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Abstract

Healthcare delivery has traditionally been structured on the performance of expert, individual practitioners, reflecting the fundamental notion of specialization. In the rapidly changing healthcare industry, this approach is evolving. The increasing amount of clinical knowledge and technological advances, in combination with aging populations, are shaping organizations. Interdisciplinary healthcare teams have become the new model for patient care delivery. In this article we review why Virtual Hospitals are being proposed as a new training model paradigm. Virtual Hospitals replicate substantial aspects of the work environment, and allow simulated clinical immersion. They offer opportunities to reflect on how organizations work, learn how to be more effective when working with others, and acquire the tools that make the differences between an average and an excellent provider.

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... Los escenarios de simulación están diseñados para reproducir situaciones clínicas críticas con diferentes elementos como manejo de emociones, la toma de decisiones, dilemas morales e interacciones complicadas con pacientes, familias o miembros de un equipo multidisciplinario (27) . Se requiere de una introducción (briefing) y el establecimiento de un contenedor seguro para la ejecución del escenario clínico donde se establezcan las condiciones de lo que se puede hacer y lo que no, así como los contratos de confidencialidad y de ficción para el desarrollo del caso. ...
... Los instructores de simulación tienen la oportunidad de dirigirse al profesional para el análisis del rendimiento en su conjunto durante el escenario clínico, con la ayuda de un componente esencial de este método de aprendizaje, el debriefing, definido como la conversación entre los participantes, útil para reflexionar y reconocer sus emociones durante el caso, además permite el análisis del desempeño durante éste, así como el papel de los procesos de pensamiento y las habilidades psicomotrices para mejorar o mantener su rendimiento en situaciones futuras (27,(29)(30)(31) . En este sentido, es muy importante que se genere un ambiente seguro para reflexionar, partiendo de las emociones propias de cada participante, con el objetivo de analizar cómo hacer frente a ellas, de forma interna y externa, para salvaguardar los intereses del participante, con la oportunidad de prevenir un estado de disonancia de identidad, relacionado con el agotamiento físico y mental, así como la insatisfacción profesional durante Tabla 3: Escenario de simulación: paro cardíaco en paciente con sospecha de infección por COVID-19. ...
Article
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Simulation-based learning has been widely used to improve response to crisis situations. It has played an important role in preparing care teams for patients with infections such as Ebola, influenza, severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). The recent pandemic caused by the coronavirus (SARS CoV-2) declared by the World Health Organization (WHO) in March of this year 2020, requires special attention in these moments, where the disease has exceeded the response of the health systems in several countries, so it is necessary training of response teams to reduce risks. The objectives proposed in this review through deliberate practice, the clinical scenario and simulation in situ, in the patient with suspected or infected by COVID-19, try to systematize the placement and removal of personal protective equipment (PPE), the management of the airway and the approach of the patient in cardiac arrest, in order to improve technical skills and strengthen non-technical skills. Furthermore, during the development of these strategies, unexpected situations can be identified and addressed, some compromise in patient and/or staff safety can be detected, which allows these deficiencies to be rectified and response capacity to be optimized. Likewise, it allows to reflect and analyze the emotions of the staff to prevent adverse situations regarding the performance of health workers. With this, it seeks to strengthen the safety and quality of patient care during the course of this pandemic.
... do de muchas profesiones y disciplinas de la salud en todo el mundo. 1 Ello es debido a que durante las dos últimas décadas, numerosas publicaciones han mostrado que promueve la integración de conocimientos y el desarrollo de habilidades procedimentales, además de mejorar el trabajo en equipo y la toma de decisiones clínicas, aumentando el grado de retención de lo aprendido cuando se compara con los métodos docentes tradicionales. 2 Además, lo aprendido en el laboratorio de simulación se transfiere al entorno de trabajo, facilitando el cambio de la organización, mejorando los resultados en los pacientes y el retorno de la inversión. 3 Esto ha provocado un aumento en la demanda de profesionales de enfermería, medicina, psicología, pedagogía u otras áreas de la salud formados como educadores para utilizar la simulación como herramienta de entrenamiento. 1 Por otra parte, revisiones recientes de la literatura de simulación resaltan el papel fundamental del debriefing para lograr un aprendizaje efectivo; 4,5 se entiende por debriefing la conversación entre dos o más personas que revisan un episodio real o simulado en la que los participantes analizan sus acciones y reflexionan sobre el papel de los procesos de pensamiento, habilidades psicomotrices y estados emocionales para mejorar o mantener su rendimiento en el futuro. ...
