Simulation to Improve Trainee Skill and Comfort with Forceps-Assisted Vaginal Deliveries

Objective Simulation training is a powerful learning tool for low frequency events. Forceps-assisted vaginal deliveries (FAVD) are an important tool in reducing cesarean deliveries. The aim of this study is to create a high-fidelity simulation-based curriculum for residency education and investigate pre- and posttest skill and confidence. Methods A prospective cohort study was conducted involving obstetrics and gynecology residents over 2 academic years. Residents participated in one to three FAVD simulation trainings. All sessions involved video, didactic, and hands-on practice. Pre- and postsurvey and skills assessment were conducted to assess confidence, ability to consent, and perform a FAVD. Wilcoxon's signed-rank tests and Kruskal–Wallis tests were used. Results Thirty residents (73%) completed at least one forceps simulation training session. Participants demonstrated significant improvement in confidence (p < 0.005) following training. Before the intervention, there was a disparity in confidence by postgraduate level (p < 0.005); however, this difference was not seen postsimulation (p = 0.24). Residents demonstrated significant improvement in their FAVD skills (p < 0.05), as well as their ability to consent (p < 0.01). Conclusion Simulation training improves residents' perceived confidence in FAVD. Simulation helped to better equalize confidence across classes. FAVD simulations improves resident confidence, skill, and more broadly broadened the armamentarium to decrease the cesarean delivery rate.

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Reinstating a national simulation programme in anaesthesiology during the coronavirus pandemic

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2021-000894 ◽

2021 ◽

pp. bmjstel-2021-000894

Author(s):

Sinead Campbell ◽

Sarah Corbett ◽

Crina L Burlacu

Keyword(s):

Simulation Training ◽

Online Video ◽

Safety Measures ◽

Face To Face ◽

Video Assisted ◽

Simulation Based ◽

High Standards ◽

Strongly Agree ◽

Training Opportunities ◽

Simulation Programme

BackgroundWith the introduction of strict public health measures due to the coronavirus pandemic, we have had to change how we deliver simulation training. In order to reinstate the College of Anaesthesiologists Simulation Training (CAST) programme safely, we have had to make significant logistical changes. We discuss the process of reopening a national simulation anaesthesiology programme during a pandemic.MethodsWe approached how to reinstate the programme with three distinct but intertwined projects, as in the following: (1) a survey of effects of the pandemic on training opportunities for anaesthesiology trainees, (2) proposals for methods of reinstating simulation were developed under the headings avoidance, compromise, accommodation and collaboration. A small online video-assisted simulation pilot was carried out to test the compromise method, (3) having opted for combined accommodation (onsite with smaller participant numbers and safety measures) and collaboration (with other regional centres), a postreinstatement evaluation during a 4-month period was carried out.Results(1) Eighty-five per cent of 64 trainees surveyed felt that they had missed out not only just on simulation-based education (43%) but also on other training opportunities, (2) when five trainees were asked to state on a 1 to 5 Likert scale (strongly disagree, disagree, undecided, agree and strongly agree) whether online video-assisted simulation was similar to face-to-face simulation in four categories (realism, immersion, sense of crisis and stress), only 9 (45%) of the 20 answers agreed they were similar, (3) When onsite simulation was reinstated, the majority of trainees felt that training was similar to prepandemic and were happy to continue with this format.ConclusionIn order to reinstate simulation, we have identified that accommodation and collaboration best suited the CAST while compromise failed to rank high among trainees’ preferences. Onsite courses will continue to be delivered safely while meeting the high standards our trainees have come to expect.

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Implementing the transvaginal ultrasound simulation training (TRUSST) programme for obstetric registrars

Advances in Simulation ◽

10.1186/s41077-020-00152-y ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Sally Byford ◽

Sarah Janssens ◽

Rachel Cook

Keyword(s):

