Book

Defining excellence in simulation programs

Authors:
  • Harvard University, Harvard Medical School

Abstract

Defining Excellence in Simulation Programs is an official publication of the Society for Simulation in Healthcare (SSH), created to support the Society's mission to encourage excellence in healthcare education, practice and research through the use of simulation. With nearly 140 expert clinicians and educators contributing, this authoritative guide offers clear-cut definitions, recommendations and best practices for all types of simulation training programs. This is a must-read for healthcare managers, educators and researchers looking to create or manage successful, cost-effective, researched-based simulation programs. A wide range of topics -- essential to the development and management of successful and cost-effective simulation programs - include: Simulation Standards - best practices and program development; Types of Simulation Programs - infrastructure, framework; Simulators - types, selection and usage; Funding - fundraising, income sources; Management - asset management, policies and procedures; Environmental Design - building a simulation center; technical infrastructure; and Educational Development; Faculty Development; Research, and more, including: • Well-referenced, reader-friendly content is continually available, practical and timely • Standards and recommendations based on actual programs around the world that have proven to be sustainable, cost-effective and successful • Editors and many authors central to SSH's role in learning and defining best practices for simulation and simulation program management • Interprofessional group of editors and authors offering diverse perspectives, from areas of nursing, medicine, allied health, numerous specialties, and non-clinical fields including organizational behavior, psychology, statistics, business, and engineering • Terms of Reference - Defines and standardizes simulation terms and concepts for users, learners and developers • Experts Corner - Commentary on particular areas of training, research and program development by simulation experts and founders • Consider This - Text boxes provide practical how-to sections on important related topics. © 2015 Society for Simulation in Healthcare (SSH). All rights reserved.
... Heath-care education program must be innovative and devise strategies that optimalize the learning in knowledge, skills, and attitudes, including professionalism, leadership, and communication in conjunction with safe patient outcomes. Simulation is becoming popular as a valuable tool in providing innovative learning experiences that bridge the gap between theory and practice in many fields such as business, computer industries, aviation, military, including medicine training (Meakim et al., 2013;Palaganas et al., 2015;Drews & Bakdash, 2013;Berregan, 2014). Many professional tasks and high quality evaluation can be performed at the same time with simulation. ...
... When administered correctly, SBE is shown as a realistic, safe, flexible, and cost-effective method if utilized properly that can be used to strengthen routine practices before exposed the real patients (Palaganas et al., 2015;Nestel et al., 2013). In fact, this trend is not limited to healthcare education system alone. ...
... Simulation may raise the bar for facilitating patient safety. There is a wide range of simulator fidelities, which can be utilized to role-playing the selected scenarios from simple intervention to interdisciplinary complex problem management such as virtual-reality; screen-based simulator providing feedback about the learner's practice (Palaganas et al., 2015;Paige & Morin, 2013 (Shearer et al., 2013;Palaganas et al., 2015). ...
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Article
Simulation based education (SBE) reemerged an important part of lifelong learning, which is defined as the imitation of an actual case, event or behavior. There has been increased interest in using medical simulation due to lacking of practice, changing learning environment, increasing attention to human error, patient safety, communication problem, personal rights and freedoms. This approach has created a "tipping point" in the transition to simulation education as an effective tool based on competency, which is regarded as revolutionary change. SBE provides unique opportunities for learners to fill the gap between theory and practice as a teaching strategy in a safe environment. In fact, SBE is not new; it has long been a part of the education system across all fields such as military, aviation, nuclear power generation , business, medicine, and computer science to maintain safety, to gain experience and to enhance evaluation of performance. However, high-fidelity simulation is a relatively new concept providing multi-task scenarios and many feedback options due to the increasing degree of realism in medical education. In this paper, the importance of simulation beyond just technology , wide variety of categories of simulations that range from simple to sophisticated regarding providing knowledge and skill after practices in the learning environment is discussed, and the multidimensional benefits and limitations of simulation are also mentioned. This article presents a general overview of SBE that will hopefully help to generate interest in using simulation.
... Aspects include how manikins will help the program meet desired outcomes and the resources needed to support their use. 25 Portability, including how many people are needed to move equipment, should be factored into product selection. 25 17,25 This study identified that systems to protect workers were lacking in many of the participants' ...
... 25 Portability, including how many people are needed to move equipment, should be factored into product selection. 25 17,25 This study identified that systems to protect workers were lacking in many of the participants' ...
... 25 Portability, including how many people are needed to move equipment, should be factored into product selection. 25 17,25 This study identified that systems to protect workers were lacking in many of the participants' ...
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Background: The purpose of this study was to describe the physical demands and risks associated with working in a simulation center. Methods: The 26-item online survey included questions about the physical nature of a simulationist's role and about what engineering and administrative controls they most commonly used. The sample consisted of 119 simulation operators and educators recruited from simulation interest groups based in the United States. Results: Fifty-five percent of participants reported that their job description did not match their work, and 59% of participants believed that they experienced a musculoskeletal disorder resulting from their work in a simulation center. Conclusion: This study highlights the need to address workplace safety in simulation centers. Future research is needed to inform best practices for safe handling policies and procedures in simulation programs.
