Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach

© 2015 Zimmermann et al.Background: Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. Methods: We designed and implemented a team and resuscitation training program according to Kerns six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleutens conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. Results: The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Childrens Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. Conclusions: The programmatic approach of Kerns six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program

How Can we Use Simulation to Improve Competencies in Nursing?

This open access book offers an overview of theories related to simulation and describes different simulation areas within nursing. It illustrates how simulation may be used in different levels in professional education. The book deals with the role of the Simulation Facilitator, peer learning and the use of Virtual Reality in simulation. It provides new insights and paths to the development of the use of simulation within nursing and healthcare and contributes with new knowledge from research and experiences of implementation of different simulating scenarios within nursing and midwifery. It is intended to teachers in nursing and other healthcare professionals with an interest in the use of active learning methods

Interventions to improve team effectiveness within health care

Background: A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. Objectives: To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. Methods: Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. Results: Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. Conclusion: Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research t

How Can we Use Simulation to Improve Competencies in Nursing?

This open access book offers an overview of theories related to simulation and describes different simulation areas within nursing. It illustrates how simulation may be used in different levels in professional education. The book deals with the role of the Simulation Facilitator, peer learning and the use of Virtual Reality in simulation. It provides new insights and paths to the development of the use of simulation within nursing and healthcare and contributes with new knowledge from research and experiences of implementation of different simulating scenarios within nursing and midwifery. It is intended to teachers in nursing and other healthcare professionals with an interest in the use of active learning methods

Foundations of GAM Research. Methodological Guidelines for Designing and Conducting Research that Combines Games and Agent-based Models

This thesis presents the development of the games and agent-based model methodology and provides methodological guidelines for using GAM research, i.e., combining games and agent-based models in research. GAM research is rooted in complexity sciences and transdisciplinary research, offering valuable insights into complex, adaptable systems. GAM research has particular relevance in decision-making and complex-system management, thus fostering collaboration among scientists and non-academics from various disciplines. It is an engaging platform for data collection and stakeholder processes, thus enriching causal explanations. It should be noted that GAM research has the potential to overcome the limitations of traditional methods by facilitating hypothesis testing with simulation-based observations of human behaviours. Investigations in GAM research can change how social science addresses pressing global challenges. The immersive nature of games combined with agent-based models offers an innovative approach that attracts diverse participants, making it a promising tool for science that reaches beyond the classic academic spheres. As a comprehensive handbook, this thesis offers researchers inspiration and references for conducting GAM research across diverse application domains. This thesis presents an assessment of the state of research that combines games and agent-based models and proposes a structured approach to making progress in this field. Addressing the lack of a standardised methodology, this thesis is aimed at improving research practices, transparency, and replicability . Practical advice is provided for guiding researchers through designing and conducting GAM research, thus promoting rigorous and comprehensive studies

Student Reliance on Simulations: The Extent That Engineering Students Rely on the Outcomes of Their Simulations

The purpose of this research was to investigate the factors that contributed to engineering education students’ reliance on technology while learning new concepts. The researcher hypothesized that students would give reliance to their technology, even in the face of evidence that the technology was not working as intended. This research used a mixed-methods approach to answer the research questions. Three questions guided the research: (1) How are the participant’s level of automation complacency and the correctness of the simulation that participant is using related?; (2) How is automation bias related to a participant’s ability to recognize errors in a simulation?; and (3) What factors explain the automation bias and automation complacency that the participants are experiencing? The third research question had two subquestions: (a) What factors explain the correlation between a participant’s level of automation complacency and the correctness of the simulation that participant is using?; and (b) What factors explain the impact that automation bias has on a participant’s ability to recognize errors in that simulation? This study was based on the Theory of Technology Dominance, which states that people are more likely to rely on their technology the less experience they have with the task, the higher the complexity of the task, the lower the familiarity with the technology, and the further the technology is from the skillsets needed to solve the problem. This framework is built on the automation bias and automation complacency given by an individual towards technology. Automation bias is an overreliance on automation results despite contradictory information being produced by humans, while automation complacency is the acceptance of results from automation because of an unjustifiable assumption that the automation is working satisfactorily. To ensure that the study could gather the information necessary, the mixed-study utilized deception techniques to divide participants into separate groupings. Four groupings were created, with some participants being given a properly functioning simulation with others being given a faulty simulation. Half of each grouping were informed that the simulation may have errors, while others were not. All participants who completed the study were debriefed about the real purpose of the study, but only after information had been gathered for analysis. The simulation given to all participants was designed to help students learn and practice the Method of Joints. Students participating in the statics courses taught in the College of Engineering courses at Utah State University were invited to participate in the program over Spring and Fall semesters of 2022. Sixty-nine participants began the study, but only thirty-four remained in the study through to completion. Each participant took a pre-questionnaire, worked with a provided simulation that was either correct or incorrect, were possibly informed of potential errors in the simulation, and took a post-questionnaire. A few participants were invited to participate in an interview. The findings of this study revealed that students often have high levels of automation bias and automation complacency. Participants changed their answers from wrong answers to right answers more often when using correct simulations and from right answer to wrong answers more often when using faulty simulations. The accuracy of each participant’s responses was also higher for those with correct simulations than faulty simulations. And most participants expressed that they checked their work and changed their answers when the simulation asked them to. These findings were confirmed through the use of the post-questionnaire results and in interview analysis between the groups

