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Simulation-based Learning: Just Like the Real Thing
Abstract
Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often "immersive" in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals' knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors.
... In addition, research has shown that students not only develop teamwork and communication skills but also improve their collaborative competencies (Sezgin & Bektaş, 2023). The integration of simulation software in educational settings has been linked to improved student outcomes across these dimensions (Lateef, 2010). By providing hands-on experiences and practical applications of knowledge, simulation software helps students to better understand and retain complex concepts, thereby enhancing academic performance (Brinson, 2015). ...
... While the advantages of simulation software are numerous, it is important to acknowledge the challenges and Kaysi 38 limitations associated with its use. One major concern is the significant investment required for developing and maintaining high-quality simulation tools (Johnson et al. , 2016;Lateef, 2010). Educational institutions often face financial constraints that can limit the widespread adoption of simulation software. ...
... However, integrating simulation software into education presents several challenges. Developing and maintaining these tools require substantial financial investment (Johnson et al. , 2016;Lateef, 2010). Educators also need adequate training and support to use these technologies effectively (Tondeur et al. , 2017;Koehler & Mishra, 2009). ...
Due to the frequent utilization of technological applications in contemporary times, the quality of educational processes is rapidly evolving. This study examines students' experiences through simulation software and real-world applications. A mixed-method design is employed due to the combined use of qualitative and quantitative data collection methods. Accordingly, Achievement tests, Semi-Structured Interview Form, Observation Form, and Simulation Software Participant Applications Evaluation Form were utilized for data collection. All obtained data were analyzed to support and compare the findings of the study. As a result of the study, some positive effects of simulation software on students' learning processes are identified. Among these outputs, it is highlighted that throughout the process, students' levels of achievement increase, and due to the smooth operation of the applications, students experience a sense of achievement and positive attitudes. As a result of students' experiences with the simulation software they use, it has been observed that they have the expected level of experience when performing real-world applications and carry out the applications almost flawlessly. Finally, it has been noted that some students resist these processes and their development is limited. Among the recommendations of the study, it is suggested that structured learning activities through such simulation software would be beneficial.
... The integration of digital tools in the training of medical managers has garnered increasing attention, paralleling the digital transformation in healthcare systems globally. Digital technologies offer innovative avenues for delivering education and fostering the development of competencies essential for effective healthcare management (Frehywot et al., 2013;McGowan et al., 2012). Frehywot et al. (2013) conducted a comprehensive review of e-learning in medical education within resource-constrained environments. ...
... In the realm of healthcare leadership, McGowan et al. (2012) explored the adoption of social media among physicians for sharing medical information. While focusing on physicians, the study underscores the broader trend of digital engagement in healthcare professions. ...
... Utilizing case studies and simulations allows students to apply theoretical knowledge to practical scenarios, fostering critical thinking and problem-solving skills (Lateef, 2010). Simulations can replicate real-world challenges such as managing digital system implementations, responding to cybersecurity threats, or integrating new technologies into existing workflows. ...
The article addresses the integration of digital tools in the training of medical managers, emphasizing the need for such competencies in light of the digital transformation in healthcare. It begins by highlighting the importance of digital skills for medical managers, especially with the rise of technologies like electronic health records (EHRs), telemedicine, and artificial intelligence. The COVID-19 pandemic accelerated the adoption of digital solutions, making it crucial for educational institutions to adapt their training programs to better prepare future healthcare leaders. Literature Analysis in the article reviews various studies on digital tool integration in medical education, noting that while digital technologies enhance accessibility, flexibility, and learning outcomes, challenges such as technological limitations and digital literacy gaps persist. It emphasizes the need for strategic planning, faculty development, and addressing digital inequalities to fully leverage these technologies. The purpose of the study is to analyze existing theoretical frameworks and practical experiences to develop strategies for effective digital tool integration in medical management education. The study outlines its research methods, which include a systematic review of academic literature and case studies from institutions known for innovative approaches in digital health education. In the theoretical framework, the article discusses key theories, such as Transformational Leadership, Socio-Technical Systems, and Complexity Theory, which provide insights into structuring training for healthcare managers. It underscores the importance of grounding curricula in these frameworks to develop competencies in leadership, digital literacy, and interprofessional collaboration. The article's basic theoretical provisions suggest practical recommendations, including the incorporation of digital health courses, hands-on training, certification programs, and faculty development. It highlights the role of blended learning, interprofessional education, and strategic partnerships to enhance the training of medical managers. In the discussion, the article acknowledges the benefits and challenges of digital integration. It advocates for continuous evaluation, faculty engagement, and the inclusion of change management training to ensure medical managers can lead digital transformation initiatives effectively. Addressing issues like the digital divide and ethical concerns are also highlighted as essential for equitable and responsible integration of digital tools. The conclusion reinforces the need for integrating digital competencies into medical management training programs, emphasizing that such integration is not just necessary but offers opportunities to advance healthcare systems. It calls for comprehensive educational strategies that prepare medical managers to navigate and lead in a digitally driven healthcare environment.
... In our narrative synthesis, we included 23 studies that use simulation in their interventions, which emulate reallife scenarios for practice and learning [118]. We classified twelve studies as gamification intervention [54,62,63,69,73,82,102,103,109,111,113] that uses gamified digital platforms [54,62,63,69,82,93,102,103,113] or analogue activities [73,109,111], and eleven studies as SG [49,50,55,60,64,72,74,75,87,92,101]. ...
... Feedback on performance and recognition for their work positively impact learners' academic achievement by fostering motivation and engagement [14]. Debriefing, central to simulation, meets these needs [118]. Studies implementing simulation, with game attributes like "environment", "game fiction", and "immersion" prominent, often in combination with other attributes, form a significant part of our review, and these attributes are essential in creating the virtual simulation experience [5]. ...
Background
The digital shift in higher education is moving from teacher-focused models to active learning with digital technologies, including the integration of game-based learning strategies. We aim to identify, assess, and summarize the findings of evidence and determine the effectiveness of game-thinking on learning outcomes in nursing education.
Methods
A comprehensive search for relevant literature was conducted between April and May 2022 Seven databases ERIC, Scopus, ProQuest Education Source, MEDLINE, CINAHL, Web of Science, and Embase were utilized to locate original, peer-reviewed papers published in English. The review was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
Results
Overall, 3302 studies were initially screened based on their titles and abstract. From this selection 281 studies were then assessed for full-text eligibility. In the end, 70 studies, consisting of 27 Randomized Controlled Trials (RCTs) and 43 Quasi-experimental studies were included in the review. These studies encompassed data from a total of 8348 participants. The results from the narrative synthesis of the results revealed consistencies across the included studies and their findings. The meta-analysis suggested that game-thinking could be beneficial in nursing education, notably improving students’ academic achievement (Pooled ES = 0.99, [95%CI 0.53, 1.44]). The most significant effect of game-thinking on academic achievement was observed in the academic knowledge performance of nursing students (Pooled ES = 1.06, [95%CI 0.55, 1.57]), followed by academic skill performance (Pooled ES = 0.54, [95%CI 0.06, 1.03]).
Conclusions
The systematic review and meta-analysis provide evidence supporting the effectiveness of game-thinking in nursing education. The findings highlight the potential of game-based learning in enhancing nursing education through knowledge acquisition, albeit with a nuanced effect on skill development. As nursing education continues to adapt to the digital era, integration of game-thinking strategies could serve as a valuable method for creating engaging and effective learning experiences for nursing students.
... Les appels à un changement des méthodes d'enseignement ont abouti à des recherches empiriques et à des programmes médicaux innovants [4,6]. En lien avec la trajectoire centrée autour d'un mécanisme didactique et éthique, l'intégration de la simulation est une ressource pédagogique puissante [7]. Cette [4]. ...
... Dans un espace certain et contrôlé, l'apprenant est en mesure d'affiner ses compétences, de reproduire des séquences de soins avec toutes les complexités cliniques des scénarios de la vie réelle sans risque supplémentaire de subir les conséquences attendues [1]. En identifiant les points forts et les domaines à améliorer, l'enseignement tiré est une combinaison puissante qui couvre toutes les bases pour résoudre les dilemmes pratiques et les tensions éthiques lors du traitement de personnes réelles [7,13]. ...
Physician performance has remained a major challenge since the dawn of healthcare. The fundamental goal of medical education is to train qualified doctors before meeting real patients. Despite the recognized contribution of traditional learning, it paradoxically remains narrowly effective in the transition of theoretical skills, know-how and interpersonal skills to the real world of practice. The stakes are high; how can we provide safe health care? Ingrained in the ideals of medical education is the dictum “never the first time on the patient.” Thus, a reform of teaching methods gave birth to key, safer programs. By creating a more pragmatic immersive context, simulation provides a learning experience to hone skills, make and learn from mistakes while protecting patients from unnecessary risks. Its didactic value and its added ethical interest make it an important educational tool. The integration of simulation into medical teaching has actively developed a more holistic teaching combining theory, practice and safety.
... In alignment with this theoretical foundation, we adopted several pedagogical strategies-multimedia-based learning (MBL) [35], simulation-based learning (SBL) [36], and experiential learning [37]-to foster hands-on, interactive experiences in QC education. ...
As quantum computing (QC) technologies continue to advance, there is an increasing demand for a workforce skilled in QC. Higher education plays a critical role in preparing students with the foundational knowledge and specialized skills required for careers in quantum research, development, and application. While a few studies have introduced QC to high school students or computer science majors, there is limited focus on students from diverse academic backgrounds. Existing research has primarily shared instructors' experiences and efforts in teaching quantum computing in higher education, but there is a notable lack of studies exploring ways to enhance QC instruction and examining students' learning and attitudes. This study introduces the Spin-Quantum Gate Lab, a tool designed to enable undergraduate students to learn quantum computing concepts through simulations. The tool is grounded in multimedia-based learning (MBL) and simulation-based learning (SBL) theories, incorporating MBL materials, SBL tools, and hands-on programming exercises to enhance QC education. To evaluate the tool's impact on students' learning outcomes and attitudes, 19 undergraduate students from diverse majors at a public university participated in a two-week quantum information science course using the tool. Data collection included pre-and post-surveys with knowledge tests, attitude questionnaires, and post-only engagement and usability surveys, alongside open-ended questions exploring students' feedback on the lab. The results demonstrated significant improvements in students' quantum computing knowledge (p < .001), medium-to-high engagement and perceived usability scores (M = 3.90, SD = 1.06), and no significant changes in attitude. This study introduces an innovative learning tool for undergraduate quantum computing education and provides empirical evidence supporting the effectiveness of the tool in enhancing QC learning.
