Default RSS Feed en-us Adi Health + Wellness <![CDATA[Focus groups in Healthcare Simulation]]> /article/doi/10.54531/yamj2519 <![CDATA[The use of Lego® bricks to train novice debriefers]]> /article/doi/10.54531/kupp8710 <![CDATA[The use of simulation-based education in cancer care: a scoping review protocol]]> /article/doi/10.54531/dlvs9567 Background Simulation-based education can be an effective strategy to educate nurses and physicians across the continuum of cancer care. However, there is still a lack of studies collating and synthesizing the literature around the types, functionalities and delivery systems of simulation-based education to educate different professional groups about cancer care.

Aim

To collate and synthesize the literature on how simulation has been used to educate nurses and physicians about cancer care.

Methods

Scoping review methodology according to the Joanna Briggs Institute framework. Published literature is going to be searched through Medline (OVID), CINAHL, EMBASE and PsycINFO. Unpublished literature will be searched through ResearchGate, OpenGrey and open access theses and dissertations. Articles will be considered if the population is nurses (including nurse practitioners) and/or physicians, if they use any type of simulation as an educational strategy as the concept of interest, and if the context is cancer care. This review will consider experimental, quasi-experimental, observational, quantitative and qualitative studies designs, text and opinion papers and unpublished literature.

Expected results

Results from this scoping review will generate a solid underpinning for nursing and medical community to empower evidenced innovation through the further development of simulation-based educational interventions. ]]>
<![CDATA[Team Training for Interprofessional Insight, Networking and Guidance (T<sup>2</sup>IPING) points: a study protocol]]> /article/doi/10.54531/FQAX8042 Introduction Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans.

Methods and analysis

The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).

Ethics and dissemination

The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research. ]]>
<![CDATA[Novel do-it-yourself low-cost abdominal laparoscopy entry simulator for gynaecology trainees]]> /article/doi/10.54531/EEIC5466 Introduction The COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.

Methods

A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.

Results

All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.

Discussion

Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies. ]]>
<![CDATA[Discovering careers in mental health: a qualitative pilot study of a novel simulation-based education programme]]> /article/doi/10.54531/tzae8485 <![CDATA[Simulation in plastic and reconstructive surgery: a scoping review]]> /article/doi/10.54531/hnpw7177 Introduction 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. ]]>
<![CDATA[Introducing a new initiative: Short Reports on Simulation Innovations Supplement (SRSIS)]]> /article/doi/10.54531/ytal729 <![CDATA[Impostor phenomenon in healthcare simulation educators]]> /article/doi/10.54531/zmtl172 Background 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. ]]>
<![CDATA[202 High-Fidelity Simulated Bronchoscopy: Incorporating Simulator into A Mannequin]]> /article/doi/10.54531/ICKV7674 What? Fiberoptic intubation (FOI) is a technique used to establish airway access in patients with anticipated and unanticipated difficult airways. Fiberoptic bronchoscopes are currently used to facilitate endotracheal intubation via either the nasal or oral route, in the positioning of endotracheal and endobronchial tubes and bronchial blocking devices, and in airway examination or evaluation. FOI is used in the management of awake spontaneously breathing patients with an anticipated difficult airway [1,2]. Anaesthetic trainees require development and maintenance of flexible bronchoscopy skills for tracheal intubation. For junior trainees or those who have not had exposure to this procedure, a virtual reality simulator, the ORSIM® bronchoscopy simulator (Airway Simulation Limited, Auckland, New Zealand), has been developed. The ORSIM® simulator is designed to incorporate a virtual patient with a difficult airway. A replica bronchoscope is advanced through a black box desktop sensor, which is connected to a laptop computer and allows visualization of video bronchoscopy. The laptop software program includes upper and lower virtual airways of varying complexity. Virtual oral, nasal and conduit entry points can be selected; the program provides recording, feedback, measurement and relevant clinical data.

So what? The aim of this project was to incorporate the ORSIM® simulator into a manikin for use in high-fidelity simulation. A basic resuscitation training manikin was used (Figure 1). The silicone/rubber skin was removed. The ORSIM® black sensor box was placed over the head with an exit point towards the thorax (Figure 2). Polystyrene was used to support the head and cheek region (Figure 3). Inexpensive props such as hats and wigs were used (Figure 4), and patients and monitors were positioned for high-fidelity simulation (Figure 5).

