International Journal of Healthcare Simulation - subjects-1640347750390-711e5735-2e7b-4b1c-9d96-7c31fab09c25 https://www.ijohs.com Default RSS Feed en-us Adi Health + Wellness <![CDATA[150 ‘A Safe Learning Environment’: Simulation-Induced Stress Literature Review]]> https://www.ijohs.com/article/doi/10.54531/CADQ3440 Background:Simulation-based education (SBE) is often celebrated as a safe learning environment, but this usually refers to the risk posed to patients, in this literature review the psychological safety for participants and the elements of SBE that generate or reduce stress are sought. Stress and learning have a complex relationship in adult learning; however, negative stress may inhibit memory formation and so the sustainable effect of SBE learning may be jeopardized by participants experiencing unnecessary stress during SBE. It is therefore important to identify the nature and trigger for stress in SBE to optimize this resource.

Method:

Using the online database PubMed and the search terms (stress and anxiety) AND (Simulation) AND ((clinical education, medical education)) without limits on publication type or date, 20 articles were returned. A non-systematic review was undertaken. Articles that were designed to deliberately introduce stress into SMEs to gauge the effect on performance were excluded. Included studies analysed the type, characteristics and potential triggers of stress evoked through participation in SBE. 17 studies were retained.

Findings:

No studies in the UK were returned, SBE participants were from undergraduate and post-graduate settings and there was a mixture of professional groups included with three studies looking at team-based SMEs. Study design and method varied with an observational study being the most common method. Only one looked at qualitative data from focus groups of SME participants. Nearly all studies recorded a physical marker of stress – heart rate, cortisol level or visible signs of stress such as shaking hands. Two studies looked at techniques to actively reduce stress within the SBE activity; a mindfulness exercise before a task-based simulation and an introduction of a period of relaxation prior to debriefing. Faculty awareness of participant stress was measured objectively in only one study. SME design and equipment stressors were directly considered in two studies.

Implications for practice:

There are limited dedicated studies addressing SBE-induced stress and how this can be modified; furthermore, a lack of research into faculty impact on stress hinders the opportunity to change. This was not a systematic literature review and so the findings are limited, but can help inform practitioners: (1) Repeated exposure and familiarity with SME reduce stress. (2) Designate roles that participants would be expected to undertake in real clinical scenarios. (3) Minimize distracting factors in the environment unless directly contributing to learning outcome. (4) Introducing a purposeful period of calm before debriefing may improve retention of learning outcomes. ]]>
<![CDATA[37 Simulation as a Proactive Patient Safety Tool]]> https://www.ijohs.com/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[130 Impact of Low-Dose High-Frequency <i>in situ</i> Simulation on Inpatient Diabetes Management: A Pilot Study]]> https://www.ijohs.com/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[144 Simulation Without the Bells and Whistles of Technology]]> https://www.ijohs.com/article/doi/10.54531/PGVT4167 Background:Full-scale simulation (FSS) is one of the most effective and commonly used simulation modalities in healthcare education. It enables the rehearsal of skills in a safe and controlled environment without the risk of harming patients, which provides a strong argument for it being a useful educational approach. With technological developments and the widescale use of simulation technologies in many institutions, simulation has become an essential part of healthcare professional training and curricula. However, setting up a simulation laboratory can be very costly for institutions, as can training facilitators and ensuring equipment maintenance. Simulated patients (actors) are also not universally embraced because of the costs. This makes running an FSS challenging. Furthermore, technology fear, shortage of trained staff, scarcity of space and equipment, workload and applicability to the existing curriculum can be acknowledged as further barriers to the adoption of FSS. We assert that Visually-Enhanced Mental Simulation (VEMS), which includes a patient poster instead of a patient simulator or simulated patient [1] and does not require a simulation laboratory, can be a potential alternative solution to FSS. This is particularly true for non-technical skills teaching.

Aim:

This study aimed to explore nursing students’ evaluation of the VEMS sessions.