... Simulation-based learning (SBL) has evolved significantly over the past six decades, initially starting with flight simulators and later advancing into medical education through various levels of fidelity simulators. (1,2) While traditional SBL focuses on procedural and technical skills, SB history-taking involves trained human actors portraying patients. (3,4) These actors simulate patient interactions to create a high-fidelity learning environment, offering unique benefits in developing communication and interpersonal skills. ...
... Simulation-based learning (SBL) has evolved significantly over the past six decades, initially starting with flight simulators and later advancing into medical education through various levels of fidelity simulators. (1,2) While traditional SBL focuses on procedural and technical skills, SB history-taking involves trained human actors portraying patients. (3,4) These actors simulate patient interactions to create a high-fidelity learning environment, offering unique benefits in developing communication and interpersonal skills. ...
... A prominent example is clinical simulations, where participants respond to scenarios they are likely to face in their profession [20,69]. This method has been utilized in healthcare for decades and has since been widely adopted in the field of tutor education [40,69]. Dotger [20] and Self [59] both developed simulations in which trained actors assume the roles of "representative" characters (e.g., a parent or student). ...
With the rise of online learning, many novice tutors lack experience engaging students remotely. We introduce TutorUp, a Large Language Model (LLM)-based system that enables novice tutors to practice engagement strategies with simulated students through scenario-based training. Based on a formative study involving two surveys (N1=86, N2=102) on student engagement challenges, we summarize scenarios that mimic real teaching situations. To enhance immersion and realism, we employ a prompting strategy that simulates dynamic online learning dialogues. TutorUp provides immediate and asynchronous feedback by referencing tutor-students online session dialogues and evidence-based teaching strategies from learning science literature. In a within-subject evaluation (N=16), participants rated TutorUp significantly higher than a baseline system without simulation capabilities regarding effectiveness and usability. Our findings suggest that TutorUp provides novice tutors with more effective training to learn and apply teaching strategies to address online student engagement challenges.
... These models typically do not provide the same level of engagement or realism as simulation-based methods, which can limit the development of essential competencies such as empathy and patient-centered care [5,6]. Furthermore, traditional methods may not adequately prepare students for the dynamic and unpredictable nature of clinical environments, as they often lack the interactive and experiential components that SBL offers [9,7]. By integrating simulation-based learning into clinical psychology education, institutions can overcome these limitations, offering a more comprehensive and effective training approach that aligns with the evolving demands of healthcare education [10,11]. ...
Simulation-based learning (SBL) has become an essential tool in clinical psychology education, fostering competency development through immersive, risk-free training environments. However, traditional simulation methods often lack real-time emotional feedback, accessibility, and scalability. To address these gaps, this study explores the integration of FASSLING, an AI-powered platform, into clinical psychology training. FASSLING offers interactive patient role-play, real-time coaching, and structured debriefing to enhance emotional intelligence, therapeutic communication, and clinical reasoning. The platform's AI-driven feedback mechanisms, with the right prompts, provide immediate insights into trainees' empathy, rapport-building, and intervention accuracy, offering a dynamic learning experience that adapts in real time. Additionally, FASSLINGs unlimited free access removes financial and geographical barriers, democratizing high-quality training for not only mental health professionals, but all helping professionals worldwide. It effectively cultivates highly skilled therapists in a safe, controlled environment, maximizing public benefit without exposing real clients to risk. This paper explores the effectiveness of AI-enhanced simulation training in improving therapeutic competency, highlighting its potential to revolutionize clinical education by bridging the gap between theoretical learning and practical application. The findings suggest that AI-driven simulation models like FASSLING can significantly enhance skill acquisition, promote ethical decision-making, and foster a more emotionally attuned and competent mental health workforce.
... Such experiential learning opportunities can improve confidence and preparedness in the real-world settings. [325][326][327] Despite the importance of training and capacity building, several challenges exist. These include limited time and resources for training, competing priorities within healthcare organisations and the need for standardised curricula and competencies. ...
Food insecurity remains a critical public health challenge, significantly affecting health outcomes and contributing to the burden of
chronic diseases. Integrating food security initiatives within the healthcare systems offers a strategic approach to addressing this issue by
leveraging healthcare infrastructure to identify, support and manage the nutritional needs of vulnerable populations. This article explores
the multifaceted role of policy development, stakeholder engagement and technological innovation in fostering effective integration
of food security into the healthcare systems. The study highlights the importance of comprehensive training and capacity building for
healthcare professionals to effectively recognize and respond to food insecurity. By embedding food security into medical curricula
and professional development programmes, healthcare providers can improve patient care and health outcomes. Despite the promising
benefits, several challenges impede progress, including limited research on integrated food security interventions’ long‑term impacts
and economic benefits. Programs’ cultural relevance and adaptability also require further exploration to ensure effectiveness across the
diverse populations. The paper underscores the need for robust metrics and continuous improvement methodologies to evaluate the
impact of these initiatives, facilitating the replication of successful models in varied settings. Furthermore, the paper identifies critical
research gaps and proposes future research directions to enhance the understanding and effectiveness of food security integration. These
include longitudinal impact studies, economic evaluations, and exploration of interdisciplinary collaborations. In conclusion, while
challenges remain, integrating food security initiatives within healthcare systems presents a significant opportunity to improve public
health outcomes and reduce food insecurity. With collaborative efforts from policymakers, healthcare providers and communities,
these initiatives can pave the way towards a future where food security is integral to health and well‑being, ultimately contributing to
healthier and more resilient communities.
... The findings in this training reflect the importance of balanced time and workload management to ensure that clinical mentorship is successful and patient safety is maintained. Additional research, such as that conducted by Lateef (2010), shows that simulation-based learning can improve clinical skills and understanding of patient safety. Simulation allows participants to practice in a safe environment without risk to real patients, reinforcing their knowledge of safety procedures. ...
Patient safety culture is an important multidimensional concept in healthcare. Despite efforts to improve safety culture, there are still many preventable medical incidents. Nurses play a vital role in maintaining patient safety due to the intensity and duration of their interactions with patients. This study aims to improve nurses' knowledge of patient safety culture through comprehensive training, so as to reduce adverse events and improve the quality of health services. The training was conducted online on April 5-6, 2024 with 243 participants from various hospitals in Karawang Regency. The activity included pre-test, material delivery, case study simulation, and post-test to measure the participants' knowledge improvement. The results showed that there was a significant increase in nurses' knowledge of patient safety culture after the training. The pre-test and post-test showed that the training was effective in improving nurses' understanding and competence related to patient safety. It can be concluded that the patient safety culture training for nurses is effective and able to improve nurses' knowledge and skills in maintaining patient safety. With this improvement, it is expected that nurses can optimally implement patient safety culture, reduce the risk of adverse events, and improve the quality of health services in hospitals.
... We expected that using a simulation training approach would more effectively bridge the gap between theory and practice. 5 By simulating real-world scenarios during the project design phase, we aimed to enhance the students' understanding of global health, China's role in global health engagement, and to improve their practical skills, fostering collaborative problem-solving and other transferable skills. Additionally, since the IHPM course serves as a simulation training that requires comprehensive theoretical and multidiscipline knowledge prior to real-world application, we sought to identify existing problems and provide insights for further improving and developing the undergraduate global health curriculum. ...
Background
Since 2012, China has had one degreed undergraduate programme in global health for domestic students. The International Health Project Management course is a core component of this programme’s curriculum, bridging theoretical knowledge to practice in global health engagement. This study aims to evaluate whether introducing a teamwork and role-play module would meet the learning objectives, including improving students’ perception of global health, enhancing their understanding of the management processes for global health projects, and eventually developing competencies for effective global health involvement.
Methods
The teamwork role-play module was used in a scenario assuming that all students played a specific role in project management in the ‘Health System Enhancement for Pandemic Preparedness in Southeast and South Asian Countries’ programme. This programme called for proposals to implement a project in at least one country in Southeast or South Asia. We conducted a content analysis using two types of materials from the students: (1) concept note and proposal presentations and (2) students’ responses to the open-question feedback survey with four questions.
Results
Students addressed the colonial origins of global health and its evolving definition, emphasising the need for a broader interdisciplinary approach. They perceived China’s role in global health as evolving from a recipient to a donor, collaborator or participator, with a focus on enhancing soft power. However, their inadequate background knowledge of global health issues hindered their ability to undertake the tasks in depth. Students provided positive feedback on the teamwork with the role-play module, highlighting improved efficiency, broader and deeper learning through communication, increased participation, etc. Challenges such as poor leadership in teamwork, communication breakdowns and unequal workload distribution were identified.
Conclusions
Students showed a comprehensive understanding of managing a global health project through their teamwork tasks. Introducing teaching assistants to support teamwork, providing more hands-on opportunities, and integrating a broader range of disciplines into the curriculum will be crucial for the continued development of effective global health education programmes.
... During simulation-based training, the player hones valuable skills such as interpersonal communication, teamwork, leadership, decision-making, task prioritization, and stress management (Al-Elq, 2010). Simulations allow students to see the results of their choices in real-time, and take responsibility for decisionmaking through problem-solving competencies, resulting in a more active, transforming, and experiential reception of knowledge (Lateef, 2010). The majority of the researchers preferred web-based games (62.5%). ...
