Article

Simulation Based Medical Education: An opportunity to learn from errors

Taylor & Francis
Medical Teacher
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Abstract

Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals' performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals' performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals' experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals' attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals' performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession-SBME educator-was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.

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... Then the learner returns to the simulation, actively experimenting with the new course of action or strategy. Students may be given opportunities to repeat the simulation, thereby gaining an opportunity to test the efficacy of the refined strategy (McGaghie & Harris, 2018;Pringle et al., 2010;Ziv et al., 2005). Proponents of experiential learning assert that it can lead to a deeper understanding of how knowledge is contextualized and used in practice (Bransford et al., 2000;McGaghie & Harris, 2018;Phillips & Graeff, 2014). ...
... Notably, these are hidden from the learners. Consistent with the experiential learning cycle (Kolb, 2014), these principles are discovered by students as they "gain experience" and reflect on what happened over multiple iterations of playing the simulation (Pringle et al., 2010;Salas et al., 2009;Ziv et al., 2005). ...
... Debriefing was enacted both in class and through the Online Discussion Forum, which featured an impressive participation rate of 90% for the weekly reflection questions. These data strongly suggest that students learned through a process of trial, error, and reflection (Elvira et al., 2017;Kolb, 2014;McGaghie & Harris, 2018;Ziv et al., 2005). They gradually began to develop the ability to make sense of the decision patterns that cohered (synthesis) into successful strategies (Bransford et al., 2000;Klein & Hoffman, 2020). ...
Article
This study assessed the effects of simulation-based learning on students' application of change management skills. A module organized around the Leading Change for Sustainability – Business simulation challenged learners to change the sustainability practices of stakeholders in a company. The study employed a quasi-experimental, time-series design. Friedman and Wilcoxon Signed-Ranked tests were used to assess the module's effects on the learning of 87 Master's degree students. The results affirmed significant, meaningful improvement in student execution of theory-informed change strategies. Improvements in student performance on the simulation aligned with practice and multi-faceted reflection activities that took place during the three-week intervention. The module developed a deeper understanding of the complexities of integrating new values and practices into a company. Three novel features of the study stand out. First, the study adds new evidence on the effects of simulation-based learning on the higher-order thinking of learners. Second, the research design extracted student engagement and learning performance data directly from the simulation rather than from a knowledge test. Third, the execution of the simulation-based learning intervention in a fully online learning mode heightened the timeliness of the study.
... If the training provides an objective outcome, continuous feedback loops of the achieved outcomes give the trainee the opportunity to reflect on his performance and to improve his skills and the trainer could easily communicate improvement to the trainee. Repeated training could lead to an increased performance because the trainee better understands the restriction and inherent difficulties of the training tasks [1,6,7]. ...
... Many studies have shown improved outcomes after training sessions with dental and medical students [6,7] whereas the time series of this study showed no improvement in performance for treatment with the plasma device and only a moderate improvement with the waterjet. A possible explanation for this could be that the trainees were already experts, having at least 7 years of experience in periodontal or oral surgery. ...
Article
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Objectives Clinical trials testing new devices require prior training on dummies to minimize the "learning curve" for patients. Dentists were trained using a novel water jet device for mechanical cleaning of dental implants and with a novel cold plasma device for surface functionalisation during a simulated open flap peri-implantitis therapy. The hypothesis was that there would be a learning curve for both devices. Materials and methods 11 dentists instrumented 44 implants in a dummy-fixed jaw model. The effect of the water jet treatment was assessed as stain removal and the effect of cold plasma treatment as surface wettability. Both results were analysed using photographs. To improve treatment skills, each dentist treated four implants and checked the results immediately after the treatment as feedback. Results Water jet treatment significantly improved from the first to the second implant from 62.7% to 75.3% stain removal, with no further improvement up to the fourth implant. The wettability with cold plasma application reached immediately a high level at the first implant and was unchanged to the 4th implant (mean scores 2.7 out of 3). Conclusion A moderate learning curve was found for handling of the water jet but none for handling of the cold plasma. Clinical relevance Scientific rational for study: Two new devices were developed for peri-implantitis treatment (Dental water jet, cold plasma). Dentists were trained in the use of these devices prior to the trial to minimize learning effects. Principal findings: Experienced dentists learn the handling of the water jet very rapidly and for cold plasma they do not need much training. Practical implications: A clinical study is in process. When the planned clinical study will be finished, we will find out, if this dummy head exercise really minimised the learning curve for these devices.
... Clinical simulation in the emergency setting is commonly performed by letting students manage a clinical case for a determined period of time with little to no interference by the facilitator; this experience is then followed by a debriefing session [6]. In rapid-cycle deliberate practice (RCDP), a strategy of simulation described by Hunt in 2014 [7], the same clinical case is divided into smaller cycles with predetermined goals; students participate in each cycle a number of times until all the goals for that cycle are met. ...
... One way to explain the learning during clinical simulation is throughout the Kolb Experiential Learning Cycle [13]. Participants experience a concrete situation, a simulated case, and they have the opportunity to identify performance gaps in which they can reflect on [6]. During debriefing, they have the opportunity to reflect on the simulation and their performance guided by a facilitator. ...
Article
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Introduction Rapid-cycle deliberate practice (RCDP) is a simulation-based educational strategy that consists of repeating a simulation scenario a number of times to acquire a planned competency. When the objective of a cycle is achieved, a new cycle initiates with increased skill complexity. There have been no previous randomized studies comparing after-event debriefing clinical manikin-based simulation to RCDP in adult cardiopulmonary resuscitation (CPR). Methods We invited physicians from the post-graduate program on Emergency Medicine of the Hospital Israelita Albert Einstein. Groups were randomized 1:1 to RCDP or after-event debriefing simulation prior to the first station of CPR training. During the first 5 min of the pre-intervention scenario, both groups participated in a simulated case of an out-of-hospital cardiac arrest without facilitator interference; after the first 5 min, each scenario was then facilitated according to group allocation (RCDP or after-event debriefing). In a second scenario of CPR later in the day with the same participants, there was no facilitator intervention, and the planned outcomes were evaluated. The primary outcome was the chest compression fraction during CPR in the post-intervention scenario. Secondary outcomes comprised time for recognition of the cardiac arrest, time for first verbalization of the cardiac arrest initial rhythm, time for first defibrillation, and mean pre-defibrillation pause. Results We analyzed data of three courses conducted between June 2018 and July 2019, with 76 participants divided into 9 teams. Each team had a median of 8 participants. In the post-intervention scenario, the RCDP teams had a significantly higher chest compression fraction than the after-event debriefing group (80.0% vs 63.6%; p = 0.036). The RCDP group also demonstrated a significantly lower time between recognition of the rhythm and defibrillation (6 vs 25 s; p value = 0.036). Conclusion RCDP simulation strategy is associated with significantly higher manikin chest compression fraction during CPR when compared to an after-event debriefing simulation.
... The concept of learning from errors in simulation basedlearning (SBL) is not new ( Ziv, Ben-David, & Ziv, 2005 ). SBL offers 'permission to fail, encouraging learners to deliberately experience and learn from such failures in a way that would be inconceivable with actual patients' ( Kneebone, Scott, Darzi, & Horrocks, 2004, p. 1098. ...
... SBL offers 'permission to fail, encouraging learners to deliberately experience and learn from such failures in a way that would be inconceivable with actual patients' ( Kneebone, Scott, Darzi, & Horrocks, 2004, p. 1098. SBL aims to improve patient safety as making and learning from errors in simulation can minimise the occurrence of similar mistakes in clinical practice ( Ziv et al., 2005 ). For example, recent studies suggest that when students identify, acknowledge, and correct their mistakes, it is less likely that they repeat them ( Palominos, Levett-Jones, Power, & Martinez-Maldonado, 2019 ). ...
Article
Background Productive failure simulations require students to participate in a simulation before receiving instruction. This approach contrasts with traditional simulations that typically begin with instruction followed by the simulation. Although previous studies have demonstrated that productive failure facilitates meaningful learning outcomes, students’ perspectives after being exposed to this approach have not been examined in simulation-based learning. Objective To explore nursing students’ perceptions of a productive failure simulation. Design Descriptive exploratory study. Participants Undergraduate nursing students from one large metropolitan Australian university. Methods Students involved in a productive failure simulation were invited to participate in semi-structured interviews on completion of their simulation experience. The interviews were audio-recorded, transcribed and the qualitative data were subjected to thematic analysis. Findings Fifteen small group interviews and seven individual interviews were conducted (n = 66). Three themes emerged from the analysis of the qualitative data: (i) the benefits of simulation prior to instruction; (ii) the value of performing a second simulation; and (iii) the importance of normalising errors. Conclusion The productive failure simulations helped students identify their knowledge and skill deficits and this acted as a catalyst for their learning. The normalisation of errors by the educator minimised the stress of trying to be “perfect” and assisted students to persevere despite setbacks. The provision of a second simulation helped the students rectify their errors in preparation for their future clinical practice. These aspects were considered essential for a meaningful productive failure simulation experience.
... Simulators serve as an alternative to the real patient and permit educators to gain full control over a predefined scenario, without having to encounter unwanted aspects of learning on real patients. [7][8][9] A study by Baird et al. wherein simulated scenarios were used to teach transfer training and promote clinical reasoning, concluded that 66%-88% of participants completed the transfer items correctly and considered simulation to be an efficient method of teaching. [10] The act of transferring a patient is a multifaceted task that, when not executed correctly, has been directly linked to injuries suffered by both patients and health-care providers. ...
... From mastering surgical techniques to honing communication skills, skill and simulation labs offer a safe and controlled environment for learners to develop essential competencies crucial for patient care. [1][2][3][4][5][6][7] However, amidst the praise and widespread adoption of skill and simulation labs, it is imperative to critically examine their limitations and potential drawbacks. This introduction sets the stage for uncovering the complexities inherent in skill and simulation laboratories, delving into areas that necessitate nuanced understanding and strategic improvements in medical education. ...
Article
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Skill and simulation laboratories have become integral components of modern medical education, offering hands-on training experiences in a controlled environment. While these labs are lauded for their potential to enhance learning and improve patient safety, they are not without their limitations and drawbacks. One of the primary challenges of skill and simulation labs lies in the fidelity of simulation models. While technological advancements have enabled the creation of highly realistic simulators, they often fall short in replicating the complexities and nuances of real-world clinical scenarios. This discrepancy can lead to a false sense of proficiency among learners, who may struggle to translate their skills effectively to clinical practice. Additionally, the cost involved in maintaining high-fidelity simulators and equipment poses a financial burden on educational institutions, limiting access and scalability. Another disadvantage of skill and simulation labs is the potential for simulation bias. Learners may approach simulated scenarios differently from real patient encounters, leading to skewed learning outcomes and overestimation of abilities. Moreover, the standardized nature of simulations may not adequately prepare students for the variability and unpredictability inherent in clinical practice, where factors such as patient diversity, comorbidities, and environmental stressors play significant roles. This review article highlights the disadvantages related to the skill and simulation lab.
... Simulation is an instructional process replicating real-life patients or situations with artificial models for learning, feedback, and assessment (Gaba, 2004). Simulation creates a safe education environment that encourages experiential learning with trial and error, enabling students to practice without adverse outcomes (Gordon et al., 2001;Okuda et al., 2009;Pombo et al., 2017;Ziv et al., 2005). It employs various instructional approaches, including Payton's four-step approach (Krautter et al., 2011), widely used in teaching and learning procedural skills. ...
Article
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Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.
