By Tate Skinner and Dr. Adam Dubrowski
1.Int J Occup Saf Ergon. 2016 Dec
9:1-9. [Epub ahead of print]
Moving a hospital: Simulation-a way to
coproduce safety healthcare facilities.
Gignon
M1,2, Amsallem C3,4, Ammirati C1,4.
Author
information:
1a
Educations and Health Practices research team , University Paris 13, Sorbonne
Paris Cité , Bobigny , EA 3412 , France.
2b
Head of research department , Healthcare Simulation Center SimUSanté®- Amiens
University Hospital , Amiens , France.
3c
Simulation Center SimUSanté®- Amiens University Hospital , Amiens , France.
4d
CHU Amiens-Picardie , 80 054 Amiens Cedex 1, France.
Abstract
Moving
a hospital is a critical period for quality and safety of healthcare. Change is
very stressful for professionals. Workers who have experienced relocation of
their place of work report deterioration in health status. Building a new
hospital or restructuring a unit could provide an opportunity for improving
safety and value in healthcare and for ensuring better quality of worklife for
the staff. We used in situ simulation to promote experiential learning by
training healthcare workers in the workplace in which they are expected to use
their skills. In situ simulation was a way to design, plan, assess, and
implement a new healthcare environment before opening its doors for patient
care. We can envisage that it will soon be used formally to identify potential
problems in healthcare delivery and in staff quality of worklife in new
healthcare facilities. Simulation is a way to coproduce a safe and valuable
healthcare facility.
PMID:
27935431 [PubMed - as supplied by publisher]
2.Artif Organs. 2016 Dec 9. doi:
10.1111/aor.12808. [Epub ahead of print]
A Physical Heart Failure Simulation
System Utilizing the Total Artificial Heart and Modified Donovan Mock
Circulation.
Crosby
JR1, DeCook KJ1, Tran PL1,2,3, Betterton E 3, Smith RG1,2,3, Larson DF4,
Khalpey ZI4, Burkhoff D5, Slepian MJ1,6,2.
Author
information:
1Biomedical
Engineering GIDP, University of Arizona, Tucson, AZ.
2Department
of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ.
3Artificial
Heart Department, Banner University Medical Center, University of Arizona,
Tucson, AZ.
4Department
of Surgery, University of Arizona, Tucson, AZ.
5Columbia
University, New York, NY, USA.
6Department
of Biomedical Engineering, University of Arizona, Tucson, AZ.
Abstract
With
the growth and diversity of mechanical circulatory support (MCS) systems
entering clinical use, a need exists for a robust mock circulation system
capable of reliably emulating and reproducing physiologic as well as
pathophysiologic states for use in MCS training and inter-device comparison. We
report on the development of such a platform utilizing the SynCardia Total
Artificial Heart and a modified Donovan Mock Circulation System, capable of
being driven at normal and reduced output. With this platform, clinically
relevant heart failure hemodynamics could be reliably reproduced as evidenced
by elevated left atrial pressure (+112%), reduced aortic flow (-12.6%), blunted
Starling-like behavior, and increased afterload sensitivity when compared with
normal function. Similarly, pressure-volume relationships demonstrated enhanced
sensitivity to afterload and decreased Starling-like behavior in the heart
failure model. Lastly, the platform was configured to allow the easy addition
of a left ventricular assist device (HeartMate II at 9600 RPM), which upon
insertion resulted in improvement of hemodynamics. The present configuration
has the potential to serve as a viable system for training and research, aimed
at fostering safe and effective MCS device use.
©
2016 International Center for Artificial Organs and Transplantation and Wiley
Periodicals, Inc.
PMID:
27935084 [PubMed - as supplied by publisher]
3.Nurse Educ Pract. 2016 Nov
29;22:37-46. doi: 10.1016/j.nepr.2016.11.008. [Epub ahead of print]
Aiming for excellence - A
simulation-based study on adapting and testing an instrument for developing
non-technical skills in Norwegian student nurse anaesthetists.