A basic resuscitation training manikin is used. The silicone/rubber skin is removed.
Figure 1:
A basic resuscitation training manikin is used. The silicone/rubber skin is removed.
The ORSIM® black sensor box is placed over the head with an exit point towards the thorax.
Figure 2:
The ORSIM® black sensor box is placed over the head with an exit point towards the thorax.
Place polystyrene to support head and cheek region. This could be substituted with other materials such as foam/wax.
Figure 3:
Place polystyrene to support head and cheek region. This could be substituted with other materials such as foam/wax.
Optional: the use of inexpensive props such as wigs/hats/shirts.
Figure 4:
Optional: the use of inexpensive props such as wigs/hats/shirts.
Position patient and monitor for high-fidelity simulation.
Figure 5:
Position patient and monitor for high-fidelity simulation.
Figure 6:

We found that the ORSIM® simulator was a useful tool for training. The virtual video guidance can be used to familiarize clinicians with different pathology and improve technical skills. By incorporating the simulator into a manikin, a more realistic model can be created. Here we have used very inexpensive and often readily available equipment within a healthcare setting to achieve this. This model can be used as part of a high-fidelity simulated scenario to improve the learning experience.

]]>
<![CDATA[84 Using the Team Tool in High-Fidelity Immersive Simulation for Internal Medicine Trainees: Assessing Leadership of Cardiac Arrest Scenarios]]> /article/doi/10.54531/ZSJX2498 Background:Non-technical skills (NTS) play a crucial role in cardiac arrest resuscitation performance, both in simulated and clinical environments [1]. Poor performance in these skills, particularly leadership, has been highlighted in acute medical emergency and cardiac arrest teams [2]. Simulation training aims to develop internal medical trainees (IMT) NTS in leading cardiac arrest teams, a role that is expected of them as they progress in their training.

Aim:

This observational pilot study aimed to explore the leadership and team-working behaviours of IMT1 doctors in a simulated cardiac arrest scenario, to identify strengths and areas for improvement to focus future training.

Simulation activity outline:

The Scottish national IMT1 boot camp involves a variety of high-fidelity immersive simulation scenarios across the 3-day course. Trainees are in groups of six with one IMT taking a lead role in each scenario. This study assessed a scenario of shockable rhythm cardiac arrest. All group participants are involved as the cardiac arrest team, with the original ‘hot seat’ participant expected to take the role of team leader, unless otherwise agreed by the team. The scenario is followed by a facilitated debrief around leadership in cardiac arrest.

Method:

Following ethical approval from NHS Education for Scotland and written participant consent, videos of the cardiac arrest scenario were observed by the research team. Leadership and team behaviours were scored using the validated Team Emergency Assessment Measure (TEAM) [1]. Field notes including general observations of the three main TEAM categories (leadership, teamwork and task management) were also recorded. Participants completed a pre- and post-course questionnaire, including rating their confidence in leading cardiac arrests.

Results:

Seventeen videos involving 102 trainees were reviewed and scored using the TEAM tool. The average overall TEAM score was 6.19/10. Scores for each of the 11 NTS domains ranged from 2.13/4 to 3.25/4. IMT1s scored highly on adapting to changing situations and monitoring and reassessing, but poorly on team leader displaying direction and command and leader maintaining a global perspective. When leadership scores were high, overall team performance was also high. General observations from field notes found the team often did not allocate a leader until cardiac arrest occurred. The leader often struggled to remain hands-off with a lack of assertiveness and poor communication between the leader and team. One hundred and fourteen IMT1s completed a pre- and post-course questionnaire. Average pre-course confidence in cardiac arrest team leadership was 3.8/7, and among the lowest of all situations rated. This improved to 5.35/7 post-course, but compared with other situations, remained low.

Implication for practice:

This pilot study found leadership to be a key component in managing cardiac arrest for IMT1s, influencing overall team performance. Particular areas for improvement include hands-off leadership, leader assertiveness and whole team communication, which could be the focus of future educational interventions. Scenario participation and facilitated debrief improved overall confidence, but further focussed leadership and team training is required as IMT1s transition into the leadership role. ]]>
<![CDATA[197 Maintaining Surgical Skills Through Small-Group Simulation During COVID-19 [Quality Improvement Project]]]> /article/doi/10.54531/OHXV9347 Background:The COVID-19 Pandemic has had a significant disruption to the provision of Surgical Training. Core and Improving Surgical Trainees (CSTs and ISTs) are noted to be a group profoundly affected due to the impact of the pandemic in reducing operative time, cancelled elective procedures and redeployment to other specialities [1,2].