Early Pregnancy ◽

Confidence Level ◽

Simulation Training ◽

Systematic Approach ◽

Transvaginal Ultrasound ◽

Skills Training ◽

Ultrasound Simulation ◽

Learning Gap ◽

Assessment Scores ◽

Simulation Based

Abstract Background Transvaginal ultrasound (TVUS) training opportunities are limited due to its intimate nature; however, TVUS is an important component of early pregnancy assessment. Simulation can bridge this learning gap. Aim To describe and measure the effect of a transvaginal ultrasound simulation programme for obstetric registrars. Materials and methods The transvaginal ultrasound simulation training (TRUSST) curriculum consisted of supported practice using virtual reality transvaginal simulators (ScanTrainer, Medaphor) and communication skills training to assist obstetric registrars in obtaining required competencies to accurately and holistically care for women with early pregnancy complications. Trainee experience of live transvaginal scanning was evaluated with a questionnaire. Programme evaluation was by pre-post self-reported confidence level and objective pre-post training assessment using Objective Structured Assessment of Ultrasound Skills (OSAUS) and modified Royal Australian and New Zealand College of Obstetrics and Gynaecology assessment scores. Quantitative data was compared using paired t tests. Results Fifteen obstetric registrars completed the programme. Numbers of performed live transvaginal ultrasound by trainees were low. Participants reported an increase in confidence level in performing a TVUS following training: mean pre score 1.6/5, mean post score 3/5. Objective assessments improved significantly across both OSAUS and RANZCOG scores following training; mean improvement scores 7.6 points (95% CI 6.2–8.9, p < 0.05) and 32.5 (95% CI 26.4–38.6, p < 0.05) respectively. It was noted that scores for a systematic approach and documentation were most improved: 1.9 (95% CI 1.4–2.5, p < 0.05) and 2.1 (95% CI 1.5–2.7, p < 0.05) respectively. Conclusion The implementation of a simulation-based training curriculum resulted in improved confidence and ability in TVUS scanning, especially with regard to a systematic approach and documentation.

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Simulation in Canadian postgraduate emergency medicine training – a national survey

CJEM ◽

10.1017/cem.2017.24 ◽

2017 ◽

Vol 20 (1) ◽

pp. 132-141 ◽

Cited By ~ 12

Author(s):

Evan Russell ◽

Andrew Koch Hall ◽

Carly Hagel ◽

Andrew Petrosoniak ◽

Jeffrey Damon Dagnone ◽

...

Keyword(s):

Emergency Medicine ◽

National Survey ◽

Simulation Training ◽

Survey Question ◽

Resident Participation ◽

Residency Programs ◽

Training Strategy ◽

Content Assessment ◽

Simulation Based ◽

National Organizations

AbstractObjectivesSimulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada.MethodsA national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE.ResultsResident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0–150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs.ConclusionsSBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

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Abstract TP240: Simulation-Based Learning Improves Neurology Resident Training in Acute Stroke Care

Stroke ◽

10.1161/str.44.suppl_1.atp240 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Waimei Tai ◽

J.j. Baumann ◽

Esther Melamed ◽

Nirali Vora ◽

Neil Schwartz

Keyword(s):

Acute Stroke ◽

Training Session ◽

Vital Signs ◽

Stroke Care ◽

Resident Training ◽

Acute Stroke Care ◽

Simulation Based ◽

Overall Evaluation ◽

Simulation Center

Introduction: Acute “stroke codes” are stressful for the new neurology resident who must lead a multi-disciplinary team and quickly integrate information to make high risk time-sensitive decisions. While other disciplines have used simulation technology for years for cardiac arrest codes, neurology has just begun utilizing this resource. Objective: To improve neurology trainees’ execution of a multi-disciplinary acute stroke code using simulation experience Methods: We identified three learning objectives for the simulation experience: assess tissue plasminogen activator (tPA) eligibility, utilize appropriate order sets, and communicate effectively. Scripts for two emergent scenarios were developed: ischemic stroke requiring i.v. tPA and warfarin-associated intracranial hemorrhage requiring coagulopathy reversal. A standardized patient (SP) was trained. Neurology residents in their first week of training were the learners. Six residents attended a four-hour training session in the Simulation Center at Stanford University. Half of the trainees participated in the scenario while the others observed through live video. The SP acted the part in a fully-equipped, mock emergency room. Monitors, controlled remotely, displayed vital signs which changed to reflect interventions performed. Screens also displayed radiologic data. Trainees communicated with the stroke fellow and nursing regarding the plan of care and placed orders through an electronic medical record in training mode. Debriefing occurred after each scenario. Evaluations were completed and collected. Results: Trainees had positive experiences and felt more comfortable with the stroke code after the training. On a 1-5 scale, learners rated quality of teaching (average 4.6); learning from the scenario (4.8); overall organization (4.2); facilities (5); and overall evaluation (4.6). Conclusions: Simulation training offers a valuable opportunity to enhance neurology resident’s comfort in running stroke codes. Additional studies are required to measure long-term retention of acquired skills and training effect on systems and clinical outcomes.