Flynn
FM1, Sandaker K2, Ballangrud R3.
Author
information:
1Department
of Nursing Science, Faculty of Health Sciences, University College of
Southeast, Norway. Electronic address: fiona.flynn@hbv.no.
2Department
of Nursing Science, Faculty of Health Sciences, University College of
Southeast, Norway; Vestfold Hospital Trust, Tønsberg, Norway. Electronic
address: kjersti.sandaker@siv.no.
3Department
of Nursing, Faculty of Health, Care and Nursing, Norwegian University of
Science and Technology, Norway. Electronic address: randi.ballangrud@ntnu.no.
Abstract
There
is increasing focus on building safety into anaesthesia practice, with
excellence in anaesthesia as an aspirational goal. Non-technical skills are an
important factor in excellence and improved patient safety, though there have
been few systematic attempts at integrating them into anaesthesia nursing
education. This study aimed to test the reliability of NANTS-no, a specially
adapted behavioural marker system for nurse anaesthetists in Norway, and
explore the development of non-technical skills in student nurse anaesthetists.
The pre-test post-test design incorporated a 10-week simulation-based
programme, where non-technical skills in 14 student nurse anaesthetists were
rated on three different occasions during high-fidelity simulation, before and
after taking part in a training course. NANTS-no demonstrated high overall
inter-rater reliability (ICC = 0.91), high test-retest reliability (ICC = 0.94)
and good internal consistency (Cronbach's α of 0.85-0.92). A significant
improvement was demonstrated across all categories of non-technical skills,
with greatest improvements between the first and third and second and third
sessions. There was also a significant improvement in two categories between
the first and second sessions. NANTS-no is therefore suitable for assessing non-technical
skills during simulation training in anaesthesia nursing education. More
research is needed to validate its use in clinical practice.
Copyright
© 2016. Published by Elsevier Ltd.
PMID:
27930962 [PubMed - as supplied by publisher]
4.Simul Healthc. 2016 Dec 8. [Epub
ahead of print]
First-Person Point-of-View-Augmented
Reality for Central Line Insertion Training: A Usability and Feasibility Study.
Rochlen
LR1, Levine R, Tait AR.
Author
information:
1From
the Department of Anesthesiology (L.R.R.), University of Michigan, Ann Arbor,
MI; Emergency Care Center (R.L.), Jackson Memorial Hospital, Miami, FL;
ArchieMD, Inc, Boca Raton, FL; and Department of Anesthesiology, and Center for
Bioethics and Social Sciences in Medicine (A.R.T.), University of Michigan, Ann
Arbor, MI.
Abstract
INTRODUCTION:
The
value of simulation in medical education and procedural skills training is well
recognized. Despite this, many mannequin-based trainers are limited by the
inability of the trainee to view the internal anatomical structures. This study
evaluates the usability and feasibility of a first-person
point-of-view-augmented reality (AR) trainer on needle insertion as a component
of central venous catheter placement.
METHODS:
Forty
subjects, including medical students and anesthesiology residents and faculty,
participated. Augmented reality glasses were provided through which the
relevant internal anatomical landmarks were projected. After a practice period,
participants were asked to place the needle in the mannequin without the
benefit of the AR-projected internal anatomy. The ability of the trainees to
correctly place the needle was documented. Participants also completed a short
survey describing their perceptions of the AR technology.
RESULTS:
Participants
reported that the AR technology was realistic (77.5%) and that the ability to
view the internal anatomy was helpful (92.5%). Furthermore, 85% and 82.1%,
respectively, believed that the AR technology promoted learning and should be
incorporated into medical training. The ability to successfully place the
needle was similar between experienced and nonexperienced participants;
however, less experienced participants were more likely to inadvertently
puncture the carotid artery.
CONCLUSIONS:
Results
of this pilot study demonstrated the usability and feasibility of AR technology
as a potentially important adjunct to simulated medical skills training.