Aim:

We aimed to evaluate the benefit of Small Group Surgical Simulation teaching for CSTs and ISTs recently deployed in the Norfolk and Norwich University Hospital.

Simulation activity outline:

Physical simulation models were designed with the use of animal tissue and/or surgical simulators (such as laparoscopic box trainers) to simulate surgical procedures appropriate for the grade of trainees.

Method:

We designed a monthly Surgical Simulation Programme, which took place in the Surgical Skills Laboratory. Topics were selected from those suitable for Simulation from the Intercollegiate Surgical Curriculum Programme (ISCP) Core Surgical Curriculum [3]. Consultants and Senior Registrars from various Surgical Specialties were approached. Animal tissue and surgical simulators were used in conjunction, to simulate surgical environments as closely as possible with funding provided by NANIME (Norfolk and Norwich Institute of Multi-professional Education). Sessions were advertised to all CSTs and ISTs; however, due to COVID, restrictions on the number of participants were restricted to <10. Participants were asked to anonymously complete pre- and post-session surveys.

Results:

Participants felt that the COVID pandemic affected opportunities to perform/assist or observe the surgical skills. Participant comments on COVID affecting opportunities included ‘Reduced opportunities due to cancelled lists’, ‘Fewer elective cases so less opportunity ‘ and ‘Affected in the Peak of COVID but it is improving. Following the session, 100% of participants found the sessions to be effective in improving confidence in performing the surgical skill and 87% found the sessions to be extremely effective. Participants found the teaching sessions to be useful due to the opportunities of ‘Close supervision and direct feedback’, ‘Set of tasks’, ‘Practise with animal models’, ‘Having the tutor there to assist and help us’ and ‘[Discussing] theory prior to learning the procedure’.

Implications for future practice:

Surgical simulation provides opportunities for early-year trainees to learn and perform surgical skills during the COVID-19 pandemic. Small-group surgical simulation allows CSTs and ISTs to develop and practise skills under supervision of tutors, with trainees finding real-time feedback useful. In a post-COVID era, a surgical simulation teaching programme could provide an effective training opportunity to shorten the steep learning curve of core surgical training. ]]>
<![CDATA[157 Pilot Study: Virtual vs Manikins: Simulating Reality in Medical Education]]> /article/doi/10.54531/XGKZ1523 Background:Immersive virtual reality (VR) has exciting potential as a training tool, providing opportunities for more independent learning, easier access and repeatability, and fewer cost implications [1]. But more evidence is needed regarding its utilization in teaching clinical decision-making, in particular, understanding where it fits with relation to simulation suites using high-fidelity manikins (SimS). To date, there appears to be only one other study that has investigated this question, but the comparative effects of the teaching modalities were potentially blurred as SimS was undertaken in groups compared with VR in single-player scenarios [2].

Aim:

Use mixed methods to analyse the differences in confidence and competence in clinical decision-making between medical students trained using either VR or SimS scenarios; and the perceived value and experience of VR compared with SimS.

Simulation activity outline:

To teach students through participating individually in acute medical scenarios (sepsis-based) in the VR and SimS environments. Volunteers were given time to familiarize themselves with each environment beforehand, and the scenarios and debriefing were replicated in each setting (content and timing) as much as possible.

Method:

In April 2021, nine medical students (in their first clinical year) volunteered to take part in the pilot and were randomly allocated to experience either SimS or VR first, in a simulation centre attached to a university hospital. Each session ran as follows, with paper questionnaires used to collect data: 1.Baseline confidence and competence questionnaires; 2.Lecture on the topic (sepsis); 3.Familiarization followed by scenarios and debrief (Group A – VR, Group B – SimS); 4.Follow-up competence and confidence questionnaires; 5.Familiarization followed by scenarios and debrief (Group A – SimS, Group B – VR); 6.Comparison and general feedback questionnaires. Data were transcribed into Excel® for analysis. This was a proof-of-concept pilot for a larger study that has ethical approval (MS IDREC Reference: R76053/RE001).