... For example, studies in surgical and medical specialities have shown that simulation-based training can significantly improve teamwork and communication skills, situational awareness, and decision-making. 9,10 Given the parallels between the demands of perioperative care and other healthcare settings, we anticipate that anaesthesia residents will likewise benefit from simulation-based training. ...
Article
Background Non-technical skills are pivotal in ensuring patient safety during anaesthesia crisis resource management. Simulation-based training has emerged as a promising educational approach for enhancing these skills. This study protocol outlines a prospective randomised comparative study aimed at assessing the impact of simulation-based training on the performance of anaesthesia residents during anaesthesia crisis resource management, with a focus on task management, teamwork, situational awareness, and decision-making skills, using the Assessment of Non-Technical Skills (ANTS) scoring system. Methods Anesthesia residents in postgraduate years 1 and 2 from the Department of Anesthesia at Acharya Vinoba Bhave Rural Hospital will be included as study participants. Informed consent will be obtained, and no exclusion criteria will be applied. Participants will undergo an orientation session covering essential crisis management and simulation knowledge. The study will employ advanced simulation equipment, including a Human Patient Simulator (HPS) mannequin, an anaesthesia machine, and a simulated operating room. Faculty members have selected six distinct perioperative emergency scenarios for simulation sessions. Participants will be grouped in pairs and exposed to three scenarios during each session. Debriefing and feedback will follow each scenario, reinforcing non-technical skills. Experienced staff anesthesiologists, trained in the Assessment of Non-Technical Skills (ANTS) scoring system, will serve as assessors to evaluate participant performance. Expected outcomes Data collected will include ANTS scores, debriefing feedback, and post-test results. Statistical analysis will be employed to assess the effectiveness of simulation-based training in enhancing non-technical skills among anaesthesia residents during anaesthesia crisis resource management.
... Over the past two decades, learning via simulation has gained prominence in clinical courses: today, most of the clinical training of target groups is conducted via this approach. Use of computer-assisted educational programs, advanced manikins, as well as videos and slides is part of simulation training programs and considered to be one of the most effective ways to achieving lasting acquisition of knowledge and skills by care givers [16]. In addition, video simulations of CPR scenarios of patients with cardiac arrest in hospitals can contribute to paramedics' competence, even if the pictures are of poor quality [17]. ...
Article
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Background One of the most common causes of death worldwide is cardiopulmonary arrest. Firefighters are among the first responders at the scenes of accidents and can, therefore, play a key part in performing basic cardiopulmonary resuscitation (CPR) for victims who need it. The present study was conducted to compare the effects of simulation training against workshops on the CPR knowledge and skills of firefighters in the south of Iran. Methods This experimental (Interventional) study was conducted on 60 firefighters of south of Fars province, Iran. The study was undertaken from March to July 2023. Through random allocation, the participants were divided into two groups: simulation-based training (30 members) and traditional workshop training (30 members). The participants’ CPR knowledge and practical skills were measured before, immediately after, and three months after intervention. Results The findings of the study revealed a statistically significant difference between the pretest and posttest CPR knowledge and skill mean scores of the simulation groups as compared to the workshop group (p < 0.001). As measured three months after the intervention, the firefighters’ knowledge and skill mean scores were still significantly different from their pretest mean scores (p < 0.001); however, they had declined, which can be attributed to the fact that the study population did not frequently exercise CPR. Conclusion Based on the findings of the study, even though both methods of education were effective on enhancing the firefighters’ CPR knowledge and skill, simulation training had a far greater impact than training in workshops. In view of the decline in the participants’ knowledge and skill scores over time, it is recommended that short simulation training courses on CPR should be repeated on a regular basis.
... Evolution of Simulation-Based Medical Education, initially pioneered by the aviation, aerospace, and nuclear industries during the latter half of the 20th century. It has since become a standard practice for improving skills and teamwork while reducing errors, [18] particularly in industries where mistakes can have lifethreatening consequences, such as commercial aviation and nuclear technology. [19] In the medical field, the first notable simulator, Resusci-Annie, was developed in the early 1960s for resuscitation training. ...
Article
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Simulation is a method or technique that is employed to produce an experience without going through the real event and is defined as ―the imitative representation of the functioning of one system or process employing the functioning of another‖. The degree to which a simulation resembles reality is termed fidelity. Simulation-Based Medical Education (SBME) can improve a resident‘s self-confidence, medical knowledge, clinical skills, communication, critical thinking, team building, and leadership qualities. With this, educators can provide a minimum number of simulated experiences during training to ensure exposure, while also preparing residents to fully participate in rare clinical experiences when they occur. The primary goal of SBME is to reduce mistakes to enhance patient safety and improve medical care. An additional objective of SBME is to train professionals in error management and accountability. In the medical field, the first notable simulator, Resusci-Annie, was developed in the early 1960s for resuscitation training. Since then, medical simulation has seen significant growth. Incorporation of SBME as a teaching strategy in undergraduate and postgraduate medical education curricula requires a stepwise approach where the first step is the assembly of human capital. The benefits of SBME are comparable between resource-poor and resource-abundant settings. It's crucial to universally incorporate SBME into both undergraduate and postgraduate medical education. Therefore, the strategic and integrated use of simulation emerges as the progressive path forward in global healthcare education
... The use of simulation tools can be used in place of actual patients. Trainers do not have to worry about upsetting patients when they make mistakes and learn from them [8]. Consequently, using simulation techniques in the classroom is one of the best ways to increase students' self-confidence and promote active engagement. ...
Article
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Introduction As medical knowledge, technology, and healthcare delivery continue to evolve, it is critical that upcoming healthcare workers possess the skills and information needed to ensure optimal patient care. Numerous studies indicate that students achieve better learning outcomes through active practice rather than solely relying on theoretical knowledge. The average human attention span is only 8.25 seconds, so an effective teaching program should employ various modes and techniques to ensure that students remain involved and interested. Aims and objectives The aim is to identify the primary areas where medical students need teaching and guidance and form the basis of a new teaching program to meet those needs. Materials and methods An anonymous online questionnaire, designed by the author was distributed to medical students who came for their clinical rotations at Basildon University Hospital, Mid and South Essex NHS Foundation Trust, United Kingdom, and that laid the foundations for introducing a new teaching program at the education department of the hospital in April 2023. The progress of the teaching program was evaluated by a second questionnaire-based survey conducted after six months, in October 2023. The teaching program we designed employed various modes and techniques including simulation, flip classroom, graded quizzes, and constructive feedback. The technique we used for giving feedback to students was the “star star wish” to encourage growth and further participation. The teaching program also made use of Lev Vygotsky's “Learning zone model” to ensure optimum learning. Results and discussion The program received immensely positive feedback from the students, and they felt that it catered perfectly to their requirements. Twenty-three students took part in this study and the results showed that 39% of the students felt adequately prepared for ward rounds in October 2023 in contrast to only 17% in April 2023. The mean score, on a scale of 1-10 on how comfortable the students felt in discussing patient care plans and management with the rest of the team rose from 2.78 in April 2023 to 4.26 in October 2023. When asked to score how confident the students felt in performing bedside examinations in wards, 26% scored 5 or above (on a scale of 1-10) in April 2023 as compared to 62% scoring 5 or above in October 2023. The students were then asked how confident they felt in using their theoretical knowledge in practical situations and the majority scored 2 or 3 (on a scale of 1-10) in April 2023 whereas in October, the majority scored 4 or above. Conclusions A significant number of medical students were satisfied with the teaching program and demanded more frequent sessions. The results of this study showed that in order to foster increased student engagement and effective participation, it is essential for teaching to incorporate diverse techniques and approaches.
... Simulators serve as an alternative to the real patient and permit educators to gain full control over a predefined scenario, without having to encounter unwanted aspects of learning on real patients. [7][8][9] A study by Baird et al. wherein simulated scenarios were used to teach transfer training and promote clinical reasoning, concluded that 66%-88% of participants completed the transfer items correctly and considered simulation to be an efficient method of teaching. [10] The act of transferring a patient is a multifaceted task that, when not executed correctly, has been directly linked to injuries suffered by both patients and health-care providers. ...
Article
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Background: In India, orderlies are unlicensed hospital assistants instructed to perform delegated tasks under supervision by a licensed health-care giver. They receive on-the-job training, unlike certified nursing assistants. In this study, we have integrated a simulation session in our hospital orderly training program to promote the safe transfer of patients using a low-fidelity mannequin. Methods: We conducted an interventional study with a mixed methodology in which 280 orderlies were immersed in a simulation session of transferring a mannequin from a bed to either a wheelchair or stretcher. An observer completed a prevalidated 18-item checklist assessing the team's performance on a 3-point global rating scale. Quantitative analysis of the data was done using a Paired t-test of the mean scores of the pre- and posttest. Posttraining, the participants completed a satisfaction questionnaire. Structured interviews with their ward in-charges were conducted 3-month posttraining, and the data were analyzed by thematic coding. Results: The pre- and posttest scores of team performances for both groups were 33.22 and 45.3, respectively, indicating a statistically significant difference (P < 0.001). Posttraining, the session evaluation revealed that 100% of participants strongly agreed (mean score = 5) that the training was beneficial. The structured interviews revealed improvement in communication and patient interaction without much change in other skills. They found that, overall, this simulation-based training promoted the safe transfer of patients. Discussion: Improvement in the team performance scores shows the effectiveness of this methodology in ensuring the secure transfer of patients, as well as better teamwork and communication. The results demonstrate that low-fidelity, low-cost simulation can be used effectively to create a formal training program for hospital orderlies.
... Therefore, it is ethically imperative to use simulation as a training tool to reduce avoidable medical errors and to protect patients whenever possible. [5][6][7] ...
Article
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Recommendations could be useful to guide institutions planning to incorporate simulation-based education (SBE) into their training programs or institutions that have an established program but want to benchmark it against best practices. An effective, inclusive, and enjoyable simulation learning environment must be created to optimize learning and skills development. Areas to consider when proposing recommendations for creating an effective SBE environment include the following: the environment, group learning, facilitators, and educational requirements. The common pitfalls in simulation design when simulations are not effective include inadequate prebriefing, cognitive overload, poor alignment with the real-world context or task, inadequate debriefing, and insufficient time for debriefing. The ethical imperatives of SBE must inform the training programs. The role players in the shared ethical values when using SBE include the patients, students, simulationists, and the simulators and simulated patients. SBE programs must be embedded into a curriculum and should not be an optional add-on. To ensure high standards of training in simulation centers, these centers must adhere to specific accreditation standards. SBE aims to create a better training environment, improve patient safety, and address the challenges regarding the training platform and the burden of disease in eye care globally. Surgical simulation in ophthalmology provides an opportunity for partnership between institutions nationally and across borders because simulation centers cannot function in isolation. Recommendations for creating collaborations and partnerships for surgical simulation training will enhance the impact of any eye care program.
... Actively discussing real-world instances from the clinical setting as a teaching tool promotes medical education to yet another level. The goal of clinical education is to make students ready to work in interdisciplinary teams to provide the best treatment possible for patients [4][5][6] . ...
