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

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.

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

Prehospital and Disaster Medicine ◽

10.1017/s1049023x12000775 ◽

2012 ◽

Vol 27 (3) ◽

pp. 239-244 ◽

Cited By ~ 44

Author(s):

Mark X. Cicero ◽

Marc A. Auerbach ◽

Jason Zigmont ◽

Antonio Riera ◽

Kevin Ching ◽

...

Keyword(s):

Educational Intervention ◽

Simulation Training ◽

Low Frequency ◽

Disaster Medicine ◽

Care Needs ◽

High Stakes ◽

Head Injured ◽

Post Test ◽

And Performance ◽

Disaster Scenario

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.

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1241 MaxSim, a Novel Simulation Based Education Course for OMFS Emergencies

British Journal of Surgery ◽

10.1093/bjs/znab259.900 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Holden

Keyword(s):

Simulation Training ◽

Medical Training ◽

Maxillofacial Surgery ◽

Oral And Maxillofacial Surgery ◽

Safe Environment ◽

Clinical Scenarios ◽

Simulation Based ◽

Medical Emergencies ◽

Second Year ◽

First Time

Abstract Introduction For Oral and Maxillofacial Surgery (OMFS) Senior House Officers (SHOs), with no formal medical training, the first exposure to inpatient medical or OMFS emergencies will be the first time they are having to manage them, usually alone. Simulation based education has been demonstrated to increased experience and confidence when used in medical education 1, therefore an OMFS simulation-based education course was created to facilitate this learning in a safe environment. Method The course included stations on medical emergencies such as sepsis, and OMFS emergencies centred around scenarios that necessitate rapid response including retrobulbar haemorrhage and carotid artery blowout. A pre and post course questionnaire was given to all delegates to assess their change in confidence when managing the scenarios. Each was asked to score their confidence in managing the scenarios numerically from one to ten. Results Delegate numbers were limited due to the Covid-19 pandemic with all ten completing both questionnaires. There was an even distribution between first and second year SHOs. Two had received simulation training before however, very limited. In all ten simulation stations every delegate felt an increase in confidence on average by 4.5 (range: 3.8-5.6) on the ten-point scale, p < 0.05. Positive feedback was also given by all stating it was extremely useful. Conclusions Simulation based education has been shown to be invaluable method of training for clinical scenarios and needs to become more common place in Oral and Maxillofacial Surgery. This course is to be expanded post Covid-19 to become available nationally.

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Using Innovative Simulation Modalities for Civilian-based, Chemical, Biological, Radiological, Nuclear, and Explosive Training in the Acute Management of Terrorist Victims: A Pilot Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00003824 ◽

2006 ◽

Vol 21 (4) ◽

pp. 272-275 ◽

Cited By ~ 25

Author(s):

Italo Subbarao ◽

William F. Bond ◽

Christopher Johnson ◽

Edbert B. Hsu ◽

Thomas E. Wasser

Keyword(s):

Test Scores ◽

Medical Training ◽

Statistical Significance ◽

Low Frequency ◽

First Responders ◽

Mean Value ◽

Clinical Vignettes ◽

Clinical Scenarios ◽

Post Test ◽

The Mean

AbstractObjectives:Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents are low frequency, high impact events that require specialized train-ing outside of usual clinical practice. Educational modalities must recreate these clinical scenarios in order to provide realistic first responder/receiver training.Methods:High fidelity, mannequin-based (HFMB) simulation and video clinical vignettes were used to create a simulation-based CBRNE course directed at the recognition, triage, and resuscitation of contaminated victims. The course participants, who consisted of first responders and receivers, were evaluated using a 43-question pre- and post-test that employed 12 video clinical vignettes as scenarios for the test questions. The results of the pre-test were analyzed according to the various medical training backgrounds of the participants to identify differences in baseline performance. A Scheffe posthoc test and an ANOVA were used to determine differences between the medical training backgrounds of the participants. For those participants who completed both the pre-course and post-course test, the results were compared using a paired Student's t-test.Results:A total of 54 first responders/receivers including physicians, nurses, and paramedics completed the course. Pre-course and post-course test results are listed by learner category. For all participants who took the pre-course test (n = 67), the mean value of the test scores was 53.5 ±12.7%. For all participants who took the post-course test (n = 54), the mean value of the test scores was 78.3 ±10.9%. The change in score for those who took both the pre- and post-test (n = 54) achieved statistical significance at all levels of learner.Conclusions:The results suggest that video clinical vignettes and HFMB simulation are effective methods of CBRNE training and evaluation. Future studies should be conducted to determine the educational and cost-effectiveness of the use of these modalities.