... 3 Esto ha provocado un aumento en la demanda de profesionales de enfermería, medicina, psicología, pedagogía u otras áreas de la salud formados como educadores para utilizar la simulación como herramienta de entrenamiento. 1 Por otra parte, revisiones recientes de la literatura de simulación resaltan el papel fundamental del debriefing para lograr un aprendizaje efectivo; 4,5 se entiende por debriefing la conversación entre dos o más personas que revisan un episodio real o simulado en la que los participantes analizan sus acciones y reflexionan sobre el papel de los procesos de pensamiento, habilidades psicomotrices y estados emocionales para mejorar o mantener su rendimiento en el futuro. 6,7 Por ello y para dar respuesta a las necesidades planteadas, el número de profesionales que se han formado en debriefing ha aumentado incesantemente en los últimos años. ...
... do de muchas profesiones y disciplinas de la salud en todo el mundo. 1 Ello es debido a que durante las dos últimas décadas, numerosas publicaciones han mostrado que promueve la integración de conocimientos y el desarrollo de habilidades procedimentales, además de mejorar el trabajo en equipo y la toma de decisiones clínicas, aumentando el grado de retención de lo aprendido cuando se compara con los métodos docentes tradicionales. 2 Además, lo aprendido en el laboratorio de simulación se transfiere al entorno de trabajo, facilitando el cambio de la organización, mejorando los resultados en los pacientes y el retorno de la inversión. 3 Esto ha provocado un aumento en la demanda de profesionales de enfermería, medicina, psicología, pedagogía u otras áreas de la salud formados como educadores para utilizar la simulación como herramienta de entrenamiento. 1 Por otra parte, revisiones recientes de la literatura de simulación resaltan el papel fundamental del debriefing para lograr un aprendizaje efectivo; 4,5 se entiende por debriefing la conversación entre dos o más personas que revisan un episodio real o simulado en la que los participantes analizan sus acciones y reflexionan sobre el papel de los procesos de pensamiento, habilidades psicomotrices y estados emocionales para mejorar o mantener su rendimiento en el futuro. ...
... 3 Esto ha provocado un aumento en la demanda de profesionales de enfermería, medicina, psicología, pedagogía u otras áreas de la salud formados como educadores para utilizar la simulación como herramienta de entrenamiento. 1 Por otra parte, revisiones recientes de la literatura de simulación resaltan el papel fundamental del debriefing para lograr un aprendizaje efectivo; 4,5 se entiende por debriefing la conversación entre dos o más personas que revisan un episodio real o simulado en la que los participantes analizan sus acciones y reflexionan sobre el papel de los procesos de pensamiento, habilidades psicomotrices y estados emocionales para mejorar o mantener su rendimiento en el futuro. 6,7 Por ello y para dar respuesta a las necesidades planteadas, el número de profesionales que se han formado en debriefing ha aumentado incesantemente en los últimos años. ...
Article
Recent simulation literature reviews highlight the critical role of debriefing in the learning process. As a consequence, there has been an increase in the number of health and allied professionals that have been trained to conduct debriefings. However, as the number and scope of the activities increase, it is not always possible to find expert debriefers who are also experts in the specific content area. Therefore, it is increasingly common for educators to collaborate with content experts in various fields in healthcare, who often have no previous experience with simulation-based education. No references to the particular opportunities and challenges of this interaction has been found. Therefore, the objective was to propose a guide to: 1) describe the advantages of this type of collaboration, 2) discuss common challenges and 3) overcome specific challenges; also, to suggest future directions for research.
... The training was designed to provide an immersive, dynamic environment in which learners could practice general and stroke-specific skills without risk to patients [14]. Simulation training is established in healthcare as a valid teaching modality for students, trainees and multiprofessional groups [15]. However multiple-site programmes are rare, as is longitudinal follow-up of candidates [16,17]. ...