... 23 Healthcare simulation, integrated into the larger healthcare education curriculum, is currently being used to provide this evidence, specifically with a focus on observed evidence of competencies. 24 Competence includes a broad range of knowledge, attitudes and observable patterns of behavior which together, account for the ability to deliver the specified professional service which is under evaluation. 25 Generally, there are two types of assessment. ...
... Formative assessment serves to inform the learner and the educator on how to achieve learning for each individual. 24 Summative assessment serves to inform the educator on whether or not the learner is competent to pass a level of competence. 24 ...
Thesis
The purpose of this study was to evaluate if Student Registered Nurse Anesthetists (SRNAs) who participate in lecture and view of a trigger film video, related to undiagnosed malignant hyperthermia, would experience enhanced clinical decision-making behaviors in the simulation lab versus those that participate in lecture alone. Trigger films are short video clips (thirty seconds to two minutes) that portray situations a learner or clinician might experience. Members of the Oakland University Beaumont Graduate Program of Nurse Anesthesia (OUBGPNA) class of 2018 received lectures on the recognition and treatment of Malignant Hyperthermia (MH), anaphylaxis and bronchospasm. Following the lectures, students were randomized to one of two groups. Group A viewed trigger films pertaining to anaphylaxis, bronchospasm, and MH and were later tested in the simulation lab on one of the three high-risk, low-frequency events. Group B reviewed PowerPoint lecture slides on the same three topics before participating in their simulated scenario. Both groups were unaware of which of the three scenarios would be simulated. Both groups underwent a Malignant Hyperthermia simulation scenario. The two groups were compared to determine which group demonstrated superior clinical decision-making behaviors in the simulation lab following the implementation of the teaching strategies. No statistical significance was found concerning time to recognition of symptoms or time to initiate treatment for all but one of the variables examined. Time to cooling demonstrated statistical significance with Group A initiating cooling measures more quickly than Group B. Post study debriefing revealed that participants felt access to a trigger film either did, or would have afforded them more comfort with decision-making skills in the scenario. Teaching critical thinking skills for high-risk, low-frequency events is of utmost importance to the development of nurse anesthetists. Determining the best teaching strategy to provide this education is imperative.
... ■ Adil: Önyargının azaltılmasına, katılımcılara eşit şekilde yaklaşılmasına ve teorik bilgi ve beceriyi eşit öğrenme fırsatına olanak tanıyacak şekilde standartlaştırılmıştır. 16 ■ Standardize hasta modalitesi kullanımının dezavantajları ise; ...
... ■ Uzmanlık: Standardize hastaların belirlenmesi ve eğitilmesi, ilgili materyallerin geliştirilmesi ve uygun şekilde değerlendirilmesi uzmanlık gerektirmektedir. 16 Oh ve ark. tarafından yapılan meta-analiz çalışmasında; standardize hasta modalitesi kullanılan simülasyona dayalı öğrenmenin; hemşirelik öğrencilerinde, bilişsel alanda bilgi kazanımının ve iletişim becerilerinin, duyuşsal alanda öz yeterliğin ve öğrenme motivasyonunun, psikomotor alanda ise klinik beceri kazanımının gelişmesinde etkili olduğu belirlenmiştir. ...
... The exclusion criteria were: (1) different context from healthcare training; (2) low fidelity simulations defined as: simulations using role playing or task trainers designed for specific tasks or procedures for student learning "not needing to be controlled or programmed externally for the learner to participate" (25,32); (3) no evaluation of the instruments' validity or reliability; (4) evaluation of TS only; (5) systematic reviews; (6) unavailability of full texts; (7) language other than English. ...
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Introduction: High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers’ (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS. Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence. Conclusion: Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.
... In-situ simulation provides registered nurses with training in clinical settings and improves the quality of the simulation. 26 Using standardized patient in-situ simulation and evidence-based algorithms together might positively affect pressure ulcer incidence rates. However, there are no studies in which standardized patient in-situ simulation and evidence-based algorithms were used together. ...
... © The Internet Journal of Allied Health Sciences and Practice, 2020 though roles may overlap, it is important for each to support and reinforce the care and patient education they individually and collectively impart to the patient. For future IPE activities, faculty development needs to be addressed to ensure successful implementation and alignment to best practices in IPE design, facilitation, debriefing and evaluation.Though there exists evidence that interprofessional education is successful, this study adds to the existing body of knowledge in the field of IPE in that the activity was introduced early in the respective disciplines healthcare education programming.11,24 Early and consistent simulation exposure to IPE embedded in healthcare curriculum fosters collaboration.7,25,26,27 ...
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Purpose: Interprofessional Education (IPE) incorporated into healthcare discipline instruction has been shown to be successful in improving the understanding perceptions of complimentary professions. The purpose of this mixed method study was to measure differences in perceptions of early Baccalaureate of Science in Nursing (BSN) students and Doctor of Physical Therapy (DPT) with participation in a immersive interprofessional education experience. Method: Students completed a pre and posttest survey consisting of the Readiness for Interprofessional Learning Scale and several short answer qualitative questions. Cohorts of BSN and DPT students participated in a computerized mannequin simulation experience or a hybrid simulation. Results: Students indicated they learned about each other’s scope of practice and recognized the benefits of teamwork through collaboration. Conclusion: Students showed increased knowledge of the other profession, appreciated the opportunity for interprofessional learning, and were interested in having more IPE simulation learning experiences.