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Background: Physiology is the basic and most crucial subject that is being taught in the early years of medical life as it lay the foundation upon which all major subjects including medicine and surgery rest upon, so its understanding and implication is of the utmost importance for all medical students. Objective: This research aims to determine effects of CBL sessions in MBBS students and to examine the attitudes of faculty and learners on the efficiency of the CBL strategy among students of Liaquat University of Medical and Health Sciences Jamshoro medical students (LUMHS). Methodology: This cross-sectional study was conducted involving 411 medical undergraduates of LUMHS. Random sampling technique was used for sample selection to minimize the bias. Out of 411 sample size male students were 157(38.1%) and female 254(61.8%) respectively, studying form 1st year and 2nd year MBBS students of LUMHS campus. And 10 teachers who are conducting case-based learning sessions weekly at physiology department, were interviewed and their response were included in this study. Data was collected using self-reported questioner, then SPSS version 26.0 was used to analyze the data. P-value of 0.05 or lower was significant. Results: Data of this study shows that 97% students and 100% teachers thinks that CBL sessions, helps them understand topic better, whereas 90% students and 90% teachers thinks that CBL helped bridge the gap between theory and clinical scenarios. Furthermore over research shows that 70% students and 60% teachers thinks that cases that were presented in CBL sessions were interesting, and 98% students and 100% teachers prefer CBL sessions over old methods of learning, 90% students and 70% teachers thinks that CBL sessions motivate them to learn Physiology in depth, this shows that CBL sessions have very positive overall effects on the students as well as teacher, and this is very effective tool of teaching Physiology. Conclusion: Our research has proven that Physiology students may benefit from the unique and effective CBL teaching style. Case studies in the classroom improve student engagement, critical thinking, and intrinsic motivation. Their general comprehension of the subject improves, their recollection of the topic's key elements improves, they get better at interpreting clinical settings, and their overall interest in the subject grows.
... Simulation has been defined as an instructional process that substitutes real patient encounters with artificial models, live actors, or virtual reality patients with the goal of replicating patient care scenarios in a realistic environment for the purposes of feedback and assessment [29][30]. A simulator is defined as a device that enables the operator to reproduce or represent under test conditions phenomena likely to occur in actual performance [31]. Systematically designed simulations have been employed since ancient times in those pursuits where training and testing in the real world have been too dangerous (e.g., war games), too expensive (e.g., aviation), or simply unfeasible (e.g., space exploration) [32,33]. ...
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Medical and non-medical personnel commonly encounter victims of life threatening injuries inflicted by various causes in diverse settings. More than 90% of global deaths and disability adjusted life-years (DALYs) lost because of injuries reportedly occur in low-income and middle-income countries (LMICs). The degree of readiness and competence to manage victims of accidents is likely to vary among individual care givers for knowledge, skill and confidence which would also depend on their training status. It would thus be justified that training in basic life support and other emergency clinical skills be administered to enhance competences in resuscitating the accident victims. Whatever the scale of a mass casualty incident, the first response will be carried out by members of the local community-not just health care staff and designated emergency workers, but also many ordinary citizens. Therefore, both medical and non-medical personnel should be targeted to receive training in basic life support (BLS). In medical training, the traditional (didactic) approach has been suggested to be an efficient and well-experienced training method while with the advances in technology the use of simulation-based medical training (SBMT) is increasing since SBMT provides a safe and supportive educational setting, so that students can improve their performance without causing adverse clinical outcomes. Similarly, the use of simulation based training in BLS would not only reduce the procedural associated risks but also benefit more participants from the public domain than would be the case if the training was conducted on human subjects. Compared with the developed world setup simulation based training in resource constrained settings may not be that well established. This paper will therefore seek to examine the role of medical simulation as a necessary advancement and supplementary method of training in basic life support for medical and non-medical personnel in resource limited settings.
... In that programme the selected HCWs are trained for the position as guardians ("mediators") who support all other workers to speak up about their concerns and assure that issues are resolved, and all involved in the process receive the solution and feedback [46]. Another example is regulations in the USA, in which the apologies of HCWs are legally protected; this motivates them to apologise more and act transparently with patients [49]. Training is needed for hospital management, as well, especially with a focus on communication skills with case simulations [50,51]. ...
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Background The COVID-19 pandemic endangered the quality of health care and the safety of patients and health care workers (HCWs). This provided challenges for HCWs’ resilience and for hospital management and probably increased risks for patient safety incidents (PSI). HCWs may also have experienced psychological consequences as second victims of PSI, but evidence on this is lacking. Therefore, we mapped HCWs’ experiences with PSI during the second wave of COVID-19, the associations of these experiences with the hospital management of patient safety culture and HCWs’ interests in receiving further training. Methods We obtained data from 193 HCWs working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire developed in direct collaboration with them. We measured PSI experiences as various HCWs’ experiences with near miss and adverse events and the hospital management of patient safety culture using indicators such as risk of recurrence, open disclosure and second victim experiences. For analysis, we used logistic regression models adjusted for age and gender of the HCWs. Results One-third of the hospital HCWs had experienced PSI; these were more likely to expect adverse events to recur (odds ratio, OR = 2.7–3.5). Regarding the hospital management of patient safety culture, the HCWs’ experiencing openly disclosed PSI was associated with one negative outcome, i.e. conflicts among colleagues (OR = 2.8), and one positive outcome, i.e. patients’ acceptance of their explanation and apologies (OR = 2.3). We found no associations for any other essential domains after disclosure. PSI experiences were strongly associated with psychological indicators of second victimhood, such as sadness, irritability, anxiety and depression (OR = 2.2–4.3), while providing support was not. The majority of the HCWs would like to participate in the suggested trainings (83.4%). Conclusion HCWs with PSI experiences reported poor hospital management of the patient safety culture, which might reflect they missed the opportunities to strengthen their resilience, especially during the COVID-19 pandemic.
... Simulation has been defined as 'a technique, not a technology, to replace or amplify real experiences with guided experience, often immersive in nature, that evokes or replicates substantial aspects of the real world in a fully interactive fashion' [41]. Simulation-based medical education can therefore be defined as any educational activity which uses simulated components to replicate clinical practice [42]. Several systematic reviews have investigated the effectiveness of simulation-based medical education in terms of knowledge and skills outcomes and there is now a large body of good quality research evidence which demonstrates that simulation-based education is not only effective in terms of skill acquisition but also that clinical skills acquired during simulation-based training translate directly into improved patient care and better clinical outcomes [2]. ...
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Noninvasive ventilation (NIV) is a commonly used respiratory support. The use of the NIV is expanding over time and, but its knowledge and skills are very important for the proper use of this life-saving support. This study aims to evaluate the available evidences for the education and training of NIV. There are no clinical trials examining the impact of education and training of the NIV as the primary objective. However, few studies with indirect evidences, and evidence from a simulation-based training, and some reviews were found. Organized training to increase NIV skills is also limited mostly within few developed countries. Education and training in NIV have the potential to increase knowledge and skills of the staff. The development of organized education and training program in NIV appears to be the need in several types of disciplines and care environments.
... Teachers can choose what aspects of their subject they want to train and continuously improve their work over time [3]. While supporting students in learning from their mistakes and fostering critical thinking, prior experience with the simulation methodologies and information from dentistry academic teachers are essential for efficiently achieving the educational goals using simulation methods [4][5][6]. ...
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Background Medical simulation allows for the achievement of many educational goals and the continued education of some practical skills. The COVID-19 pandemic’s restrictions have led to a major increase in dental education simulations. The aim of this study was to analyse the perspectives of academic teachers towards dental simulation, their concerns and evaluation of this teaching method, as well as their opinion on the use of medical simulation during the COVID-19 pandemic. Method A focus study was conducted in a group of 5 academic teachers, comprising 10% of academic teachers of a Dental Faculty using simulation techniques. Prior to and during the COVID-19 pandemic, the interviewed teachers had expertise with medical simulation in dentistry education methods. A facilitator used pre-planned, open-ended questions about the use of simulation in dentistry also with regard to the COVID-19 pandemic period. The group discussion has been managed, monitored, and recorded. The data analysis model was based on Braun and Clarke’s six phases of thematic analysis. Five thematic domains/fields were evaluated: (1) Simulation as a didactic method; (2) Simulation during COVID-19 pandemic; (3) General observations and expectations with regard to simulation; (4) Teachers in simulation; (5) Concerns in relation to simulation. Two researchers analysed the data. Results Based on interviewed teachers’ perspective the simulation allows students to learn basic and complex skills providing the repeatability of the procedures performed. During Covid-19 the simulation methods undoubtedly filled the gap in the training of future dentists. However, interviewed teachers pointed out the high cost of the methods dictated by the need to prepare the simulation environment at a high level, in order to reflect the real clinical situation. Conclusions The use of simulation methods requires adequate preparation of academic teachers, continuous education and updating of knowledge in the field of medical simulation. The COVID-19 pandemic significantly influenced the growth of dental education simulation techniques as well as staff knowledge of the usage of medical simulation.
... Използването на симулационно обучение в педиатрията нараства през последните десетилетия, като цел е и стремежа на медицинските университети да интегрират този тип обучения и да бъде измерена ефективността им (5,6). ...
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Налице е промяна в традиционният модел на обучение по медицина. Все повече намаляват възможностите за обучение директно върху пациент, защото се обръща все по-голямо внимание на неговата безопасност. Използването на симулационно обучение в педиатрията нараства през последните десетилетия, като фактор за това е и стремежа на медицинските университети да интегрират този тип обучения и да бъде измерена ефективността им. Представяме философията на въведените пет основни модела на симулационно обучение, като се спираме на ефективността им в педиатрията. Ясно се очертава тенденцията, че в бъдеще във всички медицински специалности ще се изисква оценяване базирано на симулация, като мерило за компетентност и запазване на знанията и уменията. Ключови думи: медицинско образование, симулационно обучение в педиатрията
... Skills laboratories provide students the opportunity to practice manual procedures before utilizing them in patient care, while simultaneously having an avenue for self-reflection and confidence building. (2,3) This paper outlines the process by which a physiotherapy practice lab was created within a chiropractic education program as a result of a collaboration between both academic and clinical faculty. Throughout the history of healthcare education, collaborations between academic and clinical institutions have existed to provide the best training for future practitioners. ...
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Objective: Chiropractic students expressed a desire for more "hands-on" learning opportunities regarding physiotherapies. Outpatient clinic faculty reported dissatisfaction with student abilities in the delivery of both active and passive care modalities. A physiotherapy practice lab was designed to offer students a new learning opportunity. Methods: The practice lab was made available to students early in the curriculum before entering outpatient clinic. Therapies and modalities practiced in the lab reflect those learned in active and passive care classes within the curriculum. Average practical examination scores in active and passive physiotherapy classes were analyzed both pre and post lab implementation. Results: Positive student response was demonstrated by high usage rates of the lab, averaging over 700 student encounters per 10-week instructional term. Average practical examination scores increased by 8.92% and 3.73% for active and passive care classes, respectively. Outpatient clinic faculty have reported an increase of student abilities in the delivery of both active and passive physiotherapies. Conclusion: The practice lab was created to improve chiropractic students' usage, understanding, and skills regarding physiotherapies. Outcomes have been positive. (J Contemporary Chiropr 2023;6:84-87)
... Any learning activity that employs simulation technology to replicate clinical scenarios can be termed simulation-based medical education (SBME). It allows learners to make mistakes and learn from them without the fear of real harm to the patients [3]. Medical simulation has shown that adequately trained medical graduates would make less lifethreatening mistakes and costly medical errors [4,5]. ...