Results:

Both the VR and the SimS groups increased their confidence (VR 3.75%, SimS 4.2%) and competence (VR 10.73%, SimS 11.44%) in relation to clinical decision-making. Overwhelmingly, 89% of the students wanted to undertake the VR training before SimS, although 66% preferred SimS overall to VR. Participants described VR training as feeling safer, less pressured and allowing them to consolidate prior learning. This subsequently increased their confidence to tackle SimS training, which felt more stressful, challenging and true-to-life, with the added bonus that more could then potentially be gained from SimS. Each modality was felt to increase the students’ confidence in clinical decision-making, while adding different aspects to the learning experience.

Implications for practice:

This pilot indicates that a larger study would give more information on the best utilization of VR in medical student training. The data suggest VR training is a good introduction to and complements SimS training. Additionally, the increases in confidence and competence it induces make it an independently valuable tool, suggesting it could be a viable alternative where SimS is unavailable, e.g. due to lack of funds or a pandemic, where face-to-face educational opportunities may be limited. ]]>
<![CDATA[130 Impact of Low-Dose High-Frequency <i>in situ</i> Simulation on Inpatient Diabetes Management: A Pilot Study]]> /article/doi/10.54531/TTAC2270 Background:Even in the presence of established institutional guidelines, failure of compliance by the clinical teams plays an important role in the control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care [1].

Aim:

We wanted to demonstrate the efficacy of low-dose high-frequency in situ simulation exercises through a pilot study in a ward setting to improve outcomes in patients with diabetes.

Simulation activity outline:

The exercise was a 15-minute session, delivered during working hours to individual nurses. This consisted of a 5-minute scenario, involving a standardized patient followed by a 10-minute debrief. Modified Diamond-model debrief with an advocacy-inquiry model was used by the debriefer, a trained fellow in simulation, and overseen by an expert. The scripted scenario involved a patient with Diabetic Ketoacidosis (DKA), with learning outcomes of recognizing DKA, managing the patient and adhering to the institutional guidelines including management of hypoglycaemia. The scenario was individualized based on the roles of the participants. Pre- and post-questionnaires were given to the participants. The simulation was repeated twice in the second week and once in the third week.

Methodology:

This mixed-method study was conducted in a UK teaching hospital, in a ward designated for patients with diabetes, as a part of a quality improvement programme. In the first week, patients with diabetes, admitted for DKA, were chosen and their blood sugar recordings, dysglycaemic episodes and adherence to guidelines were noted. Every week data were collected as in the first week. GNU pspp 1.0.1 [version 3] free software was used. The confidence scores were given as mean and standard deviation with confidence interval (CI) of 98.75%. A p-value of <0.0125 was considered significant based on the number of data points.

Results:

The in situ simulation was delivered to a total of nine ward staff. There was a significant improvement in the confidence levels at the end of the session. The number of blood sugar recordings were 1.4 per person-days in the first week, 2.07 in the second week and 3.6 in the third week (Table 1). Hypoglycaemic episodes correctly identified were 4.76%, 6.9% and 14.29% in the 3 weeks, respectively. Sugars >14 mmol/L were identified 28.57%, 37.93% and 57.14%, respectively, for the 3 weeks. Qualitative analysis showed protocol adherence issues and latent medication errors in addition to positive changes with regards to handover and diagnosis of hypoglycaemia.
Table 1:
Dysglycemic episodes and protocol adherence from medical records
Week Age/
Sex Patient Days Number of sampling hypoglycaemic episodes hyperglycaemic episodes Treatment for hypoglycaemia as per protocol Protocol adherence once sampled
1 40/F 1 5 9 1 3 No Yes
28/F 2 4 5 0 2 NA No
29/F 3 3 3 0 1 NA No
71/M 4 3 4 0 0 NA No
2 64/M 5 2 3 0 0 NA No
72/M 6 6 18 0 10 NA No
31/F 7 2 3 1 0 No Yes
70/M 8 3 3 0 1 NA No
73/M 9 1 2 1 0 Yes No
3 39/F 10 2 7 1 3 Yes Yes
68/M 11 2 6 0 0 NA Yes
77/M 12 4 15 3 5 Yes Yes
30/F 13 2 8 0 8 NA Yes

Implication for practice:

