:
Training within a competency-based curriculum (CBC) outside the operating room enhances performance during real basic surgical procedures. This study aimed to design and validate a virtual reality CBC for an advanced laparoscopic procedure: sigmoid colectomy.
DESIGN:
This was a multicenter randomized study. Novice (surgeons who had performed <5 laparoscopic colorectal resections as primary operator), intermediate (between 10 and 20), and experienced surgeons (>50) were enrolled. Validity evidence for the metrics given by the virtual reality simulator, the LAP Mentor, was based on the second attempt of each task in between groups. The tasks assessed were 3 modules of a laparoscopic sigmoid colectomy (medial dissection [MD], lateral dissection [LD], and anastomosis) and a full procedure (FP). Novice surgeons were randomized to 1 of 2 groups to perform 8 further attempts of all 3 modules or FP, for learning curve analysis.
SETTING:
The 2 academic tertiary care centers-division of surgery of St. Mary's campus, Imperial College Healthcare NHS Trust, London and Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, were involved.
PARTICIPANTS:
Novice surgeons were residents in digestive surgery at St. Mary's and Nord Hospitals. Intermediate and experienced surgeons were board-certified academic surgeons.
RESULTS:
A total of 20 novice surgeons, 7 intermediate surgeons, and 6 experienced surgeons were enrolled. Evidence for validity based on experience was identified in MD, LD, and FP for time (p = 0.005, p = 0.003, and p = 0.001, respectively), number of movements (p = 0.013, p = 0.005, and p = 0.001, respectively), and path length (p = 0.03, p = 0.017, and p = 0.001, respectively), and only for time (p = 0.03) and path length (p = 0.013) in the anastomosis module. Novice surgeons' performance significantly improved through repetition for time, movements, and path length in MD, LD, and FP. Experienced surgeons' benchmark criteria were defined for all construct metrics showing validity evidence.
CONCLUSIONS:
A CBC in laparoscopic colorectal surgery has been designed. Such training may reduce the learning curve during real colorectal resections in the operating room.
Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

PMID: 27342755 [PubMed - as supplied by publisher]


  

8. Anaesth Crit Care Pain Med. 2016 Jun 20. pii: S2352-5568(16)30057-1. doi: 10.1016/j.accpm.2016.02.008. [Epub ahead of print]



Abstract
BACKGROUND AND OBJECTIVE:
High-fidelity medical simulation is a source of stress for participants. The aim of this study was to assess if repeated simulated courses decrease perceived stress and/or physiological stress level and increase performance in anaesthesiology registrars.
METHOD:
Fourteen anaesthesiology specialty registrars participated individually in three successive sessions of crisis simulation in the operating room. Participants' perceived stress levels were measured by self-assessment (simple numerical scale from 0 to 10 (0 = no stress, 10 = maximum stress)) and physiological stress was estimated via the maximal heart rate measured by a Holter system). Technical and non-technical performances were also assessed. Data are expressed as medians with interquartile ranges and extremes (median (IQR [Min-Max])).
RESULTS:
Between the first and third session, simulation repetition was associated with a decrease in perceived stress (9 (8-10 [5-10]) versus 7 (5-8 [2-9]) from session 1 to session 3 respectively, p = 0.02), whereas physiological stress assessed by the maximum heart rate remained unchanged (130 beats per minute (116-141 [85-170]) and 123 beats per minute (115-136 [88-166]) between sessions 1 and 3 respectively). There was also a significant inverse correlation between perceived stress levels experienced by registrars during the session and non-technical performance (p = 0.008).
CONCLUSION:
We observed a reduction in perceived stress levels experienced by registrars while physiological stress was unchanged with repeating simulation sessions combining simulated practice and debriefing. Learning through simulation could improve perceived stress management in critical situations.
Copyright © 2016. Published by Elsevier Masson SAS.

PMID: 27338521 [PubMed - as supplied by publisher]


  

9. BMC Med Educ. 2016 Jun 10;16(1):161. doi: 10.1186/s12909-016-0685-2.


Hogg G1,2,3, Miller D4,5.

Abstract
BACKGROUND:
Clinical deterioration in adult hospital patients is an identified issue in healthcare practice globally. Teaching medical students to recognise and respond to the deteriorating patient is crucial if we are to address the issue in an effective way. The aim of this study was to evaluate the effects of an enhanced simulation exercise known as RADAR (Recognising Acute Deterioration: Active Response), on medical students' confidence.
METHODS:
A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students' perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to a cohort of third-year medical students (n = 158) in the North East of Scotland 130 (82 %) were returned for analysis, employing IBM SPSS v18 and ANOVA techniques.
RESULTS:
Students' responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students' confidence to recognise deterioration increased significantly (p. < .001) as a result of the sessions. Effect sizes (Eta(2)) were high, (0.68-0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios.
CONCLUSIONS:
The use of this enhanced form of simulation with simulated patients and the judicious use of moulage is an effective method of increasing realism for medical students. Importantly, it gives them greater confidence in recognising and responding to clinical deterioration in adult patients. We recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups.
PMCID: PMC4902916 Free PMC Article

PMID: 27287426 [PubMed - in process]


   

10. Pediatr Emerg Care. 2016 Jun 2. [Epub ahead of print]



Abstract
OBJECTIVES:
To assess the effectiveness of pediatric simulation by remote facilitation. We hypothesized that simulation by remote facilitation is more effective compared to simulation by an on-site facilitator. We defined remote facilitation as a facilitator remotely (1) introduces simulation-based learning and simulation environment, (2) runs scenarios, and (3) performs debriefing with an on-site facilitator.
METHODS:
A remote simulation program for medical students during pediatric rotation was implemented. Groups were allocated to either remote or on-site facilitation depending on the availability of telemedicine technology. Both groups had identical 1-hour simulation sessions with 2 scenarios and debriefing. Their team performance was assessed with behavioral assessment tool by a trained rater. Perception by students was evaluated with Likert scale (1-7).
RESULTS:
Fifteen groups with 89 students participated in a simulation by remote facilitation, and 8 groups with 47 students participated in a simulation by on-site facilitation. Participant demographics and previous simulation experience were similar. Both groups improved their performance from first to second scenario: groups by remote simulation (first [8.5 ± 4.2] vs second [13.2 ± 6.2], P = 0.003), and groups by on-site simulation (first [6.9 ± 4.1] vs second [12.4 ± 6.4], P = 0.056). The performance improvement was not significantly different between the 2 groups (P = 0.94). Faculty evaluation by students was equally high in both groups (7 vs 7; P = 0.65).
CONCLUSIONS:
A pediatric acute care simulation by remote facilitation significantly improved students' performance. In this pilot study, remote facilitation seems as effective as a traditional, locally facilitated simulation. The remote simulation can be a strong alternative method, especially where experienced facilitators are limited.

PMID: 27261952 [PubMed - as supplied by publisher]




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