... Depending on the pedagogical scenario, a subscenario can be required to support the use of the serious game. This subscenario generally includes 3 phases: prebriefing, orchestration of the game, and debriefing [52][53][54][55]. The activities taking place around the game (prebriefing and debriefing) are as important as the game itself. ...
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Background Serious games are increasingly used at all levels of education. However, research shows that serious games do not always fulfill all the targeted pedagogical objectives. Designing efficient and engaging serious games is a difficult and multidisciplinary process that requires a collaborative approach. Many design frameworks have been described, most of which are dedicated to the development of specific types of serious games and take the collaborative dimension into account only to a limited extent. Objective Our aim was to create a generic serious game design framework that could be adapted to all kinds of serious games and implemented in a collaborative web platform. Methods We combined the results of a literature review with our experience in serious game design and development to determine the basic building blocks of a collaborative design framework. We then organized these building blocks into categories and determined the features that a generic design framework should include. Finally, based on the paradigm of complex systems and systemic modelling, we created the co.LAB generic design framework and specifications to allow its implementation in a collaborative web platform. Results Based on a total of 10 existing design methodologies or frameworks, 23 building blocks were identified and represent the foundation of the co.LAB framework. These blocks were organized into 5 categories: “context and objectives,” “game design,” “mechanics,” “learning design,” and “assessment.” The arrangement by categories provides a structure that can be visualized in multiple and complementary ways. The classical view links game and learning design while other views offer project, systemic, and process visualizations. For the implementation of the co.LAB framework in a web platform, we propose to convert the building blocks into “cards.” Each card would constitute a collaborative working space for the design of the corresponding block. To make the framework adaptive, cards could be added, adapted, or removed according to the kind of serious game intended. Enhancing the visualization of relationships between cards should support a systemic implementation of the framework. Conclusions By offering a structured view of the fundamental design elements required to create serious games, the co.LAB framework can facilitate the design and development of such games by virtue of a collaborative, adaptive, and systemic approach. The different visualizations of the building blocks should allow for a shared understanding and a consistent approach throughout the design and development process. The implementation of the co.LAB framework in a collaborative web platform should now be performed and its actual usability and effectiveness tested.
... If monies are available for paid embedded participants, current best practice in simulation education would include one to two designated anesthesia learners (playing an anesthesia attending and/or anesthesia resident) and three embedded participants (playing the surgeon, circulating nurse, and scrub nurse or scrub tech). 7 The other learners present watch via video and participate in the debriefing. At our institution, monies are not routinely available and budgeted for all simulation learning events, which we hold weekly. ...
Article
Introduction: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. Methods: This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. Results: To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. Discussion: Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment.
... About three fourths of participants in this study conduct in situ simulations, such as mock codes and patient deterioration scenarios. Research indicates that conducting simulation in patient care areas increases simulation fidelity (Palaganas, Maxworthy, Epps, & Mancini, 2014). However, patient census may create challenges to conducting in situ simulation. ...
Article
Three national nursing associations formed a collaborative partnership to research simulation use in acute care hospitals in the United States and military hospitals abroad. An electronic survey was used to determine simulation modalities used, participants engaged, space allocation, purposes of use, commonly taught skills, logistics, and barriers to use. Data from 521 respondents revealed widespread use of a variety of simulation modalities. However, use of this educational strategy could be expanded to patients and families.
... As an interprofessional global organization membership includes physicians, nurses, allied health professionals, paramedic personnel, researchers, and educators. The organization began the process of initiating accreditation and certification standards for simulation programs, educators, and technology in 2007 (Palaganas et al. 2014). The process was rolled out in three phases beginning with site accreditation standards. ...
Chapter
Simulation usage in nursing education has been increasing over the past several years. Nursing educators should familiarize themselves with the necessary tools to incorporate simulation experiences in their nursing curriculum. National and international organizations have developed to advance and endorse simulation in healthcare. Nursing research has provided evidence that simulation contributes to student learning.
... An SP confederate is a person who portrays a patient, family member, or healthcare provider in order to meet the objectives of the simulation [4]. SP confederates can also participate in providing feedback to the learners so that they receive a patient/colleague's perspective [5]. This option, however, is not utilized in this simulation run. ...
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Article
Emergency physicians frequently are required to perform timely assessments on patients who are unable to provide a comprehensive history due to an altered level of responsiveness. The etiology of their altered mental status (AMS) causes a diagnostic dilemma due to its wide differential diagnosis. Physicians must use a timely combination of collateral history, physical examination skills, and investigations to diagnose the cause of the patient's AMS, as many of the potential etiologies can be life-threatening if not quickly managed. For this reason, training learners to perform the required actions accurately and effectively proves difficult during real-life emergencies, where an individual's life may be at risk. Simulation-based education (SBE) offers one solution to this challenge. It allows learners to build confidence by dealing with life-threatening conditions in a safe environment and has been shown to be superior to other forms of clinical training. This scenario explores learners' comfort in some less-practiced, but very important, areas of medicine including obtaining consent for treatment from a substitute decision maker (SDM), explaining various goals of care, and eliciting an advanced care directive from the SDM. Learners and physicians in all fields of medicine must be able to confidently discuss these subjects with patients and their families in order to provide individualized and appropriate management. In this simulation, learners will have the opportunity to explore an unusual AMS presentation and develop their clinical and communication skills by working as a team to manage the patient.