Game-based learning (GBL) is an effective learning tool for medical and dental undergraduates in enhancing knowledge and skills as well as gaining student engagement and motivation. Educational games can create a social constructivist learning environment, where learners can construct their knowledge through interactions with their peers and instructors. This concept is promising for learners to self-direct their learning. However, there is no clear evidence yet to support their effectiveness over traditional approaches in terms of competence improvement. The present systematic review aimed to assess and compare all the available literature on the effect of game-based learning on dental education. The PubMed, Scopus, Cochrane, Science Direct, Lilac, and Web of Science databases were searched using the pre-determined MeSH terms and eligibility criteria. The search yielded a total of eight articles. The studies included applications like Kahoot, GoDental, DentalByte, Skills-o-mat, and Playdent for GBL and compared their effectiveness to conventional methods. It was found that overall student satisfaction, motivation and interest was higher in GBL methods compared to the conventional methods of learning. GBL seems to be an effective tool for knowledge acquisition among dental students. However, further research should be conducted to compare the effectiveness of GBL against other learning methods. Newer games can also be tailor-made for specific learning objectives.
... Beyond single-user training modules (Li et al., 2011), the integration of AI and VR supports multi-user simulations for scenarios like pandemic responses and critical care crises. By using real-time data to assign roles and challenge learners in realistic, high-pressure settings, these environments prepare future healthcare leaders for the collaborative demands of internal medicine (Reeves et al., 2017;Lateef, 2010). ...
Problem Statement As an AI architect specializing in internal medicine architecture, I have observed that traditional medical education spaces often fail to keep pace with the rapidly changing needs of internal medicine. Static designs and predetermined workflows do not account for the unpredictable nature of modern clinical challenges. Without integrating predictive analytics, machine learning, and adaptive architecture, training environments risk producing clinicians who are ill-prepared for emerging diseases, intricate diagnostic dilemmas, and large-scale health crises. This paper argues that by embedding AI-driven internal medicine architecture within training labs, we can transform rigid educational spaces into dynamic ecosystems, equipping future healthcare leaders with the critical thinking, resilience, and collaborative capabilities they need to thrive in complex clinical settings (Cook et al., 2011; Gaba, 2004). Theoretical Philosophy Guided by the Philosophy of Immersive Techno-Embodiment (PITE), this paper positions architecture as an active participant in medical education. Rather than serving merely as a backdrop, architectural design-when combined with AI-becomes a responsive, intelligent partner that adapts in real time to the needs of its users. Drawing on Merleau-Ponty's phenomenology, PITE emphasizes that physical space and human experience are deeply intertwined. In this framework, training labs are conceived as environments that continuously learn from occupant data, adjusting their configuration, lighting, acoustics, and virtual reality modules to optimize learning outcomes. As an AI architect, I propose that internal medicine education spaces be transformed into adaptive environments where architecture and technology are inseparably linked, fostering more intuitive and effective learning experiences (Gaba, 2004; Reeves et al., 2017). New Knowledge Contribution
... Especially in the urban environment, which can be considered a small universe for artificial objects, there are many elements that can negatively affect people in terms of psychological experience (Turan, & Besirli, 2008;Summer, 2020). There are also some studies that show that there are benefits for users when it comes to education and science-based simulations in the experience of artificial and virtual worlds (Chernikova et al., 2020;Landriscina, 2013;Lateef, 2010). However, the proportion of studies showing that users were negatively affected by these worlds in terms of their experience was higher than the proportion of positive studies. ...
The concept of the shared experience plays an important role in human life as well as in the arts and sciences. Because users communicate with the objects in the environment they are in, depending on the time, and as a result of this communication they can be psychologically affected in a positive or negative way. In this sense, it is necessary to study what kind of structure the objects have in the shared experience space in which the user is located. The main purpose of the research is to examine the concept of shared experience in visual design by considering the relationship between user, object and time in three different worlds: real, artificial and virtual. The method used for the article was document analysis, one of the qualitative research methods. In this context, a search process was carried out in various sources, based on the keywords experience and common experience concept. At the centre of these different worlds, which are treated in three different categories, are the user and the object. It is concluded that the shared experience resulting from the different ways in which users communicate with the object has certain limitations in all three categories. In the real world, due to the unique structures of natural objects, shared experience means unlimited diversity for users, while in the artificial world, objects have more limitations due to their imitation or similar structure. It was found that the virtual world simulates the real world and therefore has certain limitations in terms of originality and creativity. It was also found that all three worlds are different from each other in terms of structural aspects and user experience. As a result, it was concluded that real, artificial and virtual worlds have intertwined relationships with each other in the context of shared experience; the real world can be defined as the universe, the artificial world is a subset of the real world, and the virtual world is a subset of the artificial world. It was also concluded that these defined the worlds have the potential to show variability in the context of object-time relationships. To cite this article Demirel, M.R. (2024). Examining shared experience in visual design in three categories. Journal for the Interdisciplinary Art and Education, 5(2), 153-162.
... Since the advent of simulation-based training in medicine by David Gaba's group in 2007, specifically within anesthesiology for crisis management in the operating room, simulation has increasingly permeated medical education at various stages and disciplines, utilizing diverse simulators ( Bradley, 2006 ;Lateef, 2010 ;. Despite the well-documented benefits of simulation-based education (SBE) in undergraduate healthcare training, the implementation, embedding, and sustainability of SBE as a complex intervention warrant further exploration ( Ferguson et al., 2020 ). ...
Objectives: An interdisciplinary research team began developing a new simulation-based medical education (SBME) method called drama and simulation-based medical education (DSBME) with HiFi manikins in Advanced Life Support (ALS) classes with fifth-year medical students. Methods: This study involved 80 fifth-year medical students who participated in 20 true experiments ALS simulations, employing both SBME and DSBME approaches in equal measure. Participants' personalities were evaluated using the Big Five Inventory (BFI), and their workloads were measured through NASA-TLX tests while interviews were conducted with the ALS team leaders. Additionally, during the simulation, the team leaders wore eye-tracking glasses to record the direction of their eye movements. Results: The analysis revealed that the DSBME group experienced a higher workload than the SBME group. Furthermore, ALS team leaders in the DSBME group reported greater perceived realism than those in the SBME group. Eye-tracking data analysis substantiated a significant divergence between DSBME and SBME approaches. Conclusions: The research demonstrates that interdisciplinary research teams can transfer good practices and methods from different fields to simulation-based education. Findings indicate the effectiveness of the DSBME method across various metrics. While the enhanced realism is affirmed, adopting the DSBME approach in simulation-based medical education practice is advocated.
... PBL enhances students' motivation by strengthening cognitive skills and encouraging deep learning (14). SBL provides a safe environment for practicing skills, enabling the development of clinical competencies without risk to patients (15,16). Effective learning strategies rooted in understanding cognitive neural pathways have the potential to revolutionize education. ...
... Medical simulation is often defined as, "a technique (not a technology) to replace and amplify real life experiences with guided ones, often "immersive" in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion". 2 Indeed, it is a tool for quality improvement, and safety of care by providing the opportunity to repeat clinical situations or therapeutic procedures in a secure (safe) environment. ...
Simulation-based education, is a relatively new approach, for practice and learning to develop healthcare professionals’ knowledge, skills, and attitudes, with different simulation modalities. This educational strategy is used to achieve adequate command in learning on preselected, programmed real-life or near-real-life clinical scenarios, avoiding undesirable features encountered or confronted in learning with real patients and undue stress to real patients within a safe learning environment. This editorial aimed to give a general overview of simulation in healthcare education. A brief history, the healthcare simulation concept and challanges of this training modality mentioned in the highlights of relevant references. Simulation based education has emerged as a transformative approach, significantly enhancing healthcare professionals’ learning experience and clinical competency. The various types of simulations offer a safe and controlled environment for participants to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The integration of simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide.
... PBL enhances students' motivation by strengthening cognitive skills and encouraging deep learning (14). SBL provides a safe environment for practicing skills, enabling the development of clinical competencies without risk to patients (15,16). Effective learning strategies rooted in understanding cognitive neural pathways have the potential to revolutionize education. ...
Learning represents "the ability to use past experiences in service of the present" (1). This concise definition emphasizes the integrated relationship between memory and learning - two processes that form the foundation of all aspects of human behavior and cognition. Memory, as a repository of past experiences, is not merely a passive storage but an active enabler of adaptive learning and problem-solving. Together, these processes underpin human interaction, creativity, and success.
Learning comprises three main stages: acquisition, consolidation, and recall. Acquisition is the moment of initial learning. Consolidation, which requires gene expression and protein synthesis, leads to the formation of long-term memory. During this process, information is held in short-term memory. Recall is the stage of information retrieval, accompanied by reactivation of relevant synapses (4). These stages are interconnected; reconsolidation is essential for memory enrichment, and active retrieval can strengthen this process.
Functionally, there are three main types of memory: working memory, sensory memory, and long-term memory. Working memory refers to the ability to consciously maintain and manipulate information. Sensory memory retains incoming information for a very brief period, and long-term memory is the permanent repository of life experiences. Information retrieval from long-term memory depends on factors such as meaningfulness, repetition, and the strength of sensory cues.
One of the most important elements of learning in medical sciences is the formation of schemas. Schemas are complex networks that organize knowledge and allow the brain to connect new information with existing knowledge. This process, known as the "schema effect," demonstrates the importance of prior knowledge in learning.
In contemporary medical education, innovative methods such as Problem-Based Learning (PBL) and Simulation-Based Learning (SBL) have replaced traditional methods. PBL enhances students' motivation by strengthening cognitive skills and encouraging deep learning. SBL provides a safe environment for practicing skills, enabling the development of clinical competencies without risk to patients. Effective learning strategies rooted in understanding cognitive neural pathways have the potential to revolutionize education. By moving away from rote memorization strategies toward strategies that prioritize long-term recall and critical thinking, educators can empower students to achieve academic success and develop lifelong learning skills.Today, lifelong learning is recognized by educators, governing bodies, accreditation organizations, and the general public as one of the most important competencies that learners should possess. Promoting lifelong learning as an ongoing, collaborative, active, broad, positive, satisfying, and applicable challenge in the medical profession and all aspects of individual life has emerged as a major global educational challenge.