... But with the enormous volume of information available, the constant evolution of clinical processes and management plans, the acquisition of more knowledge does not necessarily ensure greater predictability and control. 1 To address this situation, some programs are teaching not just how to diagnose and treat patients, but also are helping to understand how the whole system works, and prepare doctors for the inevitable constant changes they will face during their professional lives. An alternative approach is not trying to predict how the healthcare system is going to be like, but trying to give the residents the tools to be adaptable, to be resilient to change, to accept and maintain some practices and to adopt new ones, so they can face problem solving more efficiently. ...
Article
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... Como consecuencia, muchas organizaciones han vivido una pérdida progresiva de eficiencia y no han logrado aprovechar el conocimiento experto de los equipos multidisciplinarios. Las organizaciones que desean aprovechar plenamente a sus profesionales altamente cualificados están reorganizando algunos de sus recursos para estructurar la atención a los pacientes y redefinir los procesos alrededor de equipos de personas; además, están entrenando a sus profesionales para que puedan desempeñarse eficazmente en un ambiente de trabajo en equipo 26 . ...
Article
Full-text available
Introduction Healthcare continues to grow in complexity. Numerous publications have confirmed that most adverse events are caused by inherent problems within the processes being used, which implies that reengineering the systems can reduce the incidence of error. Objective Understand the value of team education with clinical simulation to promote a systems-oriented, multidisciplinary team-driven, patient-centered approach for optimal patient outcomes. Methodology We present several simulation-based strategies as an example on how to cope with changes at the organizational level. Results After simulation based training inter-professional teams were able to safely provide sedation for colonoscopy, and to enhance teamwork for early detection and goal-directed treatment of sepsis in the surgical ward. Conclusion Clinical simulation provide a safe environment to reorganize care and train professionals to work in teams.
... Organizations that want to take full advantage themselves of their highly trained professionals are shifting some of their resources to organize patient care, to redefine processes, around teams and training professionals to effectively perform in a team environment. 26 In our experience an effective teamwork needs to be understood as the coordination of individual activities for effective results; not the subordination of the individual to the group. Healthcare professionals have to develop the ability and enthusiasm to work with others. ...
Article
Introducción Las organizaciones sanitarias continúan aumentando su complejidad. La mayoría de efectos adversos son causados por problemas inherentes a los procesos utilizados. Objetivo Comprender el valor del entrenamiento de equipos con simulación para promover un enfoque orientado al sistema, centrado en el paciente y conducido por equipos interprofesionales. Metodología Reflexión sobre estrategias de simulación para afrontar cambios organizativos. Resultados Equipos interprofesionales fueron capaces de proporcionar sedación de modo seguro para procedimientos de colonoscopia, y para promover el diagnóstico precoz y el rápido tratamiento de pacientes con sepsis severa. Conclusión La simulación clínica proporciona un entorno seguro para reorganizar el cuidado en salud y entrenar profesionales a trabajar en equipo.
... Ademá s, las habilidades adquiridas se transfieren al entorno de trabajo, lo que se traduce en una mejora de los resultados clínicos. Todo ello sin poner en riesgo a pacientes y profesionales 3 . ...
Article
The PDF can be downloaded from https://www.revespcardiol.org/es-theories-and-styles-of-debriefing-articulo-S0300893214003868
... Más aún, existe una evidencia creciente de que las habilidades adquiridas en el entorno docente son transferidas al entorno de trabajo, y que se obtienen mejores resultados clínicos cuando se comparan con profesionales formados con los métodos tradicionales. Por todo ello, esta modalidad de entrenamiento se está integrando cada vez más con otros métodos docentes 23 . ...
Article
La formación de los especialistas en Medicina Crítica y Cuidado Intensivo tradicionalmente se ha realizado con un modelo pedagógico basado en la transmisión enciclopedista de conocimientos y un sistema halstediano basado en la práctica durante un tiempo determinado con pacientes «viendo un caso, practicando un caso y enseñando un caso». Se ha integrado en las últimas décadas un modelo basado en competencias junto con una evaluación terminal o por resultados en relación a los contenidos que se recuerdan y comprenden. En él se obtiene el mismo número de créditos independientemente de los resultados, siempre que se considere al menos apto.