... Any kind of accreditation/certification program could be seen as a means along those lines, prescribing and standardizing the approaches. 23,24 A second approach would aim to generate a broad consensus of accepted and expected practice. What are the "international" expectations for the role of the facilitator and the course participant? ...
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Introduction: Culture is believed to play a role in education, safety, and patient outcome in healthcare. Hofstede's culture analysis permits a quantitative comparison between countries, along different culture dimensions, including power distance (PD). Power distance index (PDI) is a value reflecting social hierarchy in a country. We sought to explore the relation between PDI and self-reported behavior patterns of debriefers during simulation debriefings. We determined six culture-relevant debriefing characteristics and formulated six hypotheses on how these characteristics correlate with national PDIs. Methods: Low-PDI countries have a PDI of 50 or less, and high-PDI countries have a PDI of 51 or greater as defined by Hofstede. Interviews with simulation debriefers were used to investigate culture-relevant debriefing characteristics: debriefer/participant talking time, debriefer/participant interaction pattern, debriefer/participant interaction style, debriefer/participant initiative for interactions, debriefing content, and difficulty with which nontechnical skills can be discussed. Results: During debriefing, in low-PDI countries, debriefers talked less and used more open-ended questions and focused more on nontechnical issues than on medical knowledge and simulation participants initiated most interactions. In low-PDI countries, debriefers felt that participants interacted more with each other and found it easier to address nontechnical skills such as speaking-up. Conclusions: Our results supported our hypotheses. National culture is related to debriefing practice. There is a clear relation between PDI and debriefer-participant behavior patterns as described by debriefers. The higher the PDI of a country, the more the debriefer determines the course of the debriefing and the more difficult it becomes to address nontechnical skills.
... In addition, SPs can also engage in assessment by providing feedback to the learner. This is a feature that was not utilized in this scenario but it can be added [10]. ...
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Newfoundland and Labrador (NL) has one of the highest provincial drowning rates in Canada, largely due to the many rural communities located near bodies of water. Factor in the province's cold climate (average NL's freshwater temperature is below 5.4°C)and the prevalence of winter recreational activities among the population, there exists an inherent risk of ice-related injuries and subsequent hypothermia. Oftentimes, these injuries occur in remote/rural settings where immediate support from Emergency Medical Services (EMS) may not be available. During this critical period, it frequently falls on individuals without formal healthcare training to provide lifesaving measures until help arrives. Training individuals in rural communities plays an important role in ensuring public safety. In recent years, simulation-based education has become an essential tool in medical, marine and first aid training. It provides learners with a safe environment to hone their skills and has been shown to be superior to traditional clinical teaching methods. The following case aims to train laypeople from rural settings in the immediate management of an individual who becomes hypothermic following immersion into cold water. However, reaching these individuals to provide training can be a challenge in a province with such a vast geography. To assist with overcoming this, the development of a simulation center that is portable between communities (or Mobile Tele-Simulation Unit) has occurred. By utilizing modern technology, this paper also proposes an innovative method of connecting with learners in more difficult to reach regions.
... Simulation experiences may elicit recall of bad memories that can influence the learning of all the simulation participants in a session. 37 Although seemingly a rare event, psychologically distressed states during simulation experiences can cause panic, fear, anger, crying, and hostility. These reactions can negatively affect and inhibit learning and performance. ...
Introduction: Despite efforts to prepare a psychologically safe environment, simulation participants are occasionally psychologically distressed. Instructing simulation educators about participant psychological risks and having a participant psychological distress action plan available to simulation educators may assist them as they seek to keep all participants psychologically safe. Methods: A Simulation Participant Psychological Safety Algorithm was designed to aid simulation educators as they debrief simulation participants perceived to have psychological distress and categorize these events as mild (level 1), moderate (level 2), or severe (level 3). A prebrief dedicated to creating a psychologically safe learning environment was held constant. The algorithm was used for 18 months in an active pediatric simulation program. Data collected included level of participant psychological distress as perceived and categorized by the simulation team using the algorithm, type of simulation that participants went through, who debriefed, and timing of when psychological distress was perceived to occur during the simulation session. The Kruskal-Wallis test was used to evaluate the relationship between events and simulation type, events and simulation educator team who debriefed, and timing of event during the simulation session. Results: A total of 3900 participants went through 399 simulation sessions between August 1, 2014, and January 26, 2016. Thirty-four (<1%) simulation participants from 27 sessions (7%) were perceived to have an event. One participant was perceived to have a severe (level 3) psychological distress event. Events occurred more commonly in high-intensity simulations, with novice learners and with specific educator teams. Simulation type and simulation educator team were associated with occurrence of events (P < 0.001). There was no association between event timing and event level. Conclusions: Severe psychological distress as categorized by simulation personnel using the Simulation Participant Psychological Safety Algorithm is rare, with mild and moderate events being more common. The algorithm was used to teach simulation educators how to assist a participant who may be psychologically distressed and document perceived event severity.
