A systematic review: children & adolescents as simulated patients in health professional education

Simulated patients (SP) contribute to health professional education for communication, clinical skills teaching, and assessment. Although a significant body of literature exists on the involvement of adult SPs, limited research has been conducted on the contribution of children and adolescents. This systematic review, using narrative summary with thematic synthesis, aims to report findings related to children/adolescents as simulated patients in health professions education (undergraduate or post-graduate). A systematic review of qualitative and quantitative literature published between 1980 and September 2014 was undertaken using databases including CINAHL, Ovid Medline and Scopus. The lack of literature related to the employment of children and adolescents in nursing education dictated the expansion of the search to the wider health professions. Key search terms related to the employment of children and adolescents in health professional education programs. A total of 58 studies reduced to 36 following exclusion based on abstract review. Twenty-two studies reached full text review; following application of inclusion and exclusion criteria, 15 English language studies involving children and/or adolescents in simulation formed part of this systematic review. Five key themes emerged: Process related to recruitment, duration and content of training programs, support and debriefing practice, ethical considerations, and effects of participation for key stakeholders such as children and adolescents, parent and faculty, and learner outcomes. The results suggest that the involvement of children and adolescents in simulation for education and assessment purposes is valuable and feasible. The review identified the potential for harm to children/adolescents; however, rigorous selection, training and support strategies can mitigate negative outcomes. The ability of children to portray a role consistently across assessments, and deliver constructive feedback remains ambiguous

“Thinking on your feet”—a qualitative study of debriefing practice

Background: Debriefing is a significant component of simulation-based education (SBE). Regardless of how and where immersive simulation is used to support learning, debriefing has a critical role to optimise learning outcomes. Although the literature describes different debriefing methods and approaches that constitute effective debriefing, there are discrepancies as to what is actually practised and how experts or experienced debriefers perceive and approach debriefing. This study sought to explore the self-reported practices of expert debriefers.Methods: We used a qualitative approach to explore experts’ debriefing practices. Peer-nominated expert debriefers who use immersive manikin-based simulations were identified in the healthcare simulation community across Australia. Twenty-four expert debriefers were purposively sampled to participate in semi-structured telephone interviews lasting 45–90 min. Interviews were transcribed and independently analysed using inductive thematic analysis.Results: Codes emerging through the data analysis clustered into four major categories: (1) Values: ideas and beliefs representing the fundamental principles that underpinned interviewees’ debriefing practices. (2) Artistry: debriefing practices which are dynamic and creative. (3) Techniques: the specific methods used by interviewees to promote a productive and safe learning environment. (4) Development: changes in interviewees’ debriefing practices over time.Conclusions: The “practice development triangle” inspired by the work of Handal and Lauvas offers a framework for our themes. A feature of the triangle is that the values of expert debriefers provide a foundation for associated artistry and techniques. This framework may provide a different emphasis for courses and programmes designed to support debriefing practices where microskill development is often privileged, especially those microskills associated with techniques (plan of action, creating a safe environment, managing learning objectives, promoting learner reflection and co-debriefing). Across the levels in the practice development triangle, the importance of continuing professional development is acknowledged. Strengths and limitations of the study are noted

Data as symptom: Doctors’ responses to patient-provided data in general practice

People are increasingly able to generate their own health data through new technologies such as wearables and online symptom checkers. However, generating data is one thing, interpreting them another. General practitioners (GPs) are likely to be the first to help with interpretations. Policymakers in the European Union are investing heavily in infrastructures to provide GPs access to patient measurements. But there may be a disconnect between policy ambitions and the everyday practices of GPs. To investigate this, we conducted semi-structured interviews with 23 Danish GPs. According to the GPs, patients relatively rarely bring data to them. GPs mostly remember three types of patient-generated data that patients bring to them for interpretation: heart and sleep measurements from wearables and results from online symptom checkers. However, they also spoke extensively about data work with patient queries concerning measurements from the GPs’ own online Patient Reported Outcome system and online access to laboratory results. We juxtapose GP reflections on these five data types and between policy ambitions and everyday practices. These data require substantial recontextualization work before the GPs ascribe them evidential value and act on them. Even when they perceived as actionable, patient-provided data are not approached as measurements, as suggested by policy frameworks. Rather, GPs treat them as analogous to symptoms—that is to say, GPs treat patient-provided data as subjective evidence rather than authoritative measures. Drawing on Science and Technology Studies (STS) literature,we suggest that GPs must be part of the conversation with policy makers and digital entrepreneurs around when and how to integrate patient-generated data into healthcare infrastructures

How are examinations inclusive for students with disabilities in higher education? A sociomaterial analysis

As a form of assessment, examinations are designed to determine whether students have met learning outcomes. However, students with disabilities report avoiding examinations, selecting units of study where the assessments align with their strengths. To ensure examinations do not contribute to the systematic exclusion of students with disabilities, it is important to explore their experiences. In this paper, we use a sociomaterial frame to analyse how examination arrangements construct inclusion in examinations. Interviews with 40 students were conducted across two universities. Inclusion or exclusion was variably constituted for students through emergent combinations of social and material arrangements. Covid-19 pandemic related social distancing related changes such as shifting examinations online, using technology, increasing time limits and moving to open-book examinations contributed to increased inclusion for most students, who were able to use familiar equipment in spaces they had adapted to their own needs. Staff acceptance and implementation of access requirements and assessment flexibility also contributed. While the attitudes and actions of staff involved in examinations can facilitate inclusion, reducing the need for adjustments through assessment design is important. This requires consideration of how time, technology, equipment and materials contribute to inclusion or exclusion, which may have benefits for many students