Generally, teaching-learning processes must be continuously reviewed to keep students interested and engaged in the classroom. In recent years, the volume of information available to students has increased, and transforming classrooms into places of active student participation has become a challenge for the teaching process. As the field of medical education continues to evolve, educators must utilize insights from neuroscience and cognitive sciences to optimize the learning experience. By understanding and applying these principles, they can empower students to transition from passive learners to active, adaptive thinkers with the ability for lifelong learning and professional excellence.
... Simulations, on the other hand, provide immersive learning experiences by allowing students to experiment with real-world scenarios in a virtual environment. For example, medical students can practice surgical procedures in a risk-free virtual setting, which helps in building their skills and confidence (Lateef, 2010). Both gamification and simulations encourage active participation and foster critical thinking and problem-solving abilities. ...
As education evolves to meet the demands of the 21st century, the role of technology in shaping instructional practices becomes increasingly significant. However, the scarcity of comprehensive information on technology integration in classroom instruction significantly hampers its effective implementation in educational settings. This paper examines the theoretical underpinnings and practical applications of technology integration, focusing on how digital tools can foster deeper student engagement and improved academic performance. A systematic literature review will be employed to gather relevant research and scholarly articles. The analysis will focus on the integration of technology, exploring the mechanisms through which technology enhances student engagement and examining the impact of technology integration on various learning outcomes. Drawing on recent research, the analysis highlights key factors that influence successful technology integration, including best practices and strategies, case studies and examples, assessment methods and tools and future directions. The study also addresses the challenges and barriers educators face when incorporating technology into their teaching, such as the digital divide distractions and over-reliance on technology. By synthesizing current literature and theoretical frameworks, this paper offers a comprehensive understanding of the strategies that can optimize technology’s role in education and provide valuable insights for educators and policymakers in designing and implementing technology-rich learning environments that foster student engagement and optimize learning outcomes.
... It can be used in a variety of fields and with many different types of trainee (Shojania et al., 2001). Simulation-based learning (SBL) can be considered as a solution for developing the knowledge and skills of healthcare professionals (Lateef, 2010). ...
... Still, training and teaching take place at the patient bed, and well-equipped simulator laboratories are scarce. 40 AR and MR can limit these disadvantages, by bringing this VR superimposed on the real world, closer to the medical students, which will imply fewer investments in medical simulation labs. 41 Especially for emergency medicine where it is well known that a key factor for success is the level of expertise, 42 to improve knowledge and emergency skills, an MR simulation, as a continuous medical training will allow the specialist readiness and preparedness for most of the emergencies. ...
The advancements of technological devices and software are putting mixed reality in the frontline of teaching medical personnel. The Microsoft® HoloLens 2® offers a unique 3D visualization of a hologram in a physical, real environment and allows the urologists to interact with it. This review provides a state-of-the-art analysis of the applications of the HoloLens® in a medical and healthcare context of teaching through simulation designed for medical students, nurses, residents especially in urology. Our objective has been to perform a comprehensively analysis of the studies in PubMed/Medline database from January 2016 to April 2023. The identified articles that researched Microsoft HoloLens, having description of feasibility and teaching outcomes in medicine with an emphasize in urological healthcare, have been included. The qualitative analysis performed identifies an increasing use of HoloLens in a teaching setting that covers a great area of expertise in medical sciences (anatomy, anatomic pathology, biochemistry, pharmacogenomics, clinical skills, emergency medicine and nurse education, imaging), and above these urology applications (urological procedures and technique, skill improvement, perception of complex renal tumors, accuracy of calyx puncture guidance in percutaneous nephrolithotomy and targeted biopsy of the prostate) can mostly benefit from it. The future potential of HoloLens technology in teaching is immense. So far, studies have focused on feasibility, applicability, perception, comparisons with traditional methods, and limitations. Moving forward, research should also prioritize the development of applications specifically for urology. This will require validation of needs and the creation of adequate protocols to standardize future research efforts.
... Medical simulations often use mannequins as simulated patients that are connected to typical medical data displays such as heart rate monitors. Observing changes in the vital signs of a mannequin in response to interventions allows students to reflect and make informed decisions to aid the 'patient' , thereby refining their clinical skills through continuous evaluation and adjustment (Lateef 2010). This consequential feedback is central to the simulation experience. ...
Most research on feedback in higher education focuses on evaluative feedback and its recipience, uptake, and enactment. Evaluative feedback information includes judgments, critiques and suggestions for improvement provided by a teacher, peer, self, pre-programmed automatic feedback, or artificial intelligence tutoring systems. In contrast, we elaborate the neglected concept of consequential feedback. Consequential feedback offers information about the natural effect (consequence) of an action, such as getting burned when touching a hot stove, eliciting a laugh (or not) from a comedy routine, or the trajectory of a newly designed model rocket. This information is available during (simulated) professional/disciplinary/social practice when using professional or disciplinary tools or systems (e.g. stoves), audiences, clients, or products (e.g. comedy routines or rockets). We discuss how this concept builds on and extends the literature on feedback in higher education. We draw on examples from the health professions, business, mathematics and the arts to illustrate how we can harness the power of consequential feedback to create more impactful feedback. We centre educational simulations, first considering how non-human actors offer consequential feedback and then how human interactions embedded in role plays present consequential feedback. We conclude by exploring implications for research and practice.
... 25 Through simulation-based training, students are put in a situation where they have to work in a team in realistic patient scenarios, which is a safe and controlled environment, and thus they can learn and refresh their teamwork skills. 26 Additionally, the implementation of TBL (team-based learning) techniques in the medical curricula stimulates students' active involvement, peer teaching, and teamwork, which eventually leads to a good teamwork skill and readiness for collaboration in the medical practice. 27 Reflection and feedback mechanisms are the means through which students can understand the impact of their teamwork experiences, pinpoint the areas for improvement and work on their skills over time, which is a process that promotes lifelong learning and development. ...
The implementation of Personal Enrichment Competency (PEC) modules in medical education curricula should be recognized as an initiative that is geared towards developing students’ multifaceted skills and assets which would be required in modern medical practice. PEC modules will be implemented using an integrated approach which suggests putting content in different subjects and making the PEC concepts part of both medical and health science courses for students to have experiential learning experiences. Emphasis is put on strategies that motivate active learning, involving, for example, interactive lectures, case-based discussions, role-playing activities, games and project tasks, to generate engagement and comprehension of key competencies. Disciplines from the same healthcare but from various programs have an opportunity to share ideas through the multidisciplinary teams which develops teamwork, communication, and respect for diverse perspectives within institutions. The continuous assessment and improvement make sure that the PEC modules are always up to date, problem-solving as well as answering the ever-changing requirements of the healthcare field. Institutions can achieve this goal through regular feedback mechanisms and assessment of students’ knowledge and skills data, which will help them find limitations in the PEC programs and improve their modules to make them work well in the field of modern medical practice. Lastly, incorporating PEC modules into the curriculum helps students gain the advanced skills of teamwork, leadership, communication, ethics and values in healthcare. Overall, they are well equipped to excel in the delivery of patient-centred care in different clinical settings after their training. Such a study gives essential findings to medical education resources who are striving to improve their curricula to be able to upskill future healthcare professionals to embrace the demands of current medical practice.
... The learning setting present in this study is set in a high-fidelity healthcare simulation environment, a widely used instructional method in healthcare education that replicates real clinical situations with sophisticated patient manikins [70]. Aligning with constructivist learning theories, this technique engages students in active, reflective tasks within authentic contexts [42]. The simulation classroom featured four patient beds, medical equipment, and advanced patient manikins controlled by teaching staff. ...
Multimodal Learning Analytics (MMLA) leverages advanced sensing technologies and artificial intelligence to capture complex learning processes, but integrating diverse data sources into cohesive insights remains challenging. This study introduces a novel methodology for integrating latent class analysis (LCA) within MMLA to map monomodal behavioural indicators into parsimonious multimodal ones. Using a high-fidelity healthcare simulation context, we collected positional, audio, and physiological data, deriving 17 monomodal indicators. LCA identified four distinct latent classes: Collaborative Communication, Embodied Collaboration, Distant Interaction, and Solitary Engagement, each capturing unique monomodal patterns. Epistemic network analysis compared these multimodal indicators with the original monomodal indicators and found that the multimodal approach was more parsimonious while offering higher explanatory power regarding students' task and collaboration performances. The findings highlight the potential of LCA in simplifying the analysis of complex multimodal data while capturing nuanced, cross-modality behaviours, offering actionable insights for educators and enhancing the design of collaborative learning interventions. This study proposes a pathway for advancing MMLA, making it more parsimonious and manageable, and aligning with the principles of learner-centred education.
... Similar to the results found in Aluisio et al. [8], previous studies have also demonstrated that CBL is a highly effective modality for knowledge retention and skill acquisition, particularly in disaster preparedness and emergency response training [13]. This is consistent with prior evidence showing that interactive and scenario-based learning approaches engage learners more effectively compared to traditional didactic or simulation exercises, which may not always mirror real-life complexities adequately [14]. The significant improvement in knowledge scores observed in our review reaffirms the potential of CBL as a superior method for enhancing prehospital primary survey skills. ...