... The training was designed to provide an immersive, dynamic environment in which learners could practice general and stroke-specific skills without risk to patients [14]. Simulation training is established in healthcare as a valid teaching modality for students, trainees and multiprofessional groups [15]. However multiple-site programmes are rare, as is longitudinal follow-up of candidates [16,17]. ...
Article
Full-text available
Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London. This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment. The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty. Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5-6.33]; pre-course median 5 [IQ range 4.67-5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated 'debrief' was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity. Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.
... Los procesos de evaluación docente no están desvinculados del contexto educativo en los que suceden, pues se relacionan con el modelo pedagógico que sustenta la estructura curricular del plan de estudios, así como las normas y reglas de operación que rigen en la institución. La evaluación docente también depende de los escenarios en que tiene lugar la enseñanza y el aprendizaje, de tal manera que no es lo mismo en medicina la labor de los profesores en el aula o en un centro de simulación que en espacios clínicos 7 . ...
Article
Full-text available
Resumen Uno de los retos actuales en la formación de personal para la salud es la seguridad del paciente. La enseñanza mediante la simulación nos permite tener aprendizajes significativos por medio de la práctica segura, la comunicación efectiva. La experiencia simulada en ambientes controlados es fundamental, el debriefing se ha convertido en una de las herramientas fundamentales para el logro de estos propósitos, toda vez que implica reflexión guiada que se realiza posterior a un esce-nario de simulación donde se analiza y se da sentido a la experiencia vivida, en este modelo la reflexión es la base nece-saria para la enseñanza. El debriefing representa además en el área clínica un fundamento pedagógico de aprendizaje basado en la experiencia. La calidad educativa depende en buena parte de la preparación de los docentes, un profesor capacitado es crucial para mejorar los procesos y la formación de los estudiantes. Su competencia en debriefing dentro del aprendizaje por simulación es fundamental para que el alumno adquiera un aprendizaje significativo. La capacitación y evaluación del docente en debriefing mejora está técnica dentro de su práctica, les permite estandarizar el lenguaje y la metodología aplicada en la docencia con simulación. Abstract One of the current leftovers in health personnel training is patient safety. Teaching through simulation allows us to have meaningful learning through safe practice, effective communication. The simulated experience in controlled environments is essential, debriefing has become one of the fundamental tools for achieving these purposes, since it involves guided reflection that takes place after a simulation scenario where it is analyzed and meaning is given to the lived experience, in this model reflection is the necessary basis for teaching. The debriefing also represents in the clinical area a pedagogical foundation for learning based on experience. Educational quality depends largely on the preparation of teachers, a trained teacher is crucial to improve the processes and training of students. Their competence in debriefing within simulation learning is essential for the student to acquire meaningful learning. The training and evaluation of the teacher in debriefing improves this technique within their practice, allows them to standardize the language and the methodology applied in teaching with simulation.
... Ademá s, las habilidades adquiridas se transfieren al entorno de trabajo, lo que se traduce en una mejora de los resultados clínicos. Todo ello sin poner en riesgo a pacientes y profesionales 3 . ...
... Not surprisingly, clinical simulation has been used for many different purposes and in many variants. 6 As previously stated by Gaba,7 ''Lessons learned in preparation for this outbreak will likely be valuable for both the health care community as a whole and for each site in particular in anticipation of other highly infectious diseases that may come. These include virulent strains of influenza, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome.'' ...
Introduction: We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain. Methods: The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes. Results: Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment). Conclusions: Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.
... But with the enormous volume of information available, the constant evolution of clinical processes and management plans, the acquisition of more knowledge does not necessarily ensure greater predictability and control. 1 To address this situation, some programs are teaching not just how to diagnose and treat patients, but also are helping to understand how the whole system works, and prepare doctors for the inevitable constant changes they will face during their professional lives. An alternative approach is not trying to predict how the healthcare system is going to be like, but trying to give the residents the tools to be adaptable, to be resilient to change, to accept and maintain some practices and to adopt new ones, so they can face problem solving more efficiently. ...