Further development and evaluation of this innovative technology under a
variety of simulated medical training settings would be an important next step.
PMID:
27930431 [PubMed - as supplied by publisher]
5.Surg Endosc. 2016 Dec 7. [Epub ahead
of print]
Effective stepwise training and
procedure standardization for young surgeons to perform laparoscopic left
hepatectomy.
Yamada
S1, Shimada M2, Imura S2, Morine Y2, Ikemoto T2, Saito Y2, Takasu C2, Yoshikawa
M2, Teraoku H2, Yoshimoto T2, Takata A2.
Author
information:
1Department
of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima City,
Tokushima, 770-8503, Japan. yamada.shinichiro@tokushima-u.ac.jp.
2Department
of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima City,
Tokushima, 770-8503, Japan.
Abstract
BACKGROUND:
Laparoscopic
hepatectomy remains one of the most difficult procedures for young surgeons to
perform. We recently developed a new training method and standardization
procedure for teaching young surgeons to perform laparoscopic left hepatectomy
(Lap-LHx). The aim of this study was to assess the effectiveness of our method.
METHODS:
In
2004, we standardized a laparoscopic procedure for Lap-LHx, using a laparoscopy-assisted
method as a stepping stone. The laparoscopic training method comprised the
following three steps: (1) training in fundamental procedures using a dry box
and checking by mentors; (2) detailed preoperative simulation using Vincent
three-dimensional software for each patient; and (3) self-assessment including
understanding of relevant anatomy and completion grade for each procedure using
a check sheet and feedback by both mentors and a professor. Twenty-three
Lap-LHx procedures performed during the study period were divided into two
groups: those performed by young non-board-certified surgeons (n = 9) and those
performed by senior board-certified surgeons (n = 14).
RESULTS:
The
blood loss and operative time were similar in the young surgeon (194 g and 336
min, respectively) and senior surgeon groups (208 g and 322 min, respectively).
CONCLUSION:
Our
standardized Lap-LHx procedure and stepwise training to perform it enable young
surgeons to perform Lap-LHx as confidently and safely as more experienced
surgeons.
PMID:
27928671 [PubMed - as supplied by publisher]
6.J Ultrasound Med. 2016 Nov 30. doi:
10.7863/ultra.16.01037. [Epub ahead of print]
The Predictive Value of Ultrasound
Learning Curves Across Simulated and Clinical Settings.
Madsen
ME1, Nørgaard LN1,2, Tabor A1, Konge L3, Ringsted C4, Tolsgaard MG2,3.
Author
information:
1Department
of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark.
2Department
of Gynecology and Obstetrics, Nordsjaellands Hospital, University of
Copenhagen, Hillerød, Denmark.
3Copenhagen
Academy for Medical Education and Simulation, University of Copenhagen and The
Capital Region of Denmark, Copenhagen, Denmark.
4Centre
for Health Science Education, Faculty of Health, Aarhus University, Aarhus,
Denmark.
Abstract
OBJECTIVES:
The
aim of the study was to explore whether learning curves on a virtual-reality
(VR) sonographic simulator can be used to predict subsequent learning curves on
a physical mannequin and learning curves during clinical training.
METHODS:
Twenty
midwives completed a simulation-based training program in transvaginal
sonography. The training was conducted on a VR simulator as well as on a
physical mannequin. A subgroup of 6 participants underwent subsequent clinical
training. During each of the 3 steps, the participants' performance was
assessed using instruments with established validity evidence, and they
advanced to the next level only after attaining predefined levels of
performance. The number of repetitions and time needed to achieve predefined
performance levels were recorded along with the performance scores in each
setting. Finally, the outcomes were correlated across settings.