... No studies were conducted in situ, another surprise finding, considering this systematic review was specific to the hospital setting. In situ simulation increases the fidelity of the simulation, putting the nurse and/or team in the same location where patient care occurs (Palaganas, Maxworthy, Epps, & Mancini, 2014). It can be difficult to conduct insitu simulations because the unit census is unpredictable (i.e., there may not be an open room on the unit to conduct the simulation when it is scheduled). ...
Article
Background The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of hospital-based simulation with clinical nurses. The research question that guided this study was as follows: what research related to hospital-based simulation with clinical nurses emerged in the literature between January 2012 and October 2015? The design of this review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources are as follows: literature search was completed in PubMed, CINAHL, Cochrane Library, EMBASE, and Web of Science using a combination of medical subject headings, or MeSH terms, as well as keywords to retrieve non-indexed citations. Methods The inclusion criteria for this review were broad in order to disseminate information on future research needed; however, the sample had to include clinical bedside nurses, either alone or in conjunction with another professional group. The intervention had to include simulation, although no limits were made on the type of simulation. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language and between January 2012 and October 2015. Results The database search strategy yielded 224 citations. These results were narrowed down to 65 studies based on identified inclusion criteria. Conclusions More randomized controlled trials and studies with power analyses and validated measurement instruments are needed to fully understand the impact simulation has on the practicing nurses at the bedside. There is also a need to investigate the effects of simulation education on patient outcomes.
... A simulated patient (SP) is a person who has been coached to represent an actual patient. 5 The SP is instructed to share a specific history, use body language, and respond to questions and simulated treatments in a manner consistent with the profile of a specific patient. The UAB nursing and laboratory science programs run a simulation that requires only three rooms: two "patient rooms" with low fidelity mannequins or simulated patients with phlebotomy arms, and the CLS student laboratory. ...
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In the report, Health Professions Education: A Bridge to Quality, the Institutes of Medicine (IOM) has detailed a vision for preparing healthcare professionals.1 A focal point within this vision is teaching students to work in interdisciplinary teams. In a separate report, Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, the IOM calls for an alignment of education and healthcare delivery systems.2 The Clinical Laboratory Science (CLS) education community needs to readily embrace the IOMs vision and enthusiastically answer the call with innovative educational methods such as interprofessional simulation (IP).
... Teamwork and its components (e.g., leadership, communication) are typical content of learning objectives in simulation-based training [4,5,[11][12][13][14][15][16][17][18][19][20]. This is important because effective teamwork has been linked to patient safety [21,22]. ...
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We submit that interaction patterns within healthcare teams should be more comprehensively explored during debriefings in simulation-based training because of their importance for clinical performance. We describe how circular questions can be used for that purpose. Circular questions are based on social constructivism. They include a variety of systemic interviewing methods. The goals of circular questions are to explore the mutual dependency of team members’ behavior and recurrent behavior patterns, to generate information, to foster perspective taking, to “fluidize” problems, and to put actions into relational contexts. We describe the nature of circular questions, the benefits they offer, and ways of applying them during debriefings.
... Scenarios were chosen so as to focus on topics familiar to both American and French residents but which may also display differences in management recommendations between the two countries. The scenarios chosen were: difficult airway management (Simulated Learning Environment 1 or SLE1) in the intra-operative setting; and local anaesthetic toxicity (SLE2) [3][4][5]. ...
... It is generally agreed that the debriefing process has 3 main phases. 6,[13][14][15] The Institute for Medical Simulation suggests a 3-phase structure: ...
Article
Debriefing following a simulation event is a conversational period for reflection and feedback aimed at sustaining or improving future performance. It is considered by many simulation educators to be a critical activity for learning in simulation-based education. Deep learning can be achieved during debriefing and often depends on the facilitation skills of the debriefer as well as the learner's perceptions of a safe and supportive learning environment as created by the debriefer. On the other hand, poorly facilitated debriefings may create adverse learning, generate bad feelings, and may lead to a degradation of clinical performance, self-reflection, or harm to the educator-learner relationship. The use of a structure that recognizes logical and sequential phases during debriefing can assist simulation educators to achieve a deep level of learning.
Article
Introduction: Practical examinations are necessary to demonstrate learning in the psychomotor, cognitive, and affective domains. Student perceptions of the organization and execution of practical examinations are an important consideration in the development of practical examinations. Review of the literature: Multiple other health professions have investigated students' perceptions of objective structured clinical examinations (OSCE). There is little in the physical therapy literature with respect to student perception regarding proctor presence during practical examinations or OSCEs. Subjects: The participants were members of the classes of 2019-2021 in a Doctor of Physical Therapy (DPT) program at a New England University. Methods: A qualitative thematic approach was applied to de-identified transcripts of student focus group interviews. Independently coded themes were identified, discussed, and refined iteratively. Results and discussion: Four themes emerged with multiple subthemes: impact of proctor being present; realistic, patient-focused experience; preparation for the practical; and stress. Students valued preparation that included clear expectations, utilization of formative assessments, and peer feedback prior to the practical. They also noted that a distractive-free testing space, having no proctor present in the room, recording the practical, and the format of OSCE's decreased stress and improved performance. Conclusions: These findings add to the body of knowledge in physical therapy and provide guidance to faculty as they plan and organize practical examinations.
