Top simulations for November and December

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]