RESULTS:
A
good correlation was found between time needed to achieve predefined
performance levels on the VR simulator and the physical mannequin (Pearson
correlation coefficient .78; P < .001). Performance scores on the VR
simulator correlated well to the clinical performance scores (Pearson
correlation coefficient .81; P = .049). No significant correlations were found
between numbers of attempts needed to reach proficiency across the 3 different
settings. A post hoc analysis found that the 50% fastest trainees at reaching
proficiency during simulation-based training received higher clinical
performance scores compared to trainees with scores placing them among the 50%
slowest (P = .025).
CONCLUSIONS:
Performances
during simulation-based sonography training may predict performance in related
tasks and subsequent clinical learning curves.
©
2016 by the American Institute of Ultrasound in Medicine.
PMID:
27925649 [PubMed - as supplied by publisher]
7.Cochrane Database Syst Rev. 2016 Dec
7;12:CD010157. [Epub ahead of print]
Behavioural interventions to promote
workers' use of respiratory protective equipment.
Luong
Thanh BY1, Laopaiboon M, Koh D, Sakunkoo P, Moe H.
Author
information:
1Department
of Biostatistics - Demography - Reproductive Health, Faculty of Public Health,
Hue University of Medicine and Pharmacy, 06 Ngo Quyen, Hue, Thua Thien Hue,
Vietnam, 47000.
Abstract
BACKGROUND:
Respiratory
hazards are common in the workplace. Depending on the hazard and exposure, the
health consequences may include: mild to life-threatening illnesses from
infectious agents, acute effects ranging from respiratory irritation to chronic
lung conditions, or even cancer from exposure to chemicals or toxins. Use of
respiratory protective equipment (RPE) is an important preventive measure in
many occupational settings. RPE only offers protection when worn properly, when
removed safely and when it is either replaced or maintained regularly. The effectiveness
of behavioural interventions either directed at employers or organisations or
directed at individual workers to promote RPE use in workers remains an
important unanswered question.
OBJECTIVES:
To
assess the effects of any behavioural intervention either directed at
organisations or at individual workers on observed or self-reported RPE use in
workers when compared to no intervention or an alternative intervention.
SEARCH
METHODS:
We
searched the Cochrane Work Group Specialised Register, the Cochrane Central
Register of Controlled Trials (CENTRAL 2016, Issue 07), MEDLINE (1980 to 12
August 2016), EMBASE (1980 to 20 August 2016) and CINAHL (1980 to 12 August
2016).
SELECTION
CRITERIA:
We
included randomised controlled trials (RCTs), controlled before and after (CBA)
studies and interrupted time-series (ITS) comparing behavioural interventions
versus no intervention or any other behavioural intervention to promote RPE use
in workers.
DATA
COLLECTION AND ANALYSIS:
Four
authors independently selected relevant studies, assessed risk of bias and
extracted data. We contacted investigators to clarify information. We pooled
outcome data from included studies where the studies were sufficiently similar.
MAIN
RESULTS:
We
included 14 studies that evaluated the effect of training and education on RPE
use, which involved 2052 participants. The included studies had been conducted
with farm, healthcare, production line, office and coke oven workers as well as
nursing students and people with mixed occupations. All included studies
reported the effects of interventions as use of RPE, as correct use of RPE or
as indirect measures of RPE use. We did not find any studies where the
intervention was delivered and assessed at the whole organization level or in
which the main focus was on positive or negative incentives. We rated the
quality of the evidence for all comparisons as low to very low. Training versus
no trainingOne CBA study in healthcare workers compared training with and without
a fit test to no intervention. The study found that the rate of properly
fitting respirators was not considerably different in the workers who had
received training with a fit test (RR 1.17, 95% Confidence Interval (CI) 0.97
to 1.10) or training without a fit test (RR 1.16, 95% CI 0.95 to 1.42) compared
to those who had no training. Two RCTs that evaluated training did not
contribute to the analyses because of lack of data. Conventional training plus
additions versus conventional training aloneOne cluster-randomised trial
compared conventional training plus RPE demonstration versus training alone and
reported no significant difference in appropriate use of RPE between the two
groups (RR 1.41, 95% CI 0.96 to 2.07).One RCT compared interactive training with
passive training, with an information screen, and an information book. The mean
RPE performance score for the active group was not different from that of the
passive group (MD 2.10, 95% CI -0.76 to 4.96). However, the active group scored
significantly higher than the book group (MD 4.20, 95% CI 0.89 to 7.51) and the
screen group (MD 7.00, 95% CI 4.06 to 9.94).One RCT compared
computer-simulation training with conventional personal protective equipment
(PPE) training but reported only results for donning and doffing full-body PPE.