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Abstract 13704: Simulation-based Uptraining Improves Provider Comfort in the Management of Critically Ill Patients With Covid-19

Circulation ◽

10.1161/circ.142.suppl_3.13704 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

James M Horowitz ◽

Eugene Yuriditsky ◽

Sunil Nair ◽

Brian S Kaufman

Keyword(s):

Critically Ill ◽

Nurse Practitioners ◽

Critically Ill Patients ◽

Simulation Training ◽

Icu Patients ◽

Large Numbers ◽

Simulation Based ◽

Critical Care Ultrasound ◽

Simulation Session ◽

Icu Physicians

Introduction: The COVID-19 surge at our institution required deployment of large numbers of non-intensive care unit (ICU) physicians and advanced practice providers to assist in the management of the critically ill. A 3-hour “uptraining” simulation session was offered to these providers that focused on various aspects of ICU care. Hypothesis: We hypothesized that following a 3-hour simulation session, providers would feel more comfortable in managing critically-ill patients with COVID-19. Methods: One hundred and seventy-five providers underwent a 3-hour simulation-based session focused on management of shock, acute respiratory distress syndrome, and critical care ultrasound. All participants were sent surveys to assess their comfort with various aspects of ICU care following return to their usual work environments. Results: One hundred and eight providers of 175 (62%) completed the surveys. Cardiology fellows and faculty accounted for 36% of the responders, acute care nurse practitioners (NPs) accounted for 16%, while other NPs, residents, and fellows accounted for the remainder. Prior to simulation training, 31% regularly managed patients in the ICU and 28% occasionally managed ICU patients. Following training, 71% of participants were deployed to a COVID-19 ICU as part of their workflow. Overall, 104/108 responders (96%) felt training either significantly or somewhat improved their knowledge in the management of ICU patients. Ninety-four participants (91%) felt training impacted their care of critically ill patients with COVID-19. Table 1 is a display of specific ICU skillsets taught in the session and if the participants felt better equipped to utilize what was covered post deployment. Conclusions: Simulation-based training improved provider comfort in the management of critically ill patients with COVID-19. Table 1: Participants response to “if they felt better equipped to utilize ICU skills following simulation training”

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Knowledge transfer and retention of simulation-based learning for neurosurgical instruments: a randomised trial of perioperative nurses

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2019-000576 ◽

2020 ◽

pp. bmjstel-2019-000576

Author(s):

David B Clarke ◽

Alena I Galilee ◽

Nelofar Kureshi ◽

Murray Hong ◽

Lynne Fenerty ◽

...

Keyword(s):

Nursing Education ◽

Simulation Training ◽

Controlled Trial ◽

Randomised Trial ◽

Control Group ◽

Perioperative Nurses ◽

Instrument Recognition ◽

Simulation Based ◽

Group A ◽

Group B

IntroductionPrevious studies have shown that simulation is an acceptable method of training in nursing education. The objectives of this study were to determine the effectiveness of tablet-based simulation in learning neurosurgical instruments and to assess whether skills learnt in the simulation environment are transferred to a real clinical task and retained over time.MethodsA randomised controlled trial was conducted. Perioperative nurses completed three consecutive sessions of a simulation. Group A performed simulation tasks prior to identifying real instruments, whereas Group B (control group) was asked to identify real instruments prior to the simulation tasks. Both groups were reassessed for knowledge recall after 1 week.ResultsNinety-three nurses completed the study. Participants in Group A, who had received tablet-based simulation, were 23% quicker in identifying real instruments and did so with better accuracy (93.2% vs 80.6%, p<0.0001) than Group B. Furthermore, the simulation-based learning was retained at 7 days with 97.8% correct instrument recognition in Group A and 96.2% in Group B while maintaining both speed and accuracy.ConclusionThis is the first study to assess the effectiveness of tablet-based simulation training for instrument recognition by perioperative nurses. Our results demonstrate that instrument knowledge acquired through tablet-based simulation training results in improved identification and retained recognition of real instruments.