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187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

British Journal of Surgery ◽

10.1093/bjs/znab134.382 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Bhattacharya ◽

J Jegadeeson ◽

J Ramsingh ◽

P Truran

Keyword(s):

Nursing Staff ◽

Simulation Training ◽

Clinical Signs ◽

Skin Wound ◽

Junior Doctors ◽

Parathyroid Surgery ◽

Surgical Department ◽

Life Threatening ◽

Clinical Questions ◽

Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

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Virtual Reality Technology and Remote Digital Application for Tele-Simulation and Global Medical Education: An Innovative Hybrid System for Clinical Training

Simulation & Gaming ◽

10.1177/10468781211008258 ◽

2021 ◽

pp. 104687812110082

Author(s):

Omamah Almousa ◽

Ruby Zhang ◽

Meghan Dimma ◽

Jieming Yao ◽

Arden Allen ◽

...

Keyword(s):

Medical Education ◽

Virtual Reality ◽

Real Time ◽

Global Education ◽

Clinical Training ◽

Simulation Training ◽

Virtual Space ◽

Control Panel ◽

Clinical Simulation ◽

Clinical Scenarios

Objective. Although simulation-based medical education is fundamental for acquisition and maintenance of knowledge and skills; simulators are often located in urban centers and they are not easily accessible due to cost, time, and geographic constraints. Our objective is to develop a proof-of-concept innovative prototype using virtual reality (VR) technology for clinical tele simulation training to facilitate access and global academic collaborations. Methodology. Our project is a VR-based system using Oculus Quest as a standalone, portable, and wireless head-mounted device, along with a digital platform to deliver immersive clinical simulation sessions. Instructor’s control panel (ICP) application is designed to create VR-clinical scenarios remotely, live-stream sessions, communicate with learners and control VR-clinical training in real-time. Results. The Virtual Clinical Simulation (VCS) system offers realistic clinical training in virtual space that mimics hospital environments. Those VR clinical scenarios are customizable to suit the need, with high-fidelity lifelike characters designed to deliver interactive and immersive learning experience. The real-time connection and live-stream between ICP and VR-training system enables interactive academic learning and facilitates access to tele simulation training. Conclusions. VCS system provides innovative solutions to major challenges associated with conventional simulation training such as access, cost, personnel, and curriculum. VCS facilitates the delivery of academic and interactive clinical training that is similar to real-life settings. Tele-clinical simulation systems like VCS facilitate necessary academic-community partnerships, as well as global education network between resource-rich and low-income countries.

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Republished: Simulation training improves ability to manage medical emergencies

Postgraduate Medical Journal ◽

10.1136/pgmj-2009-074518rep ◽

2012 ◽

Vol 88 (1040) ◽

pp. 312-316 ◽

Cited By ~ 10

Author(s):

Miriam Ruesseler ◽

Michael Weinlich ◽

Michael P Müller ◽

Christian Byhahn ◽

Ingo Marzi ◽

...

Keyword(s):

Simulation Training ◽

Medical Emergencies

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Simulation training as a tool to improve confidence in managing medical emergencies and leading cardiac arrests for core medical trainees

Clinical Medicine ◽

10.7861/clinmedicine.19-2-s145 ◽

2019 ◽

Vol 19 (Suppl 2) ◽

pp. s145-s145

Author(s):

Elisa Lewington-Gower ◽

Abigail Masding ◽

Martin Carby ◽

Amy Downes ◽

Lydia Spurr ◽

...

Keyword(s):

Simulation Training ◽

Medical Trainees ◽

Medical Emergencies

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Benefits of venom immunotherapy: How soon can they be expected

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh160307032k ◽

2017 ◽

Vol 145 (3-4) ◽

pp. 173-177

Author(s):

Sasa Kadivec ◽

Mitja Kosnik

Keyword(s):