... Our study findings support the use of simulation based training for the acquisition of skills in recognition of the deteriorating patient, and align with other evidence for this approach (Aggarwal et al., 2010;McGaghie, Issenberg, Petrusa, & Scalese, 2010;Moral & Maestre, 2013;Rudolph, Simon, Rivard, Dufresne, & Raemer, 2007). ...
... Como consecuencia, muchas organizaciones han vivido una pérdida progresiva de eficiencia y no han logrado aprovechar el conocimiento experto de los equipos multidisciplinarios. Las organizaciones que desean aprovechar plenamente a sus profesionales altamente cualificados están reorganizando algunos de sus recursos para estructurar la atención a los pacientes y redefinir los procesos alrededor de equipos de personas; además, están entrenando a sus profesionales para que puedan desempeñarse eficazmente en un ambiente de trabajo en equipo 26 . ...
... El empleo de la simulación en salud se expandió durante la última década debido a que permite aprender y practicar en un ambiente sin riesgo para pacientes y profesionales 1 . Se utilizó principalmente para el entrenamiento en la toma de decisiones clínicas (como la atención al trauma grave) 2 , la adquisición de habilidades procedimentales (como el parto con distocia de hombros) 3 , la comunicación (como la información a pacientes y familiares), el trabajo en equipo (como el manejo de pacientes críticos) 4 , el profesionalismo y aspectos éticos (como la resolución de conflictos) 5 . ...
Article
Objective: To describe the use of simulation as a tool to support the strategic management of change in the Cantabrian Regional Health Service in Spain. Methods: A working group was created to: 1) define the strategic areas of innovation and change; 2) establish criteria for the selection of proposals that can be addressed with simulation; 3) analyse and select the proposals; 4) design and implement the simulation programs, and 5) evaluate results. Results: The constantly changing needs of the regional health system enabled 6 strategic areas to be identified during 2017-208: 1) efficient use of resources; 2) implementation of health plans of interest in the community; 3) patient safety improvement; 4) management of health personnel; 5) development of new professional skills, and 6) selection and implementation of new technology. Conclusions: Clinical simulation is a useful tool to promote innovation strategies in healthcare, facilitating the adaptation of professionals and patients to change.
Article
Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice".
Article
Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees’assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through “reflective practice”.
Article
While teaching and learning are key elements to advance medicine, little time is spent educating medical professionals on how to teach. Traditionally, medical students rotate through the standard medical specialties with the goal of learning how to diagnose and treat the most common diseases. Few medical schools offer a teaching rotation or formal curriculum in education. We reflect on the experience of medical students in a one-month educational elective at the Hospital virtual Valdecilla in Santander (Spain), a simulation center with the mission of improving quality of care and patient safety by means of interprofessional team training through clinical simulation. The medical student rotation was made possible by the International Health Program at New York University School of Medicine. Learning objectives for the rotation are reviewed, including development of psychologically safe learning environments, design of learning activities based on principles of the adult experiential learning model described by Kolb, exposure to different types of simulation, introduction to debriefing and teamwork principles, and participation in an educational research project. The students' experience in this rotation is compared to their previous experience participating in simulations as students during clinical rotations at their medical school.
Article
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Objectives: To describe our experience integrating simulation based training in an Interuniversitary Master's degree in Pain Study and Management from the University Rey Juan Carlos of Madrid and University of Cantabria, Spain. Material and methods: After taking the online and on-site modules, students participated in 6 scenarios of simulated clinical immersion, in order to train patient management, clinical diagnosis, and patient safety competencies, in a realistic environment reproducing the actual clinical work. Results: Five physiotherapists, 1 psychologist, 10 medical doctors, and 9 nurses participated in the simulations during two consecutive editions of the Master. They found the scenarios very realistic and simulation a valuable teaching tool, reporting a global satisfaction of 4.5 over 5. It was also an opportunity to experiment adverse events of the analgesic that are uncommon to observe during clinical rotations. Conclusions: Participants were satisfied with the use of clinical simulation as part of the training program of an Interuniversitary Master in Pain Study and Management.
