The Effect of High-Fidelity Manikin-Based Human Patient Simulation on Educational Outcomes in Advanced Cardiovascular Life Support Courses

The use of high-fidelity manikin-based simulation has been studied in many healthcare education areas. However, the use of this education technology in the American Heart Association Advanced Cardiovascular Life Support (ACLS) course has not been well examined in the literature, despite this education program being one of the most widely taught standardized medical courses in the United States. This study examined high fidelity manikin-based simulation versus low-fidelity manikin-based simulation in the context of an actual ACLS course. Four outcomes were measured: learning outcomes as judged by an expert rater panel reviewing videos of subjects performing a simulated cardiac arrest event immediately after the conclusion of the course, and three self-reported measures examining confidence with the course material, motivation, and affect. A convenience sample of 34 subjects self assigned to one of two ACLS classes. One class utilized high-fidelity simulation (n=16) while the other used low-fidelity simulation (n=18). While the high-fidelity simulation group had a higher composite score for the video review (M= 220.88 vs. M=193.67), this did not reach a level of significance (p=.122). On item level analysis of the scoring, 7 of 14 items reached levels of significance (p \u3c .05). Although all items reported higher mean scores for the highfidelity simulation group, items that focused on manual tasks or actions in the first one to two minutes of the cardiac arrest event were more likely to be non-significant. Items that focused on actions that occurred later in the event or were expert rater assessments of team leader confidence and knowledge were more likely to be found significant. There was no statistical significance found in any of the self-reported measures examining confidence (p = .850), motivation (p = .899), and affect (p = .215)

Best Practice for Casualty Simulation - Role-playing Actor, High Fidelity Mannequin Simulation, or Virtual Reality?

Objective: The purpose of this systemic review of the literature is to determine the best practice with regards to simulating casualties during a disaster response exercise. Methods: MEDLINE was searched from 1950 till present for the key terms of disaster, simulation, and emergency preparedness. Articles were included which met the following criteria: English language, human subjects, original research using any research design (with or without intervention), and primary focus of disaster preparedness using simulation, virtual reality, or role playing actors. Results: Of the 386 articles reviewed only 18 met inclusion criteria. The literature is primarily descriptive in nature with regards to simulation in disaster preparedness. Seven articles (38%) were analytical in study design with the rest being observational or descriptive. The populations varied widely among the included articles ranging from participants at a formal training class to medical students to residents and finally nurses and full trained physicians. The majority of studies including the analytical ones used convenience sampling. These articles were assigned a level of evidence and best practice recommendations and conclusions were then determined. Conclusions: The results show that virtual reality and high-fidelity mannequin based simulation are at least equivalent to the traditional full scale exercise. In addition, both modalities have the advantage of allowing invasive procedures to be performed as well as giving a more realistic time frame experience for the participant. These modalities can be incorporated into future disaster response drills in order to complement each individual modalities strengths and weaknesses

Assessment of Tattoo and Silicone Wounds in Terms of Time of Treatment and Perceived Treatment Quality

At the point of injury, critical medical tasks include locating and identifying an injury as well as applying the appropriate initial care. Over the past decade, to increase the fidelity of wound representation and ultimately the quality of medical care, a considerable amount of research and development has occurred to improve simulated wounds during training, primarily at the point of injury. As material and techniques mature and as more relevant data is collected on tissue properties, examining what fidelity is required for training at the point of injury is crucial. The main objective of this effort was to assess a three dimensional silicone wound versus a two dimensional tattoo wound for training and to examine differences in user perceptions and treatment time. This was accomplished with a test population of 158 City of Orlando Fire Department First Responders which were randomly assigned to each group (three dimensional silicone wound group versus a two dimensional tattoo wound group). The data analyses incorporated the use of non-parametric statistics (Mann-Whitney U Test) to compare the differences between the two groups on depth perception, sense of urgency, immersion, and time on task. Other factors that were examined included the costs for the average tattoo wound and silicone wound as well as the number of uses before the synthetic wound is visibly damaged. The data results indicated that at the point of injury, there were relatively few statistically significant differences in the survey data or time on task between the silicone and tattoo wounds. Additionally, the cost analysis revealed that the silicone wound is significantly more expensive than the tattoo wound. Supporting the military and civilian first responder communities, the results of this study provides statistically reliable data on the use of trauma tattoos as a tool for mastering point of injury treatment during training exercises

Simulation in medical education : a case study evaluating the efficacy of high-fidelity patient simulation

Indiana University-Purdue University Indianapolis (IUPUI)High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature

Human-Centred Design for Improving VR Training of Clinical Skills

With the advent of modern VR technology in 2016, its potential for medical simulation and training has been recognized. However, challenges like low user acceptance due to poor usability are frequently found, hampering wide-spread adoption. This research aims to address the usability of VR clinical skills simulations, particularly focusing on interaction design, and proposes improvements for higher learning outcomes and user retention. A literature review and a usability case study of an off-the-shelf clinical VR training application was conducted, revealing usability concerns and areas requiring improvement. The prevalent issues include difficulties with controls, hardware and the 'gulf of execution' in broader 'possibility space' - issues that extend beyond direct interaction designs. A market analysis further reinforced these findings, showing gaps in interaction affordances, pointing to design patterns and trends that could be improved for better usability and interaction. The synthesis of these findings indicate that the limitations of novel interaction schemes and understanding of the VR simulation's 'possibility space' affect the knowledge transferability. Given these issues and limitations in current VR clinical training simulations, this study outlines several Human-Centred Design recommendations for improvement, incorporating findings from wider VR design research. This research's findings seek to facilitate the development of more user-centric VR training applications, ultimately leading to enhanced training of healthcare professionals and improved patient outcomes. The study sets a foundation for future interaction design work, addressing the primary usability issues and limitations in current VR clinical simulations