This systematic review evaluates the impact of trauma care and emergency preparedness training programs on prehospital primary survey effectiveness. A comprehensive search strategy was employed across multiple databases, including PubMed, Cochrane Library, Embase, and the Cumulated Index to Nursing and Allied Health Literature (CINAHL), focusing on studies involving healthcare professionals such as paramedics, nurses, and emergency medical technicians (EMTs). The review included randomized controlled trials (RCTs), clinical trials, and cohort studies that assessed various training modalities like virtual reality (VR) simulations, case-based learning (CBL), and hands-on workshops. Quality assessment was performed using the Cochrane risk-of-bias (RoB) tool for randomized trials and the Newcastle-Ottawa Scale (NOS) for clinical trials, ensuring methodological rigor and consistency. The findings suggest that CBL significantly improves knowledge retention and prehospital primary survey skills, outperforming other methods such as simulation exercises, which showed mixed results. VR training increased confidence levels but did not demonstrate significant improvements in objective skills compared to traditional methods. The use of supplementary triage assistance teams (physician-nurse supplementary triage team (MDRNSTAT)) was found to be effective during high patient volume hours, though not cost-effective as a daytime strategy. While the review highlights the importance of interactive and scenario-based training programs, limitations such as variability in study designs, publication bias, and language bias were noted, suggesting that caution should be exercised in generalizing the results. Future research should focus on long-term effectiveness, the integration of emerging technologies, and larger, well-designed trials across diverse healthcare settings to strengthen the evidence base.
Simulation-based learning (SBL) has transformed nursing education by offering realistic, controlled environments for clinical decision-making practice. This paper investigates the effect of SBL on improving decision-making skills among nursing students. Drawing from literature prior to 2023, evidence shows consistent enhancement of critical thinking, confidence, and clinical reasoning through simulation interventions. Quantitative analysis of multiple studies reveals significant skill development, especially when using high fidelity simulations. The study concludes with recommendations for integrating SBL more systematically across nursing curricula.
Training for Unknowns is a comprehensive guide designed to help organizations master the art of training employees to solve complex, unpredictable problems in today's rapidly evolving world.
In the business world characterized by volatile, uncertain, complex, and ambiguous (VUCA) challenges amidst brittle, anxious, non-linear, and incomprehensible (BANI) environments, the ability to prepare your workforce for the “unknowns” has never been more critical to maintaining a competitive edge.
This book equips learning and development professionals with the tools, methods, and frameworks necessary to design effective training programs that impart complex problem-solving (CPS) skills—skills that are essential for addressing high-order, multi-dimensional problems. Whether it's advanced analytical thinking, strategic decision-making, technical troubleshooting, or critical thinking, Training for Unknowns covers it all.
Divided into 15 insightful chapters, the book begins by exploring the unpredictable nature of today’s business landscape. It then introduces powerful, problem-centered learning methodologies, including Problem-Based Learning (PBL), Project-Based Learning (PjBL), Scenario-Based Learning (SBL), Case-Based Learning (CBL), and Simulation-Based Learning (SmBL). Each approach is accompanied by real-world case studies, practical tips, and key considerations for implementation.
The book also dives deep into the cognitive science behind CPS, breaking down the mental processes required to solve complex, high-level problems. With advanced frameworks for integrating multiple learning methods, Training for Unknowns provides cutting-edge solutions for instructional designers, educators, and corporate training professionals. It presents actionable strategies for creating contextualized learning experiences that prepare employees to face the unknown challenges of the future.
With its focus on innovative training strategies, practical methodologies, and in-depth analysis of CPS, Training for Unknowns is an essential resource for L&D leaders, instructional designers, and organizations seeking to future-proof their workforce, improve decision-making capabilities, and stay ahead in an ever-evolving business environment.
El aprendizaje basado en simulación es una metodología innovadora, factible, flexible y pertinente para el desarrollo de competencias clínicas, que contribuye a la seguridad del paciente. Objetivo: Analizar los resultados de usabilidad y aplicación de la metodología basada en simulación mediante una investigación cuasiexperimental. Esta investigación se llevó a cabo tras la implementación de una estrategia metodológica que consistió en cursos docentes sobre simulación, con una duración de 40 horas académicas por semestre y carácter obligatorio, complementados con evaluaciones basadas en los estándares internacionales de buenas prácticas en simulación. Estas acciones permitieron a los estudiantes modificar sus percepciones sobre la simulación y el desarrollo de competencias mixtas a través de interacciones dinámicas que fomentaron el trabajo colaborativo, experiencial y basado en problemas. Materiales y métodos: El diseño de la investigación fue exploratorio, mixto y de participación activa. Se analizaron concepciones teóricas que sustentan actividades lúdicas. Los grupos de estudiantes fueron seleccionados de manera no aleatoria, y se utilizó una encuesta semiestructurada con escala de Likert para comparar las respuestas del grupo de control con las del grupo que fue intervenido mediante la metodología de aprendizaje basado en simulación (ABS). Resultados: Los resultados mostraron que, la metodología de simulación, fortalece el desarrollo de competencias y es efectiva como estrategia educativa. Conclusión: La simulación se confirma como una estrategia educativa flexible y aplicable a diversos contextos clínicos, lo que la convierte en una herramienta valiosa para la formación de competencias en entornos educativos en salud.
This chapter provides a comprehensive historical overview of healthcare simulation, tracing its origins from ancient China to the aviation industry’s influence in the early 1900s. Pivotal moments in medical simulation evolution, including the development of wax anatomical models and Resusci Annie and SIM one mannequins, are highlighted. Moving to the contemporary landscape, the chapter defines healthcare simulation as a methodology for practice, learning, and system evaluation, emphasizing its role in developing essential cognitive, technical, and behavioral skills for healthcare professionals. The multifaceted purposes of simulation, advantages such as improved patient safety, and limitations like cost and fidelity are explored. The chapter concludes by previewing subsequent sections that will delve into effective strategies for simulation-based education, underscoring its critical role in modern medical education and practice.
Commercial diving, a specialized profession encompassing various underwater tasks for industries such as construction and maintenance, exposes divers to unique hazards and challenges. Fundamental diving knowledge, encompassing the understanding of diving theories (DTs) and decompression procedures (DCPs), plays a pivotal role in enhancing diving safety. This study aims to assess the knowledge level of professional commercial divers regarding fundamental DTs and DCPs. The findings reveal notable disparities in knowledge levels among divers based on their qualifications, service sectors and professional experiences. While first-class divers, mixed-gas divers and second-class divers demonstrated satisfactory understanding of essential DTs and DCPs, individual divers and aquaculture divers exhibited potential knowledge gaps. The identified discrepancies underscore the significance of professional knowledge in ensuring diver safety and signal the need for targeted training programs to enhance divers' understanding of essential DTs and DCPs.
Objectives:
Within paramedic education immersive simulation is widely used to teach technical skills, but its application to non-technical aspects of practice, such as research skills, is limited. This study aimed to explore immersive simulation as a tool to teach specific research skills to paramedic students in higher education to investigate its novel capacity beyond the more traditionally considered technical elements of practice.
Methods:
A didactic pre-briefing was delivered to undergraduate paramedic students before they undertook an immersive simulation in which they were expected to assess, extricate, and treat a stroke patient, whilst also assessing whether he was suitable to be enrolled onto a clinical trial, provide information on this, and take consent. A large-scale immersive environment furnished with surround audio-visual display equipment was utilized; the environment also contained an ambulance, a hatchback car, and two actors. After the simulation and debriefing, students completed an online questionnaire comprising open-ended questions and the following scales: Simulation Design Scale (fidelity subscale only), Simulation Effectiveness Tool - Modified, and Satisfaction with Simulation Experience. Data were analyzed using descriptive statistics and a manifest qualitative content analysis.
Results:
Data were collected from twenty-eight undergraduate paramedic students. Most students believed simulation fidelity was important (89.3%) and most agreed that the simulation was realistic (82.1%). Pre-briefing (100%) and debriefing (85.7%) opportunities were considered important for increasing student's confidence and learning, and, overall, students enjoyed the simulation (89.3%). Three themes emerged during the qualitative analysis: the significance of an immersive "real" environment, enjoyment as important for engagement and learning, and improved confidence via opportunities for autonomous practice.
Conclusions:
Immersive simulation is a valuable pedagogical tool for the delivery of research skills teaching. These findings align with previous research which has investigated immersive simulation for teaching clinical skills, but more broadly, also highlight the compounding positive impact of immersive technology when deployed alongside actors and high-fidelity equipment.
Introduction: Gap remains in understanding how students perceive the impact of simulations on their development of critical thinking skills and how their emotional well-being is affected during high-fidelity simulations. This gap occurs because little attention is paid to what students think about such specifics in learning activities.
Aim: This study aimed to explore the strengths and weaknesses of simulation as perceived by students, with a focus on understanding the associated scenario design, emotional impact, and skills development.
Methods: This qualitative study was conducted at a government university in central Saudi Arabia. Twenty nursing students participated in one-to-one interviews between November 2023 and January 2024.
Results: Five themes and six subthemes emerged from the students’ verbatim accounts: (1) conceptual understanding (subtheme: preparation for real-world practice), (2) development and refinement of clinical skills (subtheme: identifying weaknesses), (3) trepidation to triumph (subthemes: stepping outside the comfort zone and reframing difficulty), (4) technical and scenario limitations of advanced simulation (subtheme: gap between simulation and reality), and (5) yearning for the cutting edge (subtheme: interest in immersive learning technologies).
Conclusion: Participants reported positive experiences, including increased confidence, skill development, and an improved understanding of complex clinical concepts. However, limitations such as unrealistic scenarios and technical difficulties were identified. This study emphasizes the potential of advanced technologies, such as virtual and augmented reality, to overcome these challenges and create more immersive and engaging learning experiences.
Background
Simulation-based medical education (SBME) involves using techniques to replicate real scenarios that health profession students will encounter in the clinical areas.
Aims
This research aimed to investigate medical student experiences before and after integrating SBME in the internal medicine clerkship courses at the Faculty of Medicine (FOM), Jazan University (JU), Saudi Arabia (SA).
Settings and Design
This quasi-experimental design was based on the NLN Jeffries Nursing Education Simulation Framework, which was conducted among medical students at the FOM at JU, SA.
Subjects and Methods
Data were gathered through validated questionnaires aligned with the chosen framework: the Educational Practices Questionnaire, the Simulation Design Scale, and the Self-Confidence in Learning Questionnaire. These instruments were translated into Arabic and circulated among 532 medical students enrolled in the internal medicine clerkship courses.