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Introduction Simulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions. Methods An anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks. Results A total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources. Conclusion SBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision. Implications for practice Increased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.
Article
Background: Simulation faculty development refers to the education of faculty in preparation and facilitation of simulation-based experiences. A college of nursing with six campuses implemented a simulation work group to ensure consistent simulation faculty development across six campuses. Method: The simulation work group was formed in four stages and used the International Nursing Association for Clinical Simulation and Learning Standards as a framework for standardizing simulation. The work group consisted of 14 faculty from five nursing campuses. Members were recruited via email, telephone call, or a simulation newsletter. Results: Challenges were identified and addressed. Work group implementation has provided the simulation program with new initiatives and a unified scheduling system, budget, standardized debriefing, and student evaluation method. Conclusion: With the greater dependence on simulation as an educational modality, implementation of a simulation work group may enable collaboration and growth across campuses while decreasing the disparity of simulation experiences. [J Nurs Educ. 2021;60(3):165-168.].
Article
Background Communication skills of nursing students is an area of interest for development, research, and refinement. The Health Communication Assessment Tool (HCAT©), allows evaluation of nursing students’ communication skills and behaviors. Method Data were collected to determine the statistically significant difference in student group evaluations. Results Chi-square statistics revealed a 33% difference in student group evaluations proving the alternative hypothesis true. Cohen's kappa, Cronbach's alpha, and factor analysis confirmed interrater reliability and validity of adapted HCAT©. Conclusion(s) The adapted HCAT© is an effective evaluation tool of students’ communication skills.
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As the number and complexity of patients supported with ECMO increase, a formalized program for instruction and simulation training is more important than ever. While the types of patients supported with ECMO vary from center to center, the basic fundamentals and physiology of ECMO support are the same everywhere. In this chapter, we will discuss adult learning, the fundamental components of an ECMO curriculum, and the appropriate use of ECMO simulation to maintain high performance in ECMO providers and specialists.
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Many common misconceptions about simulated/ standardized patient (SP) methodology have emerged over the past few decades. While some of these ideas may appear to be humorous or benign, others can have an undesireable impact on a simulation session. Collected from the reports of a wide range of SP educators (SPEs) from around the world, we address these misperceptions in an evidence-based manner. Topics include authenticity, acting, general considerations for working with SPs, training, assessment, the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) (Lewis et al., Adv Simul 2(1):10, 2017) and the role of SPEs. We draw on evidence and practice for clarifying these misunderstandings and provide strategies that can be shared with stakeholders such as faculty, other SPEs or SPs, to promote the implementation of SP methodology in a knowledgeable, safe and effective manner.
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Accreditation of simulation programs is relatively new, and entails a rigorous process of planning, development and evaluation of all aspects of the simulation experience for students and/or health care professionals. The purpose of this paper is to describe the experience of a Nursing Simulation Program in achieving designation as a fully accredited program. The process of developing a formal simulation program, strategic plan, policies and procedures, and an evaluation plan are included, as well as the benefits to achieving accreditation.
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Simulation facility design is not just about the outcome, but how one gets to the desired outcome. Owners and users must accept that the end-product will never be perfect, but working to avoid common preventable errors and omissions is an important consideration. A well-defined design team, lines of communication, effective project management, cross-checks, seeking advice from others are but a few of the considerations to reaching an outcome that meets the end-users and stakeholders needs. With all this said, we remind the reader that a facility is part of a simulation program, and a spectacular facility will be meaningless without a program that is effective, efficient, and sustainable.
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Simulation facility design is emerging as new industry segment in the architectural, engineering, and design industry. While it is complex, many of the concepts can be borrowed from higher education, clinical settings, and education theory. Simulation facilities in healthcare seek to emulate an environment, at times clinical, that suits the desired outcomes and objectives of the training or assessment. The infrastructure to support these facilities differs from higher education or clinical environments, in that flexibility, storage, control, and debrief space must all be considered. As is the case in all facilities, flow and adjacencies (proximity of rooms) is also an important consideration. Following a basic premise that form follows function, having a good understanding of what the facility will be used for, in as granular terms as possible, will allow the designers to develop space(s) that meet the functional needs of the end-users.
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Ceviri kitap. Fikti Mulkiyet Hakki Society Simulation for Healthcare aittir
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Creating quality simulation training and associated scenarios is time-consuming and costly. Following systematic approach throughout planning and execution is helpful. Conducting a needs assessment will help educators determine which educational interventions—if any—will best meet learner needs. Learning objectives will serve as touchpoints throughout the process and aid in assessing learner outcomes. The purpose of this chapter is to present a series of steps one to use while creating scenarios and assessing the success of the scenarios.