Simulation activity outline:

VEMS is a mental form of simulation which includes basic representations of a patient, equipment and interventions. A laminated patient poster is used to represent the patient and laminated equipment cards are used for equipment. A whiteboard or flipchart are used to write interventions and patient parameters in real-time. Also, the simulation session includes ‘thinking aloud’ (participants verbalize their thinking process and actions). Before the scenario, pre-briefing takes place, and a debriefing follows after the scenario, as in FSS.

Method:

As part of a wider project, we piloted the use of VEMS with 30 final-year adult nursing students who consented to participate in VEMS sessions. The main study relied on a quasi-experimental design to compare two simulation modalities, FSS and VEMS. The study was approved by the University of Hertfordshire Ethics Committee (protocol number: aHSK/PGR/UH/03692(2)). Final-year adult nursing students studying at the university were targeted for this study. Control (FSS) and experimental (VEMS) groups were exposed to the same scenarios which included two deteriorating postoperative patients. Students were asked to evaluate the effectiveness of the simulation session with the Simulation Effectiveness Tool-Modified (SET-M) [2].

Results:

The students found VEMS to be effective for their learning and confidence as they marked it 43.70 (SD: 9.11) out of 57. The pre-briefing part scored 2.41 (SD: 0.61), the learning scored 2.19 (SD: 0.50), the confidence subscale scored 2.25 (SD: 0.57), and the debriefing part scored 2.51 (SD: 0.53), all out of three points.

Implication for practice:

This may suggest that students found the VEMS session a useful learning activity which also contributed to developing their confidence. Based on the pilot study questionnaire data, it could be argued that VEMS can be a valuable simulation approach in nursing education as it does not rely on technology and is easy to facilitate anywhere. ]]>
<![CDATA[182 Surgical Simulator Design, What are Educators and Trainees Requirements?]]> https://www.ijohs.com/article/doi/10.54531/QSDB8946 Background:Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to enable trainees to learn technical skills, practice skills and to be assessed in competency exams, need to be of the highest standard and to be of consistent design. Input into the design and makeup of task trainers used to teach surgical skills come from a multitude of sources. Enquiry into the perspectives of simulation has been described in the past but there is little description, in the literature, of the expectations of the desired features of the simulator itself.

Aim:

This study investigates the perceived requirements of simulation and simulators used to acquire skills in the surgical field, particularly in limb exploratory procedures in trauma.

Simulation activity outline:

This study concentrated on the implementation and desired features of simulators for the acquisition of surgical technical skills.

Methods:

Semi-structured interviews were conducted until data saturation was achieved. An international group of 11 surgical educators and 11 surgical trainees, who had experience with surgical simulation, were interviewed via one-to-one video calls. The interviews focussed on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. This study concentrated on synthetic and virtual reality simulators for open surgical skills, as these types of simulators are open to design and redesign or adaptation. Interviews were recorded, transcribed and underwent thematic analysis. Ethical approval was obtained for this study.

Results:

Analysis of the perspectives of surgical educators and surgical trainees on simulated training in open surgery yielded three main themes: (1) attitudes to simulation, (2) implementing simulation, (3) features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt that simulation could be improved with increased accessibility and a variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost-effectiveness, easy setup and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.

Implications for practice:

There is a clear positive appetite for the incorporation of simulation into general surgical and limb trauma training. The findings of this will inform the optimal requirements for high-quality implementation of simulation into a surgical trauma curriculum. The findings will inform the optimal features desired in a simulator or task trainer design. The aim is to inspire a more considered design approach to optimize surgical skills training and ultimately lead to increased patient safety. ]]>
<![CDATA[27 Use of Live Patient Simulation to Train Providers on Sexual Assault Response]]> https://www.ijohs.com/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. ]]>
<![CDATA[31 Debriefing strategies for inter-professional simulation]]> https://www.ijohs.com/article/doi/10.54531/ISLV8283 Background:Inter-professional education is becoming more common worldwide and simulation is one way in which this can effectively take place [1]. The debrief after the simulation is a critical part of the simulation process [2]. There appears to be little research looking into the specific challenges posed by inter-professional debriefing and effective strategies that can be used in this context [3].