First Year ◽

Severe Reaction ◽

Allergic Reactions ◽

Venom Immunotherapy ◽

Emergency Situations ◽

Sting Reaction ◽

Life Threatening ◽

Medical Emergencies ◽

The Cost ◽

Patients Experience

Introduction/Objective. Allergic reactions to insect stings are medical emergencies that could be prevented by venom immunotherapy (VIT). The main purpose of VIT is to prevent fatal or life-threatening reactions. We aimed to show the rapidity with which patients experience the benefits of VIT and estimate the number of emergency treatments that are prevented. Methods. We reviewed the medical files of patients who started VIT between 2010 and 2014. We calculated the costs of treatment of the sting reactions, the costs of immunotherapy, and estimated the costs of prevented allergic reactions. Results. In a cohort of 514 patients (40.9% female, age 47.2 ? 14.4 years), the cost of treatment of the index sting reaction was 180.4 ? 166.8 euros. During VIT, 195 patients experienced 446 field stings. In 86.3% of patients, stings were well tolerated, and only one patient experienced a severe reaction (grade III, according to Mueller). A total of 20.4% of VIT treated patients were stung during the first year of VIT and 57% during five years of VIT. The expenditure for five years of VIT was 2,886 euros per patient, which corresponded to an average of 16 emergency treatments for systemic reactions. Conclusion. Emergency situations are prevented in a substantial number of venom-allergic patients and a beneficial effect was already observed during the first year of VIT.

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

American Journal of Perinatology Reports ◽

10.1055/s-0039-1677736 ◽

2019 ◽

Vol 09 (01) ◽

pp. e6-e9 ◽

Cited By ~ 4

Author(s):

Kelsey Rose ◽

Kirsten Jensen ◽

Rong Guo ◽

Yalda Afshar

Keyword(s):

Simulation Training ◽

Training Session ◽

Low Frequency ◽

Ability To Consent ◽

Powerful Learning ◽

Postgraduate Level ◽

Signed Rank ◽

Vaginal Deliveries ◽

Simulation Based ◽

Cesarean Delivery Rate

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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Placement of a transjugular intrahepatic portosystemic shunt in addition to recanalization of acute and chronic portomesenteric vein occlusions – a retrospective evaluation

Acta Radiologica Open ◽

10.1177/2058460120964074 ◽

2020 ◽

Vol 9 (10) ◽

pp. 205846012096407

Author(s):

Charlotte Ebeling Barbier ◽

Fredrik Rorsman ◽

Lars-Gunnar Eriksson ◽

Per Sangfelt ◽

Reza Sheikhi ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Venous Stasis ◽

Radiology Department ◽

Retrospective Evaluation ◽

Vein Thrombosis ◽

Portomesenteric Vein Thrombosis ◽

Life Threatening ◽

Intrahepatic Portosystemic Shunt ◽

Interventional Radiology Department

Background Portomesenteric vein thrombosis may be life-threatening due to bowel ischemia caused by venous stasis, or variceal bleeding caused by portal hypertension. Purpose To evaluate the effectiveness and safety of recanalization combined with transjugular intrahepatic portosystemic shunt in acute and chronic portomesenteric vein thrombosis in patients with and without liver cirrhosis. Material and Methods 21 consecutive patients (5 women, 16 men; mean 48 years) with portomesenteric vein thrombosis (8 acute, 13 chronic) treated at the Interventional Radiology department between March 2014 and September 2018 were retrospectively reviewed. The main portal vein was completely obliterated and the portomesenteric vein thrombosis extended into the superior mesenteric vein in all patients. The portomesenteric vein thromboses were recanalized transhepatically, a transjugular intrahepatic portosystemic shunt was inserted, thrombectomy was performed in acute portomesenteric vein thrombosis, and angioplasty with or without additional stenting was performed in chronic portomesenteric vein thrombosis. Results Recanalization was successful in 8/8 patients (100%) with acute portomesenteric vein thrombosis, and in 11/13 patients (85%) with chronic portomesenteric vein thrombosis. In 12 patients, blood flow was restored in one session. Several sessions were more frequently needed in patients with acute portomesenteric vein thrombosis compared to those with chronic portomesenteric vein thrombosis ( p = 0.003). Re-occlusion occurred and was recanalized in 10/19 patients and was more frequent in patients with chronic ( n = 8/11) than on those with acute ( n = 2/8) portomesenteric vein thrombosis ( p = 0.04). Adverse events occurred in five patients. There was no 30-day mortality. Conclusion Recanalization and insertion of a transjugular intrahepatic portosystemic shunt is safe and effective in patients with acute and chronic portomesenteric vein thrombosis with or without cirrhosis. Recanalization was more likely to stay patent in acute compared with chronic portomesenteric vein thrombosis.

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