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Effect of Implementing Simulation Education on Health Care Worker Comfort With Nasopharyngeal Swabbing for COVID-19

Otolaryngology ◽

10.1177/0194599820933168 ◽

2020 ◽

Vol 163 (2) ◽

pp. 271-274 ◽

Cited By ~ 3

Author(s):

Michelle E. Mark ◽

Phillip LoSavio ◽

Inna Husain ◽

Peter Papagiannopoulos ◽

Pete S. Batra ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Simulation Training ◽

False Negative ◽

Nasopharyngeal Swab ◽

Level Of Evidence ◽

Improve Health Care ◽

Care Workers ◽

Simulation Based ◽

Improve Health

Objective To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency. Methods A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from “No knowledge, unable to perform” up to “Highly knowledgeable and confident, independent.” Results Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 ( P < .0001). This reflects a large effect size with a Glass’s delta value of 1.3. Discussion Lecture coupled with simulation-based teaching can significantly improve health care workers’ confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner. Implications for Practice To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers’ confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs. Level of Evidence/Study Design Prospective cohort study.

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Stroke Simulation Improves Acute Stroke Management: A Systems-Based Practice Experience

Journal of Graduate Medical Education ◽

10.4300/jgme-d-17-00167.1 ◽

2018 ◽

Vol 10 (1) ◽

pp. 57-62 ◽

Cited By ~ 9

Author(s):

Tapan Mehta ◽

Sara Strauss ◽

Dawn Beland ◽

Gilbert Fortunato ◽

Ilene Staff ◽

...

Keyword(s):

Blood Pressure ◽

Medical Education ◽

Acute Stroke ◽

Simulation Training ◽

Stroke Registry ◽

Practice Experience ◽

Intravenous Tissue Plasminogen Activator ◽

Simulation Based ◽

Comprehensive Stroke Center ◽

Stroke Center

ABSTRACT Background Literature on the effectiveness of simulation-based medical education programs for caring for acute ischemic stroke (AIS) patients is limited. Objective To improve coordination and door-to-needle (DTN) time for AIS care, we implemented a stroke simulation training program for neurology residents and nursing staff in a comprehensive stroke center. Methods Acute stroke simulation training was implemented for first-year neurology residents in July 2011. Simulations were standardized using trained live actors, who portrayed stroke vignettes in the presence of a board-certified vascular neurologist. A debriefing of each resident's performance followed the training. The hospital stroke registry was also used for retrospective analysis. The study population was defined as all patients treated with intravenous tissue plasminogen activator for AIS between October 2008 and September 2014. Results We identified 448 patients meeting inclusion criteria. Simulation training independently predicted reduction in DTN time by 9.64 minutes (95% confidence interval [CI] –15.28 to –4.01, P = .001) after controlling for age, night/day shift, work week versus weekend, and blood pressure at presentation (> 185/110). Systolic blood pressure higher than 185 was associated with a 14.28-minute increase in DTN time (95% CI 3.36–25.19, P = .011). Other covariates were not associated with any significant change in DTN time. Conclusions Integration of simulation based-medical education for AIS was associated with a 9.64-minute reduction in DTN time.

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A low-cost alternative for nasolaryngoscopy simulation training equipment: a randomised controlled trial

The Journal of Laryngology & Otology ◽

10.1017/s0022215115002388 ◽

2015 ◽

Vol 129 (11) ◽

pp. 1101-1107 ◽

Cited By ~ 4

Author(s):

D I Johnston ◽

V Selimi ◽

A Chang ◽

M Smith

Keyword(s):

Randomised Controlled Trial ◽

Simulation Training ◽

Cost Model ◽

Low Cost ◽

Controlled Trial ◽

Endoscopy Training ◽

Patient Discomfort ◽

Simulation Based ◽

Model Training ◽

Randomised Controlled

AbstractObjectives:Flexible nasolaryngoscopy is a key diagnostic procedure used in many specialities. Simulation-based teaching is beneficial for endoscopy training, but it is expensive. This study assessed whether an inexpensive simulation model is an effective training method for flexible nasolaryngoscopy.Methods:A three-armed, randomised, controlled trial was performed. One group received no simulation training, while two others were trained with either a high-cost or a low-cost model. All candidates then performed flexible nasolaryngoscopy on a volunteer. Their ability to perform this task was assessed by the patient discomfort score and time taken by a blinded expert.Results:Simulation-based teaching reduced patient discomfort and improved candidate skill level. Low-cost model training did not have a negative effect when compared with high-cost model training.Conclusion:Simulated flexible nasolaryngoscopy training may be more accessible with the use of an effective low-cost model.

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