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)

Certified Registered Nurse Anesthetist Performance and Perceptions: Use of a Handheld, Computerized, Decision Making Aid During Critical Events in a High-fidelity Human Simulation Environment

With the increasing focus on patient safety and human error, understanding how practitioners make decisions during critical incidents is important. Despite the move towards evidence-based practice, research shows that much decision making is based on intuition and heuristics (“rules of thumb”). The purpose of this study was to examine and evaluate the methodologic feasibility of a strategy for comparing traditional cognition versus the use of algorithms programmed on a personal digital assistant (FDA) in the management of unanticipated critical events by certified registered nurse anesthetists (CRNAs). A combined qualitative-quantitative methodology was utilized. The quantitative element consists of a pilot study using a cross-over trial design. Two case scenarios were carried out in a full-scale, high fidelity, simulated anesthesia care delivery environment. Four subjects participated in both scenarios, one without and one with a PDA containing a catalog of approximately 30 events with diagnostic and treatment related information in second scenario. Audio—videotaping of the scenarios allowed for definitive descriptive analysis of items of interest, including time to correct diagnosis and definitive intervention. The qualitative approach consisted of a phenomenological investigation of problem solving and perceptions of FDA use and the simulation experience by the participants using “think aloud” and retrospective verbal reports, semi-structured group interviews, and written evaluations. Qualitative results revealed that participants found the PDA algorithms useful despite some minor technical difficulties and the simulated environment and case scenarios realistic, but also described feelings of expectation, anxiety, and pressure. Problem solving occurred in a hypothetico-deductive manner. More hypotheses were considered when using the PDA. Time to correct diagnosis and treatment varied by scenario, taking less time with the PDA for one but taking longer with the PDA for the other, likely due to differences in pace and intensity of the two scenarios. The methodologic investigation revealed several areas for improvement including more precise control of case scenarios. All participants agreed with the value of using high fidelity simulation, particularly for problem solving of critical events, and provided useful information for more effective utilization of this tool for education and research

Medical Emergency Training for Dentists: A study of the acquisition and retention of theoretical and practical knowledge

While medical emergencies occurring in dental practices are generally perceived to be uncommon, there is consensus that dentists should possess the knowledge and skills to manage adverse medical events. National and international studies show that the level of medical emergency knowledge among dentists is low. The present study, based on a NSW Health medical emergency training program, was a prospective cohort study of dentists employed in two Local Health Districts in NSW Australia. The objectives of the study were to determine: the underlying level of knowledge, the acquisition of knowledge after training, the retention of knowledge over time, and whether retraining further improved the level of knowledge. The results of the study found that the participating dentists did possess some pre-existing medical emergency knowledge. Their level of knowledge improved significantly after training, but the knowledge gained was gradually lost over time. Retraining resulted in the reacquisition of knowledge, but not an increase of knowledge over that which was initially learned. The study also revealed that some specific areas were significantly less well learned than others. Participant feedback indicated that such training was perceived as valuable for dentists. The outcomes of the study have resulted in the development of a training program which is more focussed on the specific needs of the dental community

Workshop 21. Faculty Development - Equipping clinical tutors with the skills to assist students to develop their clinical reasoning in patient consultations

Workshop ObjectivesTo consider the particular challenges for clinical tutors (experts) in helping medical students (novices) develop their clinical reasoning skills.To develop awareness of innovative approaches to faculty development to help tutors develop their skills in facilitating students development of their clinical reasoning skills in patient encounters.To encourage delegates to share best practice and reflect on faculty development in their own institutions

Oral 13. Unconscious Bias Training for our Simulated Patients: Showcasing a new and innovative workshop

Oral Presentation objectives1) To develop awareness of our innovative workshop delivered to our Simulated Patients to increase their understanding of unconscious biases, how these might impact their work as Simulated Patients in our teaching and assessments and to equip them with skills to challenge and interrogate their automatic thinking. 2) To consider Simulated patient feedback and reflections and my own critical reflections on the Workshop.3) To share best practice with delegates regarding their own experiences of developing Unconscious Bias training to Simulated Patients / other groups in their own institutions

Workshop 47. The Future of consulting: Impact of changing practice on our cognitive load as experts and educators & insights into the novice perspective

Objectives1) To consider current & future impact of remote consulting & the covid pandemic on our cognitive load as clinical reasoning ‘experts’ 2) To consider & reflect on the insights this has provided us as clinicians & educators into the student perspective (clinical reasoning ‘novices’) & their clinical reasoning development 3) To analyse delegates’ own experiences where this & similar transformative learning experiences could be deployed to drive effective learning 4) To recognise & describe the impact on traditional curricula structures

How to Improve Assessment of Tetanus Immunity in the Emergency Room: A Prospective Cost-Effectiveness, Double Blind Study

peer reviewe

ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES

This thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education