Education versus no educationOne RCT found that a multifaceted educational
intervention increased the use of RPE (risk ratio (RR) 1.69, 95% CI 1.10 to
2.58) at three years' follow-up when compared to no intervention. However, there
was no difference between intervention and control at one year's, two years' or
four years' follow-up. Two RCTs did not report enough data to be included in
the analysis.Four CBA studies evaluated the effectiveness of education
interventions and found no effect on the frequency or correctness of RPE use,
except in one study for the use of an N95 mask (RR 4.56, 95% CI 1.84 to 11.33,
1 CBA) in workers. Motivational interviewing versus traditional lecturesOne CBA
study found that participants given motivational group interviewing-based
safety education scored higher on a checklist measuring PPE use (MD 2.95, 95%
CI 1.93 to 3.97) than control workers given traditional educational sessions.
AUTHORS'
CONCLUSIONS:
There
is very low quality evidence that behavioural interventions, namely education
and training, do not have a considerable effect on the frequency or correctness
of RPE use in workers. There were no studies on incentives or organisation
level interventions. The included studies had methodological limitations and we
therefore need further large RCTs with clearer methodology in terms of
randomised sequence generation, allocation concealment and assessor blinding,
in order to evaluate the effectiveness of behavioural interventions for
improving the use of RPE at both organisational and individual levels. In
addition, further studies should consider some of the barriers to the
successful use of RPE, such as experience of health risk, types of RPE and the
employer's attitude to RPE use.
PMID:
27925149 [PubMed - as supplied by publisher]
8.Surg Endosc. 2016 Dec 6. [Epub ahead
of print]
Laparoscopic and robotic skills are
transferable in a simulation setting: a randomized controlled trial.
Thomaier
L1, Orlando M2, Abernethy M2, Paka C2, Chen CC2.
Author
information:
1Department
of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
lthomai1@jhmi.edu.
2Division
of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology
and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord
Drive, Suite 3200, Baltimore, MD, 21224, USA.
Abstract
BACKGROUND:
Although
surgical simulation provides an effective supplement to traditional training,
it is not known whether skills are transferable between minimally invasive
surgical modalities. The purpose of this study was to assess the
transferability of skills between minimally invasive surgical simulation
platforms among simulation-naïve participants.
METHODS:
Forty
simulation-naïve medical students were enrolled in this randomized
single-blinded controlled trial. Participants completed a baseline evaluation
on laparoscopic (Fundamentals of Laparoscopic Surgery Program, Los Angeles, CA)
and robotic (dV-Trainer, Mimic, Seattle, WA) simulation peg transfer tasks.
Participants were then randomized to perform a practice session on either the
robotic (N = 20) or laparoscopic (N = 20) simulator. Two blinded, expert
minimally invasive surgeons evaluated participants before and after training
using a modified previously validated subjective global rating scale. Objective
measures including time to task completion and Mimic dV-Trainer motion metrics
were also recorded.
RESULTS:
At
baseline, there were no significant differences between the training groups as
measured by objective and subjective measures for either simulation task. After
training, participants randomized to the laparoscopic practice group completed
the laparoscopic task faster (p < 0.003) and with higher global rating scale
scores (p < 0.001) than the robotic group. Robotic-trained participants
performed the robotic task faster (p < 0.001), with improved economy of
motion (p < 0.001), and with higher global rating scale scores (p = 0.006)
than the laparoscopic group. The robotic practice group also demonstrated
significantly improved performance on the laparoscopic task (p = 0.02).