Method:

A literature search (see Figure 1) was performed to prompt discussion around debriefing after inter-professional simulation (IPS) and identify the challenges that this IPS debriefing poses and some potential strategies to overcome these. Gaps in the research were also identified. The papers included were analysed by the authors and key themes were identified.
Figure 1:

Findings:

The results of the literature search included 20 papers from 2013 to 2019. Four themes relevant to inter-professional debriefing identified during analysis were: ‘The Debriefer’, ‘Method of Debriefing’, ‘The Learner’ and ‘Psychological Safety’. Several challenges around debriefing after IPS have been identified in the literature, including larger groups of debriefers; inter-professional and larger learner groups; multiple debrief tools and psychological safety including hierarchy issues. Potential strategies to overcome them include an inter-professional debriefing team; a lead debriefer; and learner-centred debriefs with a clear structure. Gaps in the research include challenges around having more than one debriefer including around the psychological safety of participants; whether we should be using the same debriefing tools/practices in IPS as well as other forms of simulation; ensuring a balance between inter-professional learning outcomes and individual learner needs; and the effect of hierarchy in debriefing after IPS.

Implications for practice:

Multiple gaps in the research were identified and there is a need for further research in this area to improve our understanding. Identifying firm answers or rules to follow for every debrief is unlikely to be useful, but a framework to consider the challenges and strategies to overcome them may benefit educators in this area. ]]>
<![CDATA[152 A Narrative Review: Primary Research in Simulation-Based Education using Eye-Tracking Technology]]> https://www.ijohs.com/article/doi/10.54531/UCFQ7265 Background:There has been a gradual increase in research using technology such as eye-tracking in medical education in simulation. Subsequently, the aim of this review is to examine primary research for simulation-based education using eye-tracking technology.

Method:

The Strengthening of observational studies in epidemiology (STROBE) method was used to evaluate the reliability of the simulation and eye-tracking articles [1]. The search strategy included articles published between 2010 and 2021. Articles were searched using terms derived from McCormack et al. (2014). An electronic database search was performed in January 2021: CINAHL, Medline, SCOPUS, Web of Science, Science Direct and APA Psych INFO with 2,621 hits. The search strategy included the following Boolean terms; ‘expert’ AND ‘visual’ OR eye track* (eye tracking) AND simulat* (simulation or simulated) AND diagnos* (diagnose or diagnosis).

Findings:

The key finding from this narrative review highlighted the use of eye-tracking technology as an objective assessment tool in simulation-based education [2]. The literature reinforced the use of algorithms (e.g. ABCDE approach) when assessing a patient. Furthermore, the different gaze patterns between novices and experts were identified. There are limited studies available in simulation-based education using eye-tracking technology. Furthermore, none of the studies has measured the development of gaze patterns in simulation using a longitudinal study with a repeated simulated scenario.

Implication for practice:

Eye-tracking technology can pinpoint the exact areas the healthcare provider is gazing upon during a simulated scenario to help focus the debrief and highlight the gaze patterns. Encourage the use of algorithms when delivering simulation-based 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]]> https://www.ijohs.com/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[84 Using the Team Tool in High-Fidelity Immersive Simulation for Internal Medicine Trainees: Assessing Leadership of Cardiac Arrest Scenarios]]> https://www.ijohs.com/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[165 Medical Students’ Lived Experiences of Online Forum Theatre as a Form of Learning in Consulting with Victims of Domestic Abuse]]> https://www.ijohs.com/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[197 Maintaining Surgical Skills Through Small-Group Simulation During COVID-19 [Quality Improvement Project]]]> https://www.ijohs.com/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[140 What Effect Does Systems Integration Simulation Have on the Sense of Preparedness of Teams Moving to a New Unit?]]> https://www.ijohs.com/article/doi/10.54531/BWLE1794 Background:Testing new healthcare systems, environments and processes using simulation-based methods is a rapidly growing topic in the literature. By testing systems in a safe and controlled environment, simulation for system integration allows operational and safety issues to be flagged up without risking patient care [1]. However, there remains a gap in the literature detailing how these approaches might impact staff experiences of change in healthcare. This research seeks to explore the experience of staff members in the midst of large organizational change, and the use of simulation (using a systems integration approach) to increase confidence and perceived preparedness.

