scholarly journals Simulation-based Training Improves Physicians' Performance in Patient Care in High-stakes Clinical Setting of Cardiac Surgery

2010 ◽  
Vol 112 (4) ◽  
pp. 985-992 ◽  
Author(s):  
Heinz R. Bruppacher ◽  
Syed K. Alam ◽  
Vicki R. LeBlanc ◽  
David Latter ◽  
Viren N. Naik ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Setting ◽  
Retention Test ◽  
Rating Scale ◽  
Training Session ◽  
Global Rating Scale ◽  
Global Rating ◽  
High Stakes ◽  
Randomized Controlled ◽  
Simulation Based

Background Simulation-based training is useful in improving physicians' skills. However, no randomized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care. This study aimed to determine whether simulation-based training or an interactive seminar resulted in better patient care during weaning from cardiopulmonary bypass (CPB)-a high stakes clinical setting. Methods This study was conducted as a prospective, single-blinded, randomized controlled trial. After institutional research board approval, 20 anesthesiology trainees, postgraduate year 4 or higher, inexperienced in CPB weaning, and 60 patients scheduled for elective coronary artery bypass grafting were recruited. Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB (pretest). One week later, each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar. Each trainee then weaned patients from CPB within 2 weeks (posttest) and 5 weeks (retention test) from the intervention. Clinical performance was measured using the validated Anesthesiologists' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions. Results Pretest Global Rating Scale and checklist performances were similar. The simulation group scored significantly higher than the seminar group at both posttest (Global Rating Scale [mean +/- standard error]: 14.3 +/- 0.41 vs. 11.8 +/- 0.41, P < 0.001; checklist: 89.9 +/- 3.0% vs. 75.4 +/- 3.0%, P = 0.003) and retention test (Global Rating Scale: 14.1 +/- 0.41 vs. 11.7 +/- 0.41, P < 0.001; checklist: 93.2 +/- 2.4% vs. 77.0 +/- 2.4%, P < 0.001). Conclusion Skills required to wean a patient from CPB can be acquired through simulation-based training. Compared with traditional interactive seminars, simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology.

scholarly journals Medical Simulation as a Competency-Based Assessment within Physician Assistant Education

2021 ◽  
Author(s):  
Michele Toussaint
Keyword(s):  
Patient Care ◽  
Communication Skills ◽  
Internal Consistency ◽  
Clinical Training ◽  
Rating Scales ◽  
Rating Scale ◽  
Physician Assistant ◽  
Global Rating ◽  
Simulation Based ◽  
Competency Based

Simulation-based practices are widely utilized in medical education and are known to be a safe and effective way to train and assess learners, improve provider confidence and competency, and improve patient safety. Competency-based initiatives are being more broadly utilized to assess learner proficiency in health professions education. Recent publication of competencies expected of new graduate physician assistants, and updated accreditation requirements which include assessment of learner competencies in non-knowledge based domains, have led to the creation of this simulation-based summative assessment of learner competency in communication and patient care skills for Physician Assistant students. The purpose of this quantitative study was to identify if this simulation assessment had appropriate construct validity and rater consistency, and to identify if correlation existed between learner performance on the simulation exam and in required Supervised Clinical Training Experiences for measures of communication skills and patient care skills. While raters for the simulation assessment had minimal variability, measures of internal consistency did not achieve suitable thresholds for patient care skills. Communication skills assessment was able to achieve the minimum suitable threshold for internal consistency with minor revisions. No correlation was noted between exam performance for communication skills or patient care skills and clinical practice ratings. Several key areas exist which may explain these results including the rating scale for the simulation exam which utilized checklists and not global rating scales, faculty raters with broad and diverse clinical backgrounds, observation-related factors on the part of the student, and the high-complexity and multidimensional nature of provider-patient interactions.

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 405-413 ◽  
Author(s):  
Robert McGraw ◽  
Tim Chaplin ◽  
Conor McKaigney ◽  
Louise Rang ◽  
Melanie Jaeger ◽  
...  
Keyword(s):  
Rating Scale ◽  
Deliberate Practice ◽  
Venous Catheter ◽  
Global Rating Scale ◽  
Global Rating ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Simulation Based ◽  
Technical Proficiency ◽  
The Mean

AbstractObjectiveTo develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency.MethodsTen post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale.ResultsNone of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently.ConclusionWe successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.

scholarly journals P.181 High-Fidelity Simulation-Based Microsurgical Training for Neurosurgical Residents