Considering the T2 (increased recognition of diabetic emergencies and adherence to protocol) and T3 (improved patient outcomes) outcomes, the methodology was recommended as a modality of training the nursing staff involved in inpatient care of patients with diabetes. Future programmes including multi-disciplinary teams, to explore teamwork and communication, are planned. ]]>
<![CDATA[37 Simulation as a Proactive Patient Safety Tool]]> /article/doi/10.54531/JPSD8969 Background:Traditionally, in situ simulation has been used to improve patient care by identifying knowledge or skills gaps and improving teamwork and non-technical skills. However, there are little data demonstrating objective improvement in morbidity and mortality directly attributed to in situ simulation [1]. There is a growing recognition of the use of in situ simulation to detect latent safety errors (LSEs) [1,2]. These are errors of system, environment or teams which may be unrecognized until they are identified in the stressful and realistic conditions of a simulated scenario in a clinical environment. Currently, no standardized system is described to score type or severity of LSE limiting the reproducibility and application of this approach to harm reduction.

Aim:

The aim of the study was to develop a tool to detect latent safety errors during in situ simulation which is fully integrated with existing Trust safety metrics.

Simulation activity outline:

In situ simulation in a district general hospital across community and acute clinical areas.

Method:

Multi-professional in situ simulation was led by an experienced facilitator. A pilot phase was limited to the Acute Medical Unit and informed the thematic classification of errors. Further in situ simulation took place in medical, surgical, emergency department and community hospital settings. Thematic analysis was completed using the framework of Trust incident coding (Radar Healthcare). During the simulation sessions, latent errors were identified and discussed in the debrief. A data collection proforma was developed using an iterative process over 12 months using Microsoft forms. This research was funded by Health Education England South West Simulation Network with the support of the local Somerset Simulation Team.

Results:

During the pilot phase, 73 participants took part in 7 simulations on AMU. Facilitators identified 28 latent errors. Comparison with other sources of safety data (formal incident reporting and critical care outreach team data) showed that in situ simulation identified errors in oxygen and fluid management unrecognized by other data sources. In the second phase, 146 participants took part in 32 in situ simulations. Facilitators identified 82 latent safety errors and coded them into 18 error types (see Table 1). Work is ongoing to compare these to trust incident reports.
Table 1:
Latent safety error by incident code
Theme No. of latent errors detected Radar incident code Total by incident code
Oxygen use and equipment 12 Medical devices 43
Defibrillator use and equipment 13 Medical devices
Fluid delivery and equipment 4 Medical devices
Glucose monitoring equipment 2 Medical devices
Other equipment 7 Medical devices
Location of equipment 5 Medical devices
Incorrect medication dose 1 Medication 5
Other medication issue 4 Medication
Access to a locked area 3 Health and safety/environment 11
Emergency call system issue 2 Health and safety/environment
Noise 2 Health and safety/environment
Other environment 4 Health and safety/environment
Cardiac arrest algorithm 7 Care pathway issues 17
Getting help in an emergency 7 Care pathway issues
Organizational 3 Care pathway issues
Communication/teamwork 2 Communication/documentation/IT 4
E-Obs issue 2 Communication/documentation/IT
Assessment of deteriorating patient 2 Patient safety 2
Total 82

Implications for practice:

We have identified three major outcomes: Shared learning: latent safety errors are rarely unique to one clinical area and have the potential to occur elsewhere in the Trust. Wider dissemination of latent safety errors at a directorate level allows proactive interventions to reduce patient harm. A monthly Simulation Safety Outcome Report shared with senior nursing staff at a directorate level is being evaluated. Responsive learning and staff engagement: latent safety errors were discussed at every debrief. Participants provided valuable suggestions often resulting in immediate local interventions. This internal resolution has engaged and empowered clinical staff in patient safety. Targeting resources: Integration of active and latent error data from numerous sources allows Trust safety management structures to target resources to improve patient safety and develop sustainable approaches to risk reduction. National standardization of coding active errors (incidents) and latent errors would broaden the use of in situ simulation as a proactive safety tool. ]]>
<![CDATA[145 Scenario-Based Perinatal Psychosis Simulation for Final-Year Midwifery Students: A Qualitative Study]]> /article/doi/10.54531/JTGP9733 Background:Approximately 20% of women will reach diagnostic thresholds for mood disorders during the perinatal period, and between 0.1% and 0.2% will experience a psychotic disorder [2]. Postnatal psychosis is a dangerous condition with an often rapid onset following a baby’s birth. In severe cases, symptoms may include a mother’s desire to harm herself or her baby. The midwifery profession reports feeling ill-prepared to provide mental healthcare, and the adequacy of mental health content in training curricula has been questioned. The rarity of perinatal psychosis also means that clinical placement opportunities for student midwives are limited. Scenario-based simulated learning provides one possible solution to this challenge.

