In-situ simulation: A different approach to patient safety through immersive training

Simulation is becoming more and more popular in the field of healthcare education. The main concern for some faculty is knowing how to organise simulation training sessions when there is no simulation centre as they are not yet widely available and their cost is often prohibitive. In medical education, the pedagogic objectives are mainly aimed at improving the quality of care as well as patient safety. To that effect, a mobile training approach whereby simulation-based education is done at the point of care, outside simulation centres, is particularly appropriate. It is usually called “in-situ simulation”. This is an approach that allows training of care providers as a team in their normal working environment. It is particularly useful to observe human factors and train team members in a context that is their real working environment. This immersive training approach can be relatively low cost and enables to identify strengths and weaknesses of a healthcare system. This article reminds readers of the principle of « context specific learning » that is needed for the good implementation of simulation-based education in healthcare while highlighting the advantages, obstacles, and challenges to the development of in-situ simulation in hospitals. The objective is to make clinical simulation accessible to all clinicians for the best interests of the patient.Peer reviewe

Designing intelligent computer‐based simulations: A pragmatic approach

This paper examines the design of intelligent multimedia simulations. A case study is presented which uses an approach based in part on intelligent tutoring system design to integrate formative assessment into the learning of clinical decision‐making skills for nursing students. The approach advocated uses a modular design with an integrated intelligent agent within a multimedia simulation. The application was created using an object‐orientated programming language for the multimedia interface (Delphi) and a logic‐based interpreted language (Prolog) to create an expert assessment system. Domain knowledge is also encoded in a Windows help file reducing some of the complexity of the expert system. This approach offers a method for simplifying the production of an intelligent simulation system. The problems developing intelligent tutoring systems are examined and an argument is made for a practical approach to developing intelligent multimedia simulation systems

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

The neurocognitive gains of diagnostic reasoning training using simulated interactive veterinary cases

The present longitudinal study ascertained training-associated transformations in the neural underpinnings of diagnostic reasoning, using a simulation game named “Equine Virtual Farm” (EVF). Twenty participants underwent structural, EVF/task-based and resting-state MRI and diffusion tensor imaging (DTI) before and after completing their training on diagnosing simulated veterinary cases. Comparing playing veterinarian versus seeing a colorful image across training sessions revealed the transition of brain activity from scientific creativity regions pre-training (left middle frontal and temporal gyrus) to insight problem-solving regions post-training (right cerebellum, middle cingulate and medial superior gyrus and left postcentral gyrus). Further, applying linear mixed-effects modelling on graph centrality metrics revealed the central roles of the creative semantic (inferior frontal, middle frontal and angular gyrus and parahippocampus) and reward systems (orbital gyrus, nucleus accumbens and putamen) in driving pre-training diagnostic reasoning; whereas, regions implicated in inductive reasoning (superior temporal and medial postcentral gyrus and parahippocampus) were the main post-training hubs. Lastly, resting-state and DTI analysis revealed post-training effects within the occipitotemporal semantic processing region. Altogether, these results suggest that simulation-based training transforms diagnostic reasoning in novices from regions implicated in creative semantic processing to regions implicated in improvised rule-based problem-solving

The Evaluation of Teaching the Nursing Process Using Traditional Lecture, Campus Laboratory, Clinical, and the Addition of High Fidelity Human Simulation (HFHS) Unfolding Scenarios

It is not sufficient to just make changes in a nursing curriculum without a plan to evaluate the impact on program outcomes. This study sought to determine the outcomes of teaching the nursing process to Foundation of Nursing students in an Associate Degree Nursing program using a factorial design study. Four groups of students were taught the nursing process as follows: case study and concept mapping; case study, concept mapping with a pocket reference; case study, two hours HFHS, concept mapping with a pocket reference, or four hours of HFHS, concept mapping with a pocket reference. The Simulation Design Scale (SDS) measured the perceptions of the simulation groups for design elements. The four hour group mean was significantly lower on both the importance of the objectives and information and importance of fidelity design elements (p \u3c .05). This suggests that as time in a simulation increases more attention to these elements is required. There was not a significant difference between the four study groups on the Nursing Process or the Assessment Technology Institute (ATI) RN Fundamentals 2010 Assessment Form B examinations individual scores. Two sub-categories on the ATI were significant. Planning was significantly higher for fall 2012 cohort (p = .024) and analysis/diagnosis was almost significant for fall 2011 cohort (p = .054). The results for Factorial Groups was not significant. The National League for Nursing (NLN) PAX-RN entrance examination had a significant correlation with students passing onto the second semester in a nursing program (p \u3c .001). The ATI results of students were the same without regard to the Factorial Group assigned in relation to instructor employment status of full time versus part time