Simulation Training with Structured Debriefing Improves Residents’ Pediatric Disaster Triage Performance

AbstractIntroductionPediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners’ acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.MethodsA 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.ResultsA total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001).Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.ConclusionsStructured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.Cicero MX, Auerbach MA, Zigmont J, Riera A, Ching K, Baum CR. Simulation training with structured debriefing improves residents’ pediatric disaster triage performance. Prehosp Disaster Med. 2012;27(3):1-6.

Download Full-text

Improving the competence and confidence of pulmonary and critical care medicine fellows in performing a cricothyrotomy

Canadian Medical Education Journal ◽

10.36834/cmej.61818 ◽

2019 ◽

Vol 10 (3) ◽

pp. e107-109

Author(s):

Kapil Rajwani ◽

Elizabeth Mauer ◽

Timothy C. Clapper

Keyword(s):

Critical Care ◽

Educational Intervention ◽

Lesson Plan ◽

Low Frequency ◽

Critical Care Medicine ◽

Evidence Based ◽

Practice Opportunities ◽

And Performance

Clinical opportunities to practice or perform a cricothyrotomy are limited. We developed an evidence-based cricothyrotomy course following the 4-phase lesson plan for simulation that provides pulmonary and critical care medicine fellows with demonstrations, practice, and feedback to increase their confidence and competence.Survey results demonstrated an improvement in perceived confidence (p<0.005) and competence (p<0.002) following this educational intervention. Fellows also achieved significant improvement in knowledge (p<0.003) and performance in two cricothyrotomy techniques (Seldinger and MacIntyre) (p<0.004).It is important that we provide fellows with practice opportunities that can be used to develop and maintain proficiency, particularly in low frequency events.

Download Full-text

Use of High-fidelity simulation training for radiology healthcare professionals in the management of acute medical emergencies

British Journal of Radiology ◽

10.1259/bjr.20200520 ◽

2021 ◽

Vol 94 (1117) ◽

pp. 20200520

Author(s):

Matthew Wheeler ◽

Eleanor Powell ◽

Philip Pallmann

Keyword(s):

Simulation Training ◽

Low Frequency ◽

Radiology Department ◽

Knowledge Domains ◽

Clinical Scenarios ◽

Post Test ◽

High Acuity ◽

Life Threatening ◽

Medical Emergencies ◽

Radiology Staff

Objectives: Life-threatening emergencies are relatively uncommon in the radiology department, but when encountered, require timely intervention. With an increasing number of critically unwell patients visiting the radiology department each year for both diagnostic and interventional procedures, it is vital that radiology staff are trained to provide basic resuscitation before further assistance arrives. Simulation training is a well-validated, effective method for rehearsing low-frequency, high-acuity events in a supportive and safe environment. The aim of our study was to investigate whether the introduction of a focussed, multidisciplinary simulation course would improve healthcare professional’s knowledge and confidence when managing common medical emergencies; including cardiac arrest, anaphylaxis and airway obstruction. Methods: A multidisciplinary group of radiology staff attended a dedicated simulation teaching course. Participants completed a pre- and post-test questionnaire which assessed a range of knowledge domains and their perceived confidence with dealing with the clinical scenarios. The delegates were then asked to repeat this questionnaire 6 months after taking part in the course to assess their retention of skills and knowledge. Results: Knowledge scores increased by a mean difference of 4 points (p < 0.001). The mean pre- and post-course perceived confidence scores were 4.4/10 and 8/10, respectively. Advances in knowledge: This study suggests that embedding simulation training into the radiology curriculum improves healthcare professional’s knowledge and perceived confidence when dealing with common medical emergencies. Although previous studies have looked at the use of simulation training for radiology trainees in the management of selected medical emergencies, to the authors’ knowledge, this is the first study to demonstrate these benefits across a range of clinical scenarios, within an interprofessional environment.

