A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.

PurposeHigh-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.MethodsThis study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.ResultsSelf-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can300, instructor debriefing was the preferred alternative.ConclusionWith a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education

Integrated Maritime Simulation Complex Management, Quality And Training Effectiveness From The Perspective Of Modeling And Simulation In The State Of Florida, USA (A Case Study)

Naturally, maritime training simulators at all events are valuable instructional and pedagogical tools. Through the history, the maritime simulation was utilized to train prospective maritime apprentices in whom it has filled the gap left by the acute shortage of opportunities for jobs onboard vessels around the globe. However, professional seafarers are the axis of success and competitiveness in the field of maritime training. They are the ones that, who are well trained and have the responsibilities of their work and the surrounding environment. In order to achieve the success along with effective training skills, both maritime companies and seafarers should implement a management of safety onboard ships, which only can be executed through the effective usage of the Bridge Resource Management (BRM) and righteous maritime simulation training. Qualitative upgrading of the maritime training process at higher education levels depends predominantly on the instructive value of the instructors\u27 educational software and the content of these programs which contains advanced and intelligent scenarios that benefit positively in providing effective training in order to, transfer and implement their gained skills from virtual reality to the actual environment with minimal risks and additionally to avoid the unforeseen occurrences at sea. The outcomes of the evaluation have shown the instructional suitability of the maritime educational scheme and significant capabilities, it provides, as well as the domains and frameworks for its instructional development. The above facts are substantial in the refinement and improvement of the current maritime education and growth of the apprentices\u27 capabilities and the professionalism of their skills, along with the farthest purpose of creating more educated marine navigators in the worldwide merchant fleet. This research proposes and demonstrates in details the purpose of the maritime simulation training complexes, the elements that if provided, will lead to an effective maritime simulation training, types of maritime simulation, the International Maritime Organization (IMO), its tools and its power for the effectiveness of the maritime simulation training through different conventions & codes and the future for the maritime simulation training, in order to emphasize and accentuate the interplay between instructors and apprentices in an integrated maritime simulation complex on which a serious maritime event is taking place. The distillation of this thesis draws an attention to the effectiveness of the partnership between maritime apprentices and their instructors across a maritime simulation training complex scheme during a virtual maritime scenario event in an advanced facilities located in the state of Florida, which is armed with modern technology, provides both added stimulation for the apprentice himself and elevates the simulator a degree toward a vessel for practical training and/or sailing

Developing high-fidelity health care simulation scenarios : a guide for educators and professionals

“The final, definitive version of this article has been published in the Journal, Simulation & Gaming, 42 (1), 2011, copyright SAGE Publications Ltd on SAGE Journals Online: http://online.sagepub.com/ "The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteertoact as the patient, or even obtaining ready-made scenarios from another simulation center are rarely insurmountable challenges. The issue often lies in how to use or adapt these for your own purpose: with your team, facilities, and resources but primarily for your learners. Published information is limited in the area of scenario preparation for health care education and continuing medical education or continuing professional development. This article is a guide for clinical tutors, standardized patient trainers, and patient simulator operators on how to script scenarios and proposes a new detailed and reusable template for writing scenarios. It contains practical sections such as how to decide on the learning objectives to be addressed, how to script and organize your scenarios, and how to pitch the suitable level of details to make the scenarios appropriately realistic.Peer reviewe

A Cost-Benefit Analysis of Pilot Training Next

The United States Air Force (USAF) is currently facing a 2,400-pilot shortage in an increasingly constrained budgetary environment. Without pilots to engage the enemy, deliver weapons, and provide logistics support for operations, the USAF could lose the ability to fly, fight, and win global engagements and defend the homeland. This study focused on Undergraduate Pilot Training (UPT) as a means of producing the USAF’s pilots to offset the current shortage. Specifically, this study compared UPT to the recently initiated Pilot Training-Next (PTN) program through a cost-benefit analysis. Like any new technology integration, PTN’s virtual reality training will require further study for proofing and justification prior to full-scale implementation and further utilization of constrained USAF resources. This study’s use of extant financial and historical production data, coupled with interviews with PTN instructors, highlights the potential of PTN. Ultimately, this study’s cost-benefit analysis uniquely contributes to the growing body of virtual reality training research through a Formula for Change theoretical lens, while simultaneously providing USAF decision makers a comparison of program costs, projected production capacity, and quality of training

Teamwork training using patient simulation

Teamwork is an important factor in safe healthcare. Simulation based team training (SBTT) is a method to gain the non-technical skills important for proficient teamwork. This thesis evaluated SBTT using different modalities and evaluation levels, looking at whole teams of either medical students or full professionals. In study I 15 medical students participated in a target-focused scenario-based teamwork practice during a one-day course. Their team behaviour skills were video-recorded and their attitudes towards safe teamwork assessed in this observational cohort study. Team behaviour skills showed improvement after five scenarios in a full-scale patient simulator environment, while no change in attitudes toward safe teamwork were detected. In study II 54 medical students participated in three video-recorded scenarios (n=36). Clinical performance improved in one variable; the frequency of sum-ups. Changes in individual experiences could be detected early during SBTT; self-efficacy improved after training. Individual teamwork behaviours did not change after this half-day course. Participants communicated to a greater extent and experienced higher mental strain and concentration in the role of leader than in the role of follower. Study III investigated whether training with high-fidelity simulators (HFS) could increase trainees’ experience of realism in task performance and facilitate the trainers’ task, resulting in different behaviour and individual experiences than training with low-fidelity models (LFM). A case control study was conducted with 34 teams using either a LFM (n=17) or a HFS (n=17). Professionals involved in paediatric emergencies performed one video-recorded emergency scenario in situ in an authentic emergency room. The trainees’ time to deliver oxygen was significantly longer (p=0.014) when using a HFS, which was interpreted as more realistic timing of task performance. Leaders experienced a higher level of mental strain during training with a HFS. There was a reduction in the trainers’ frequency of interventions in the scenarios as well as their mental strain, signifying potential for the trainers to focus more on trainees’ behaviours and performance during training using a HFS. In study IV all staff members (n=152) in an intensive care unit (ICU) were trained during one day. An observational cohort study (case control design on sick leave and staff turnover) was conducted. The training was performed in situ at the ICU and preceded by an interactive lecture concerning human factors. Before training, the medical professions’ perceptions of safety differed. After the training period, nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived that the quality of collaboration and communication with physician specialists improved. In addition, nurse assistants’ perception of the Safety Attitude Questionnaire (SAQ) factors teamwork climate, safety climate and working conditions were more positive after the project and in concert with nurses’ perception of safety climate. In comparison to a control ICU during the study period, the number of nurses quitting their job and nurse assistants’ time on sick leave was reduced. In conclusion, the SBTT protocols applied in these studies are promising. A one-day course seems to benefit medical students’ teamwork behaviour. During a half-day course, i.e. early phase of training, aspects of clinical performance were improved as well as self-efficacy. Equipment fidelity influenced trainees’ clinical performance to some extent, but the trainers’ performance and experience to a larger extent. Leaders, followers and the different medical professions reported different experiences and attitudes. This finding accords with earlier studies on professions but has not been well studied earlier in the context of leaders and followers. All professions benefited from one day of SBTT in an ICU, but it was expressed in different ways