Opportunities for authentic simulated patients

Background and aim/objectives: Traditionally, simulated patients are played by actors and / or fellow peers taking part in the simulation-based training. Literature indicates that there are many benefits to employing real people in simulation scenarios especially when the training addresses empathy and communication (Oh et al. 2015). The question therefore is why do we not involve actual service users as ‘authentic simulated patients’ or ‘authentic standardised patients’ (abbreviated to ‘authentic SPs’) in the scenarios? Yet, literature also points to the need for consistency (Wilbur et al. 2018, Lewis et al. 2017) in simulation-based learning concerning exam situations such as Objective Standardised Clinical Examination (OSCE)s, which may be more difficult to achieve when a person contributes with their lived experience rather than their acting skills. Additionally, the training of simulated patients / standardised patients is variable and inconsistent, which calls for a renewed approach that acknowledges and adapts to the requirements and abilities of authentic SPs. The aim of this talk is to present a framework and checklist for the involvement of SPs with the lived experience to explore what the opportunities for the employment of ‘authentic simulated patients’ is. The anticipated benefits they bring to the learning experience will be discussed, whilst considering the risks for the services user, learners, and educators alike. Method or activity: A framework using a checklist for the involvement of ‘authentic SPs’ has been developed, which is based on a systematic search of literature reviews as well as on discussions with simulation practitioners and educators. It draws on examples from practice of those involving persons with learning disabilities in the structuring of the simulation learning activities in an undergraduate nursing course. Results/Findings discussion: The talk will present the overall ‘authentic SP’ framework and how the checklist could be applied. For this, examples from practice will be given such as involving persons with learning disabilities as SP in simulation-based learning. Conclusion: The framework and checklist will provide simulationists with an approach and tool to consider the involvement of ‘authentic SPs’ to enrich the learning experience in a mutually beneficial way. References: Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, Thompson TM, Wallace A, Gliva-McConvey G. The association of standardized patient educators (ASPE) standards of best practice (SOBP). Advances in Simulation. 2017 Dec;2(1):1-8. Oh PJ, Jeon KD, Koh MS. The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis. Nurse education today. 2015 May 1;35(5):e6-15. Wilbur K, Elmubark A, Shabana S. Systematic review of standardized patient use in continuing medical education. Journal of Continuing Education in the Health Professions. 2018 Jan 1;38(1):3-10

Use of standardised outcome measures among physiotherapists in French-speaking sub-Saharan Africa

Background: The use of standardised assessment tools is a fundamental aspect of good clinical practice. However, to our knowledge, no study has documented the use of standardised assessment tools in physiotherapy in French-speaking sub-Saharan Africa. Objectives: Documenting the use of standardised outcome measures in physiotherapy in French-speaking sub-Saharan Africa. Method: Our cross-sectional survey used an online self-questionnaire on facilitators and barriers to the use of standardised outcome measures, distributed to physiotherapists in French-speaking sub-Saharan Africa. Results: A total of 241 physiotherapists working in French-speaking sub-Saharan Africa responded to the survey. The most represented countries were Benin (36.9%), Cameroon (14.1%), and Burkina Faso (10.8%). Although 99% of participants reported using standardised outcome measures, only 27% of the respondents used them systematically (all the time). The most reported facilitators included the recognition that standardised outcome measures help to determine whether treatment is effective, help to guide care, and improve communication with patients. The most significant barriers were the lack of time, unavailability of the standardised outcome measures, and non-sensitivity of measures to patients’ cultural and ethnic concerns. There was a higher proportion of use in the middle age group (30–40) (p = 0.02) and a lower proportion of use in physiotherapists simultaneously working in public and private sectors (p = 0.05). Conclusion: Standardised outcome measures are still not widely used by physiotherapists in French-speaking sub-Saharan Africa. Clinical implications: The perceived barriers and facilitators could help to develop strategies to improve the systematic use of outcome measures in French-speaking sub-Saharan Africa