Oral application of L-menthol in the heat: From pleasure to performance

When menthol is applied to the oral cavity it presents with a familiar refreshing sensation and cooling mint flavour. This may be deemed hedonic in some individuals, but may cause irritation in others. This variation in response is likely dependent upon trigeminal sensitivity toward cold stimuli, suggesting a need for a menthol solution that can be easily personalised. Menthol’s characteristics can also be enhanced by matching colour to qualitative outcomes; a factor which can easily be manipulated by practitioners working in athletic or occupational settings to potentially enhance intervention efficacy. This presentation will outline the efficacy of oral menthol application for improving time trial performance to date, either via swilling or via co-ingestion with other cooling strategies, with an emphasis upon how menthol can be applied in ecologically valid scenarios. Situations in which performance is not expected to be enhanced will also be discussed. An updated model by which menthol may prove hedonic, satiate thirst and affect ventilation will also be presented, with the potential performance implications of these findings discussed and modelled. Qualitative reflections from athletes that have implemented menthol mouth swilling in competition, training and maximal exercise will also be included

The effect of immersive versus traditional forms of simulation on ratings of self-perceived performance in second-year paramedicine students

Immersive methods of simulation have recently been introduced to undergraduate paramedicine education as an adjunct to traditional simulation that have the purpose of improving outcomes such as performance. However, there is limited research that directly compares immersive and traditional forms of simulation. This study aimed to determine (a) the feasibility of an intensive simulation program comparing traditional and immersive simulation; (b) if one form of simulation provided better self-perceived outcomes; (c) the level of self-perceived performance in students using traditional and immersive simulation; and (d) the sustainability of ratings after a nine-week period. This feasibility study utilised a randomised controlled methodology, allocating second-year paramedicine students (N = 20) to either traditional or immersive simulation. The intervention (immersive) group completed the simulation in the 360-degree projection simulation room, whereas the control (traditional) group completed the simulations in the standard simulation rooms currently used within the practical setting. Ratings were collected using the Seattle University Simulation Evaluation tool (Mikasa et al., 2014) after the first simulation of the three-day program (Rating 1), after the final simulation of the three-day program (Rating 2), and after a nine-week washout period (Rating 3). For the primary outcome of determining if one form of simulation provided greater ratings of self-perceived performance in second-year paramedicine students, an overall statistically significant (p = 0.04) difference in ratings was noted between groups. When observing the effect of a three-day immersive simulation program ( = 15.45) in comparison to a three-day traditional simulation program ( = 15.67), a non-statistically significant difference was noted at Rating 2. In both groups, there was a non-statistically significant improvement between Rating 1 ( immersive = 11.81; traditional = 13.22) and Rating 2 ( immersive = 15.45; traditional = 15.67) which was sustained at Rating 3 ( immersive = 14.09; traditional = 16.00). However, the traditional group reported a mean increase from Rating 2 ( = 15.67) to Rating 3 ( = 16.00) in comparison to a mean decrease between Rating 2 ( = 15.45) and Rating 3 ( = 14.09) in the immersive group. Differences between Rating 3 in the immersive ( = 16.00) and traditional ( = 14.09) groups were statistically significant (p = 0.02). This research project has demonstrated that the methodology was feasible to test these hypotheses and indicates that traditional forms of simulation may result in greater ratings of self-perceived performance

The use of simulation-based education in cardio-respiratory physiotherapy

This thesis is situated in the context of simulation-based education (SBE) within cardio-respiratory physiotherapy in the UK. A pragmatic mixed methods study has provided a comprehensive examination of the use of SBE from two perspectives: 1) physiotherapy education and 2) pre-registration physiotherapy students’ experiences of managing a deteriorating patient in a simulation context. Two national surveys in Phase 1 provided the first insight into the spectrum of SBE utilised in pre-registration and postgraduate physiotherapy education in the UK between 2009 and 2010. National inconsistencies in simulation provision and accessibility were identified. Financial costs, time and access to simulation centres/laboratories reportedly influenced the use of SBE within cardio-respiratory physiotherapy education. Phase 2 combined SBE and video-reflexive ethnography (VRE) methods to elicit a unique and comprehensive exploration of performance, behaviours, errors and personal experiences of 21 final year (pre-registration) physiotherapy students from one higher education institution in the UK. This study has identified the multi-layered impact of personal experiences and behaviours on practices, clinical decisions, dynamics and the complexities and interconnectivity of participants to the simulation environment. The range of errors identified by this study also highlights the complexity of managing an acutely deteriorating patient in a simulation context. The combination of SBE and VRE allowed the participants to explore errors and defences erected within the scenario and their impact on patient safety. The findings of this thesis emphasise the importance of scenario design, considering the learner’s level of experience, prior knowledge and sequencing of abstract skills before requiring contextualisation within a complex scenario. Carefully planned and executed SBE and VRE methods can provide a safe learning environment to allow participants to explore routine, evolving and complex situations whilst allowing them to learn to be become comfortable with making and exploring errors. Thus, the findings provide valuable insights to inform future research regarding physiotherapy practice and integration of educational methods to augment patient safety awareness and enhance safe healthcare practice. The key message of this thesis is that SBE is a valuable learning modality to explore the complexities of healthcare education and practice