Statistical Analysis Used
Data collected from Google Forms underwent analysis using These data had been entered and analyzed using Statistical Package for Social Sciences software version 24.0 (SPSS, Chicago, IL, USA). Frequencies and means were computed for descriptive statistics, and relationships, as well as predictions for student satisfaction and self-confidence, were evaluated through Chi-square tests and multiple regression.
Results
A total of 433 students participated, representing an 81.4% response rate. The participants displayed a balanced gender distribution (46.3% being male and 53.7% female). The academic distribution among the participants was diverse, with 38.2% in their 4 th year, 34.5% in their 5 th year, and 27.3% in their 6 th year. A majority of the students (72.9%) exhibited a cumulative grade point average indicative of very good performance. Following the intervention, notable enhancements were observed in simulation design and educational practices. Mean scores for objectives and support experienced a significant increase ( P < 0.05). Students’ satisfaction with their learning significantly rose ( P = 0.027); however, improvements in self-confidence were not statistically significant. Moreover, the predictors of satisfaction underscored the significance of diverse learning methodologies and clear objectives. The importance of feedback mechanisms for improving satisfaction and self-confidence became apparent, suggesting that customized educational strategies could optimize the advantages of SBME.
Conclusions
The current study emphasizes significant enhancements in student contentment and teaching methods after the intervention, emphasizing the value of varied learning approaches. Although the increase in self-confidence was not statistically notable, personalized feedback mechanisms are crucial for improving student experiences in medical education based on simulation. Tailored strategies can optimize educational advantages.
Background: Serious illness communication (SIC) competency is essential for health care professionals. However, many clinicians receive little-to-no SIC training, and there is little evidence as to which teaching method is most feasible to incorporate into postgraduate curricula. Two e-modules were created to adapt high-yield knowledge to deliver asynchronous, time-efficient, standardized communication skills teaching. This project evaluated SIC e-module teaching feasibility, learner and faculty perceptions toward e-module learning on this topic, as well as learner confidence and skill usage post-completion.
Methods: Family Medicine residents and palliative care fellows from two training sites were invited to asynchronously complete the e-modules on their own time and complete a survey to assess attitudes, perceptions, and needs toward them and impact on SIC skills immediately and 1-month post-completion. Faculty from the main site were also invited to view the e-modules and complete a survey immediately afterward assessing attitudes, perceptions, and feasibility on SIC e-module learning.
Results: In total, 19/50 (38%) learners completed the e-modules and post-training survey and 14/19 (73%) of those learners completed the 1-month follow-up survey. In total, 13/60 (22%) faculty completed the survey. Participants liked the structure and design of the e-modules and felt they were appropriate for their learners’ level of training, were effective, time-efficient, and provided relevant SIC information. Case-based video demonstrations were identified as the most useful teaching method. Most learners intended to use new skills in clinical practice, rewatched both e-modules within 1 month of initial viewing, and reported using learned skills in practice.
Conclusion: E-module training provides a standardized method to scale postgraduate SIC skills teaching asynchronously and was well liked by learners and faculty. Barriers exist to completing them outside of a core curriculum. Early data suggest e-modules can be used iteratively and further research is needed to determine how their use impacts communication confidence and competency.
This chapter starts the first part of the book, which aims to build a shared conceptual framing between applied drama and person-centred nursing. This chapter begins that task by mapping the main challenges facing nursing, and how applied drama and person-centred nursing can offer solutions to these issues independently, and in a small way, how they can do so together as an interdisciplinary practice (though this will be completed more fully in Chap. 4). This chapter takes a journey through key concepts surrounding applied drama and nursing and explores some of the ways in which the two fields have encountered each other. This includes an in-depth examination of resonant approaches that contribute to what can be called drama and nursing. This includes explorations into arts and health, medical humanities, theatre in education, healthcare simulation, and more, creating a robust and unique picture of the field of drama and nursing across the globe. This chapter provides examples of practices and interventions, identifying points of influence for my work, and carving out a space for the approach used in my study to sit within—and indeed where it hopes to chart new waters. Though not comprehensive, this chapter presents a diverse and ranging view of the field of drama and nursing, creating a story of how the interdisciplinary field emerged conceptually and how it manifests into practice. This chapter aims to provide readers with a comprehensive sense of the field of drama and nursing, to highlight areas of greater and lesser attention, and to point towards a space that this study hopes to fill within that field.
The active development of mobile and autonomous robotics in the last decade contributes to the search for opportunities for their application and solving tasks in the field of "Military Affairs, National Security, State Border Security". The study provides a classification, considers modern aspects and the state of military simulators in the world. An analysis of the use of modern military simulator technologies used in Ukraine to ensure the most realistic and effective training of military personnel is carried out, and examples of the use of military simulators in Ukraine are given. In the process of describing a multi-functional military mobile robot control simulator with FPV and feedback system, the target feedback function is provided, and the importance of using a mathematical apparatus to build a simulation device is determined. The work provides schemes and modes of operation of a multifunctional military simulator of controlling a mobile robot with FPV and a feedback system. When writing the conclusions, it is indicated that an important factor of modernity is the integration of new technologies. Future military simulators are sure to include a number of new technologies that will further enhance their effectiveness and realism.
Introduction
The critical role of emergency physicians in military settings underscores the necessity for a broad and proficient skill set, especially in life-saving procedures such as thoracostomies, endotracheal intubations, and cricothyrotomies, to maintain combat readiness. The current peacetime phase, however, presents challenges in maintaining these skills because of decreased exposure to high-acuity medical scenarios. This decrease in exposure jeopardizes skills retention among military emergency medicine physicians, highlighted by studies showing a significant decline in performance over time because of reduced practice.
Materials and Methods
This study was carried out at the Naval Medical Readiness Training Center Portsmouth under IRB approval, employing a prospective, observational, mixed-methods design. Participants included board-certified emergency medicine physicians engaged in a self-directed, small-group skills lab focusing on central venous catheterization, thoracostomy, intraosseous access, endotracheal intubation, cricothyrotomy, and resuscitative thoracotomy. Pre- and post-lab surveys on a 5-point confidence scale assessed the impact of the lab, with data analyzed via the Wilcoxon signed-rank test to evaluate significant changes.
Results
Fourteen physicians reported pre-lab confidence levels, showing high confidence in central venous catheter access, thoracostomy tube placement, intraosseous catheter placement, and endotracheal intubation. The interventions of cricothyrotomy, resuscitative thoracotomy, and suprapubic catheterization started with notably lower confidence levels. Statistically significant improvements in confidence were observed post-lab for cricothyrotomy, resuscitative thoracotomy, and suprapubic catheterization suggesting the lab’s effectiveness in addressing less frequently practiced procedures.
Conclusions
The Military Health System must find avenues to maintain the clinical skills of wartime procedures in the peacetime environment. Although there is no substitute for clinical encounters, alternative modalities are needed to augment skills retention in high-acuity, low-frequency procedures. Self-directed, small-group task trainers and cadaveric labs are a lower maintenance mechanism by which faculty can improve their confidence in certain procedural skills. Further studies should evaluate if this translates to changes in clinically oriented outcomes and how to optimize such training evolutions within the skills retention paradigm.
Introduction
This study, part of a series, analyses the Swiss cohort from an EBO survey on cataract surgery training in Europe, focusing on Switzerland's unique program. The survey identifies two models: training all residents in surgery, and a “high-volume surgeon” model where only some learn CS post-residency.
Methods
This study analyses the survey results of Swiss participants in the EBO examinations (2018–2022) and compared them with the most important cohorts (Germany, France and Spain).
Results
Out of 251 respondents, 87 (34.7%) answered the questionnaire. Most (70.1%) had taken the EBO exam between 2021–2022, with the majority of study participants being men (55.2%) with a median age of 34 years and came from 12 different cantons. Two third (68.8%) of respondents had not performed any steps of cataract surgery on patients during their residency. Notably, 22.1% stated that they had carried out 10 or more training sessions on virtual reality simulator, 5.8% on synthetic eyes and 21% on animal eyes. A notable discrepancy was observed between participants with 10 or more training sessions and those without specific training in four key areas: self-assessed confidence and ability to perform cataract surgery (p = 0.006), management of challenging cases (p = 0.027), handling complications like posterior capsular tear (p = 0.031) and in performing corneal sutures (p = 0.023).
Discussion
Switzerland fits into the “high-volume surgeon” model group; extensive simulation-based training there significantly boosts self-confidence in performing CS, an effect less noticeable in countries offering hands-on training during residency.
Delivering simulation across a health system can engage the entire workforce by moving beyond traditional educational delivery and focusing on broader organizational needs specific to a particular organization. The commonly known use of simulation as a form of life support education has progressed to include fully immersive simulation experiences focusing on team-based communication, leadership, fellowship, and clinical care. It continues beyond this point with the inclusion of patient safety strategies, root cause analysis investigation, leadership, and management training, and recently, it has included environments that catalyze innovation in complex healthcare systems. The focus on pure fiscal elements of simulation-based approaches does not give a health system the accurate nontangible benefits simulation can provide, and importantly, acknowledging that each location has differing needs is essential when considering what investment should be made and where. A small community hospital will have vastly different needs from specialty hospitals that deliver specialist care. It must also be understood that every simulation center, to some extent, will always be unique, as it should. The commonly quoted statement “when you have seen one simulation center, you have seen one simulation center” really does reflect the reality of this established and rapidly growing specialty. In this article, we reflect on the traditional use of simulation and discuss some wider uses that may engage a wider audience and, importantly, provide a greater return on investment for your facility, making the case for investment more reasonable and impactful to each part of a busy health system.