Live virtual placements: an alternative to traditional ‘in person’ placements

Background and aim: The role of the paramedic is diversifying, and universities need to respond by developing curriculums that support paramedic graduates to meet future workforce needs. Placements are key to our students developing the necessary competencies to become qualified paramedics and the pressure is on universities to offer a wide range of placements to reflect professional diversification. In addition, Health and Care Professions Council’s new standards of proficiency acknowledge that paramedics of the future are likely to consult patients in the virtual world [1]. As universities strive to meet this demand, they are often faced with placement capacity issues. Rising student numbers, staff retention issues and competition for placements from other healthcare students can make it extremely challenging to secure placements, especially in desirable areas such as primary care. Activity: The author, with the support from colleagues, was successful in obtaining funding from Health Education England to pilot a series of live virtual placement experiences, the first of which was successfully delivered on 20th April. On this date, 30 learners from our paramedic degree apprenticeship programme, in a classroom on our Lancaster campus, virtually attended a live clinic in a primary care setting in the south of England. The clinic was rigged with various cameras and microphones, with real patients consenting to being filmed. The experience comprised of 5 patients, with the lead clinician providing a brief to the learners before each patient arrived for their consultation. Afterwards, the clinician would complete their clinical documentation before engaging in a two-way conversation with our learners and academic staff via Microsoft teams. Following the clinic, our apprentices had the opportunity to consolidate their learning via case study driven seminars which linked to the mornings experience. Findings: Overall, student feedback was supportive, with the majority stating they found the experience enjoyable and engaging. The video stream of the placement was recorded for reuse in the programme’s curriculum, and we hope that future live virtual placements will see other professions, such as physiotherapy and nursing, take part. Eventually, we want to develop the model for other disciplines and placement settings Conclusion: The academic team are looking forward to the second of three experiences, in May, with the view to contributing to the growing evidence base in this area, to reflect the value that we believe ‘Live Virtual Placement’ experiences have in the development of our future workforce. Ethics statement: Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable. References: 1. Health and Care Professions Council [Internet]. 2023 [cited 2023 Apr 29]. Available from: https://www.hcpc-uk.org/globalassets/standards/standards-of-proficiency/reviewing/paramedics---new-standards.pd

STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma

Background Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not demonstrated a significant impact on clinical outcomes. The aim of this study was to determine whether introduction of this approach into routine practice would result in improved clinical outcomes. Methods Children with asthma aged 6–16 years were randomised to the active intervention consisting of electronic adherence monitoring with daily reminder alarms together with feedback in the clinic regarding their inhaled corticosteroid (ICS) use or to the usual care arm with adherence monitoring alone. All children had poorly controlled asthma at baseline, taking ICS and long-acting β-agonists. Subjects were seen in routine clinics every 3 months for 1 year. The primary outcome was the Asthma Control Questionnaire (ACQ) score. Secondary outcomes included adherence and markers of asthma morbidity. Results 77 of 90 children completed the study (39 interventions, 38 controls). Adherence in the intervention group was 70% vs 49% in the control group (p≤0.001). There was no significant difference in the change in ACQ, but children in the intervention group required significantly fewer courses of oral steroids (p=0.008) and fewer hospital admissions (p≤0.001). Conclusions The results indicate that electronic adherence monitoring with feedback is likely to be of significant benefit in the routine management of poorly controlled asthmatic subjects

Subjective well-being indicators for large-scale assessment of cultural ecosystem services