Developing a pedagogical model for simulation-based healthcare education

The purpose of my research is to facilitate healthcare education in simulation-based learning environments (SBLEs). The specific aim of the present study is to give examples of how simulationbased education can be applied in pedagogically appropriate ways by developing a pedagogical model. Multiple research questions were set to meet this goal. The study uses design-based research (DBR) and case study approaches, which provided an opportunity to answer the research questions as well as develop theory and practice. Altogether the study involved 21 facilitators and 136 students. In the first sub-study, eight facilitators were interviewed in order to find out their approaches to teaching and learning and the educational tools they used. The second sub-study examined 97 healthcare students’ expectations of simulation-based learning through questionnaires. In addition, data were collected during two case studies. In both case studies, the students trained within SBLEs on scenarios on a given topic. Data were collected through pre- and post-questionnaires, observations and field notes, video recordings and interviews (group and individual interviews). During the first case study, the students also wrote learning diaries. The data collected from the questionnaires were analyzed using statistical methods, whereas the qualitative data were analyzed using a qualitative content analysis method. The principle result of this study is a pedagogical model, which is informed by educational theories and previously developed pedagogical models, as well as previous studies related to simulationbased education. However, it also provides information concerning the current pedagogical use of simulations. The present study ascertains that teaching is seen as entailing the facilitation of students’ learning and is viewed mostly as a student-centered activity. However, there are differing viewpoints that can cause friction during the instructional process. The pedagogical use of SBLEs also sets various requirements for the healthcare educator. Students’ expectations of simulation-based learning were also high. Furthermore, simulation-based learning can be viewed as meaningful, although special attention should be paid to goal-oriented, self-directed and individual characteristics of meaningful learning. The research results have several implications for research, theory and practice.acceptedVersio

Oral Paper S26 - What are students frightened of?

Background Despite extensive consistent integrated early clinical experience at HYMS, students have often been noted to struggle in making the transition from the largely University-based Phase I (2 years) to immersion in the clinically-based Phase II. Tutors report student difficulties in adopting an appropriate attitude to learning in this environment; some are noted to respond to this by minimising the time spent on the wards with obvious consequences for their experience and education. Presentation A new “Core Clinical Skills and Professional Expectations” course, lasting 2 weeks was introduced in August 2014 for students making this transition. This block aimed to address many areas which students have been noted to struggle with, including professionalism and development of clinical diagnostic reasoning and skills for independent learning. Evaluation Students were asked to identify their own fears and anxieties about moving into the clinical environment. All students completed a brief survey at both the beginning and the end of this two week period which included identification of their own sources of anxiety in approaching immersion in the clinical environment. Results of this survey are presented and discussed with implications for clinical teaching

Roundtable RT06. Clinical Reasoning skills: Something that can be taught or just a matter of seeing lots of patients?

There is considerable literature regarding the complex nature of clinical reasoning for clinicians. Norman (2005) stated “there is no such thing as clinical reasoning - there is no best way through a problem. The more one studies the clinical expert, the more one marvels at the complex and multidimensional components of knowledge and skill that he brings to bear on the problem, and the amazing adaptability he must possess to achieve the goals of effective care”.For novices to become experts they need extensive deliberate practice to facilitate the availability of conceptual knowledge and add to their storehouse of already solved problems (Norman 2005).The authors are aware that previously students learnt how to reason clinically by clerking lots of patients and constructing lists of likely differential diagnoses. Students were repeatedly interrogated by doctors to justify their differential diagnoses. Changes in working time directives and increased shift working mean that students are less likely to have to justify their thinking on several occasions to the same doctor who then helps them develop their reasoning skills.Today’s students face further challenges, as modern medical curricula generally focus on delivering clinical experience in system-specific rotations leaving students unable to organise information effectively when patients present with complex, multisystem illnesses. A limitation of systems based curricula is that it does not encourage the development of clinical reasoning skills.There is now extensive literature regarding the need to explicitly teach clinical reasoning skills to students in addition to them having lots of practice in clerking patients and then constructing lists of the most likely differential diagnoses.Delegates at this round table discussion will be encouraged to debate whether they believe that students can be explicitly taught clinical reasoning skills or whether it is just a case of ‘seeing lots of patients’