Aim:

This study aims to explore the lived experience of change in nurses moving to a new hospital, and the impact of a simulation programme on their sense of preparedness.

Simulation activity outline:

The Patient Environment Simulation for Systems Integration (PESSI) programme was developed to test new processes and environments to identify latent safety threats and systems issues prior to staff, patient and community use. A major PESSI project was commissioned to aid the transition of paediatric care in Edinburgh to a new hospital site. Simulation scenarios were developed to mimic an average working morning for each department using staff feedback on processes or factors that might be affected by the change in environment. Staff were invited to participate in departmental simulation days which included orientation in the new environment, a simulation scenario, and a professional debriefing. Following each session, a report was produced detailing key findings.

Method:

The research team selected a constructivist phenomenological approach to the enquiry and using Bartunek’s et al.’s conceptual framework designed pre- and post-simulation semi-structured interviews (SSIs), and mid-intervention ‘headline reflections’ [2]. Nurses were chosen as key ward-based staff who could offer a breadth of experience on operational use of the new healthcare environment, and who are not regularly expected to rotate and adapt to new environments like their medical colleagues. Twelve participants were recruited from a range of departments. Data were analysed using a deductive thematic analysis based on Bartunek et al’s conceptual framework [2].

Results:

Results are currently being analysed following the hospital move in March this year. Early findings suggest ‘quality of communication’ and ‘opportunity for familiarization with the environment’ were key themes influencing participant’s feelings of preparedness prior to the move. While ‘recognition of voice’, ‘personal impact’ and ‘good leadership’ appear to be factors impacting participants’ feelings towards the change in working environment after the move. Early indications suggest that the inclusion of local staff groups as part of this simulation had a positive impact on the perception and preparedness of large-scale change.

Implications for practice:

As simulation for system integration becomes more common, it is important that we tailor simulation programmes to best prepare not only the new systems but also the people working there. This can only be done through listening and learning from staff experiences. The research team will seek to publish these findings to help inform future simulation for systems integration programmes. ]]>
<![CDATA[132 Assessment Tools to Measure Clinical Reasoning While Attending Simulation-Based Courses]]> https://www.ijohs.com/article/doi/10.54531/UDZB8526 Background:Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety [1]. To avoid practice mistakes, healthcare professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, healthcare professionals should get the chance to practise and be exposed to various experiences and levels of patient complexities. Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [2]. Through simulation, learners can get the chance to practise clinical reasoning with focussed learning opportunities [3]. Several assessment tools have been used to measure clinical reasoning while attending simulation-based activities. However, we would like to explore the most valid and reliable tools to assess clinical reasoning while attending simulation, in addition to finding out whether these tools have considered the seniority and competency levels of their users.

Method:

A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.

Findings:

There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST [1]; 
Lasater Clinical Judgment Rubric LCJR [4]; Creighton Competency Evaluation Instrument Creighton C-SEI- Tool [5]. 
However, the validity and reliability of these tools were tested on undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.

Implications for practice:

There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions. ]]>
<![CDATA[145 Scenario-Based Perinatal Psychosis Simulation for Final-Year Midwifery Students: A Qualitative Study]]> https://www.ijohs.com/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[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]]> https://www.ijohs.com/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[154 An Observational Study: An Examination of Eye Movements When Assessing a Deteriorating High-Fidelity Patient Simulator]]> https://www.ijohs.com/article/doi/10.54531/ERVK9255 Background:Simulation has been identified as one of the principles to improve patient safety [1]. To increase and advance the research with eye-tracking and simulation, the researcher piloted a longitudinal, exploratory study of eye movement. Eye tracking is considered a novel method in assessing gaze behaviour in simulation has the potential to teach novices expert eye gaze [2,3].

Aim:

The aim of this study was to explore the gaze patterns of healthcare students when assessing an HPS.

Simulation activity outline:

A longitudinal study was conducted between 2014 and 2015 at three different time points (3, 6 and 12 months) with a final transfer study (with or without a patient monitor).