The role of feedback in supporting trainees who underperform in clinical environments

IntroductionUnderperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance – both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance.MethodsThis narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment.Synthesis and discussionThere are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of ‘earned’ failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or ‘telling’. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish

What non-technical skills competencies are addressed by Australian standards documents for health professionals who work in secondary and tertiary clinical settings? A qualitative comparative analysis

OBJECTIVES: At minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and interpersonal, that complement technical skills, with categories identified as situational awareness, communication, team working, decision-making, leadership, coping with stress and managing fatigue. The aim of this research was to explore the alignment of categories and elements of non-technical skills with those in the published standards documents of several health professions in Australia. DESIGN: A qualitative comparative analysis using document analysis and deductive coding examined, extracted and interpreted data from competency standards documents focusing on non-technical skills categories and elements. PARTICIPANTS: A purposive sample of 11 health professions competency standards documents required for registration in Australia. FINDINGS: The 11 competency standards documents contained 1616 statements. Although standards documents addressed all non-technical skills categories, there was limited reporting of managing stress and coping with fatigue. Of the 31 elements included in the non-technical skills framework, 22 were not common to all health professions and 3 elements were missing from the standards documents. Additionally, the documents were composed differently with no common taxonomy and multifaceted statements. CONCLUSION: While commonalities identified in the standards documents related to non-technical skills categories are likely to support patient safety, gaps in associated elements may undermine their effectiveness. The notable lack of reference to stress and fatigue requires further attention for health professional well-being in Australia. A shared taxonomy with clear statements may offer the best support for collaborative practice and positive patient outcomes. Competency standards need to be flexible to respond to the emerging demands of current healthcare practice along with consumer and health service needs

Reframing assessment research: through a practice perspective

Assessment as a field of investigation has been influenced by a limited number of perspectives. These have focused assessment research in particular ways that have emphasised measurement, or student learning or institutional policies. The aim of this paper is to view the phenomenon of assessment from a practice perspective drawing upon ideas from practice theory. Such a view places assessment practices as central. This perspective is illustrated using data from an empirical study of assessment decision-making and uses as an exemplar the identified practice of ‘bringing a new assessment task into being’. It is suggested that a practice perspective can position assessment as integral to curriculum practices and end separations of assessment from teaching and learning. It enables research on assessment to de-centre measurement and take account of the wider range of people, phenomena and things that constitute it

Noble gas solubility in silicate melts:a review of experimentation and theory, and implications regarding magma degassing processes

Noble gas solubility in silicate melts and glasses has gained a crucial role in Earth Sciences investigations and in the studies of non-crystalline materials on a micro to a macro-scale. Due to their special geochemical features, noble gases are in fact ideal tracers of magma degassing. Their inert nature also allows them to be used to probe the structure of silicate melts. Owing to the development of modern high pressure and temperature technologies, a large number of experimental investigations have been performed on this subject in recent times. This paper reviews the related literature, and tries to define our present state of knowledge, the problems encountered in the experimental procedures and the theoretical questions which remain unresolved. Throughout the manuscript I will also try to show how the thermodynamic and structural interpretations of the growing experimental dataset are greatly improving our understanding of the dissolution mechanisms, although there are still several points under discussion. Our improved capability of predicting noble gas solubilities in conditions closer to those found in magma has allowed scientists to develop quantitative models of magma degassing, which provide constraints on a number of questions of geological impact. Despite these recent improvements, noble gas solubility in more complex systems involving the main volatiles in magmas, is poorly known and a lot of work must be done. Expertise from other fields would be extremely valuable to upcoming research, thus focus should be placed on the structural aspects and the practical and commercial interests of the study of noble gas solubility

A national training program for simulation educators and technicians: evaluation strategy and outcomes

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Simulation-based education (SBE) has seen a dramatic uptake in health professions education over the last decade. SBE offers learning opportunities that are difficult to access by other methods. Competent faculty is seen as key to high quality SBE. In 2011, in response to a significant national healthcare issue--the need to enhance the quality and scale of SBE--a group of Australian universities was commissioned to develop a national training program--Australian Simulation Educator and Technician Training (AusSETT) Program. This paper reports the evaluation of this large-scale initiative. METHODS: The AusSETT Program adopted a train-the-trainer model, which offered up to three days of workshops and between four and eight hours of e-learning. The Program was offered across all professions in all states and territories. Three hundred and three participants attended workshops with 230 also completing e-learning modules. Topics included: foundational learning theory; orientation to diverse simulation modalities; briefing; and debriefing. A layered objectives-oriented evaluation strategy was adopted with multiple stakeholders (participants, external experts), methods of data collection (end of module evaluations, workshop observer reports and individual interviews) and at multiple data points (immediate and two months later). Descriptive statistics were used to analyse numerical data while textual data (written comments and transcripts of interviews) underwent content or thematic analysis. RESULTS: For each module, between 45 and 254 participants completed evaluations. The content and educational methods were rated highly with items exceeding the pre-established standard. In written evaluations, participants identified strengths (e.g. high quality facilitation, breadth and depth of content) and areas for development (e.g. electronic portfolio, learning management system) of the Program. Interviews with participants suggested the Program had positively impacted their educational practices. Observers reported a high quality educational experience for participants with alignment of content and methods with perceived participant needs. CONCLUSIONS: The AusSETT Program is a significant and enduring learning resource. The development of a national training program to support a competent simulation workforce is feasible. The Program objectives were largely met. Although there are limitations with the study design (e.g. self-report), there are strengths such as exploring the impact two months later. The evaluation of the Program informs the next phase of the national strategy for simulation educators and technicians with respect to content and processes, strengths and areas for development