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Background: Medical education has experienced important changes in recent times. The concern for patient's safety is one of the key reasons for the change in medical curricula. Innovative instructional methods like simulation-based medical education (SBME) has evolved to address this problem. SBME has become an essential part of education and training for health professionals in 24 many parts of the world. There are evidences that support that high-fidelity simulation (HPS) training has enhanced clinical knowledge among medical students. Aims: The objective of this study was to note the differences in the knowledge made by high-fidelity simulation-based medical education among undergraduate medical education. Methodology: The study involved 347 final year undergraduate medical students. The participants were divided into groups during the simulation sessions and their knowledge was assessed individually with Multiple Choice Questions (MCQ) and also self-reported Pre-test and Post-tests. Paired t-test was used to determine the difference of MCQ scores between pre and post simulation sessions. One-way repeated measure ANOVA was performed to determine the significant difference in knowledge assessment of self-reported Pre-test and Post-test scores. P value < .001 was taken to be of statistical significance. Results: In the unpaired t-test, Post-test MCQ scores were higher than Pre-test scores but not statistically significant (P = .013). A one-way repeated measured ANOVA with Bonferroni post hoc analysis demonstrated that the total scores of the self-reported knowledge tests were significantly increased over time (P < .001). Conclusion: There is enhancement of knowledge as perceived by the students with self-reported knowledge tests but not statistically significant as revealed by the MCQ scores.
... Simuladores de ensino médico podem ser compreendidos de forma ampla como ferramentas que permitam aos educadores manter o controle total em cenários clínicos pré-selecionados, descartando, nesta fase de aprendizagem, os riscos potenciais ao paciente [8]. Complementando, Kincaid e Hamilton [9], apresentam vantagens no uso de simuladores para o ensino médico, tais como: auxilia o aluno a compreender as relações complexas, que de outro modo exigiriam equipamentos caros ou experiências potencialmente perigosas; permite a aplicação de conhecimentos científicos e técnicos de forma integrada e simultânea; permite que o aluno busque novos métodos e estratégias para a solução de um mesmo caso do estudo; fornece um ambiente próximo da realidade para a formação e o reforço dos conhecimentos adquiridos; reduz o risco em situações autênticas. ...
Article
Este artigo apresenta o projeto Health Simulator no contexto de inteligência artificial, no que se refere ao armazenamento do conhecimento especializado na área da saúde e estratégia pedagógica, que permite o auxílio ao aluno no seu processo de aprendizagem. Para tanto é apresentada a teoria de redes bayesianas, sistemas de recomendação, o projeto Health Simulator e a proposta de aplicação das técnicas utilizadas neste ambiente.
... Com foco no ambiente que será disponibilizado ao aluno, a interface InGame relaciona elementos pedagógicos e de gameficação, sendo possível a educação através de objetos de ensino atrativos e intuitivos. Segundo Ziv et al. (2005), simuladores de ensino médico podem ser vistos como ferramentas que permitem aos educadores manter o controle total em cenários clínicos pré-selecionados, descartando, nessa fase de aprendizagem, os riscos potenciais ao paciente. Desta forma, tem-se o contato com situações diárias e recorrentes da rotina médica, levando ao jogador (aluno) a experiência o mais próximo da realidade, no entanto, com a segurança de um ambiente propício ao aprendizado e tolerância a falhas. ...
Article
El manejo adecuado de la contaminación lavada por las aguas lluvias de las calles y edificaciones de una ciudad representa uno de los principales reto de la sostenibilidad urbana, pues los escurrimientos pluviales urbanos generalmente son evacuados fuera de la ciudad trasladando la carga contaminante que estos arrastran hacia el entorno que rodea las urbes. Se propone el uso de indicadores de calidad del agua (ICA) como instrumentos de planificación, por ser herramientas que resumen gran cantidad de datos y facilitan la transmisión de información al público no especializado, además de ser útiles para fijar objetivos de mejora. En este artículo se emplearon ICAs internacionales y nacionales tomando como estudio de caso el canal El Purgatorio, cuenca de drenaje hacia donde se conducen los escurrimientos de la zona sur de Montería, Córdoba, encontrando que la aplicabilidad de los índices como instrumentos de planificación depende de la homogeneidad de los resultados.
... In most medical schools, the skills lab has long been an integral part of the comprehensive education and training offered by the institution. It provides a safe and "error forgiving" environment, which is a training environment that enables trainees the opportunity to practise [1] procedures can be practised on manikins, on standardised patients, or on actual individuals. [Citation needed] [Further citation is required] It is feasible to gain experience doing procedures on actual people. ...
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Even though the benefits of skills lab training are well known, there is a lack of data on the effectiveness of the training over a longer period of time. This is despite the fact that the benefits of skills lab training are well established. Because of this, we made the decision to conduct a prospective, randomised controlled trial with a follow-up period of either three or six months to investigate whether or not students who were instructed in accordance with a "best practise" model (BPSL) performed one skill of different suturing in a simulated environment better than students who were instructed in accordance with a traditional "see one, do one" teaching approach. The purpose of this investigation was to determine whether or not students who were instructed in accordance with a (TRAD). The goal of this research was to identify which group performed better than the others.
... As SBE can help trainees learn advanced procedural skills without risk to patients and provides a safe learning environment for trainees to identify knowledge gaps, ask questions, and learn from mistakes [1,11], an SBE curriculum was developed for pain medicine fellows. The goal was to implement an SBE curriculum to enhance training of fluoroscopic-guided spine procedures during pain medicine fellowship, with the hypothesis that implementation of this curriculum for pain medicine fellows is feasible and acceptable to trainees and teaching faculty. ...
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Several studies have demonstrated the benefits of simulation-based education (SBE) across all trainee levels in various medical fields. These benefits include allowing trainees greater autonomy and the opportunity to learn from mistakes in bioethical and procedural scenarios without compromising patient safety. While much progress has been made, there is little research on the implementation of SBE in pain medicine. This study investigated the effects of interventional pain SBE on 37 pain medicine fellows at the Brigham and Women's Hospital Pain Medicine Fellowship. The study found that fellows' performance, knowledge, and comfort were enhanced by the implementation of this curriculum.
... The aim of simulator-based training is to shorten the learning time in endoscopy for beginners and to eliminate the possible harm that can be given to the patient. For physicians who do not perform endoscopic interventions very often, working with a simulator before patient application, provides serious benefits (12). The performance of novice endoscopists using this simulator, improved significantly between pre-and post-training, according to this study. ...
... Simulation practice is considered particularly important in the acquisition of surgical skills because it allows sufficient practice before students are allowed to treat patients [3], [4]. Consequently, students can learn from their mistakes without the fear of harming the patient [5]. Thus, simulation education can serve as an efficient and ethical method for training students to deliver safe medical ...
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Dental hygienist students require a self-learning simulator to learn the correctness of hand-scaling techniques. An essential technique in hand scaling is the maintenance of contact between the tip of the hand-scaler blade and the tooth. However, imaging-based methods cannot effectively reveal this contact because the gingiva and buccal mucosa conceal the blade. Therefore, this study aimed to propose a method to identify the appropriate contact state of the blade with the tooth by using an inertial measurement unit (IMU) attached to the hand scaler and a force sensor attached to the target tooth. The hand-scaling motion was measured in an experiment in which participants were instructed to use the tip or middle of the blade to contact the tooth. The contact state of the blade, whether it was the tip or the middle, was identified using 18 features, including the average and standard deviation of nine dimensions of force, acceleration, and angular velocity with a support vector machine (SVM). The results showed that the model using all 18 features could classify the contact state with an accuracy of 97.1%. Furthermore, the accuracy was 95.9% with the 12 features from IMU alone, which was not significantly different from the accuracy with 18 features. The accuracy was 88.8% with six features from the force sensor alone. These results indicate that the IMU alone can identify the correct contact state, highlighting the possibility of creating a realistic simulator for training dental hygienists in evaluating the blade-contact state.
... Previous studies have demonstrated that students who are engaged in novel learning tasks and make errors before receiving instruction achieve better learning outcomes compared with students who receive instruction prior to solving learning activities (Cao et al., 2020;Jacobson et al., 2017;Kapur and Bielaczyc, 2012). Although simulation literature often refers to errors as learning opportunities (Helyar et al., 2013;Turner and Harder, 2018;Ziv et al., 2005) or puzzles to be addressed (Rudolph et al., 2014), little is known about how to operationalise learning from errors in healthcare simulation (Heitzmann et al., 2017). There is a need for explicit pedagogical principles that can be used to guide the design of simulation-based learning (SBL) experiences that explicitly promote errors as learning opportunities. ...
Article
Background Previous studies have demonstrated that students who are engaged in learning tasks and make errors before receiving instruction on how to complete them, achieve better learning outcomes than students who first receive instruction and then complete the learning activities with the aim of avoiding errors. Although simulation literature often refers to errors as learning opportunities, to date, there is limited understanding of how pedagogical approaches that promote learning from errors can guide the design of simulation-based learning in healthcare education. Aims To (a) present the Learning from Errors conceptual model; and (b) provide an example of how educators can use this model. Design The Learning from Errors model is drawn from critical elements of two pedagogical approaches, productive failure and error management training and pedagogical features of high-quality healthcare simulations. Methods We describe the Learning from Errors model, which emphasises the need for adopting pedagogical methods that explicitly use errors as learning opportunities and ultimately inform simulation design. We then illustrate the application of this model to a simulation example. Results The model includes the following elements: i) normalisation of errors, ii) challenging simulation scenarios, iii) self-directed learning, iv) collaborative teamwork and v) comparison with best practice. Conclusion This discussion paper presents the Learning from Errors conceptual model, an evidence-based approach that can assist educators in the design of simulations that embrace errors as a catalyst for learning.
... Numerous studies have addressed human factors and behavioral issues as a strategy to prevent the recurrence of errors (19,24,31,33,36,37,40,43). ...
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Due to the high value of human life, the occurrence of even one error that leads to death or complications is of great consequence and requires serious attention. Although significant efforts have been made to ensure patient safety, serious medical errors continue to exist. This study aimed to identify the factors associated with the recurrence of medical errors and strategies to prevent them through a scoping review. Data were gathered through a scoping review of PubMed, Embase, Scopus, and Cochrane Library databases during August 2020. Articles related to factors influencing the recurrence of errors despite the available information, as well as articles related to measures taken worldwide to prevent them, were included in study. Overall, 32 articles were selected out of the 3422 primary papers. Two main categories of factors were identified as influential in error recurrence: human factors (fatigue, stress, inadequate knowledge) and environmental and organizational factors (ineffective management, distractions, poor teamwork). The six effective strategies for preventing error recurrence included the use of electronic systems, attention to human behaviors, proper workplace management, workplace culture, training, and teamwork. It was concluded that using a combination of methods related to health management, psychology, behavioral sciences and electronic systems can be effective in preventing the recurrence of errors.
... [5][6][7] High-fidelity simulation, which represents the psychological, environmental, and situational factors within clinical scenario, is the gold standard for clinical skills acquisition in nursing and medical education. [8][9][10] Therefore, high-fidelity breast models should appropriately represent anatomy, physiology, and racial/ethnic backgrounds through realistic features and abilities (look, feel, and functionality), such as expression of milk from nipples by hand, use of a breast pump with different flanges, multiple skin tones, ability to perform a biopsy, and ability to aspirate fluid. [10][11][12] However, the training that is provided to pre-licensure or practicing health practitioners for breast assessments vary and include low-(i.e., unrealistic) or high-fidelity simulators, passive learning (e.g., watching a video), or a hybrid approach (i.e., using two or more approaches). ...
Article
Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.
... Clinical simulation used with undergraduate medical students has many potential advantages. In line with healthcare ethical commitments 5 , it is safe for both patients and students, as the students operate in a risk-free but real-istic setting, can repeat procedures until objectives are achieved, and have time and space to reflect on mistakes as a learning opportunity 6 . From the teaching perspective, scenarios can be adapted to particular needs and can include infrequent clinical situations. ...
