Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.Peer reviewe

Cost-Effective Extracorporeal Membrane Oxygenation Simulation

©2018 Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND 4.0). For further information see: https://creativecommons.org/licenses/by-nc-nd/4.0/This invited review article was presented orally on the occasion of the South West Asian Chapter conference of the Extracorporeal Life Support Organization (ELSO) held in New Delhi, India in January 2018. It has an educational focus on the topic of extracorporeal membrane oxygenation (ECMO), which is increasingly being used as a lifesaving bridge therapy. A case is being made regarding the adage “practice makes perfect” to be considered in the context of simulation-based education to ensure patient safety. Technology-enhanced simulation-based deliberate practice should be used more commonly to support clinicians in the development of all their professional skills. This is an ethical imperative that may be addressed using low-cost simulation modalities that are sometimes proven to be as effective as more expensive approaches. Educators can now design their programs according to published best practice standards for the benefit of their learners, and ultimately the patients they care for. Simulation-based education clearly has a place and important role to play in preparing ECMO teams dealing with routine procedures as well as emergency situations. Several solution and approaches are being presented alongside innovative work currently being done in collaboration between a regional ELSO center of excellence and an academic institution. This innovative simulator is composed of several modules serving different functions required for the simulation of ECMO emergencies at a much lower cost than using the real machine and its various expensive disposable components.Peer reviewedFinal Published versio

Enhancing Clinical Learning Through an Innovative Instructor Application for ECMO Patient Simulators

© 2018 The Authors. Reprinted by permission of SAGE PublicationsBackground. Simulation-based learning (SBL) employs the synergy between technology and people to immerse learners in highly-realistic situations in order to achieve quality clinical education. Due to the ever-increasing popularity of extracorporeal membrane oxygenation (ECMO) SBL, there is a pressing need for a proper technological infrastructure that enables high-fidelity simulation to better train ECMO specialists to deal with related emergencies. In this article, we tackle the control aspect of the infrastructure by presenting and evaluating an innovative cloud-based instructor, simulator controller, and simulation operations specialist application that enables real-time remote control of fullscale immersive ECMO simulation experiences for ECMO specialists as well as creating custom simulation scenarios for standardized training of individual healthcare professionals or clinical teams. Aim. This article evaluates the intuitiveness, responsiveness, and convenience of the ECMO instructor application as a viable ECMO simulator control interface. Method. A questionnaire-based usability study was conducted following institutional ethical approval. Nineteen ECMO practitioners were given a live demonstration of the instructor application in the context of an ECMO simulator demonstration during which they also had the opportunity to interact with it. Participants then filled in a questionnaire to evaluate the ECMO instructor application as per intuitiveness, responsiveness, and convenience. Results. The collected feedback data confirmed that the presented application has an intuitive, responsive, and convenient ECMO simulator control interface. Conclusion. The present study provided evidence signifying that the ECMO instructor application is a viable ECMO simulator control interface. Next steps will comprise a pilot study evaluating the educational efficacy of the instructor application in the clinical context with further technical enhancements as per participants’ feedback.Peer reviewedFinal Accepted Versio

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

The role of simulation in neonatal and pediatric training and research

From a pediatric perspective, the two main types of simulation-based research are: studies that assess the efficacy of simulation as a training methodology and studies where simulation is used as an investigative methodology. Aim of the study. Overall, the aim of the research activity is to inquire the use of simulation as investigative methodology in pediatric and neonatal settings. Study design: Previously, we investigated the current use of simulation in pediatric fellowships in Italy in order to understand the state of the art and the expectations of pediatric residents with regard to simulationbased training and research. Furthermore, we developed suitable simulated scenarios for pediatric training and research. As second step, we evaluated technical (TS) and non-technical (NTS) skills in a sample of Italian pediatric residents using a neonatal resuscitation scenario; Finally, we aimed to evaluate the accuracy of NeoTapAS in reliably determining HR from auscultation in a high-fidelity simulated newborn resuscitation scenario. Results and future perspectives: Firstly, we highlighted that an extremely high percentage of pediatric italian residents spent less than 5 hours/year in simulation-based education. Secondly, the mean compliance to last ILCOR recommendations about neonatal resuscitation was 59 % and a very low compliance (< 30%) was observed for a number of important technical items. Finally, NeoTapAS showed a good accuracy in estimating HR and it could be an important resource for neonatologists in delivery room resuscitation As future perspective, we designed a new simulation-based multi-center research (\u201cSimarrest \u201d) in collaboration with University of Padua in order to identify gaps about in-hospital pediatric cardiac arrest management in a standardized setting

Bridging the clinical experience gap: –using simulation to improve ventilation performance during neonatal resuscitation in a high-resource setting