Background Simulation-based learning (SBL) has emerged as a valuable pedagogical approach in nursing education, allowing students a safe and controlled environment to practice clinical skills with varying levels of fidelity. Furthermore, SBL has become an increasingly popular teaching strategy in nursing education; however, few studies have investigated the effectiveness of SBL in Saudi Arabia. This study evaluates the impact of SBL on nursing students' knowledge and skill acquisition and retention. Methods A quasi-experimental study used a repetitive test design with a 6-week follow-up after the intervention was conducted. A total of 100 nursing students were exposed to a simulation protocol during the internship year. Descriptive statistics and ANOVA were used to analyse the data. Results The findings indicated that SBL significantly improved nursing student knowledge and skills immediately after the intervention, with mean post-test scores higher than pre-test scores (p < 0.01). Moreover, the follow-up test conducted six weeks after the intervention indicated that while there was a slight decline in scores compared to the immediate post-test, the retention of knowledge and skills remained significantly higher than baseline levels (p < 0.01). The improvement of SBL was consistent regardless of the individual characteristics of participants. Conclusions This study provides evidence supporting SBL as an effective teaching strategy within nursing education to enhance knowledge and skill acquisition and retention. While acknowledging certain limitations and the need for further research to explore strategies to enhance the acquisition and retention of knowledge and skills, these findings have important implications for nursing education, particularly in Saudi Arabia. They provide valuable insights for nursing educators and policymakers on the benefits of SBL for enhancing student learning outcomes.
Background
The World Health Organization (WHO) recommends simulation‐based education (SBE) to acquire skills and accelerate learning. Literature focusing on SBE in the Pacific Islands is limited. The aim of this study was to determine Pacific Island healthcare workers' experiences, perspectives, and access to SBE.
Methods
This was a cross‐sectional survey of Pacific Island healthcare workers. We designed an online questionnaire based on existing literature and expert consultation. The questionnaire included Likert scales, multiple‐choice, multi‐select and open‐ended questions. Participants were healthcare workers recruited from professional networks across the region. Descriptive statistics and relative frequencies summarized data, and comparative testing included unpaired t‐tests, Mann–Whitney U , Chi‐squared and Fisher's exact tests. Free‐text responses were presented to illustrate findings.
Results
Responses from 56 clinicians working in 11 Pacific Island countries were included. Fifty were medical doctors (89%), including 31 (55%) surgeons. Participants reported experience with scenario‐based simulation (73%), mannequins (71%), and simulated patients (61%). Discrepancies were identified between previous simulation experience and current access for simulated patients ( P = 0.002) and animal‐based part‐task trainers ( P = 0.002). SBE was seen as beneficial for procedural skills, communication, decision‐making and teamwork. Interest in further SBE was reported by most participants (96%). Barriers included equipment access (59%), clinical workload (45%) and COVID‐19 restrictions (45%).
Conclusion
Some Pacific Island healthcare workers have experience with SBE, but their ongoing access is predominantly limited to low‐technology modalities. Despite challenges, there is interest in SBE initiatives. These findings may inform planning for SBE in the Pacific Islands and may be considered prior to programme implementation.
Objectives: To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew. Design: Cross sectional surveys. Setting: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world. Participants: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers). Main outcome measures: Perceptions of error, stress, and teamwork. Results: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes. Conclusions: Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members.
This article describes emergency department care work teams designed to improve team communication and coordination and reduce error. The core of this teamwork system is the teaching of teamwork behaviors and skills, development of teamwork habits, and creation of small work teams, all of which are key teamwork concepts largely drawn from successful aviation programs. Arguments for enculturating teamwork into ED practice are drawn from a retrospective study of ED malpractice incidents. Fifty-four incidents (1985-1996), a sample of convenience drawn from 8 hospitals, were identified and judged mitigable or preventable by better teamwork. An average of 8.8 teamwork failures occurred per case. More than half of the deaths and permanent disabilities that occurred were judged avoidable. Better teamwork could save nearly $3.50 per ED patient visit. Caregivers must improve teamwork skills to reduce errors, improve care quality, and reduce litigation risks.
Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises.
Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied.
Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used.
Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.
To assess the effects of preventive home visits to elderly people living in the community.
Systematic review.
15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register.
Physical function, psychosocial function, falls, admissions to institutions, and mortality.
Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects.
No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.
To survey operating theatre and intensive care unit staff about attitudes concerning error, stress, and teamwork and to compare these attitudes with those of airline cockpit crew.
: Cross sectional surveys.
: Urban teaching and non-teaching hospitals in the United States, Israel, Germany, Switzerland, and Italy. Major airlines around the world.
: 1033 doctors, nurses, fellows, and residents working in operating theatres and intensive care units and over 30 000 cockpit crew members (captains, first officers, and second officers).
: Perceptions of error, stress, and teamwork.
: Pilots were least likely to deny the effects of fatigue on performance (26% v 70% of consultant surgeons and 47% of consultant anaesthetists). Most pilots (97%) and intensive care staff (94%) rejected steep hierarchies (in which senior team members are not open to input from junior members), but only 55% of consultant surgeons rejected such hierarchies. High levels of teamwork with consultant surgeons were reported by 73% of surgical residents, 64% of consultant surgeons, 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses, and 10% of anaesthetic residents. Only a third of staff reported that errors are handled appropriately at their hospital. A third of intensive care staff did not acknowledge that they make errors. Over half of intensive care staff reported that they find it difficult to discuss mistakes.
Medical staff reported that error is important but difficult to discuss and not handled well in their hospital. Barriers to discussing error are more important since medical staff seem to deny the effect of stress and fatigue on performance. Further problems include differing perceptions of teamwork among team members and reluctance of senior theatre staff to accept input from junior members.
To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams.
Nine teaching and community hospital EDs.
A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions.
Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level.
A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040).
Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum.
Level 1 trauma center and academic emergency medicine training program.
Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians.
ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention.
Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams.
There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method.
High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.
In the second paper of this two part series on Key Elements of Interprofessional Education (IPE), we highlight factors for success in IPE based on a systematic literature review conducted for Health Canada in its "Interprofessional Education for Patient Centred Practice" (IECPCP) initiative in Canada (Oandasan et al., 2004). The paper initially discusses micro (individual level) meso (institutional/organizational level) and macro (socio-cultural and political level) factors that can influence the success of an IPE initiative. The discussion provides the infrastructure for the introduction of a proposed framework for educators to utilize in the planning and implementation of an IPE program to enhance a learner's opportunity to become a collaborative practitioner. The paper also discusses key issues related to the evaluation of IPE and its varied outcomes. Lastly, it gives the reader suggestions of outcome measurements that can be used within the proposed IPE framework.
Advance cardiac life support (ACLS) training does not address coordination of team resources to improve the ability of teams to deliver needed treatments reliably and rapidly. Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team (MET) performance. We report findings of a crisis team training course that is focused on organization.
Large center for human simulation training at a university affiliated tertiary care hospital.
Ten courses were delivered and 138 clinically experienced individuals were trained (69 critical care nurses, 48 physicians, and 21 respiratory therapists). All participants were ACLS trained and experienced in responding to cardiac arrest situations. COURSE DESIGN: Each course had four components: (1) a web based presentation and pretest before the course; (2) a brief reinforcing didactic session on the day of the course; (3) three of five different simulated scenarios; each followed by (4) debriefing and analysis with the team. Three of five simulator scenarios were used; scenario selection and order was random. Trainees did not repeat any scenario or role during the training. Participants were video recorded to assist debriefing. Debriefing focused on reinforcing organizational aspects of team performance: assuming designated roles independently, completing goals (tasks) assigned to each role, and directed communication. MEASURES FOR IMPROVEMENT: Participants graded their performance of specific organizational and treatment tasks within specified time intervals by consensus. Simulator "survival" depended on supporting oxygenation, ventilation, circulation within 60 seconds, and delivering the definitive treatment within 3 minutes.
Simulated survival (following predetermined criteria for death) increased from 0% to 89%. The initial team task completion rate was 10-45% and rose to 80-95% during the third session.
Training multidisciplinary teams to organize using simulation technology is feasible. This preliminary report warrants more detailed inquiry.
To estimate the proportion and characteristics of patients injured by medical care in New Zealand public hospitals who complain to an independent health ombudsman, the Health and Disability Commissioner ("the Commissioner").
The percentage of injured patients who lodge complaints was estimated by linking the Commissioner's complaints database to records reviewed in the New Zealand Quality of Healthcare Study (NZQHS). Bivariate and multivariate analyses investigated sociodemographic and socioeconomic differences between complainants and non-complainants.
New Zealand public hospitals and the Office of the Commissioner in 1998.
Patients who lodged claims with the Commissioner (n = 398) and patients identified by the NZQHS as having suffered an adverse event who did not lodge a complaint with the Commissioner (n = 847).
Adverse events, preventable adverse events, and complaints lodged with the Commissioner.
Among adverse events identified by the NZQHS, 0.4% (3/850) resulted in complaints; among serious, preventable adverse events 4% (2/48) resulted in complaints. The propensity of injured patients to complain increased steeply with the severity of the injury: odds of complaint were 11 times greater after serious permanent injuries than after temporary injuries, and 18 times greater after deaths. Odds of complaining were significantly lower for patients who were elderly (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1 to 0.4), of Pacific ethnicity (OR 0.3, 95% CI 0.1 to 0.9), or lived in the most deprived areas (OR 0.3, 95% CI 0.2 to 0.6).
Most medical injuries never trigger a complaint to the Commissioner. Among complaints that are brought, severe and preventable injuries are common, offering a potentially valuable "window" on serious threats to patient safety. The relatively low propensity to complain among patients who are elderly, socioeconomically deprived, or of Pacific ethnicity suggests troubling disparities in access to and utilisation of complaints processes.
The US healthcare delivery system is in a state of change. Medical science and technology are advancing at an unprecedented rate, while cost containment and productivity pressures on clinicians make the clinical environment less than ideal for training. Training is one of the vehicles for addressing new knowledge requirements and for enhancing human and system based performance. Yet the theoretical underpinnings and design aspects of training have been largely unrecognized and unexamined in health care. This paper first explores changes in the practice of medicine and the healthcare delivery environment. It then describes how healthcare training and education can benefit from findings in the behavioral and cognitive sciences. It describes the systems approach to training and explores the extent to which a systems approach can be applied to the clinical environment. Finally, the paper examines innovative training and education techniques that are already gaining acceptance in health care.
