Simulation for healthcare students: lessons learned from C19

Abstract. Part of the higher education (HE) experience of our healthcare students is to implement theoretical lessons learned within a practice environment – most often within the country’s National Health Service (NHS). With the emergence of the worldwide C19 pandemic, HE institutions had to reconfigure ways to support students to experience practical elements of their course online or via simulation. With the help of external funding from Health Education England (HEE), Bournemouth University piloted a variety of simulated projects across a variety of professions including: paramedicine and child and adult nursing. Students were able to access simulated skills via online and virtual reality (VR) resources, contributing to their learning experience during a worldwide pandemic. This has created a platform for further investment and educational pedagogy around simulation in healthcare provision, contributing to workforce development and future proofing educational establishment

Pilot study looking at the benefits of Virtual Reality (VR) simulation for Physician Associates (PA)

Background and aim: Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation. Methods: As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software. Results: Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus. Conclusion: VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation. 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. Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. Quality & Safety in Health Care. 2010;19(Suppl 2). 2. Tabatabai S. COVID-19 impact and virtual medical education. Journal of Advances in Medical Education & Professionalism [Internet]. 2020;8(3):140–143. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32802908 3. Barteit S, Lanfermann L, Bärnighausen T, Neuhann F, Beiersmann C. Augmented, mixed, and virtual reality-based head-mounted devices for medical education: systematic review. Vol. 9, JMIR Serious Games. JMIR Publications Inc. 2021

Paramedic performance when managing patients experiencing mental health issues – exploring paramedics’ Presentation of Self

Introduction Mental health is a growing global concern with a significant rise in patients calling emergency services to respond to their needs. Paramedics in the UK are increasingly being asked to respond to this increase in demand. Aim This study explores how paramedics perform in practice when managing patients experiencing mental health issues. Methods Qualitative observation over 240 h and interviews involving 21 paramedics and 20 patients with mental illness. Results Using Goffman’s seminal text Presentation of Self to frame the analysis the findings of this study reveal that paramedics '“perform” on two stages: front stage and back stage. Their coping mechanisms, in the metaphorical sense, include props such as uniform and scripts filled with humour, stereotyping and nostalgia to aid in their management of this specialist patient group. Conclusions Paramedics feel frustrated and unsupported when dealing with patients experiencing mental health issues. This study identifies the coping mechanisms paramedics use to manage this patient group but questions the longevity of these mechanisms and therefore recommends additional support for paramedics with further supportive education around mental health

Exercise Martian Attack!: Using VR feedback as a reflective tool for paramedic science students.

Paramedic students have had to overcome the restrictions Covid-19 with many of their clinical skills moving online, limiting opportunities to engage with clinical practice partners, a key requirement of their professional programme. Social distancing has been challenging to overcome and the paramedic teaching team’s solution was to offer a the University underground carpark to stage a simulated Casualty Clearing Point for a Major Incident Martian Attack

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer.

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months.   Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up

What are the barriers and facilitators to effective health promotion in urgent and emergency care? A systematic review

Background: There are potential health gains such as reducing early deaths, years spent in ill-health and costs to society and the health and care system by encouraging NHS staf to use encounters with patients to help individuals signifcantly reduce their risk of disease. Emergency department staf and paramedics are in a unique position to engage with a wide range of the population and to use these contacts as opportunities to help people improve their health. The aim of this research was to examine barriers and facilitators to efective health promotion by urgent and emergency care staf. Methods: A systematic search of the literature was performed to review and synthesise published evidence relating to barriers and facilitators to efective health promotion by urgent and emergency care staf. Medical and social science databases were searched for articles published between January 2000 and December 2021 and the reference lists of included articles were hand searched. Two reviewers independently screened the studies and assessed risk of bias. Data was extracted using a bespoke form created for the study. Results: A total of 19 papers were included in the study. Four themes capture the narratives of the included research papers: 1) should it be part of our job?; 2) staf comfort in broaching the topic; 3) format of health education; 4) competency and training needs. Whilst urgent and emergency care staf view health promotion as part of their job, time restraints and a lack of knowledge and experience are identifed as barriers to undertaking health promotion interventions. Staf and patients have diferent priorities in terms of the health topics they feel should be addressed. Patients reported receiving books and leafets as well as speaking with a knowledgeable person as their preferred health promotion approach. Staf often stated the need for more training. Conclusions: Few studies have investigated the barriers to health promotion interventions in urgent and emergency care settings and there is a lack of evidence about the acceptability of health promotion activity. Additional research is needed to determine whether extending the role of paramedics and emergency nurses to include health promotion interventions will be acceptable to staf and patients

Staff views on health promotion in emergency care settings – A qualitative scoping study

AimTo investigate the attitudes and barriers to health promotion practice behaviours amongst emergency nurses and ambulance service paramedics.MethodsWe used direct enquiry to recruit a convenience sample of emergency care staff (emergency department nurses and ambulance service paramedics). We conducted semi-structured interviews exploring the attitudes of staff. The interviews were analysed thematically.ResultsA total of six participants were interviewed: three emergency department nurses and three ambulance service paramedics. From the transcripts two main themes were identified: health promotion as part of the role of emergency care staff, and barriers to health promotion in the emergency care setting.ConclusionStaff interviewed were willing to undertake health promotion activities despite the barriers they discussed. There are opportunities for further development, and patients would benefit from a more structured approach to health promotion in these care settings