Download Full-text

ELIXIR TO EXAMINATION STRESS AMONG STUDENT - STUDY SKILLS TRAINING AND SYSTEMATIC DESENSITIZATION

Scholarly Research Journal for Humanity Science & English Language ◽

10.21922/srjhsel.v6i26.11618 ◽

2018 ◽

Vol 6 (26) ◽

Author(s):

Jyoti Baijal

Keyword(s):

Study Skills ◽

Knowledge Society ◽

Skills Training ◽

Well Being ◽

Systematic Desensitization ◽

Performance Study ◽

High Stakes ◽

Deficit Model ◽

Examination Stress ◽

And Performance

Examination stress is a ubiquitous phenomenon that has, in the present times, adversely affected the learning outcomes and performance of the students at all levels- primary, secondary or higher education. It’s increasing intensity specifically among students appearing for high stakes board examination evokes a response from the teaching fraternity at the earliest. The reason being that a prolonged experience of stress with respect to evaluative situations is bound to prove detrimental to the mental, physical and emotional well-being of the students. For the nation to develop and progress towards a knowledge society, it is imperative that the students are taught to cope with stressful stimuli and improve performance. Study-Skills Training is an intervention intended to improve their study and test- taking habits and skills. It is based on a cognitive-deficit model which is directed towards improving a variety of cognitive activities that affect the organization, processing and retrieval of information and thereby help in reducing the experience of examination stress. Systematic desensitization as a process can be used to unlearn anxiety reactions by replacing the anxiety response with a calm, relaxed state. Thus, a combination of study-skills training and systematic desensitization has been shown to be effective and superior in alleviating test anxiety

Download Full-text

Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults

Palliative & Supportive Care ◽

10.1017/s1478951520001200 ◽

2020 ◽

pp. 1-9

Author(s):

Hyunjin Noh ◽

Lewis H. Lee ◽

Chorong Won

Keyword(s):

Older Adults ◽

Palliative Care ◽

Cognitive Impairment ◽

Educational Intervention ◽

Test Scores ◽

Informal Caregivers ◽

Cognitively Impaired ◽

Significant Difference ◽

Post Test ◽

Seriously Ill

Abstract Objective Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. Method Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann–Whitney U test. Results There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). Significance of results This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.

Download Full-text

Improving the Efficiency and Performance of Calculations in the Analysis of Low-Frequency Oscillations

2020 3rd International Youth Scientific and Technical Conference on Relay Protection and Automation (RPA) ◽

10.1109/rpa51116.2020.9301739 ◽

2020 ◽

Author(s):

M. A. Danilov ◽

K. P. Butin ◽

A. V. Rodionov ◽

A. I. Popov

Keyword(s):

Low Frequency ◽

Low Frequency Oscillations ◽

And Performance

Download Full-text

Terrorism-Related Chemical, Biological, Radiation, and Nuclear Attacks: A Historical Global Comparison Influencing the Emergence of Counter-Terrorism Medicine

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000625 ◽

2021 ◽

pp. 1-4

Author(s):

Derrick Tin ◽

Fredrik Granholm ◽

Alexander Hart ◽

Gregory R. Ciottone

Keyword(s):

Health Care ◽

Grey Literature ◽

Low Frequency ◽

Disaster Medicine ◽

Terrorist Attacks ◽

Fecal Matter ◽

Counter Terrorism ◽

Global Comparison ◽

State Terrorism ◽

Fatal Injuries

Abstract Background: Terrorist attacks are growing in complexity, increasing concerns around the use of chemical, biological, radiation, and nuclear (CBRN) agents. This has led to increasing interest in Counter-Terrorism Medicine (CTM) as a Disaster Medicine (DM) sub-specialty. This study aims to provide the epidemiology of CBRN use in terrorism, to detail specific agents used, and to develop training programs for responders. Methods: The open-source Global Terrorism Database (GTD) was searched for all CBRN attacks from January 1, 1970 through December 31, 2018. Attacks were included if they fulfilled the terrorism-related criteria as set by the GTD’s Codebook. Ambiguous events or those meeting only partial criteria were excluded. The database does not include acts of state terrorism. Results: There were 390 total CBRN incidents, causing 930 total fatal injuries (FI) and 14,167 total non-fatal injuries (NFI). A total of 347 chemical attacks (88.9% of total) caused 921 FI (99.0%) and 13,361 NFI (94.3%). Thirty-one biological attacks (8.0%) caused nine FI (1.0%) and 806 NFI (5.7%). Twelve radiation attacks (3.1%) caused zero FI and zero NFI. There were no nuclear attacks. The use of CBRN accounted for less than 0.3% of all terrorist attacks and is a high-risk, low-frequency attack methodology. The Taliban was implicated in 40 of the 347 chemical events, utilizing a mixture of agents including unconfirmed chemical gases (grey literature suggests white phosphorous and chlorine), contaminating water sources with pesticides, and the use of corrosive acid. The Sarin gas attack in Tokyo contributed to 5,500 NFI. Biological attacks accounted for 8.0% of CBRN attacks. Anthrax was used or suspected in 20 of the 31 events, followed by salmonella (5), ricin (3), fecal matter (1), botulinum toxin (1), and HIV (1). Radiation attacks accounted for 3.1% of CBRN attacks. Monazite was used in 10 of the 12 events, followed by iodine 131 (1) and undetermined irradiated plates (1). Conclusion: Currently, CBRN are low-frequency, high-impact attack modalities and remain a concern given the rising rate of terrorist events. Counter-Terrorism Medicine is a developing DM sub-specialty focusing on the mitigation of health care risks from such events. First responders and health care workers should be aware of historic use of CBRN weapons regionally and globally, and should train and prepare to respond appropriately.