The substantial importance of cultural benefits as a source of human well-being is increasingly recognised in society-environment interactions. The integration of cultural ecosystem services (CES) into the ecosystem services framework remains a challenge due to the difficulties associated with defining, articulating and measuring CES. We operationalise a novel framework developed by the UK National Ecosystem Assessment that identifies CES as the interactions between environmental spaces (i.e. physical localities or landscapes), and the activities that occur there. We evaluate the benefits of the CES provided by 151 UK marine sites to recreational sea anglers and divers, using subjective well-being indicators. Factor analysis of an online questionnaire with 1220 participants revealed multiple CES benefits that contribute to human wellbeing e.g. including ‘engagement with nature’, ‘place identity’ and ‘therapeutic value’. In addition to regional differences, we also found that biophysical attributes of sites, such as the presence of charismatic species and species diversity, were positively associated with provision of CES benefits. The study provides evidence that could be used to inform designation of protected areas. The indicators used in the study may also be adapted for use across a range of marine and terrestrial spaces for improved integration of CES in environmental decisionmaking

Visual feedback and age affect upper limb reaching accuracy and kinematics in immersive virtual reality among healthy adults

This cross-sectional study aimed to evaluate the effect of visual feedback, age and movement repetition on the upper limb (UL) accuracy and kinematics during a reaching task in immersive virtual reality (VR). Fifty-one healthy participants were asked to perform 25 trials of a reaching task in immersive VR with and without visual feedback of their hand. They were instructed to place, as accurately and as fast as possible, a controller held in their non-dominant hand in the centre of a virtual red cube of 3 cm side length. For each trial, the end-point error (distance between the tip of the controller and the centre of the cube), a coefficient of linearity (CL), the movement time (MT), and the spectral arc length of the velocity signal (SPARC), which is a movement smoothness index, were calculated. Multivariate analyses of variance were conducted to assess the influence of visual feedback, age and trial repetition on the average end-point error, SPARC, CL and MT, and their time course throughout the 25 trials. Providing visual feedback of the hand reduced average end-point error (P < 0.001) and MT (P = 0.044), improved SPARC (P < 0.001) but did not affect CL (P = 0.07). Younger participants obtained a lower mean end-point error (P = 0.037), a higher SPARC(P = 0.021) and CL (P = 0.013). MT was not affected by age(P = 0.671). Trial repetition increased SPARC (P < 0.001) and CL (P < 0.001), and reduced MT (P = 0.001) but did not affect end-point error (P = 0.608). In conclusion, the results of this study demonstrated that providing visual feedback of the hand and being younger improves UL accuracy and movement smoothness in immersive VR. UL kinematics but not accuracy can be improved with more trial repetitions. These findings could guide the future development of protocols in clinical rehabilitation and research

Immersive Virtual Reality to Assess Arm Kinematics among Older Adults with and without Major Neurocognitive Disorder – An Exploratory Cross-Sectional Study

Despite the recommendation of improving assessment objectivity and frequency, the use of immersive virtual reality to measure and quantify movement quality remains underexplored. In this study, we aimed to evaluate the reliability, validity and usability of an immersive virtual reality application, KinematicsVR, to assess upper limb kinematics among older adults with and without major neurocognitive disorder. The KinematicsVR involves the drawing of three-dimensional straight lines, circles and squares using a controller in a virtual environment. Twenty-eight older adults with or without major neurocognitive disorder were recruited. Reliability was evaluated through correlations on test–retest and validity through correlations between KinematicsVR variables and other functional tests (TEMPA, BBT-VR and Finger-Nose Test). The usability of the KinematicsVR was assessed with the System Usability Scale questionnaire. Kinematic indexes were compared between eight adults with major neurocognitive disorder and eight matched controls. Results indicated that most variables provided by the KinematicsVR had excellent reliability for tasks involving the drawing of straight lines and circles, but moderate reliability for tasks involving the drawing of squares. Secondary analyses showed that the usability of the application was excellent but few significant and strong correlations were observed between variables of the KinematicsVR and the scores of the TEMPA scale, Finger-Nose Test and BBT-VR. Adults with major neurocognitive disorder, when compared to other older adults, made larger and less linear hand movements. These findings provide perspectives for the use of immersive virtual reality to improve assessment frequency and objectivity through the autonomous measure of upper limb kinematics in older adults