Laparoscopic-trained participants also improved their robotic performance (p =
0.02), though the robotic group had a higher percent improvement on the robotic
task (p = 0.037).
CONCLUSIONS:
Skills
acquired through practice on either laparoscopic or robotic simulation
platforms appear to be transferable between modalities. However, participants
demonstrate superior skill in the modality in which they specifically train.
PMID:
27924388 [PubMed - as supplied by publisher]
9.J Interprof Care. 2016 Nov 16:1-8.
[Epub ahead of print]
Learning by viewing versus learning by
doing: A comparative study of observer and participant experiences during an
interprofessional simulation training.
Reime
MH1, Johnsgaard T1, Kvam FI1, Aarflot M1, Engeberg JM2, Breivik M1, Brattebø
G2,3.
Author
information:
1a
Department of Nursing, Faculty of Health and Social Sciences , Bergen
University College , Bergen , Norway.
2b
Department of Anaesthesia & Intensive Care , Haukeland University Hospital
, Bergen , Norway.
3c
Department of Clinical Medicine , University of Bergen , Bergen , Norway.
Abstract
Larger
student groups and pressure on limited faculty time have raised the question of
the learning value of merely observing simulation training in emergency
medicine, instead of active team participation. The purpose of this study was
to examine observers and hands-on participants' self-reported learning outcomes
during simulation-based interprofessional team training regarding non-technical
skills. In addition, we compared the learning outcomes for different
professions and investigated team performance relative to the number of
simulations in which they participated. A concurrent mixed-method design was chosen
to evaluate the study, using questionnaires, observations, and focus group
interviews. Participants included a total of 262 postgraduate and bachelor
nursing students and medical students, organised into 44 interprofessional
teams. The quantitative data showed that observers and participants had similar
results in three of six predefined learning outcomes. The qualitative data
emphasised the importance of participating in different roles, training several
times, and training interprofessionally to enhance realism. Observing
simulation training can be a valuable learning experience, but the students'
preferred hands-on participation and learning by doing. For this reason, one
can legitimise the observer role, given the large student groups and limited faculty
time, as long as the students are also given some opportunity for hands-on
participation in order to become more confident in their professional roles.
PMID:
27849424 [PubMed - as supplied by publisher]
10.Anaesth Crit Care Pain Med. 2016
Nov 17. pii: S2352-5568(16)30212-0. doi: 10.1016/j.accpm.2016.09.008. [Epub
ahead of print]
Residual Anxiety after High Fidelity
Simulation in Anaesthesiology: An observational, prospective, pilot study.
Evain
JN1, Zoric L2, Mattatia L2, Picard O2, Ripart J2, Cuvillon P2.
Author
information:
1Division
Anesthésie Réanimation Urgences Douleur, Groupe Hospitalo-Universitaire
Carémeau, CHU Nîmes, Nîmes, France; Centre de Simulation Médicale SIMHU-Nîmes,
Groupe Hospitalo-Universitaire Carémeau, CHU Nîmes, Nîmes, France. Electronic
address: jnevain@hotmail.com.
2Division
Anesthésie Réanimation Urgences Douleur, Groupe Hospitalo-Universitaire
Carémeau, CHU Nîmes, Nîmes, France; Centre de Simulation Médicale SIMHU-Nîmes,
Groupe Hospitalo-Universitaire Carémeau, CHU Nîmes, Nîmes, France.
Abstract
BACKGROUND:
High
fidelity simulation (HFS) in anaesthesiology intentionally provides stress on
students, but anxiety may be detrimental if it goes on through debriefing. The
primary goal of this study was to estimate the proportion of students with
significant anxiety remaining after debriefing (Residual Anxiety: RA).
Secondary goals were to evaluate the instructors' ability to estimate students'
RA and to identify potential risk factors for high RA.