Aim:

The aim of the study was to explore final-year midwifery students’ experiences of a perinatal psychosis, scenario-based simulation (SBS).

Simulation activity outline:

A 1-day SBS learning activity with two scenarios of women exhibiting psychotic symptoms. Each scenario included a background narrative, actors’ roles with partial scripts and comprehensive patient clinical information. Two midwifery students acted as assessment staff in each scenario whilst their colleagues took observer roles. Guided debriefing followed each scenario.

Method:

The study was conducted in March 2020 at a UK Higher Educational Institute. It employed an exploratory, descriptive design to capture qualitative data from 11 final-year midwifery students who took part in the SBS. Data sources included semi-structured interviews and information shared during scenario debriefings. Data were thematically analysed following the seven-step process of Dahlgren and Fallsberg [2]. Ethical approval for the study was granted in July 2019 (LRU-18/19-13171).

Results:

Three main themes emerged from the data. The SBS facilitated learning through different ways of knowing. Students drew on personal experiences to identify communication and care challenges, re-appraised assumptions they held about mental health and ethnicity and articulated the benefits of peer learning. Students held equivocal views concerning the adequacy of mental health content in existing curricula, and not all had encountered women with perinatal psychosis on clinical placements. Clinical environments were highly valued learning contexts for the observation of staff and the gradual, supervised application of practice skills. Both learning mechanisms were replicated in the SBS, which helped the students realize attributes and skills in themselves necessary for the care of women with perinatal psychosis. The SBS facilitated transformative learning through its realism and the development of skillsets not amendable to didactic teaching, e.g. teamwork and communication skills. Debriefing helped to cement learning in the minds of students.

Implications for practice:

The SBS was an effective form of pedagogy that enabled invigorating and deep learning. It is recommended that other educators consider its use, particularly for conditions that students do not always encounter in clinical placements. Well-prepared, detailed scenarios are recommended to promote realism and each SBS should be followed by a structured debrief. Developments should be accompanied by evaluative methodologies to gauge their impact and further research is needed to better understand how SBS can be used more effectively throughout midwifery education. ]]>
<![CDATA[179 A Cross-Sectional Study on the Effectiveness of Simulation-Based Learning in Emergency Medicine for Medical Undergraduates in a Low-Middle Income Country During the COVID-19 Pandemic]]> /article/doi/10.54531/PBNR8697 Background:Learning emergencies is a challenge during COVID-19 pandemic for medical students. Managing a real patient in an emergency exposes the medical students and patients to risks now more than ever before. Simulation-based learning (SBL) is a proven safer teaching method to improve technical and non-technical medical knowledge, skills, and to enhance confidence in high-income countries. There is limited literature on the effectiveness of SBL in low-middle income countries (LMICs) [1].

Aim:

This study evaluates final-year medical undergraduates’ knowledge, skills and confidence improvement through a novel SBL in an LMIC during the COVID-19 pandemic.

Simulation activity outline:

Four simulation scenarios were conducted by an instructor to a small group of five to six participants. The instructors were Emergency Medicine Senior Registrars or Registrars, who had prior knowledge in teaching techniques through a formal instructor development course elsewhere. The simulation sessions were based on four scenarios. A high-fidelity mannequin, basic airway devices, IV access, monitoring devices and a defibrillator were used. Pendleton Model [2] was used for debriefing. A pre- and post-questionnaire was used to assess improvement of knowledge and confidence level of management of the scenario.

Method:

Final-year medical students of the University of Colombo were trained on medical emergency care skills and subsequently they were given the opportunity to apply skills in simulation. This course was conducted twice a week, 4-hour sessions, for 6 weeks in March and April 2021. There were four skills stations, including ABCDE assessment, airway management, defibrillation with BLS and non-technical skills. A pre- and post-MCQ was used to assess improvement of knowledge and confidence level on performing each skill. Likert-scale questionnaires were administered before and after each simulation session to assess the level of confidence in performing each task of the simulated scenario. The normal distribution of data was tested with the Shapiro–Wilk test. If the distribution of data was not normal, Wilcoxon signed-rank test was used to compare pre- and post-test scores. Paired sample t-test was used to compare pre- and post-test data if the distribution of data is normal.