Method:

The study was conducted in a simulated environment with student paramedics and operating department practitioners (N = 6). Participant eye movements were measured whilst participants assessed a simulated patient with and without a monitor.

Results:

The images represent the gaze behaviour of 1 participant at testing phase 1 (Figure 1) and phase 3 (Figure 2). The gaze pattern changes and the participant demonstrates a more holistic approach when assessing a patient in phase 3 without monitor 3.
Phase 1.
Figure 1:
Phase 1.
Phase 3.
Figure 2:
Phase 3.

Implications for practice:

Encourage the use of an algorithm from the end of the bed to recognize a deteriorating patient and teach simulation with the HPS monitor switched into the off mode. Training through the observation of gaze patterns may help develop the design of simulation alongside augmented or mixed reality technology for the future. ]]>
<![CDATA[136 Point-of-View Simulation of Illness Experiences for Health Professions: A Scoping Review of the Literature]]> https://www.ijohs.com/article/doi/10.54531/DIUB9547 Background:Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness but to date there has been no overarching review of the extent of this practice or the impact on empathic skills. Our aim was to determine from the evidence – what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills.

Methods:

Arksey and O’Malley’s methodological framework informed our scoping review of articles relevant to our research question. Three databases (Medline, Embase and Web of Science) were searched in November 2020 and a sample of 516 citations were exported to Covidence Systematic Review Software© for screening. Following review and application of our exclusion criteria, 79 articles were selected in February 2021 to be included in this review.

Findings:

Of the 79 articles, 52 [66%] originated from the USA, 37 (47%) were qualitative based and 17 (28%) used a mixed-methods model. 77 (97%) of the articles explored the impact on learners with the majority (85%) reporting positive impact and range of emotions evoked. For instance, loss of independence throughout paralysis or impairment simulations left the majority of participants feeling vulnerable – ‘somebody they did not want to be, something negative’. Often learners gained a greater sense of empathy towards their patients, generating a range of measures that they could translate into practice to demonstrate a more holistic approach (providing more time, conveying reduced amounts of information). However, some studies observed more negative effects and additional debriefing was required post-simulation. For example, auditory hallucination studies reported a decrease in intention to help or interact with individuals with a mental illness, they did not engender goodwill or a desire to have contact, but rather facilitated social distance and negative emotions, as well as an increased willingness to apply forced treatment. A sense of suspicion and less positive attitudes towards older adults was likewise observed in some simulations of old age. Learners were noted to internalize perceived experiences of illness and to critically reflect on their empathic role as healthcare providers.

Implications for practice:

A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown. ]]>
<![CDATA[157 Pilot Study: Virtual vs Manikins: Simulating Reality in Medical Education]]> https://www.ijohs.com/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[76 Benefits and Challenges of Inter-Professional Education Within the Emergency Department <i>in situ</i> Simulation]]> https://www.ijohs.com/article/doi/10.54531/OSHE3724 Background:A comprehensive literature review was performed to critically evaluate the benefits and challenges of inter-professional education (IPE) in the Emergency Department (ED) and within in situ simulation.

Method:

A literature review was carried out for manuscripts within my institution’s high-quality online library, as part of a post-graduate assignment. Search terms included keywords: ‘interprofessional education’, ‘interprofessional teams’, ‘simulation’, ‘emergency medicine’, and ‘healthcare’. A total of 23 peer-reviewed manuscripts were identified spanning a publication range of 22 years (1998 to 2020). Analysis of the literature resulted in the identification of 7 subject headings as most relevant to IPE. These subject headings were ‘patient safety’, ‘patient flow’, ‘learning outcomes’, ‘professional identities’, ‘organization’, ‘technology enhanced learning’ and ‘faculty’.

Findings:

EDs are demanding [1], resource limited [2] and inter-professional (IP) areas, and as a result, anything leading to a reduction in errors and improvement of team working must be welcomed. IPE has been shown to improve both of these key factors; however, IPE within a busy ED is fraught with challenges. These include shift patterns, clinician ‘buy-in’, and not least physical space in a social distancing world. Faculty must consider shared learning outcomes for all professions, which is recognized as being hard to achieve [3], ensuring that the professions are learning ‘with, from and about’ [4], to prevent the step over to multi-professional education. To do this, we must understand each other’s professional identities to improve our team working and by having IP faculty we can represent these identities and use a ‘co-tutoring’ approach [ref. 3, p.89].