SUBJECTS
AND METHODS:
Following
IRB approval and informed consent, data from a cohort of subjects were
prospectively collected by an independent expert. State-anxiety after
debriefing (RA) was prospectively measured using the State-Trait Anxiety
Inventory (a score varying from 20 to 80/80). RA was considered significant
when ≥ 36/80. Instructors simultaneously estimated the levels of subjects' RA
via a visual analogue scale. Data about subjects, stress during scenarios
(including continuous heart rate monitoring), and debriefings (including DASH©
quality scores) were also collected.
RESULTS:
Seventy
study subjects (30 residents, 26 nurses and 14 anaesthetists) were enrolled
during 52 HFS sessions. As concerns the primary endpoint, RA was ≥ 36/80 in 15
subjects (21%; 95% CI: 13 - 32). The median RA was 30/80 [25 - 35]. For
secondary endpoints, the instructors' estimations poorly correlated with
measurements: rho = 0.36 (p < 0.01); limits of agreement: -16 and 22.
Subjects with RA ≥ 36/80 had significantly higher trait-anxiety (p < 0.01).
An easy scenario (p = 0.04) and low quality debriefing (p = 0.04) were
associated with higher RAs.
CONCLUSION:
Most
students experienced low anxiety after debriefing. Instructors seem to be
unable to reliably estimate students' RA. Students with an anxious personality
are more likely to be anxious after debriefing.
Copyright
© 2016 Société française d'anesthésie et de réanimation (Sfar). Published by
Elsevier Masson SAS. All rights reserved.
PMID:
27867134 [PubMed - as supplied by publisher
11. J Surg Res. 2016
Nov;206(1):199-205. doi: 10.1016/j.jss.2016.07.019. Epub 2016 Jul 16.
Effectiveness of a mental skills
curriculum to reduce novices' stress.
Anton
NE1, Howley LD2, Pimentel M2, Davis CK2, Brown C3, Stefanidis D4.
Author
information:
1Carolinas
Simulation Center, Carolinas HealthCare System, Charlotte, North Carolina;
Department of Surgery, Indiana University, Indianapolis, Indiana.
2Carolinas
Simulation Center, Carolinas HealthCare System, Charlotte, North Carolina.
3Get
Your Head in the Game Inc, Charlotte, North Carolina.
4Carolinas
Simulation Center, Carolinas HealthCare System, Charlotte, North Carolina;
Department of Surgery, Indiana University, Indianapolis, Indiana. Electronic
address: dimstefa@iu.edu.
Abstract
BACKGROUND:
Stress
has been shown to negatively impact surgical performance, and surgical novices
are particularly susceptible to its effects. Mental skills are psychological
strategies designed to enhance performance and reduce the impact of stress to
consistently facilitate the ideal mental conditions that enable performers to
perform their best. Mental skills have been used routinely in other high-stress
domains (e.g., with Navy SEALs, military pilots, elite athletes, and so forth)
to facilitate optimal performance in challenging situations. We have developed
a novel mental skills curriculum (MSC) to aid surgical trainees in optimizing
their performance under stressful conditions. The purpose of this study was to
determine the effectiveness of this MSC in reducing novices' stress.
METHODS:
The
MSC was implemented with a convenience sample of surgical novices over 8 wk.
Two stress tests were administered before and after completion of the MSC to
assess its effectiveness in reducing trainee stress. The Trier Social Stress
Test (TSST) is a validated method of measuring participants' stress responses;
it was implemented by giving participants 10 min to prepare for an impromptu
presentation and 5 min to present it in front of a medical education expert who
would be assessing them. The O'Connor Tweezer Dexterity Test (OTDT) is a test
of fine motor dexterity; participants competed against each other in small
groups who would complete the test the fastest. Such competition has been shown
to cause acute stress in performers. To assess stress, heart rate (HR),
perceived stress (STAI-6), and perceived workload (NASA-TLX) were completed
during all testing sessions.