Results:

All 42 participants experienced SBL for the first time ever. Post-test MCQ score significantly improved compared with pre-test score (p < 0.001). Confidence in skills increased in all 17 domains following the skills sessions in all participants. Confidence to manage cardiac arrest increased in all 10 tasks of the cardiac arrest simulation and the total average confidence score rose from 17.1 (±4.7) to 32.0 (±7.7) after the simulation-based intervention (p < 0.001). Confidence increased significantly in all 12 domains of asthma and anaphylaxis management with the total average confidence score rising from 21.4 (±0.8) to 39.2 (±2.1) (p < 0.001). Satisfaction and attitudes towards simulation-based learning were very positive.

Implication for practice:

The course has shown a statistically significant improvement of students’ knowledge and confidence in skills with a high level of satisfaction. Therefore, SBL is an effective, safe and feasible alternative to train emergency medicine for the students of LMICs during COVID-19 pandemic. ]]>
<![CDATA[165 Medical Students’ Lived Experiences of Online Forum Theatre as a Form of Learning in Consulting with Victims of Domestic Abuse]]> /article/doi/10.54531/IFJD5167 Introduction:Domestic abuse (DA) is a prevalent problem in today’s society; over 2.4 million adults in England and Wales experienced DA in 2019 [1]. DA can have a significant impact on its victims. Healthcare professionals (HCPS) have an important role in the care of DA patients. Therefore, it is important that HCPs are adequately trained in recognizing DA features and supporting victims during/following disclosure. One area that significantly requires improvement is domestic abuse teaching in medical students, as shown in a cross-sectional study carried out across UK medical schools, 52% of medical students who received DA training reported it only lasted between 0 and 2 hours [2]. In this study, we aim to gain a deep understanding of medical students’ lived experiences of online Forum theatre (FT) in consulting with DA victims.

Method:

A multi-disciplinary team developed an online FT exercise, which involved a simulated consultation between a GP and DA victim. Spectators are invited to take the place of an actor or guide the actor and decide what action to take, thus helping to change the outcome of the scene. A qualitative approach was conducted, involving hermeneutic phenomenology, to explore participants’ lived experience of the FT exercise. Following the online FT experience, medical students were interviewed, and interview transcripts were analysed using a template analysis approach.

Results:

Five themes were developed through our analytical process: (1) ‘Almost being there…but not quite’: the realistic experience of FT; (2) ‘Taken on an emotional journey’; (3) ‘Opening and controlling a privileged space’; (4) ‘Small things matter…’: cultivating and maintaining rapport and (5) critically reflecting on future professional self.

Discussion:

This study provides an in-depth view of a medical student’s experience of online FT. Online FT has the potential to provide a novel DA teaching method for medical students. By providing students with a unique opportunity to step into a GP’s shoes in a DA consultation, students can practice how they will handle a DA scenario, without any potential consequences, helping them to improve their consultation skills. ]]>
<![CDATA[172 Student Perception of Skills and Simulation Delivery Within an Undergraduate Nursing Curriculum: Looking at the Creation and Introduction of a Skills and Simulation Delivery Framework]]> /article/doi/10.54531/MCGO1218 Background:When developing our new undergraduate nursing curriculum, we wanted to ensure that it was simulation based; however, we were unable to find frameworks or direction of how to integrate this. Despite a wealth of evidence to support the use of simulation as an effective modality, there is no current literature that describes a system of integrating simulation in a standardized manner. Ferguson [1] concluded that there is a gap in how a simulation strategy becomes effectively implemented and embedded within a curriculum. Before we started to make changes, we first wanted to gain an understanding of how students found the existing delivery of clinical skills and simulation and understand what was working and where improvement could be made.

Aim:

The aim of this research was to have both qualitative and quantitative data to support the hypothesis that a framework is needed to integrate skills and simulation with a healthcare education curriculum.

Simulation activity outline:

For this study, there was no new addition of simulation; the aim was to look at what was in existence and gather student experience data.