2021 ◽  
Vol 48 (s3) ◽  
pp. S72-S72
Author(s):  
B Santyr ◽  
M Abbass ◽  
A Chalil ◽  
D Krivosheya ◽  
LM Denning ◽  
...  
Keyword(s):  
Rating Scale ◽  
Global Rating Scale ◽  
High Fidelity ◽  
Global Rating ◽  
High Fidelity Simulation ◽  
Femoral Vessel ◽  
Simulation Based ◽  
Microsurgical Techniques ◽  
One Year ◽  
Training Modules

Background: Microsurgical techniques remain a cornerstone of neurosurgical training. Despite this, neurosurgical microvascular case volumes are decreasing as endovascular and minimally invasive options expand. As such, educators are looking towards simulation to supplement operative exposure. We review a single institution’s experience with a comprehensive, longitudinal microsurgical simulation training program, and evaluate its effectiveness. Methods: Consecutive postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat femoral vessel training modules were used. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses during the study. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.

Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT)

2016 ◽  
Vol 13 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Gerben E. Breimer ◽  
Faizal A. Haji ◽  
Giuseppe Cinalli ◽  
Eelco W. Hoving ◽  
James M. Drake
Keyword(s):  
Internal Structure ◽  
Internal Consistency ◽  
Interrater Reliability ◽  
Rating Scale ◽  
Assessment Tool ◽  
Global Rating Scale ◽  
Global Rating ◽  
Validity Evidence ◽  
Simulation Based ◽  
Endoscopic Ventriculostomy

Abstract BACKGROUND: Growing demand for transparent and standardized methods for evaluating surgical competence prompted the construction of the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). OBJECTIVE: To provide validity evidence of the NEVAT by reporting on the tool's internal structure and its relationship with surgical expertise during simulation-based training. METHODS: The NEVAT was used to assess performance of trainees and faculty at an international neuroendoscopy workshop. All participants performed an endoscopic third ventriculostomy (ETV) on a synthetic simulator. Participants were simultaneously scored by 2 raters using the NEVAT procedural checklist and global rating scale (GRS). Evidence of internal structure was collected by calculating interrater reliability and internal consistency of raters' scores. Evidence of relationships with other variables was collected by comparing the ETV performance of experts, experienced trainees, and novices using Jonckheere's test (evidence of construct validity). RESULTS: Thirteen experts, 11 experienced trainees, and 10 novices participated. The interrater reliability by the intraclass correlation coefficient for the checklist and GRS was 0.82 and 0.94, respectively. Internal consistency (Cronbach's α) for the checklist and the GRS was 0.74 and 0.97, respectively. Median scores with interquartile range on the checklist and GRS for novices, experienced trainees, and experts were 0.69 (0.58-0.86), 0.85 (0.63-0.89), and 0.85 (0.81-0.91) and 3.1 (2.5-3.8), 3.7 (2.2-4.3) and 4.6 (4.4-4.9), respectively. Jonckheere's test showed that the median checklist and GRS score increased with performer expertise (P = .04 and .002, respectively). CONCLUSION: This study provides validity evidence for the NEVAT to support its use as a standardized method of evaluating neuroendoscopic competence during simulation-based training.

scholarly journals Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents

CJEM ◽  
2012 ◽  
Vol 14 (06) ◽  
pp. 354-362 ◽  
Author(s):  
Christopher M. Hicks ◽  
Alex Kiss ◽  
Glen W. Bandiera ◽  
Christopher J. Denny
Keyword(s):  
Emergency Medicine ◽  
Resource Management ◽  
Rating Scale ◽  
Improve Patient Safety ◽  
A Priori ◽  
Global Rating Scale ◽  
Global Rating ◽  
Crisis Resource Management ◽  
Emergency Workers ◽  
Simulation Based

ABSTRACTObjectives:Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviationbased crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of “Crisis Resources for Emergency Workers” (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents.Methods:Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS).Results:Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved teambased attitudes as assessed by the HFAS (p= 0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p= 0.16).Conclusions:EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

scholarly journals Otoskills training during covid-19 pandemic: a before-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maxime Fieux ◽  
Antoine Gavoille ◽  
Fabien Subtil ◽  
Sophie Bartier ◽  
Stéphane Tringali
Keyword(s):  
Surgical Training ◽  
Rating Scale ◽  
Surgical Simulation ◽  
Global Rating Scale ◽  
Middle Ear Surgery ◽  
Global Rating ◽  
Training Requirements ◽  
Significant Difference ◽  
Before And After ◽  
Total Performance

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

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