A review of virtual-simulation for assessing healthcare students' clinical competency

Objectives: Health professional education is transitioning to online platforms to meet students' need for flexibility and international access. However, there is a necessity for authentic presentation of educational material par-ticularly in regard to clinical skills development. There has been major growth in the delivery of virtual simu-lated-based learning and assessment to provide clinical skill acquisition in an online platform. The aim of this review was to explore the use of virtual simulation to assess clinical competence in health education. Design: Integrative review. Data sources: Peer reviewed studies published between 2008 to March 2020 were searched across PubMed, Embase, Cochrane Library, CINAHL Medline, Scopus, and PsycINFO. Review methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed. Twenty- three studies, which met the inclusion criteria, were downloaded, and a quality appraisal and analysis was completed by the research team. Results: A thematic analysis identified four themes; pedagogy differences across disciplines, debriefing to en-hance learning, preparing healthcare professionals in a safe and cost-effective environment, and managing challenges of virtual simulation. Debriefing with students within the online environment enabled students to share experience and reflect on choices for a deeper learning experience. Conclusions: Virtual simulation can prepare students for the clinical environment by providing safe practice within complex clinical situations. Challenges related to managing and debriefing students must be overcome to ensure best student learning outcomes. Virtual simulation is a feasible strategy to assess students' clinical competency and support their learning in both medical and nursing programs, however simulation should be authentic and incorporate reflection

Search strategy for library databases (final search undertaken on 02/03/2018).

Search strategy for library databases (final search undertaken on 02/03/2018).</p

Levels of evidence for recommendations for SSI prevention as reported in included CPGs.

Levels of evidence for recommendations for SSI prevention as reported in included CPGs.</p

AGREE II scaled domain scores of CPGs for SSI prevention.

AGREE II scaled domain scores of CPGs for SSI prevention.</p

Characteristics of CPGs regarding SSI prevention.

Characteristics of CPGs regarding SSI prevention.</p

Search strategy for guideline repositories (final search undertaken on 02/03/2018).

Search strategy for guideline repositories (final search undertaken on 02/03/2018).</p

AIFM2 is required for high-intensity aerobic exercise by promoting glucose utilization

   Skeletal muscle is a major regulator of glycemic control at rest and glucose utilization increases drastically during exercise. Sustaining a high glucose utilization via glycolysis requires efficient replenishment of NAD+ in the cytosol. Apoptosis-inducing mitochondrion-associated factor 2 (AIFM2) has previously been shown to be a NADH oxidoreductase domain–containing flavoprotein to promote glycolysis for diet and cold-induced thermogenesis. Here, we find that AIFM2 is selectively and highly induced in glycolytic extensor digitorum longus (EDL) muscle during exercise. Overexpression of AIFM2 in myotubes is sufficient to elevate the NAD+/NADH ratio, increasing the glycolytic rate. Thus, overexpression of AIFM2 in skeletal muscle greatly increases exercise capacity, with increased glucose utilization. Conversely, muscle-specific Aifm2 depletion via in vivo transfection of hairpins against Aifm2 or tamoxifen-inducible haploinsufficiency of Aifm2 in muscles decreases exercise capacity and glucose utilization in mice. Moreover, muscle-specific introduction of NDE1, Saccharomyces cerevisiae external NADH dehydrogenase, NDE, ameliorates impairment in glucose utilization and exercise intolerance of the muscle-specific Aifm2 haploinsufficient mice. Together, we show a novel role for AIFM2 as a critical metabolic regulator for efficient utilization of glucose in glycolytic EDL muscles. </p