Background: Up to 10% of newborn babies need help to establish regular breathing at birth. Those who do breathe, and who are not fortunate enough to receive prompt and effective help, will die. The burden of neonatal mortality is highest in sub-Saharan Africa and Central-Southern Asia. However, the burden of morbidity in those babies who survive is proportionately a greater problem in middle-income, but also in high-income, countries. Many non-breathing babies respond to stimulation. For those who need more help, positive pressure ventilation of the lungs via a facemask is by far the most important intervention. Training midwives in low-resource settings using simulation training has led to better simulated performance, improved parameters of real-life facemask ventilation, and reduced early neonatal mortality. In high-resource settings like Norway, where paediatricians perform most neonatal facemask ventilation, infrequent simulation training does not replace the lack of clinical experience for midwives and other medical professionals working with women giving birth. It is not known if more frequent simulation training for healthcare providers (HCPs) in a high-resource setting can train and maintain ventilation skills, nor whether it has the potential to change practice in the clinical setting, or impact neonatal outcomes. Aim: The aim of this thesis was to study methods of using simulation training to bridge the clinical experience gap in ventilation of non-breathing babies at birth in a high-resource setting. The specific aims of the individual papers were to: - 1) determine the realism of simulated ventilation using the high-fidelity manikin NeoNatalie Live; 2) evaluate the effects of a low-dose, high frequency simulation training (LDHFST) programme using NeoNatalie Live on the ventilation competence of multidisciplinary HCPs; and 3) determine the optimal simulation training load to maintain ventilation competence in these HCPs. Method: A prospective observational study of HCPs from six different professions involved in neonatal resuscitation, with a randomised controlled study arm. Following baseline testing (T1) of simulated ventilation performance, participants attended an educational session, after which their ventilation performance was re-tested (T2). Participants were randomised to one of two training-frequency groups and asked to train independently for nine months, receiving targeted feedback from the simulator to guide their training. These groups were a) intervention group aiming for two training sessions per month and b) control group permitted to choose their own training frequency. After nine months of independent training, participants’ simulated ventilation performance was re-tested a final time (T3). Parallel to the simulation study, all real neonatal ventilation was recorded using a respiratory function monitor (RFM). To evaluate the realism of the simulated ventilation experience (study I, observational), we used panel data regression analysis of RFM data. We compared ventilation data obtained from the manikin when ventilated by paediatricians, with data obtained from real resuscitations performed by the same group of HCPs. The educational benefit of the simulation training programme (study II, randomised controlled study) was assessed by Kruskal-Wallis testing to compare T3 scores for the two training frequency groups. The same test was used to analyse the effect of the ventilation performance test scores, T1, 2 and 3, for the different professions. Finally, we used generalized linear mixed effects models to correlate ventilation competence scores, obtained by participants during their nine months of independent training, with training load (frequency and dose) (study III, observational). Estimated marginal probabilities of successful outcomes identified training loads predictive of high scores. Results: Study I - We found similarities in three important ventilatory parameters and their inter-relationships, and the same frequency of upper airway obstruction, in the manikin and neonates, supporting the fidelity of the simulated ventilation experience. Study II - 187 HCPs from paediatric, obstetric and anaesthesia services completed the simulation study. Those randomised to the intervention group trained on average 8 sessions in 9 months, while those in the control group trained 2.8 sessions. There was no difference in T3 scores between these two groups. Subgroup analysis comparing T3 scores for those performing no sessions versus those performing 9 or more sessions in 9 months showed a significant difference in favour of training. Paediatricians scored significantly higher at T1 than the other five professions. For the paediatricans, there was no difference in scores at T1, 2 or 3. Overall, scores improved significantly from T1 to T2 and to T3. At T3 there was no difference in the scores for all six professions. Study III - During the 9 months of independent training, 4348 simulation cases were performed. Training on average 0.6 sessions per month was predictive of high ventilation competence scores for all 187 participants. Conclusion: NeoNatalie Live effectively simulates conditions encountered during real-life neonatal ventilation. Ventilation competence can be trained through simulation, and brief, frequent sessions maintain competence despite a lack of on-going clinical opportunities to practice this skill. For this multidisciplinary group of healthcare providers, training on average once every other month maintains competence

Ergonomics of the Operative Field in Paediatric Minimal Access Surgery

Imperial Users onl

Addressing Interprofessional Competence in Interpretation of Electronic Fetal Monitor Tracings

Interpretation of electronic fetal monitor (EFM) tracings is a critical clinical practice skill nurses and physicians perform during the intrapartum stage of pregnancy. However, if performed inaccurately can potentially jeopardize the well-being of the neonate. This risk is present because if concerning EFM tracings are not interpreted accurately, preventative care interventions to promote the well-being of the unborn child do not occur. The project was initiated by completing a scoping literature review on the methods for training and evaluating EFM interpretation competence, which revealed current EFM interpretation training and evaluation methods are lacking. A concept analysis defined nurse competence in diagnostic healthcare technologies. The analysis included examining surrogate terms, related concepts, attributes, antecedents, and consequences. This dissertation evaluated the feasibility and effectiveness of a Simulation-Based Mastery Learning intervention on clinical interprofessional team members’ EFM interpretation competence and self-efficacy compared to clinical experience alone. In addition, it determined how participants’ characteristics affect baseline EFM interpretation scores. The study was a randomized longitudinal design with participants recruited from a convenience sample of interprofessional healthcare team members from a large research hospital in the southeastern United States. Randomization procedures placed recruited participants into either an intervention or clinical experience alone group, with competence evaluations for both groups occurring at baseline, immediately post-intervention, and three months post-intervention. Once completed, add results and conclusion here