Implications for practice:

IPE occurs frequently in in situ simulation, but how can each profession feel like they have equal learning outcomes when the faculty is uniprofessional? By having inter-professional faculty some of the challenges of delivering effective IPE, for all, are easier to overcome. In situ simulation should be inherently IPE but with faculty often uniprofessional we may be creating our own barriers to true inclusivity. There is no doubt that IPE simulation is beneficial when delivered well; however, IP facilitation is currently an area underexplored in the literature. ]]>
<![CDATA[4 Departmental Paediatric Simulation Teaching: How Can we Best Involve Adolescents as Simulated Patients?]]> https://www.ijohs.com/article/doi/10.54531/MKKA9212 Background:Paediatrics requires diverse, adaptable, age and developmentally appropriate communication and clinical skills which HCPs can find challenging, negatively impacting paediatric care. The involvement of simulated patients (SPs) could be used to bridge this gap and bring patient perspectives. To create authentic, high-fidelity paediatric simulations it makes sense that young people should have a role. As a paediatric registrar in a district general hospital, I considered how to involve adolescent SPs in teaching by performing a literature review.

Method:

On 2 February 2021, an advanced title and abstract search on PubMed: ‘paediatric’/’children’/’adolescent’ AND ‘simulated patient’/’simulated patients’/’standardized patient’/’standardized patients’. In total, 196 results returned which I filtered as per the inclusion and exclusion criteria (Table 1) leaving five articles.
Table 1:
Inclusion/exclusion criteria
Inclusion criteria Exclusion criteria
1. Real-time encounters with 
SPs -SPs >18 years old -Parental SPs only
-SPs 12–18 years old -Adult playing child or young person
-Available in English -Not available in English
Findings 1.Recruitment: SPs were recruited from theatre groups [1], schools [2,3] or by word of mouth [4,5]. One group ran sessions at a local school which were included in the curriculum [2]. 2.Training: some authors ran didactic teaching about conditions, rehearsals or video training [4]. A lack of training was found to be troublesome. 3.Scenarios: standards of best practice state that simulated patients should be involved in resource writing and evaluation. However, while one group personalized scenarios [5] no SPs collaborated in writing. One study felt that it was unkind to ask SPs to draw upon potentially negative personal experiences [1]. 4.Feedback: honest feedback from SPs is central to optimizing learning which SPs found challenging. Training to feedback with ‘I’ statements or using ‘the character’ to feedback was useful [1,5]. Some studies paired SPs with parents for feedback [1]. 5.Positive impact: SPs felt the experience was positive and would be involved again. Positive impacts include: increased trust in HCPs [1,2], increased confidence [1], learning about illnesses and reduced stigma around mental illness [2,4]. I also note the future benefits of having well-trained and competent HCPs who communicate effectively. 6.Negative impact: exhaustion, boredom and potential for exploitation (missed schooling) [5]. Mental health roles fostered anxiety and depressive symptoms which were underestimated by the SPs themselves [4]. Some parents were debriefing their own children in the absence of a formal debrief [1]. 7.Student learning: real children challenged students’ interpersonal skills and rendered encounters realistic. Implications for practice 1.‘Do no harm’ remains paramount in medical education. The benefit to society must be weighed against the risks to the child and their best interests must be kept central in educational processes. 2.When planning teaching I will: 3.Run monthly simulation sessions consolidating weekly didactic teaching 4.Limit sessions to 1 hour 5.Recruit young people within the hospital to minimize school absence 6.Invite collaboration between SPs and students to create scenarios around self-identified learning needs while maintaining psychological safety, allowing for complexity and fidelity that would be impossible if written by faculty 7.Train SPs to feedback using ‘I’ statements 8.Collaborate with the Child and Adolescent Mental Health Team prior to mental health scenarios to consider training and debriefing 9.Keep the SPs voice central to the debrief and feedback ]]>