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Objective: Our aim was to reach expert consensus on specific learning outcomes (LOs) that can be achieved through clinical simulation aimed at developing the competencies that medical students need to be able to successfully manage patients and assume general clinical responsibilities. Materials and methods: The six-member scientific committee peer-reviewed Spanish reference documentation (in line with the Bologna Process) on required competencies in medical undergraduate students to select an initial set of 16 competencies that could feasibly be developed through simulation and a corresponding set of 75 LOs. Snowball sampling was used to identify candidates for an international panel of simulation experts. Applying a set of pre-defined criteria, 19 panelists from seven Spanish-speaking regions were recruited to participate in a modified two-round Delphi procedure based on electronic questionnaires and aimed at reaching formal consensus on appropriate LOs for simulated medical training. Results: Final agreement between the panelists was high: no mean score fell below 7.26 of a maximum of 9, and all 75 LOs were agreed on, 74 in the first round and only one requiring the second round. The 16 LOs with mean scores in the top 25th percentile were selected as a set of core LOs to attain via simulation. Conclusions: This Ibero-American consensus on observable and measurable LOs, reflecting competencies that can feasibly be developed via clinical simulation, is a framework that aims at helping medical schools' plans and delivering specific kinds of undergraduate medical training through simulation. It is also proposed in a set of core LOs as a starting point for less experienced schools to design a simulated training program.
Article
Statement This study highlights the growing significance of healthcare simulation in enhancing the quality and safety of patient care across Latin America and the Caribbean, by analyzing bibliometric trends and the impact of publications on simulation-based clinical training between 2012 and 2022. Leveraging the Scopus database and VOSviewer software for thesaurus interaction analysis, the research identified 610 documents, accumulating 4681 citations, thereby indicating a burgeoning interest in this field with notable publication spikes in 2017 and 2020. Brazil and the United States emerged as leading contributors, with a primary focus on “simulation training,” “clinical competence,” “medical education,” and “education.” The study observed an uptick in international collaboration, mirroring the increase in document count and citations. This bibliometric review underscores the emphasis on evaluating technical skills and clinical practices as prevailing areas of interest, highlighting Brazil's significant academic contributions, and suggesting a promising future for the implementation of clinical simulation in the region. The study advocates for continued scholarly output to align with global advancements in medical simulation, aiming to optimize patient outcomes.
Article
Background Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher’s Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.
Article
Purpose Simulation-based medical education has changed the teaching of clinical practice skills, with scenario-based simulations being particularly effective in supporting learning in veterinary medicine. In this study, we explore the efficacy of simulation education to teach infection prevention and control (IPC) as part of Antimicrobial Stewardship (AMS) teaching for early years clinical veterinary medicine undergraduates. Methods The intervention was designed as a 30-minute workshop with a simulation and script delivered online for 130 students as a part of hybrid teaching within the undergraduate curriculum. Learning outcome measures were compared between an intervention group and waitlist-control group using one-way between-groups analysis of covariance tests. Results Significant differences between groups were found for outcomes measures related to short-term knowledge gain and confidence in IPC and AMS in small animal clinical practice. However, lateral knowledge transfer to large animal species clinical practice showed no significant differences. Student feedback indicated that the intervention was an enjoyable and engaging way to learn AMS. Conclusions The intervention provided short-term knowledge gain in IPC protocols and enhanced procedural skills via active learning and motivation to learn in large groups of students. Future improvements would be to include large animal clinical scenario discussions and evaluate longer-term knowledge gain.
Article
Background Limited research has explored the impact of skill laboratory (lab) training on skill retention. Aims This study aimed to assess and compare the effectiveness of skill retention between the modified Peyton’s four-step (MPFS) skill lab training approach and the conventional approach (CA) for intravenous (I.V.) access. This research employed a randomized controlled study design conducted within the Skill Development Unit of a Private Medical College and Hospital. Materials and Methods Fifty-eight first-year medical students were randomly allocated into two groups. These groups received the MPFS or CA approach in small-sized skill lab training sessions focusing on I.V. access. The teacher-to-student ratio was maintained at 1:8, and the duration of each skill session was meticulously documented. Student performance was video recorded right after the teaching session and again at 3 months. The evaluation of skill effectiveness on both occasions was conducted by an impartial faculty member using a binary checklist. Additionally, feedback from both students and faculty members was collected. Group characteristics were analyzed using the chi-square test, and the outcomes of the groups were compared with the Student t test. A P < 0.05 was deemed to be of statistical significance. Results The MPFS group consistently achieved significantly higher scores and had more proficient students during both assessment times (12 and 13) compared to the CA group, which had lower scores at both time points (3 and 4). Notably, there was no decline in skill proficiency within either group at the 3-month mark. The CA group expressed their appreciation for the chance to demonstrate independent performance, while the MPFS group placed value on receiving feedback and undergoing repeated observations. It is worth noting that both training approaches were manageable for faculty; however, the MPFS approach necessitated more time compared to the CA approach. Conclusion The MPFS approach outperformed the CA method in acquiring I.V. access skills immediately after training and at the 3-month follow-up.
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Collaborative, patient-centred care delivered by interprofessional clinical teams is known to improve healthcare efficiency, as well as patient and staff satisfaction [1]. Therefore, inclusion of interprofessional education as an accredited element within prequalifying healthcare programmes is growing [2]. The use of simulation-based learning may provide an effective method of delivering high quality, safe and effective interprofessional education in challenging but transferable settings like caring for patients presenting with mental health difficulties. A half-day simulation course consisting of three scenarios was designed. Actors trained in the portrayal of mental health difficulties by service users were workshopped into the scenarios, with representation from each professional group to enhance authenticity. Each scenario was followed by a facilitated debrief that allowed for whole group learning, using a debrief model [3]. Effective interprofessional collaboration and professional representation was modelled by an interprofessional faculty. Facilitators were encouraged to reflect on their own biases around other professions, recognizing the impact these may have on their debriefing choices. During debriefing, participants were encouraged to consider the impact that collaborative practice has on patient-centred care. Facilitators were encouraged to draw out unconscious biases and highlight issues that can inhibit the successful delivery of collaborative, patient-centred care. Staff development was supported through mentorship and faculty debriefing. The pilot programme ran four times for 72 nursing and medical students. 50 of the 72 (69%) participants provided anonymous feedback via a mixed methods questionnaire. Of these, 54% were medical students and 46% were nursing students. On a Likert scale (1 = poor, 10 = excellent), all participants rated the experience 7/10 or above, with 74% rating it 9 or 10/10. Likert scale questions regarding applicability, course design elements and perceived learning were also highly rated. Thematic analysis was used to analyse the free text questions by two discrete researchers. The results were broadly categorized into learner experience and learning outcomes. Participant perspectives of the benefits of the simulation training on aspects of interprofessional collaboration can be seen in Participant perspectives of the benefits of the simulation training on aspects of interprofessional collaboration This pilot demonstrates that interprofessional education can be successfully delivered in this way, and has been adopted into the medical and nursing student curricula. The next run includes 300 students from medical, nursing and allied health programmes across two institutions, and will be re-evaluated. A qualitative research study to explore the learning that higher educational institutions can gain by delivering interprofessional learning using simulation is also underway. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
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The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.
Article
The usefulness of virtual reality (VR) technology in physiology education is largely unexplored. Although VR has the potential to enrich learning experience by enhancing the spatial awareness of students, it is unclear whether VR contributes to active learning of physiology. In the present study, we used a mixed-method research approach to investigate students' perceptions of physiology learning based on VR simulations. Quantitative and qualitative data indicate that the implementation of VR learning environments improves the quality of physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. In the Technology-Enabled Active Learning Inventory, which consisted of 20 questions to which students responded along a 7-point Likert scale, the majority of students agreed that VR learning of physiology not only stimulated their curiosity (77%; P < 0.001), but also allowed them to obtain knowledge through diverse formats (76%; P < 0.001), participate in thought-provoking dialogue (72%; P < 0.001), and interact better with peers (72%; P < 0.001). Positive responses in the social, cognitive, behavioral, and evaluative domains of active learning were received from students across different disciplines, including medicine, Chinese medicine, biomedical sciences, and biomedical engineering. Their written feedback showed that VR enhanced their interest in physiology and facilitated the visualization of physiological processes to improve their learning. Overall, this study supports that the integration of VR technology into physiology courses can be an effective teaching strategy.