Unlabelled:
BACKGROUND AND REVIEW CONTEXT: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review identified, collated, analysed and synthesised the best available contemporary evidence from 21 of the strongest evaluations of IPE to inform the above proposition. In this way we sought to help shape future interprofessional education and maximize the potential for interprofessional learning to contribute to collaborative practice and better care.
Objectives of the review:
To identify and review the strongest evaluations of IPE. To classify the outcomes of IPE and note the influence of context on particular outcomes. To develop a narrative about the mechanisms that underpin and inform positive and negative outcomes of IPE.
Search strategy:
Bibliographic database searches as follows: Medline 1966-2003, CINAHL 1982-2001, BEI 1964-2001, ASSIA 1990-2003 which produced 10,495 abstracts. Subsequently, 884 full papers were obtained and scrutinized. In addition, hand searching (2003-5 issues) of 21 journals known to have published two or more higher quality studies from a previous review.
Topic definition and inclusion criteria:
Peer-reviewed papers and reports included in the review had to be formal educational initiatives attended by at least two of the many professional groups from health and social care, with the objective of improving care; and learning with, from and about each other.
Data collection, analysis and synthesis:
Standard systematic review procedures were applied for sifting abstracts, scrutinizing full papers and abstracting data. Two members of the team checked each abstract to decide whether the full paper should be read. A third member was consulted over any discrepancies. Similarly, each full paper was read by at least two members of the team and agreement sought before passing it to one member of the team (SR) for data abstraction. Other members of the team checked 10% of the abstraction records. Coding into a Statistical Package for Social Scientists (SPSS) data base led to collection of different outcome measures used in the primary studies via the common metric of an adapted Kirkpatrick's four-level model of educational outcomes. Additionally, a narrative synthesis was built after analysis of primary data with the 3-P model (presage-process-product) of education development and delivery.
Headline results:
Government calls for enhanced collaboration amongst practitioners frequently leads to IPE that is then developed and delivered by educators, practitioners or service managers. Staff development is a key influence on the effectiveness of IPE for learners who all have unique values about themselves and others. Authenticity and customization of IPE are important mechanisms for positive outcomes of IPE. Interprofessional education is generally well received, enabling knowledge and skills necessary for collaborative working to be learnt; it is less able to positively influence attitudes and perceptions towards others in the service delivery team. In the context of quality improvement initiatives interprofessional education is frequently used as a mechanism to enhance the development of practice and improvement of services.
Objective
To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum.
Setting
Level 1 trauma center and academic emergency medicine training program.
Participants
Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians.
Intervention
: ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC®) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention.
Design
Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams.
Results
There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method.
Conclusion
High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.
The growing complexity of patient care requires that emergency physicians (EPs) master not only knowledge and procedural skills, but also the ability to effectively communicate with patients and other care providers and to coordinate patient care activities. EPs must become good team players, and consequently an emergency medicine (EM) residency program must systematically train these skills. However, because teamwork-related competencies are relatively new considerations in health care, there is a gap in the methods available to accomplish this goal. This article outlines how teamwork training for residents can be accomplished by employing simulation-based training (SBT) techniques and contributes tools and strategies for designing structured learning experiences and measurement tools that are explicitly linked to targeted teamwork competencies and learning objectives. An event-based method is described and illustrative examples of scenario design and measurement tools are provided.
Emergency medicine (EM) residency programs are a new concept to India. As these programs develop in India the need for effective teaching tools for skills education will rise. A high fidelity simulation workshop was conducted with a intent to expose current residents posted in emergency departments (EDs) to the concept of simulation technology. The participants were subjected to scenarios which tested their core competencies, medical knowledge, and procedural skills using simulation technology. 50 residents were tested over 5 days and an overall satisfaction score and personal comments were assessed to rate the performance of this study. A pre- and post simulation survey was done. Results showed that participants felt that their understanding of communication of expectations increased from 38% fair or good to 76% very good or best. The frequency in which they thought they would ask for help increased from 36% fair or good to 88% very good or best. It was found that students had increased their confidence to challenge a questionable order from a superior from 48% occasionally or half of the time to 76% who would do it the majority of the time or always. In the post-survey, 80% would the majority of the time or always admit that they did not know something from 46% who stated they would only do it occasionally or half of the time. We concluded that simulation as a tool for teaching unknown and stressful conditions of ED naturally pair. Resident core competencies can be taught and evaluated more effectively in the simulation lab in a controlled, safe, and collegial manner.
Harvey, a life-sized cardiovascular patient simulator which depicts the auscultatory, tactile and visual findings for a broad range of cardiac problems was used as an adjunct to a standard sophomore physical skills course. Significant gains, as measured by a pre-posttest, were found in overall scores as well as in assessment and interpretation of carotid pulses and precordial auscultation. There were no significant changes in jugular venous pulse or precordial motion assessment. There were no significant correlations between student perceptions of skills gained and objective test measurements.
This study underscores the need for cardiovascular examination skills training and confirms the utility of a simulator such as Harvey in developing these abilities. The lack of correlation between perceived improvements and actual changes highlights the need for objective evaluations of educational endeavours. Use of a simulator such as Harvey presents the student with the opportunity to compare and contrast cardiovascular findings in a time and faculty resource efficient fashion.
In this study, we describe changes in the nature of Crew Resource Management (CRM) training in commercial aviation, including its shift from cockpit to crew resource management. Validation of the impact of CRM is discussed. Limitations of CRM, including lack of cross-cultural generality are considered. An overarching framework that stresses error management to increase acceptance of CRM concepts is presented. The error management approach defines behavioral strategies taught in CRM as error countermeasures that are employed to avoid error, to trap errors committed, and to mitigate the consequences of error.
Educating healthcare professionals is a key issue in the provision of quality healthcare services, and interprofessional education (IPE) has been proposed as a means of meeting this challenge. Evidence that collaborative working can be essential for good clinical outcomes underpins the real need to find out how best to develop a work force that can work together effectively. We identify barriers to mounting successful IPE programmes, report on recent educational initiatives that have aimed to develop collaborative working, and discuss the lessons learned. To develop education strategies that really prepare learners to collaborate we must: agree on the goals of IPE, identify effective methods of delivery, establish what should be learned when, attend to the needs of educators and clinicians regarding their own competence in interprofessional work, and advance our knowledge by robust evaluation using both qualitative and quantitative approaches. We must ensure that our education strategies allow students to recognise, value, and engage with the difference arising from the practice of a range of health professionals. This means tackling some long held assumptions about education and identifying where it fosters norms and attitudes that interfere with collaboration or fails to engender interprofessional knowledge and skill. We need to work together to establish education strategies that enhance collaborative working along with profession specific skills to produce a highly skilled, proactive, and respectful work force focused on providing safe and effective health for patients and communities.
The traditional system of clinical education in emergency medicine relies on practicing diagnostic, therapeutic, and procedural skills on live patients. The ethical, financial, and practical weaknesses of this system are well recognized, but the alternatives that have been explored to date have shown even greater flaws. However, ongoing progress in the area of virtual reality and computer-enhanced simulation is now providing educational applications that show tremendous promise in overcoming most of the deficiencies associated with live-patient training. It will be important for academic emergency physicians to become more involved with this technology to ensure that our educational system benefits optimally.
This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy.
Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR.
No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores.
Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.
High fidelity simulation has become a popular technique for training teamwork skills in high risk industries such as aviation, health care, and nuclear power production. Simulation is a powerful training tool because it allows the trainer to systematically control the schedule of practice, presentation of feedback, and introduction (or suppression) of environmental distractions within a safe, controlled learning environment. Unfortunately, many within the training community have begun to use the terms simulation and high fidelity simulation almost synonymously. This is unfortunate because doing so overemphasises the instructional technology to the detriment of more substantive issues, such as the training's goals, content, and design. It also perpetuates several myths: simulation fidelity is unidimensional, or higher levels of simulation fidelity lead to increased training effectiveness. The authors propose a typology of simulation fidelity and provide examples of how the different classes of simulation have been successfully used to train teamwork skills in high risk industries. Guidelines are also provided to maximise the usefulness of simulation for training teamwork skills in health care.
Simulation is a technique-not a technology-to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient's age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality.
Introduction Clinical simulation is on the point of having a significant impact on health care education across professional boundaries and in both the undergraduate and postgraduate arenas.
Scope of simulation The use of simulation spans a spectrum of sophistication, from the simple reproduction of isolated body parts through to complex human interactions portrayed by simulated patients or high-fidelity human patient simulators replicating whole body appearance and variable physiological parameters.
Growth of simulation After a prolonged gestation, recent advances have made available affordable technologies that permit the reproduction of clinical events with sufficient fidelity to permit the engagement of learners in a realistic and meaningful way. At the same time, reforms in undergraduate and postgraduate education, combined with political and societal pressures, have promoted a safety-conscious culture where simulation provides a means of risk-free learning in complex, critical or rare situations. Furthermore, the importance of team-based and interprofessional approaches to learning and health care can be promoted.
Conclusion However, at the present time the quantity and quality of research in this area of medical education is limited. Such research is needed to enable educators to justify the cost and effort involved in simulation and to confirm the benefit of this mode of learning in terms of the outcomes achieved through this process.
Simulation based training in anaesthesia crisis resource management: a decade of experience
- D Gaba
- SK Howard
- K Fish
- D Gaba
- SK Howard
- K Fish
Reducing the risk of military aircrew training through simulation technology
- D Farrow
- D Farrow
Simulator based training and patient safety in: Making health care safer: a critical analysis of patient safety practices
- AK Jha
- BW Duncan
- DW Bates
- AK Jha
- BW Duncan
- DW Bates
Simulator based training and patient safety in: Making health care safer: a critical analysis of patient safety practices. Agency for Health care
- A K Jha
- B W Duncan
- D W Bates