Download Full-text

Assessment of an Educational Intervention to Improve Healthy Life Habits in Children Living in Vulnerable Socioeconomic Conditions

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094495 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4495

Author(s):

María López ◽

Irene Alcoceba ◽

María-José Castro ◽

María-José Cao ◽

Sara García ◽

...

Keyword(s):

Educational Intervention ◽

Eating Habits ◽

Vegetable Consumption ◽

Socioeconomic Conditions ◽

Healthy Living ◽

Mortality And Morbidity ◽

Test Study ◽

Post Test ◽

Quasi Experimental ◽

Life Habits

Nutritional condition impacts academic performance and cognitive development. In Peru, the prevalence of chronic undernutrition in children is 6.9%, increasing the risk of mortality and morbidity. This study aimed to develop an educational intervention to achieve an improvement in the healthy habits of children in a primary education school in Lima who live in vulnerable socioeconomic conditions. We conducted a prospective quasi-experimental pre-test and post-test study of an educational intervention. The information was collected through the adaptation of the WHO questionnaire “Global School-based Student Health Survey” (GSHS), with anthropometric variables, socioeconomic level, hygiene and eating habits. One hundred eight students from 5 to 13 years old from Arenitas del Mar School in Lima (Peru) participated. The educational intervention improved eating habits. Fruit and vegetable consumption 3 or more times/day (50.9%) increased after the educational intervention (49% vs. 62.9%,) p < 0.0001. There was an improvement in hygiene habits, such as the frequency of handwashing with soap (32.4% vs. 63.9%) and the frequency of weekly bathing 4–6 times/week (25% vs. 47.5%) p < 0.0001. The educational intervention promoted better healthy living behaviors, eating habits and hygiene. This kind of initiative is a crucial tool to establish healthy living habits.

Download Full-text

Offline Algorithms in Low-Frequency Trading

Queue ◽

10.1145/3442632.3448307 ◽

2020 ◽

Vol 18 (6) ◽

pp. 37-51

Author(s):

Terence Kelly

Keyword(s):

Real Time ◽

Real World ◽

High Frequency ◽

Low Frequency ◽

Combinatorial Auctions ◽

Hard Problem ◽

Np Hard ◽

High Stakes ◽

Drill Bits ◽

Np Hard Problem

Expectations run high for software that makes real-world decisions, particularly when money hangs in the balance. This third episode of the Drill Bits column shows how well-designed software can effectively create wealth by optimizing gains from trade in combinatorial auctions. We'll unveil a deep connection between auctions and a classic textbook problem, we'll see that clearing an auction resembles a high-stakes mutant Tetris, we'll learn to stop worrying and love an NP-hard problem that's far from intractable in practice, and we'll contrast the deliberative business of combinatorial auctions with the near-real-time hustle of high-frequency trading. The example software that accompanies this installment of Drill Bits implements two algorithms that clear combinatorial auctions.

Download Full-text

Impact of a blended curriculum on nursing handover quality: a quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2020-001024 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001024

Author(s):

Xavier Losfeld ◽

Laure Istas ◽

Quentin Schoonvaere ◽

Michel Vergnion ◽

Jochen Bergs

Keyword(s):

Educational Intervention ◽

Patient Information ◽

Professional Communication ◽

Fit Indices ◽

Negative Consequences ◽

Improvement Project ◽

Face To Face ◽

Before And After ◽

Post Test ◽

E Learning

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality.MethodsWe used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES.ResultsThe original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01).ConclusionThe applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.

Download Full-text