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Odporność organizacyjna, powszechnie rozumiana jako zdolność organiza- cji do radzenia sobie z przeciwnościami (Weick 1993), w ostatnich latach zna- cząco zyskuje na popularności jako obiekt badań w naukach o zarządzaniu i jakości (Williams, Whiteman i Kennedy 2021). Liczba publikacji w tym obsza- rze rośnie z roku na rok, a przyczyn popularności tej tematyki można upatrywać między innymi w niekorzystnych zjawiskach naturalnych (Danes i in. 2009; Clement i Rivera 2017) i ekonomicznych (Koronis i Ponis 2018; Searing, Wiley i Young 2021). Zainteresowanie to wynika z dostrzeżenia wpływu katastrof natu- ralnych (Williams i Shepherd 2016), zjawisk społecznych (Korbi, Ben Slimane i Triki 2021), kryzysów ekonomicznych (Grądzki i Zakrzewska-Bielawska 2009; Amann i Jaussaud 2012), kryzysów powodowanych na przykład przez konflikty militarne (wojna na Ukrainie) czy w ostatnich latach zwłaszcza pandemii koro- nawirusa (Dyduch i in. 2021; Brunelli i in. 2022) na funkcjonowanie podmiotów gospodarczych. Zjawiska te wywołują wzmożone wysiłki badaczy poszukujących mechanizmów pozwalających organizacjom przetrwać i rozwijać się w obliczu nieprzewidzianych, często trudnych do dostrzeżenia z wyprzedzeniem, przeciw- ności (Zastempowski 2010). Źródeł odporności poszukuje się zarówno na płasz- czyźnie indywidualnej (Duchek 2020), badając zespoły (Minichilli, Corbetta i MacMillan 2010), organizacje (Ortiz-de-Mandojana i Bansal 2016), sieci orga- nizacji (Pettit, Fiksel i Croxton 2010), społeczności (Cruz i in. 2014), miasta (Labaka i in. 2019) czy całe regiony (Salvato i in. 2020). W niniejszej monogra- fii uwaga skupiona jest przede wszystkim na odporności przedsiębiorstw, co lokuje to opracowanie w obszarze nauk o zarządzaniu i jakości. Pomimo wielu bardzo wartościowych badań nad zjawiskiem odporności organizacyjnej (Weick 1993; 2016; Williams i in. 2017; Hillmann i Guenther 2021), prowadzonych od lat 2000, głównie po wydarzeniach z 11 września 2000 roku (Coutu 2002; Sutcliffe i Vogus 2003; Gittel i in. 2006), oraz zaangażowa- nia w procesy generowania wiedzy niezwykle wpływowych badaczy (Sutcliffe i Vogu 2003; Weick 1993; Willilams i in. 2017), ciągle w literaturze podnoszone są zarzuty dotyczące niewystarczającego zrozumienia samego zjawiska (Burnard i Bhamra 2011), jego struktury (Conz i Magnani 2020), nośników (Fang i in. 2020) i efektów (Prayag i in. 2018). Nie do końca rozwikłane są także wzajemne zależności pomiędzy odpornością organizacyjną a koncepcjami pokrewnymi (między innymi zarządzaniem ryzykiem – Rød i in. 2020). Literatura zagranicz- na obfituje w rozmaite konceptualizacje odporności organizacyjnej publikowane w najlepszych źródłach (van der Vegt i in. 2015), niemniej ciągle podnoszony jest argument konieczności lepszego zrozumienia samego zjawiska oraz osadze- nia go w ramach nauk o zarządzaniu. Szczególnie ważne z perspektywy po- znawczej są zdaniem naukowców (Hillmann 2021) badania o charakterze empi- rycznym, które w sposób metodycznie poprawny pogłębiłyby zrozumienie istoty samego zjawiska oraz jego związków z funkcjonowaniem przedsiębiorstw (Khlystova, Kalyuzhnova i Belitski 2022). Na tym tle rodzą się istotne pytania, na które przegląd literatury nie daje w pełni satysfakcjonujących odpowiedzi. Dotyczą one istoty odporności organizacyjnej, sposobu jej pomiaru, jej związ- ków z innymi aspektami funkcjonowania organizacji (przedsiębiorstw) oraz mechanizmów i czynników prowadzących do wzrostu odporności wyrażającej się w formułowaniu trafnych odpowiedzi na nieprzewidziane zdarzenia o poten- cjalnie negatywnych konsekwencjach dla przedsiębiorstwa. W sferze teoretycznej niniejsza monografia zmierza do wypełnienia wska- zanej powyżej luki poprzez próbę doprecyzowania rozmytego pojęcia odporno- ści organizacyjnej, czyli określenia jej ram teoretycznych. Mając na uwadze różnorodność podmiotów rynkowych, które mogą być grupowane według wielu kryteriów, rozważania w niej odnoszą się przede wszystkim do grupy przedsię- biorstw rodzinnych, postrzeganych jako quasi-homogeniczna populacja wysoce specyficznych podmiotów gospodarczych (Glinka i Gudkowa 2003; Sułkowski 2011; Dibrell i Memili 2019). Zawężenie to wynika z trzech zasadniczych prze- słanek. Po pierwsze, jak wskazują Steinerowska-Streb i Kraśnicka (2020), przedsiębiorstwa rodzinne w gospodarkach rozwiniętych tworzą znaczącą część produktu krajowego brutto, dają zatrudnienie znacznej grupie osób i w dużej mierze decydują o poziomie rozwoju gospodarczego państw. Są one zatem nie- zwykle istotnym elementem rynku. Po drugie, specyfika przedsiębiorstw rodzin- nych, odróżniająca je od firm o charakterze nierodzinnym, sprawia, że w obliczu kryzysu są one w stanie skuteczniej odpowiadać na wyzwania tworzone przez nieprzewidziane przeciwności (Amman i Jaussaud 2012). W związku z tym rozpoznanie źródeł ponadprzeciętnej odporności przedsiębiorstw rodzinnych może potencjalnie wskazać kierunki doskonalenia procesów w innych typach organizacji. Po trzecie, o ile w odniesieniu do przedsiębiorstw w ogólności na temat odporności wiadomo relatywnie dużo, o tyle wiedza dotycząca odporności organizacyjnej przedsiębiorstw rodzinnych jest wysoce rozproszona i wycinko- wa, a prowadzone nieliczne badania kierują do często rozbieżnych wniosków (por. Mihotić, Raynard i Ćorić 2022). Zatem w niniejszej monografii, w zakresie teoretycznym, zamierzeniem jest dookreślenie istoty i mechanizmów odporności organizacyjnej tej właśnie grupy przedsiębiorstw. W sferze metodycznej podstawowym wyzwaniem jest próba operacjonali- zacji i zaproponowania metody pomiaru samej odporności rozumianej przez pryzmat zdolności przedsiębiorstwa, osadzenie jej w kontekście charakterystycz- nym dla przedsiębiorstw rodzinnych i powiązanie z główną zmienną zależną inte- resującą badaczy nauk o zarządzaniu – efektywnością organizacyjną przedsię- biorstwa. Do tej pory dociekania prowadzone na łamach międzynarodowych publikatorów nie doprowadziły do jednoznacznych rozstrzygnięć dotyczących wzajemnych związków odporności organizacyjnej z efektywnością organizacyj- ną w przedsiębiorstwach rodzinnych, choć literatura z obszaru odporności orga- nizacyjnej jako takiej daje podstawy dla dostrzeżenia możliwych powiązań (Alonso-Dos-Santos i Llanos-Contreras 2019; Battisti i in. 2019). Od strony metodycznej celem jest zatem operacjonalizacja pojęcia odporności organiza- cyjnej i kontekstualizacja zależności pomiędzy odpornością a efektywnością organizacyjną w przedsiębiorstwie rodzinnym. W sferze empirycznej praca zmierza do sprawdzenia zależności pomiędzy odpornością organizacyjną i efektywnością organizacyjną przedsiębiorstw ro- dzinnych w kontekście zmiennych charakterystycznych dla tej grupy firm – w szczególności pod uwagę wzięto zagadnienia bogactwa społeczno-emocjo- nalnego, które określane jest jako czynnik najsilniej odróżniający przedsiębior- stwa rodzinne od nierodzinnych (Berrone, Cruz i Gomez-Mejia 2012), uczenia się na błędach i niepowodzeniach, stanowiącego podstawę dla tworzenia organi- zacyjnych zdolności do adekwatnych odpowiedzi na zagrożenia płynące z oto- czenia (Williams i in. 2017; Duchek 2020), oraz wrogości, złożoności i zmien- ności otoczenia, postrzeganych jako tworzące zbiór uwarunkowań, w których funkcjonuje każde przedsiębiorstwo, także rodzinne (Bryce i in. 2020). Zgodnie z wiedzą autora, tak zakrojone badania nie były do tej pory prezentowane ani w krajowej, ani też międzynarodowej literaturze, co powinno istotnie wzbogacić wiedzę dotyczącą antecedencji i mechanizmów prowadzących do odporności organizacyjnej oraz jej powiązań z efektywnością organizacyjną przedsiębior- stwa rodzinnego. W końcu, w sferze praktycznej podjęto próbę zaprezentowania wskazówek pomagających przedsiębiorcom kierującym firmami rodzinnymi tworzyć wa- runki organizacyjne sprzyjające oraz zwiększające szanse na przetrwanie zawi- rowań i nieprzewidzianych trudności. Niemniej, ze względu na naukowy charak- ter opracowania trzeba mieć na uwadze, że wnioski płynące z prowadzonych analiz literatury i wyników badań empirycznych mają charakter silnie uzależ- niony od kontekstu – nie jest intencją autora dostarczenie zbioru uniwersalnych praktyk gwarantujących sukces, gdyż takowy nie byłby uprawniony w świetle przeprowadzonych dociekań. Aby zrealizować tak postawione cele, zdecydowano się na wykorzystanie wieloetapowego procesu badawczego, zakładającego pogłębione studia literatu- rowe, wykorzystujące między innymi technikę systematycznego przeglądu lite- ratury, oraz badania empiryczne, zaprojektowane i zrealizowane zgodnie z wy- tycznymi prowadzenia badań ilościowych. Dane stanowiące podstawę rozważań zostały zgromadzone na przełomie lat 2018 i 2019 i pochodzą od respondentów z 339 krajowych małych i średnich przedsiębiorstw rodzinnych. Treść monografii została podzielona na pięć rozdziałów, przy czym dwa pierwsze mają charakter teoretyczny, w których starano się zrealizować sformu- łowany cel odnoszący się do doprecyzowania pojęcia odporności organizacyjnej przedsiębiorstwa rodzinnego. W pierwszej kolejności na podstawie systematyczne- go przeglądu literatury dotyczącej odporności organizacyjnej zidentyfikowano ob- szary, w których do tej pory koncentrowała się uwaga badaczy w odniesieniu do odporności organizacyjnej przedsiębiorstw w ogólności. Z przeprowadzonych analiz płynie wniosek, że odporność organizacyjna jest związana ze sposobami odpowiedzi na zagrożenia – przede wszystkim zewnętrzne względem organiza- cji, a wśród nich należy wyszczególnić kryzysy i katastrofy, charakterystyki otoczenia, a zwłaszcza jego wrogość, złożoność i zmienność oraz szeroko pojęte ryzyko. Badania nad odpornością były prowadzone w wielu przypadkach w prze- krojach branżowych, w różnych typach organizacji, funkcjonujących w różnych krajach. W literaturze obecne są również badania nad odpornością zespołów, w tym zespołów projektowych. Wśród koncepcji pokrewnych pojawiających się w opracowaniach odnoszących się do odporności należy wskazać przede wszystkim koncepcje zarządzania ryzykiem, a także solidności organizacyjnej i społecznej odpowiedzialności. Wśród czynników towarzyszących odporności niezbywalne miejsce mają procesy prowadzące do przetrwania i mechanizmy przeciwdziała- nia przeciwnościom, zasoby organizacji, charakterystyki osób, szeroko pojmo- wane zdolności organizacji, przedsiębiorczość i innowacje, a także strategie, procesy zarządzania w przedsiębiorstwie, uczenia się, struktury organizacyjne czy zagadnienia współpracy. Wśród efektów odporności wyszczególniane są przede wszystkim zagadnienia trwałości organizacji i efektywności organizacyj- nej. Podstaw samej koncepcji należy poszukiwać przede wszystkim na gruncie zarządzania strategicznego i zasobowej teorii organizacji, a także zarządzania zasobami ludzkimi oraz koncepcji kapitału społecznego. W dalszym kroku przedstawiono rozwój teorii odporności organizacyjnej w przekroju chronologicznym, gdzie wskazano na trzy okresy rozwoju zaintere- sowania koncepcją – od źródeł (lata 1981-2002), przez zintensyfikowanie zain- teresowań i zabieganie o akceptację, które miały miejsce w latach 2003-2013, do rozwoju teorii odporności i jej empirycznej weryfikacji, która trwa aż do chwili obecnej. W każdym z tych okresów omówiono kluczowe z perspektywy rozwoju wiedzy opracowania naukowe wyłonione w drodze analizy cytowalności po- szczególnych prac. Efektem przeprowadzonych analiz, w tym analiz definicji pojęcia, było sformułowanie autorskiego podejścia opartego na 50 najczęściej przywoływanych w literaturze