Method:

This study took a mixed methodology collecting both qualitative and quantitative data through a questionnaire. The questionnaire was designed to ascertain the student’s existing level of experience in skills and simulation, their opinion as to how effective the current method of delivery was. Opinion was also sought on thoughts in relation to changing the delivery of skills and simulation. All first- and second-year pre-registration nursing students were invited to take part. Ethical approval was sought and granted by the university ethics panel.

Results:

Three main themes were generated and will be discussed. Communication: many students described their lack of confidence in communicating with senior staff and other members of the multi-disciplinary team (MDT). This was, they felt, linked with a lack of experience and a lack of exposure to working with more senior staff. Confidence within their role: Students felt that simulation did improve their confidence but that there should be much more of it within their curriculum. They discussed the fact that it was a much more powerful resource than ‘sitting in a lecture theatre’. Feeling stressed and intimidated: Students reported that although the high-fidelity simulation sessions and scenarios could prepare them for ‘real-life’ emergency situations they did find them rather stressful and intimidating.

Implications for practice:

The results of this initial study demonstrated that students wanted more simulation and that their confidence and competence would be improved from more simulated practice. From the responses given, it was evident that the current delivery of clinical skills and simulation preparation was not effective and student satisfaction was poor. In response to these findings, we have developed a five-stage approach to create a scaffolding of learning bringing simulation into the curriculum from the very start allowing for a gradual cognitive load. The authors expect to find an improvement in the student perceptions of both their competence and confidence in relation to clinical practice. ]]>
<![CDATA[27 Use of Live Patient Simulation to Train Providers on Sexual Assault Response]]> /article/doi/10.54531/KWSH4982 Background:Sexual assault is a worldwide epidemic. According to the World Health Organization (WHO), 35% of women worldwide have experienced sexual violence [1]. Additionally, the Director of Crimes Against Children Center states, ‘one in five girls and one in 20 boys is a victim of sexual abuse’ [2]. In the USA, SANEs (Sexual Assault Nurse Examiners) and SAFEs (Sexual Assault Forensic Examiners) respond to victims of sexual assault as part of a SART (Sexual Assault Response Team). This victim-centred approach is comprised of three members: Victim’s Advocate, Law Enforcement and a SANE/SAFE. Prior to 2014, SANEs and SAFEs obtained certification by practicing on live victims. Once initial studies proved the efficacy of simulation in SANE training, it was recommended that certification be obtained with Gynecologic Teaching Associates (GTAs). Most countries do not have a standard of trauma response for sexual assault victims, and in the USA, there is a misunderstanding of best practices and many SANEs/SAFEs still obtain certification through clinical practice on victims.

Aim:

The aim of the work being conducted in the field was to develop an effective protocol for training sexual assault responders that supports goals of trauma-informed care and provides a standardized protocol to obtain certification through simulation.

Simulation activity outline:

SANE/SAFE training requires an initial 40-hour didactic with anatomy skills training specific to trauma care. Trainees subsequently practice the sexual assault forensic evidence collection kit on simulated patients. They practice communication skills designed to build rapport with trauma survivors, the specialized urogenital examination techniques involved in sexual assault care and have opportunities for speculum insertions to competency. Additionally, they practice documentation/chain of custody procedures critical to the admissibility of evidence in court. Stations are developed to provide practical experience with the kit and with providing specialized care to patients in a variety of demographics; age, gender (or transgender), socio-economic backgrounds, etc.

Method:

This work is based on findings of previous studies that highlight the efficacy of live patient simulation in SANE training to implement safe, effective methods of trauma response via collaboration between SANE/SAFE directors and GTA programming.

Results:

GTA methodology is proved to be an effective method for training the well-patient gynaecologic examination. One of the identified benefits is a reduction in learner anxiety. Because GTAs act as both instructor and patient, they can teach trauma examination skills and provide a unique opportunity for feedback from a simulated sexual assault victim’s perspective. Developing protocol in the field is crucial as more programmes utilize simulation to train new SANEs. It is critical to meet standards of best practices and to maintain safety and reduce risk.

Implications for practice:

This protocol has influenced the way SANEs and SAFEs learn trauma-informed care. The benefits to trauma patients are numerous. The methodology, utilized across the USA, was recently brought to Brazil to train new SANEs. More work must be done internationally to bring this method to areas of the world where no standardized method of sexual assault response exists. Additionally, safety measures and better collaboration are paramount to the continued success of this method. ]]>