RESULTS:
Nine
novices (age 23 ± 7 y, 55% women) completed the MSC. HR increased significantly
from resting to performance during the TSST and from early during competition
(at 2 min and 30 s of elapsed time) to immediately after completing the task.
However, participants perceived less stress during and immediately after the
TSST and OTDT tests (P < 0.05) after completion of the MSC. In addition,
they reported significantly less workload during the second OTDT administration
(P < 0.05) and showed a trend toward faster completion of this test.
CONCLUSIONS:
The
novel MSC was effective at reducing surgical novices' perceived stress and
workload during two comprehensive stress tests. Although not statistically
significant, participant's enhanced performance during the OTDT is encouraging.
This curriculum may be valuable to help inexperienced learners reduce stress in
a variety of situations related to learning and performing surgical skills.
Additional research using a larger sample size is currently underway to validate
the effectiveness of this curriculum.
Copyright
© 2016 Elsevier Inc. All rights reserved.
PMID:
27916362 [PubMed - in process]
12.Med Educ. 2016 Dec 12. doi:
10.1111/medu.13208. [Epub ahead of print]
Imperfect practice makes perfect:
error management training improves transfer of learning.
Dyre
L1,2, Tabor A1,3, Ringsted C4, Tolsgaard MG2,5.
Author
information:
1Centre
of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark.
2Copenhagen
Academy for Medical Education and Simulation, University of Copenhagen and
Capital Region of Denmark, Copenhagen, Denmark.
3Faculty
of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
4Centre
for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus,
Denmark.
5Department
of Obstetrics and Gynaecology, Nordsjaelland's University Hospital, Hillerød,
Denmark.
Abstract
CONTEXT:
Traditionally,
trainees are instructed to practise with as few errors as possible during
simulation-based training. However, transfer of learning may improve if
trainees are encouraged to commit errors. The aim of this study was to assess
the effects of error management instructions compared with error avoidance
instructions during simulation-based ultrasound training.
METHODS:
Medical
students (n = 60) with no prior ultrasound experience were randomised to error
management training (EMT) (n = 32) or error avoidance training (EAT) (n = 28).
The EMT group was instructed to deliberately make errors during training. The
EAT group was instructed to follow the simulator instructions and to commit as
few errors as possible. Training consisted of 3 hours of simulation-based
ultrasound training focusing on fetal weight estimation. Simulation-based tests
were administered before and after training. Transfer tests were performed on
real patients 7-10 days after the completion of training. Primary outcomes were
transfer test performance scores and diagnostic accuracy. Secondary outcomes
included performance scores and diagnostic accuracy during the simulation-based
pre- and post-tests.
RESULTS:
A
total of 56 participants completed the study. On the transfer test, EMT group
participants attained higher performance scores (mean score: 67.7%, 95%
confidence interval [CI]: 62.4-72.9%) than EAT group members (mean score:
51.7%, 95% CI: 45.8-57.6%) (p < 0.001; Cohen's d = 1.1, 95% CI: 0.5-1.7).
There was a moderate improvement in diagnostic accuracy in the EMT group
compared with the EAT group (16.7%, 95% CI: 10.2-23.3% weight deviation versus
26.6%, 95% CI: 16.5-36.7% weight deviation [p = 0.082; Cohen's d = 0.46, 95%
CI: -0.06 to 1.0]). No significant interaction effects between group and
performance improvements between the pre- and post-tests were found in either
performance scores (p = 0.25) or diagnostic accuracy (p = 0.09).
CONCLUSIONS:
The
provision of error management instructions during simulation-based training
improves the transfer of learning to the clinical setting compared with error
avoidance instructions. Rather than teaching to avoid errors, the use of errors
for learning should be explored further in medical education theory and
practice.
©
2016 John Wiley & Sons Ltd and The Association for the Study of Medical
Education.
PMID:
27943372 [PubMed - as supplied by publisher]