źródłach, co doprowadziło do przedstawienia głównych wniosków i podsumowania rozważań na temat samej odporności or- ganizacyjnej w końcowej części rozdziału I. Jako główne wnioski z dokonanego przeglądu warto wskazać powiązanie odporności z efektywnością organizacyjną przedsiębiorstwa, konieczność kontekstualizacji przedmiotowej zależności oraz szczególną rolę uczenia się – zwłaszcza na błędach i niepowodzeniach – dla kształtowania zdolności do przetrwania w obliczu kryzysów. Rozdział II jest kontynuacją dociekań dotyczących odporności, tym razem w przedsiębiorstwach rodzinnych. Rozpoczyna się charakterystyką przedsiębior- stwa rodzinnego jako specyficznego obiektu badania, a rozważania w tej części prowadzą do identyfikacji cech wyróżniających firmy rodzinne. Szczególną rolę odgrywają w tym przypadku kwestie sukcesji w przedsiębiorstwie rodzinnym i rodzinności oraz zagadnienia nadzoru właścicielskiego, profesjonalizacji za- rządzania, roli rodziny, a także czynnik, który zdaniem autorów zajmujących się funkcjonowaniem przedsiębiorstw rodzinnych różnicuje te firmy od innych naj- bardziej, czyli bogactwo społeczno-emocjonalnego. Dociekania te doprowadziły do doprecyzowania pojęcia odporności organizacyjnej przedsiębiorstwa rodzin- nego, które na potrzeby niniejszej pracy sformułowano następująco: Odporność organizacyjna przedsiębiorstwa rodzinnego przejawia się w zdolności do przewidywania wystąpienia potencjalnych, niekorzyst- nych i nieoczekiwanych zakłóceń w otoczeniu zagrażających jej funk- cjonowaniu oraz dobrobytowi rodziny, a gdy się zdarzą, do szybkiego i efektywnego odpowiadania (reagowania) na nie. Prowadzą do niej procesy adaptacji (zmiany struktur, strategii i sposobów działania, wprowadzanie nowych rozwiązań i eksploatowanie nadarzających się szans), wykorzystujące dostępne dla przedsiębiorstwa i członków rodziny zasoby dla zapewnienia przetrwania (to jest do podtrzymania podstawo- wych funkcji, realizacji celów, w tym bogactwa społeczno-emocjonalnego, stabilności i sukcesji w dłuższym czasie). W przypadku wystąpienia ne- gatywnych skutków odporność prowadzi do odbudowy i powrotu do co najmniej pierwotnego stanu. W kolejnej części rozdziału II uwaga została poświęcona rozpoznaniu kwe- stii istotnych dla przedsiębiorstw rodzinnych, kluczowych z perspektywy stanu wiedzy odporności organizacyjnej w tej grupie przedsiębiorstw. W tym przy- padku analiza słów kluczowych zidentyfikowanych w opracowaniach doprowa- dziła do sporządzenia mapy badań nad odpornością ukazującej źródła zagrożeń dla organizacji, źródła i mechanizmy odporności wraz z konstruktami powiąza- nymi, konteksty prowadzonych badań, kluczowe teorie i metody, a także efekty samej odporności. W dalszym kroku przeprowadzono analizę kluczowych z per- spektywy wiedzy badań, wyłonionych na podstawie liczby cytowań. Analiza ta doprowadziła do wielu obserwacji dotyczących samej natury odporności w przed- siębiorstwach rodzinnych i umożliwiła kontekstualizację podstawowej z per- spektywy celów pracy zależności pomiędzy odpornością organizacyjną i efek- tywnością. Zmiennymi kontekstowymi, w świetle analiz literatury, godnymi szczególnego rozpoznania, są uczenie się na błędach i niepowodzeniach, wspo- mniane już bogactwo społeczno-emocjonalne oraz wrogość, złożoność i zmienność otoczenia. Analizy te dały podstawy do postawienia ośmiu hipotez badawczych, które były wyprowadzane na bieżąco, a potem syntetycznie przedstawione w rozdziale III. Hipotezy te sformułowano następująco: H1: Odporność organizacyjna przedsiębiorstwa jest pozytywnie powiązana z jego efektywnością organizacyjną. H2: Organizacyjne uczenie się na błędach i niepowodzeniach prowadzi do wzrostu odporności organizacyjnej przedsiębiorstwa rodzinnego. H3: Uczenie się na błędach i niepowodzeniach prowadzi do wzrostu efektywno- ści organizacyjnej przedsiębiorstwa rodzinnego. H4: Odporność organizacyjna mediuje w zależności pomiędzy uczeniem się na błędach i niepowodzeniach a efektywnością organizacyjną przedsiębior- stwa rodzinnego. H5: Bogactwo społeczno-emocjonalne prowadzi do wzrostu odporności organi- zacyjnej przedsiębiorstwa rodzinnego. H6: Bogactwo społeczno-emocjonalne prowadzi do wzrostu efektywności orga- nizacyjnej przedsiębiorstwa rodzinnego. H7: Odporność organizacyjna mediuje w zależności pomiędzy bogactwem spo- łeczno-emocjonalnym a efektywnością organizacyjną przedsiębiorstwa ro- dzinnego. H8: Otoczenie przedsiębiorstwa moderuje zależność pomiędzy odpornością organizacyjną przedsiębiorstwa rodzinnego a jego efektywnością organiza- cyjną w taki sposób, że im otoczenie jest bardziej wrogie, złożone i dyna- miczne, tym zależność pomiędzy odpornością organizacyjną przedsiębior- stwa rodzinnego i jego efektywnością organizacyjną jest silniejsza. Rozdział III ma charakter metodyczny i prezentuje efekty konceptualizacji kluczowych zależności pomiędzy zmiennymi, by w dalszym kroku przedstawić przebieg badań empirycznych (w tym dobór próby i techniczne aspekty groma- dzenia danych), zaprezentować podstawowe informacje o badanych firmach i scharakteryzować podejście do pomiaru podstawowych zmiennych. Wykorzy- stując podstawowe statystyki, w tej części ukazano rzetelność przyjętych skal i opisano sposób potraktowania zjawisk w dalszych etapach analizy. Rozdział IV prezentuje wyniki badań empirycznych nad wynikającymi z modelu badawczego zależnościami. Analizy rozpoczęto od przedstawienia podstawowych statystyk opisowych i miar współzależności, by w dalszej części poddać testowaniu relacje pomiędzy zmiennymi z wykorzystaniem modelowa- nia równań strukturalnych, analiz mediacji i moderacji. Wyniki doprowadziły do przyjęcia H1, H5 i H7, przyniosły częściowe potwierdzenie dla H2, H3 i H4 oraz nie potwierdziły poprawności przypuszczeń wyrażonych w H6 i H8. Zatem odporność organizacyjna w przedsiębiorstwie rodzinnym prowadzi do wzrostu jego efektywności organizacyjnej, jest zależna od uczenia się na błędach i nie- powodzeniach oraz silnie uzależniona od bogactwa społeczno-emocjonalnego. Istotnie mediuje ona zależność pomiędzy bogactwem społeczno-emocjonalnym a efektywnością organizacyjną przedsiębiorstwa. Uczenie się na błędach i nie- powodzeniach, w zależności od jego typu, różnie wpływa na efektywność orga- nizacyjną przedsiębiorstwa. Nie potwierdzono natomiast bezpośrednich związków pomiędzy bogactwem społeczno-emocjonalnym i efektywnością organizacyjną przedsiębiorstwa, a wrogość, złożoność i zmienność otoczenia nie jest istotnym moderatorem zależności pomiędzy odpornością a efektywnością w przedsiębior- stwie rodzinnym. W rozdziale V przeprowadzono dyskusję nad uzyskanymi wynikami badań, która doprowadziła do sformułowania wielu wniosków o charakterze teoretycz- nym i praktycznym, a także do identyfikacji potencjalnie interesujących przy- szłych kierunków badań. W części tej wskazano również słabości i ograniczenia przyjętych rozwiązań metodycznych i założeń. Całość kończy syntetyczne pod- sumowanie. Przyjęta metoda badawcza miała w założeniu sprzyjać realizacji postawio- nych we wstępie celów, a w poszczególnych częściach starano się konsekwent- nie odpowiadać na pojawiające się pytania. W świetle prowadzonych analiz odporność organizacyjna jest konstruktem złożonym i silnie uwikłanym w za- leżności z innymi elementami przedsiębiorstwa rodzinnego. Ma ona zdolność do kształtowania efektywności organizacyjnej i jest budowana w procesach uczenia się na błędach i niepowodzeniach oraz korzysta z bogactwa społeczno-emocjo- nalnego firmy rodzinnej. Wkład w rozwój teorii to przede wszystkim doprecy- zowanie pojęcia odporności organizacyjnej – w tym odporności organizacyjnej przedsiębiorstwa rodzinnego – oraz określenia jego ram teoretycznych. Zabieg ten zrealizowano w pierwszych dwóch rozdziałach monografii. Kluczową kwe- stią wydaje się w tym zakresie opracowanie autorskiej definicji odporności or- ganizacyjnej przedsiębiorstwa rodzinnego osadzonej na gruncie analizy pięć- dziesięciu ujęć odporności pobranych z najczęściej przywoływanych artykułów naukowych z tego obszaru. Definicja ta uwzględnia ponadto wyróżniki przed- siębiorstwa rodzinnego. Przegląd literatury doprowadził także do operacjonali- zacji odporności organizacyjnej w przedsiębiorstwie rodzinnym. Stworzona skala została uprzednio przetestowana, a w niniejszej monografii poddana głęb- szym analizom. Osadzenie odporności przedsiębiorstwa rodzinnego w kontekście uczenia się na błędach i niepowodzeniach, bogactwa społeczno-emocjonalnego oraz otoczenia zadaniowego organizacji, a także powiązanie odporności z efek- tywnością przedsiębiorstwa rodzinnego doprowadziło do stworzenia własnego modelu badawczego. Został on w dalszej kolejności poddany testowaniu, co doprowadziło do empirycznej weryfikacji zależności pomiędzy zmiennymi uję- tymi w modelu. Wyniki badań wskazują na istotną rolę odporności organizacyj- nej w kształtowaniu efektywności przedsiębiorstwa rodzinnego. Uwypuklają również rolę uczenia się na błędach i niepowodzeniach oraz bogactwa społeczno- -emocjonalnego w kreowaniu samej odporności. Analizy mediacji wykazały natomiast mediującą rolę samej odporności w zależności pomiędzy bogactwem społeczno-emocjonalnym a efektywnością przedsiębiorstwa rodzinnego. Co za- skakujące, wrogość, złożoność i zmienność otoczenia nie odgrywają zakładanej oraz wskazywanej w literaturze roli moderatora zależności pomiędzy odporno- ścią a efektywnością przedsiębiorstwa rodzinnego. Skonfrontowanie analiz statystycznych z przeprowadzonymi w dwóch pierwszych rozdziałach analizami literatury doprowadziło do identyfikacji im- plikacji teoretycznych, wniosków o charakterze praktycznym oraz wskazania przyszłych kierunków badań nad odpornością organizacyjną przedsiębiorstwa rodzinnego. Zgodnie z przeglądem literatury to pierwsze opracowanie systema- tyzujące zagadnienia odporności organizacyjnej przedsiębiorstw rodzinnych w tak szerokim ujęciu. Praca wpisuje się w badania prowadzone w nurcie zarzą- dzania strategicznego oraz badań prowadzonych w przedsiębiorstwach rodzin- nych, których dorobek starano się wzbogacić.
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Effective decision-making in crisis events is challenging due to time pressure, uncertainty, and dynamic decisional environments. We conducted a systematic literature review in PubMed and PsycINFO, identifying 32 empiric research papers that examine how trained professionals make naturalistic decisions under pressure. We used structured qualitative analysis methods to extract key themes. The studies explored different aspects of decision-making across multiple domains. The majority (19) focused on healthcare; military, fire and rescue, oil installation, and aviation domains were also represented. We found appreciable variability in research focus, methodology, and decision-making descriptions. We identified five main themes: (1) decision-making strategy, (2) time pressure, (3) stress, (4) uncertainty, and (5) errors. Recognition-primed decision-making (RPD) strategies were reported in all studies that analyzed this aspect. Analytical strategies were also prominent, appearing more frequently in contexts with less time pressure and explicit training to generate multiple explanations. Practitioner experience, time pressure, stress, and uncertainty were major influencing factors. Professionals must adapt to the time available, types of uncertainty, and individual skills when making decisions in high-risk situations. Improved understanding of these decisional factors can inform evidence-based enhancements to training, technology, and process design.