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This chapter will explore the process of scenario design. Scenario design is perhaps the most important yet difficult phase of implementing a simulation curriculum, regardless of whether that curriculum is delivered in a high-fidelity simulation center or via a mobile training session. Scenarios should be developed using educationally-sound practices, driven by a needs assessment and the learning objectives of the simulation. The choice of formative versus summative assessment will also be determined by the needs of the participants.
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Simulation instructors have a key role in the success of simulation-based education. Ongoing instructor development is vital to success in this role, due to the ever-changing growth in understanding of how best to implement simulation-based education. This chapter outlines educational needs of the simulation instructor, provides direction for obtaining that education, and presents methods with which to demonstrate and evaluate competency of the instructor. Guidelines and standards of best practice are provided to support ongoing professional development.
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Simulation can be a tremendous technology and platform to provide immersive education replicating a clinical situation or environment. Aside from clinical immersion, debriefing can host in-depth discussions and reflections on the situation, team actions, clinical judgment, critical thinking, clinical management, and communication occurring within the scenario. Replicating a lifelike clinical encounter allows learners the opportunity to navigate through their actions and behaviors for the specific situation. When learners lack knowledge and an appropriate clinical approach to manage a simulated case, time can be dedicated during the debriefing for teams to explore various solutions in solving their challenge. Utilizing video playback options during the debriefing provides an opportunity to review the situation as it unfolded. Mindful use of the video playback and technology warrants the facilitator to have undergone dedicated training in the methodology and techniques of using video playback during debriefing. Investing in staff development when video playback technology is available will help guide a safe and meaningful simulation debriefing for the learners. Since there are a variety of technology platforms available, the simulation administrator should be mindful in researching for the optimal system for their program and environment. Matching the capabilities of a video playback system to the functional need of a program while being mindful of budget constraints will be key to successfully implementing this feature into debriefing.
Article
Introduction: Health professionals often have cumbersome responsibilities, performing their roles in complex environments under stressful circumstances. Resilience has been recognized as an enabler of thriving in such adversity and remains vague in the health profession literature. Aims: This paper aims to provide a synthesis of existing literature reviews of the evidence for resilience in health professionals, thematically integrating factors affecting resilience in health professionals. Methods: Electronic databases were searched systematically using inclusion and exclusion criteria to include literature reviews that explored resilience in health care professionals using purposive sampling of primary research studies. Results: Nine studies were identified. The definition of resilience varied across the studies. Four main themes of factors affecting resilience were found: (1) the influence of individual factors (e.g. individual traits, having a higher purpose, being self-determined), (2) environmental and organizational factors (e.g. workplace culture), (3) approaches that an individual takes when interacting with her/his professional circumstances (e.g. professional shielding and self-reflection), and (4) effective educational interventions (e.g. resilience workshops). Conclusions: Resilience is multidimensional and can be affected by multiple factors. Interventions to improve resilience should consider context and focus on improvement of adaptive abilities of health professionals in adversity. A more uniformed definition and measurement of resilience can further research in this field.
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The chapter proposes a translational simulation in healthcare roadmap to a version of the future that we might want to create: pervasive, lifelong, evidence-based, cost-effective simulation training that improves patient outcomes in terms of safety (reduced complications, morbidity, and mortality), quality, and cost of care. We describe some general approaches that might help us create a version of the future of simulation in healthcare and ways to get there quicker. A modification of the return on investment equation is proposed that explicitly takes into account simulator idleness on the premise that an idle simulator is not generating a return. Different ways to reduce cost of simulation are described including simulator development (e.g., reuse, repurpose modular simulator elements, including hardware and software; select the right simulation technology based on the main type of skills that trainees are seeking to acquire or maintain) and cost of ownership and operation (e.g., as an analogy to driverless cars, instructor-less simulators designed for self-study and self-debriefing).
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Some healthcare education and patient safety professionals view their interactions with industry representatives as merely transactional, that the only purpose of corporations is simply to design, advertise, and sell goods. This simplified view can lead to the simulation industry being dismissed as a necessary evil, a source of loaned or promotional products, or a source of income to institutions and special interest groups. However, the role of commercial enterprise is much more expansive than this in practice, as the majority of companies and their representatives are true stakeholders who wish to promote best practices in education and safe patient care. Despite the often altruistic and complementary nature of the work performed by corporations that focus on simulation products and services, a healthcare simulation technology specialist may not understand the value and role of industry in this field. This creates the potential for misunderstandings between the stakeholders and can lead to unmet expectations, as even the best customer and supplier relationships can become strained at times. This chapter outlines the role and goal of industry in the education and patient safety environment, benefits for developing relationships with industry stakeholders, and an understanding of the sometimes unseen services that they provide.
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Research is one of the eight domains of a Healthcare Simulation Technology Specialist. This chapter has been written for the novice researcher as a simple “tricks of the trade” manual. It will provide a resource when planning, writing, and submitting, all manner of scholarly works. The process of writing becomes easier with each submission, but having a guide and reference is always useful to save time later in the process and ensure that pieces of information are not forgotten or omitted. Finally, the chapter describes how to collect and document your work for use in professional development and advancement.
