Making the Learner the Simulator: using empathy suits in simulation

Empathy Suits have been around as an educational tool for many years and have increasingly been used within the design world to help understand and address user challenges (Kullman 2016). Their use to explore empathy with patients is increasing with significant work being carried out around the older person and undergraduate nursing students to help in development of the attitudes towards certain patient groups (Sari and Taskiran et al 2020). This workshop will explore experiences of their use, explaining how they have been used with students in both undergraduate nursing and medicine course. We will look at what is currently available and discuss challenges to the use of empathy suits. Finally we will have an opportunity to experience some of the suits and how they can be used within simulation based education

How to use Empathy Suits in clinical simulation to give students the patient experience

Empathy Suits are an excellent way to have clinical students become immersed in a representation of the patient experience. Designed to create physical restrictions on the wearer, a restrictive empathy suit will simulate conditions such as joint restricting conditions, visual impairment, reach restriction, and increase in body weight. This HealthySimulation.com article by Phil Gurnett, RN, MSc, BSc PG Cert Ergonomics, Clinical Simulation Fellow at the University of Greenwich will explore how to incorporate the Empathy Suits, particularly ageing suits, into your clinical simulation program to further student engagement and learnin

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

A systematic mapping literature review of ethics in healthcare simulation and its feasibility

Both the ethics of simulation and how it may be used to explore, train and assess ethical issues in a clinical context have received growing interest in recent years. As ethical considerations permeate almost every element of simulation and clinical practice, the emerging literature in this field remains relatively fragmented, lacking a common vocabulary or standardised practice and methodology. Given this, the primary aim of this paper was to systematically map the literature related to ethics in healthcare simulation, guided by the research question of ‘how is ethics in healthcare simulation recorded in current literature?’. Our secondary aim was to explore the feasibility of conducting a systematic mapping review. One hundred and four papers were included and analysed. Results suggest that this is relatively small, but rapidly growing field. Most research was carried out in the US and with variety of research methods employed. Research involving samples of nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Keyword co-occurrence suggested that studies utilised simulation overwhelmingly in an educational context

Reporting on a systematic mapping literature review of ethics in healthcare simulation

Background There is a growing interest in ethics in simulation. The Ethical issues that are largely considered in simulation range from the vulnerability of standardised patients1 to debating the use of death in simulation2. This Systematic mapping review set out to systematically map the literature relating to ethics in healthcare simulation. Methods A search was carried out on Scopus, Medline, CINAHL and Psychinfo. The search terms were broad and reflected key concepts related to our research question. Bibliometric data was captured and papers were further coded. Results In total, 104 papers were included for review, 25% focused on the ethics of simulation, 73% focused on simulation as a means to explore/assess or train ethical issues related to healthcare. One paper focused on both issues. Just over half of the papers (n = 56; 54%) were coded as being empirical research. Of those, the majority focused on simulation as a means to explore/assess or train ethical issues (n = 49; 87.5%) as opposed to the ethics of simulation (n = 7; 12.5%). The majority of outputs came from the US. Studies were mainly conducted by nurse and medical doctors, with very few from other allied health professionals and limited co-authorship. Nurses relied more heavily on qualitative methods and students in their samples than that of medical doctors or other professions. Conclusions This study identified that ethics in healthcare simulation is a small but rapidly growing field. However, there is little in the way of collaboration and multi-interdisciplinary approaches. The use of simulation for training of ethical dilemmas is greater than the ethics of simulation itself, however, this may be due to terminology used within healthcare simulation. Recommendations This study has identified that there is further need to explore and develop our understanding of the role of ethics in healthcare simulation itself, looking at higher quality collaborative approaches across disciplines to further the field

Diverse nucleosome Site-Selectivity among histone deacetylase complexes

Histone acetylation regulates chromatin structure and gene expression and is removed by histone deacetylases (HDACs). HDACs are commonly found in various protein complexes to confer distinct cellular functions, but how the multi-subunit complexes influence deacetylase activities and site-selectivities in chromatin is poorly understood. Previously we reported the results of studies on the HDAC1 containing CoREST complex and acetylated nucleosome substrates which revealed a notable preference for deacetylation of histone H3 acetyl-Lys9 vs. acetyl-Lys14 (Wu et al, 2018). Here we analyze the enzymatic properties of five class I HDAC complexes: CoREST, NuRD, Sin3B, MiDAC and SMRT with site-specific acetylated nucleosome substrates. Our results demonstrate that these HDAC complexes show a wide variety of deacetylase rates in a site-selective manner. A Gly13 in the histone H3 tail is responsible for a sharp reduction in deacetylase activity of the CoREST complex for H3K14ac. These studies provide a framework for connecting enzymatic and biological functions of specific HDAC complexes

Clinical variants paired with phenotype: A rich resource for brain gene curation.

PURPOSE: Clinically ascertained variants are under-utilized in neurodevelopmental disorder research. We established the Brain Gene Registry (BGR) to coregister clinically identified variants in putative brain genes with participant phenotypes. Here, we report 179 genetic variants in the first 179 BGR registrants and analyze the proportion that were novel to ClinVar at the time of entry and those that were absent in other disease databases. METHODS: From 10 academically affiliated institutions, 179 individuals with 179 variants were enrolled into the BGR. Variants were cross-referenced for previous presence in ClinVar and for presence in 6 other genetic databases. RESULTS: Of 179 variants in 76 genes, 76 (42.5%) were novel to ClinVar, and 62 (34.6%) were absent from all databases analyzed. Of the 103 variants present in ClinVar, 37 (35.9%) were uncertain (ClinVar aggregate classification of variant of uncertain significance or conflicting classifications). For 5 variants, the aggregate ClinVar classification was inconsistent with the interpretation from the BGR site-provided classification. CONCLUSION: A significant proportion of clinical variants that are novel or uncertain are not shared, limiting the evidence base for new gene-disease relationships. Registration of paired clinical genetic test results with phenotype has the potential to advance knowledge of the relationships between genes and neurodevelopmental disorders

Update on Clubfoot: Etiology and Treatment

Although clubfoot is one of the most common congenital abnormalities affecting the lower limb, it remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment. This review provides an update on the etiology of clubfoot as well as current treatment strategies. Understanding the exact genetic etiology of clubfoot may eventually be helpful in determining both prognosis and the selection of appropriate treatment methods in individual patients. The primary treatment goal is to provide long-term correction with a foot that is fully functional and pain-free. To achieve this, a combination of approaches that applies the strengths of several methods (Ponseti method and French method) may be needed. Avoidance of extensive soft-tissue release operations in the primary treatment should be a priority, and the use of surgery for clubfoot correction should be limited to an “a la carte” mode and only after failed conservative methods