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Introduction: There is a lack of research on the long-term effectiveness of skills lab training, despite the fact that its benefits are widely acknowledged. As a result, we decided to conduct a prospective, randomised controlled trial to investigate whether or not students who were taught according to a “best practise” model (BPSL) performed one skill of different suturing in a simulated setting better than students who were taught with a traditional “see one, do one” teaching approach (TRAD), with a follow-up period of either three or six months. Aims and Objectives: To Study and understand Skill lab training Vs Clinical practice of seeing and doing to learn common surgical skills. Materials and Methods: This study was done in the Department of OBG along with the help of Department of Orthopedics, Kamineni Institute of Medical Sciences, Andhra Pradesh. The study was done from Oct 2012 to Oct 2013. Results: Significant difference seen between the two groups Conclusion: Skills lab teaching seems to be particularly helpful for the reproduction of easier skills.
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Background: Medical students are traditionally introduced to suturing in a simulated environment using animal products or synthetic materials. However, there is little evidence to support this pedagogy. Our study explored whether a modern suturing curriculum adequately prepares medical students and examined student preference for learning suturing skills. Methods: Suturing performance was recorded and assessed by expert raters. Students also completed a survey that inquired about self-perceived knowledge and confidence in suturing, and preferred pedagogical methods. Results: The majority (79%) of students that completed our suturing curriculum demonstrated competence in basic suturing techniques. There was no correlation between objective abilities and self-perceived knowledge or confidence. Students reported being significantly more confident suturing anesthetized patients and in simulated environments. Students reported a desire for earlier introduction to suturing and more frequent simulation training. Conclusion: A modern medical school suturing curriculum, comprising online modules and in-person simulation-based learning, adequately develops basic suturing techniques. .
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Surgeons work in complex systems where mistakes are made. Our goals are to reduce and avoid mistakes by learning from those mistakes and preventing patient harm.We learn as individuals and in groups through both formal and informal observations and discussions. Opportunities for learning from mistakes are discussed such as simulations, virtual reality, video, morbidity and mortality conferences, incident reporting, chart reviews, patient claims and complaints, and prospective risk analyses. Active participation in learning opportunities leads to more retention and transfer of those learnings to future action.Orthopedic surgeons as leaders and educators, and organizations, can model learning from mistakes by proactive learning efforts, humble thoughtful evaluation when mistakes occur, and subsequent action items.KeywordsLearning from mistakesMistakesErrorsSimulation-based educationVideo learningBlack box thinkingMorbidity and mortality conferencesIncident reporting systemsPatient claims
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Background and Aims Clinical skills practice is an essential component in standardized residency training. However, traditionally skill training methods are dogmatic and not all residents are exposed to such prescribed situations during their residency. The aims of this study were to evaluate the effectiveness and influence factors of a four‐step approach combining situational simulation teaching methods in clinical practice for residents. Methods Enrolled all second‐year residents from the internal medicine base between May 2017 and May 2018 (n = 94), randomly divided into two groups. Forty‐eight residents were selected as experimental group, while the others 46 as the control group. Adopted traditional clinical practice method in the teaching and assessment of the control group, while used four‐step approach combining situational simulation teaching method in experimental group. We compared the theoretical and skill assessment scores in preclass and postclass. Conducted a satisfaction survey after class and analyzed the influencing factors of the teaching effect evaluation. Results There were no significant differences in the theoretical and skill assessment scores between experimental group and control group at the beginning. After the class, both the average skill assessment and Direct Observation of Procedural Skills scores of the experimental group were higher than those of the control. Satisfaction survey findings identified that the experimental group expressed higher satisfaction. Logistic regression showed that educational background, “situational simulation mode helps to improve clinical skills training,” “helps to maintain attention during learning,” and “helps improve the ability to exercise analysis and solve problems” were the influencing factors of learners' satisfaction. Conclusion The application of four‐step approach combining situational simulation teaching methods in the clinical practice of residents can significantly improve skills, thinking ability, decision‐making ability, and teaching satisfaction. Therefore, four‐step approach combining situational simulation teaching methods is worth promoting in teaching clinical skills for internal medicine residency training.
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Background The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. Objective This study will assess whether the L-PAPR improves health care professionals’ comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. Methods This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user’s perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. Results We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. Conclusions The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. International Registered Report Identifier (IRRID) PRR1-10.2196/36549
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Continuous quality improvement is an accepted mandate in healthcare services. The delivery of the best, evidence based quality of care ultimately depends on the competences of practitioners as well as the system that supports their work. Medical education has been increasingly called upon to insure providers possess the skills and understanding necessary to fulfill the quality mission. Patient safety has in the past five years rapidly risen to the top of the healthcare policy agenda, and been incorporated into quality initiatives. Demand for curricula in patient safety and transfer of safety lessons learned in other risky industries have created new responsibilities for medical educators. Simulation based medical education will help fill these needs. Simulation offers ethical benefits, increased precision and relevance of training and competency assessment, and new methods of teaching error management and safety culture.Established and successful simulation methods such as standardized patients and task trainers are being joined by newer approaches enabled by improved technology.
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The paper deals with some new indices for ordinal data that arise from sample surveys. Their aim is to measure the degree of concentration to the “positive” or “negative” answers in a given question. The properties of these indices are examined. Moreover, methods for constructing confidence limits for the indices are discussed and their performance is evaluated through an extensive simulation study. Finally, the values of the indices defined and their confidence intervals are calculated for an example with real data
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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.
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Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.
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Medical simulation is a relatively new teaching modality suitable for medical education at all levels, although its long-term benefits have not yet been validated. Simulation allows the participant to practise diagnosis, medical management and behavioural approaches in the care of acutely ill patients in a controlled environment. Simulators have achieved widespread acceptance in the fields of anaesthesia, intensive care and emergency medicine. More recently, team training for pre-hospital and within-hospital multidisciplinary medical response teams has become popular. The increasing number and diversity of courses at "CASMS" parallels the evolution of simulation centres into regional clinical skills centres elsewhere. Such centres are likely to become a cost-effective means of achieving greater consistency in medical skill acquisition and may improve patient outcomes after medical crises.
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Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.
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1969 to 2003, 34 years. Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. HEADLINE RESULTS: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.
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The role of performance assessment in outcomebased education is discussed emphasizing the relationship and interplay between these two related paradigms. Issues of the relevancy of assessment to student learning are highlighted in the context of outcome-based education.The importance of defining assessment premises and the role of institutions in defining their educational philosophy as it pertains to student learning and assessment is also presented. A brief description of implementation guidelines of assessment programs in outcome-based education are presented indicating the key features of such programs.
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This paper explores assessment innovations which have a system-wide effect on medical education and the medical profession. Important assessment approaches such as the objective structured clinical examination (OSCE), the portfolio, and hi-tech simulations are examples of reform-driven developments. A detailed account is provided on assessment areas that require further developments. The identified areas reflect current thinking in the Centre for Medical Education, University of Dundee Medical School.The assessment innovations are being developed alongside the implementation of the outcome-based curriculum. Areas that require extensive work are: assessment of progression towards defined outcomes, assessment of integrated abilities, assessment of different forms of medical knowledge, assessment of on-the-job learning, learning through assessment, assessment of error management and assessment of portfolio evidence. The identified areas for further assessment development are discussed and where appropriate a theoretical framework is provided.
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The science of virtual reality provides an entirely new opportunity in the area of simulation of surgical skills using computers for training, evaluation, and eventually certification. A taxonomy of the types of simulators is proposed based upon the level of complexity of the task which is being simulated. These tasks are precision placement, simple manipulation, complex manipulation, and integrated procedure. Representative simulators in each category are illustrated and discussed in the context of their contribution to the education and training of a surgeon. The importance of a curriculum is to give content to the role of simulators as another advanced tool for education. Simulators must be integrated into a comprehensive curriculum and not considered as a stand-alone system. The current accomplishments as well as challenges are discussed.
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Background Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework. Simulators Simulators can provide safe, realistic learning environments for repeated practice, underpinned by feedback and objective metrics of performance. Using a simple classification of simulators into model-based, computer-based or hybrid, this paper summarises the current state of the art and describes recent technological developments. Advances in computing have led to the establishment of precision placement and simple manipulation simulators within health care education, while complex manipulation and integrated procedure simulators are still in the development phase. Evaluation Tension often exists between the design and evaluation of surgical simulations. A lack of high quality published data is compounded by the difficulties of conducting longitudinal studies in such a fast-moving field. The implications of this tension are discussed. The wider context The emphasis is now shifting from the technology of simulation towards partnership with education and clinical practice. This highlights the need for an integrated learning framework, where knowledge can be acquired alongside technical skills and not in isolation from them. Recent work on situated learning underlines the potential for simulation to feed into and enrich everyday clinical practice.
Article
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
Article
Context: Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational technique that allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks. The number and range of commercially available technologies used in simulation for education of health care professionals is growing exponentially. These range from simple part-task training models to highly sophisticated computer driven models. Aim: This paper will review the range of currently available simulators and the educational processes that underpin simulation training. The use of different levels of simulation in a continuum of training will be discussed. Although simulation is relatively new to medicine, simulators have been used extensively for training and assessment in many other domains, most notably the aviation industry. Some parallels and differences will be highlighted.
Article
Realistic medical simulation has expanded worldwide over the last decade. Such technology is playing an increasing role in medical education not merely because simulator sessions are enjoyable, but because they can provide an enhanced environment for experiential learning and reflective thought. High-fidelity patient simulators allow students of all levels to "practice" medicine without risk, providing a natural framework for the integration of basic and clinical science in a safe environment. Often described as "flight simulation for doctors," the rationale, utility, and range of medical simulations have been described elsewhere, yet the challenges of integrating this technology into the medical school curriculum have received little attention. The authors report how Harvard Medical School established an on-campus simulator program for students in 2001, building on the work of the Center for Medical Simulation in Boston. As an overarching structure for the process, faculty and residents developed a simulator-based "medical education service"-like any other medical teaching service, but designed exclusively to help students learn on the simulator alongside a clinician-mentor, on demand. Initial evaluations among both preclinical and clinical students suggest that simulation is highly accepted and increasingly demanded. For some learners, simulation may allow complex information to be understood and retained more efficiently than can occur with traditional methods. Moreover, the process outlined here suggests that simulation can be integrated into existing curricula of almost any medical school or teaching hospital in an efficient and cost-effective manner.
Article
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.
Article
Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.
Multidisciplinary, multimodality medical simulation center—the Israeli model
  • A Ziv
  • H Berkenstadt
ZIV, A. & BERKENSTADT, H. (2004) Multidisciplinary, multimodality medical simulation center—the Israeli model, in: W. DUNN (Ed.) Simulators in Critical Care Medicine and Beyond (Des Plaines, USA, Society for Critical Care Medicine (SCCM) Press).
Med Teach Downloaded from informahealthcare.com by UB Kiel on 10/28/14 For personal use only The impact of aviation-based teamwork training on the attitudes of health-care professionals
  • A Ziv
A. Ziv et al. 198 Med Teach Downloaded from informahealthcare.com by UB Kiel on 10/28/14 For personal use only. GROGAN, E.L., STILES, R.A., FRANCE, D.J., SPEROFF, T., MORRIS, J.A JR, NIXON, B., GAFFNEY, F.A., SEDDON, R. & PINSON, C.W. (2004) The impact of aviation-based teamwork training on the attitudes of health-care professionals, Journal of the American College of Surgeons, 199, pp. 843–848.
Refocusing the role of simulation in medical education: training reflective practitioners
  • E F Dannefer
  • L C Henson
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