Article
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El análisis de la jurisprudencia en relación con las reclamaciones por las consecuencias de la actuación de los profesionales sanitarios acepta el hecho de que algunos médicos poseen capacidades individuales innatas para el desempeño de su actividad. Asimismo, distingue entre capacidades y aprendizaje. En este artículo se reflexiona sobre las teorías de aprendizaje del adulto y las formas de facilitar el desarrollo profesional. Se analizan las consecuencias que los criterios elegidos pueden tener para planificar el entrenamiento de los sanitarios y la influencia de dichos criterios en las sentencias judiciales relacionadas con la valoración del desempeño profesional. Se revisa el papel de la simulación clínica como nueva herramienta de entrenamiento.
Article
Objectives: To describe our experience integrating simulation based training in an Interuniversitary Master's degree in Pain Study and Management from the University Rey Juan Carlos of Madrid and University of Cantabria, Spain. Material and methods: After taking the online and on-site modules, students participated in 6 scenarios of simulated clinical immersion, in order to train patient management, clinical diagnosis, and patient safety competencies, in a realistic environment reproducing the actual clinical work. Results: Five physiotherapists, 1 psychologist, 10 medical doctors, and 9 nurses participated in the simulations during two consecutive editions of the Master. They found the scenarios very realistic and simulation a valuable teaching tool, reporting a global satisfaction of 4.5 over 5. It was also an opportunity to experiment adverse events of the analgesic that are uncommon to observe during clinical rotations. Conclusions: Participants were satisfied with the use of clinical simulation as part of the training program of an Interuniver-sitary Master in Pain Study and Management.
Article
The analysis of medical malpractice claims related to adverse events in Spain reveals that it is commonly accepted as legal criteria that some doctors have innate and special abilities to carry out their activity. They also distinguish between ability and learning. This article reflects on adult learning theories and ways to facilitate professional development. It analyzes the consequences that the chosen criteria may influence the way healthcare providers are trained. It also reflects on the influence these criteria may have in judicial decisions related to the assessment of professional performance. The use of clinical simulation as a new training tool is reviewed.
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Durante la última década la simulación clínica se ha extendido de modo exponencial a nivel mundial como método de formación y desarrollo de los profesionales de la salud. Ello es debido a que numerosas investigaciones han mostrado que las habilidades clínicas, de comunicación y trabajo en equipo, así como las actitudes y el profesionalismo aprendidos mediante formación con simulación, se trasladan al entorno de trabajo de modo más eficaz que cuando se comparan con los métodos tradicionales. Asimismo, hay una evidencia creciente de que mejora los resultados clínicos y la seguridad del paciente. Para dar respuesta a esta reforma educativa es necesario promover el desarrollo de educadores especializados en los conceptos, teorías y habilidades en los que se fundamenta la simulación en salud. En el presente artículo se describen y estructuran las competencias para la educación basada en simulación clínica, así como los distintos programas docentes que se ofrecen en la actualidad para la formación de instructores en simulación en salud. Además, se analiza el proceso utilizado para desarrollar una estancia en simulación clínica en el Hospital virtual Valdecilla.
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Purpose – To provide two possible approaches for enhancing organizational culture awareness and promote cultural change in public sector organization. These approaches include training and leading by example. Design/methodology/approach – Literature outlining fundamental aspects of organizational culture is summarized, serving as a foundation for reviewing the potential value of training as a method for enhancing public managers' awareness of organizational culture. This is followed by an illustrated example of how the culture was changed in major department of a public organization through leading by example. Findings – Training and leading by example can serve as effective methodologies for promoting culture awareness and brining about culture change in organizations. Practical implications – The article highlights some interesting similarities and differences between cultures in public organizations and cultures in private sector organizations. The differences, in particular, reinforce the importance of training and leading by example to guide public sector employees through the complex dynamics often embodied within culture transformations in organizations. Originality/value – While there are some important similarities between cultures of private sector and public sector organizations, the differences existing in public sector organization cultures create unique challenges for managers trying to evoke change. The article provides a unique perspective on applying training and leading by example to the context of public sector organizational culture.
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