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Background Terminology describing humans’ roles in simulation varies widely. Inconsistent nomenclature is problematic because it inhibits use of a common language, impacting development of a cohesive body of knowledge. Methods A literature search was completed to identify terms used to describe roles played by humans in simulation-based education. Based on these findings, a survey was created to explore the terminology used by simulation educators and researchers to describe human roles in simulation and the perceived need for a consistent nomenclature. Results Results demonstrated wide variability in terminology, including terms such as standardised patient, simulated patient, simulated participants, confederate, embedded actor and scenario role player. Conclusion Creation of a cohesive body of knowledge for human roles in simulation requires use of common terminology, yet findings suggest a complex landscape of terminology. Building consensus on the terminology describing human roles in simulation can clarify understanding of best practice and allow for advancement in the research and state of the science in simulation-based education.
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The purpose of this chapter is to describe how to best equip and staff a surgical simulation center. The chapter addresses the differences between a wet lab, a dry lab, and human patient simulation training including the personnel, equipment, and learners for each. It also discusses resource management for efficiently running a surgical simulation center including utilization and data management, product evaluation and selection, and standard operating procedures. The chapter concludes with a focus on budgets and cost, tips and tricks, and the expected future of simulation.
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https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/research/simulation-dictionary/index.html A project of the Society for Simulation in Healthcare. The document you see represents the work of many individuals and their societies to compile and refine the dictionary. The goal of this project is to enhance communication and clarity for health care simulationists in teaching, education, assessment, research, and systems integration activities. The Agency for Healthcare Research and Quality (AHRQ) has partnered with the Society for Simulation in Healthcare and its many affiliates to produce the first comprehensive Healthcare Simulation Dictionary and disseminate it widely as part of AHRQ’s mission to improve patient safety, which includes simulation research. http://www.ssih.org/dictionary
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Use of simulation in healthcare has become pervasive within undergraduate clinical and pre-hospital education, hospital continuing education programs, and in various medical school specialties. New professional roles are emerging as the result of the identification of gaps in the simulation program's ability to address the demands in clinical and medical education. This chapter identifies many of the gaps emerging out of simulation operations, in general, and suggests ways in which such gaps are bridged with the emerging roles now identified as simulation operations specialist (SOSs). Training programs for simulation professionals are designed for clinicians/educators working in academic or hospital environments. Simulation technology systems include components manufactured and configured by many different vendors, each with their own proprietary system requirements and features. The reasons why RNs, EMTs, and allied health professionals are often preferred for simulation operations roles within healthcare simulation programs is primarily because of the knowledge, language, and culture.
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This chapter will focus on the use of standardized and simulated patients in pediatric healthcare education. The chapter will begin with a section on common terms and definitions followed by a review of the Association of Standardized Patient Educators (ASPE) standards of best practice. General information with regard to recruiting and training will be provided, and the differences in training for formative and summative assessments will be discussed. The use of children and adolescents as standardized and simulated patients will also be explored. Current trends in pediatric simulation, including the use of standardized and simulated patients to improve communication, the development of interpersonal skills, and the delivery of difficult news, will be presented along with the use of hybrid simulations. The chapter will close with a discussion on the advantages and challenges of using standardized and simulated patients in pediatrics.
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While simulation and interprofessional education (IPE) are not new fields in health care, activities and programs merging the two have increased rapidly over the past decade highlighting many gaps in knowledge. This chapter seeks to fill these gaps for simulation educators in the pediatric setting looking to achieve effective IPE by suggesting common language, a conceptual model, theoretical frameworks, variables to consider—specifically how to develop, implement, debrief, and evaluate pediatric simulation-enhanced IPE with resources, a framework for reporting and publishing activities, and areas for future research.
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Statement: Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing conversation can be guided by either a facilitator (facilitator-guided) or the simulation participants themselves (self-guided). Postevent facilitator-guided debriefing may incorporate several conversational structures. These conversational structures break the debriefing discussion into a series of 3 or more phases to help organize the debriefing and ensure the conversation proceeds in an orderly manner. Debriefing process elements are an array of techniques to optimize reflective experience and maximize the impact of debriefing. These are divided here into the following 3 categories: essential elements, conversational techniques/educational strategies, and debriefing adjuncts. This review provides both novice and advanced simulation educators with an overview of various methods of conducting healthcare simulation debriefing. Future research will investigate which debriefing methods are best for which contexts and for whom, and also explore how lessons from simulation debriefing translate to debriefing in clinical practice.
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Presentation
The AnatomyTable provides interactive large format 3D touch screen learning opportunities to reinforce anatomy & physiology objectives for clinical sciences students. The AnatomyTable situates anatomy and physiology lessons while mitigating some challenges associated with traditional anatomy and physiology education. It can be used by as a demonstration model by instructors, by individual students, or to encourage small group
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MREAL: The Beating Heart Experience, leverages Canon’s state of the art mixed-reality imaging system to provide 3D, hand-held, stand alone computer-generated images. This demonstration will include but is not limited to a beating heart that supports anatomy & physiology education throughout the health sciences.
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