ResearchPad - medical-simulation https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Constructing a Multidisciplinary Network That Relies on Disruptive Technologies to Design, Test, and Implement Simulation Training]]> https://www.researchpad.co/article/N45a2bbaf-94a5-45b5-adef-7e00fbb80c44 MaxSIMhealth is a multidisciplinary network of manufacturing, design, and simulation labs at Ontario Tech University combining expertise in health sciences, business and information technology (IT), and engineering while building community partnerships to advance simulation training. It discovers existing simulation gaps, provides innovative solutions that change systems, and leads to improved healthcare outcomes. Specifically, it utilizes disruptive technologies, including 3D printing, gaming, and extended reality, as innovative solutions that deliver cost-effective, portable, and realistic simulation, which is currently lacking. MaxSIMhealth is a novel collaborative innovation with aims to develop future cohorts of scholars with strong competencies ranging from technology application, to collaborating in new environments, communicating professionally, and problem-solving. Its work will transform current health professional education landscapes by providing novel, flexible, and inexpensive simulation environments. This editorial aims to showcase maxSIMhealth's innovative strategy focusing on collaborations of expertise in order to develop new simulation solutions that advance the health industry.

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<![CDATA[The Impact of Advanced Cardiac Life Support Simulation Training on Medical Student Self-reported Outcomes]]> https://www.researchpad.co/article/Nb0e2abb3-0d35-4627-bf9d-6cacab18d4de Introduction: Simulation has become a well-recognized and innovative tool in medical education. While there has been tremendous growth of simulation curricula at the level of graduate medical education, there have been few studies looking at simulation as a learning tool for undergraduate medical education. The goal of this study was to determine if high-fidelity simulation training impacts medical student perception of knowledge and confidence regarding comprehension and application of advanced cardiac life support (ACLS) algorithms.

Methods: This is a prospective observational survey study of third and fourth year medical students who participated in an ACLS simulation training during their emergency medicine rotation between January 2018 and October 2018. Cases covered several ACLS topics including unstable bradycardia, supraventricular tachycardia and ventricular tachycardia. After each session, students received a short survey to assess their simulation experience pertaining to knowledge and comfort levels with ACLS topics before and after the simulation experience.

Results: A total of 89 students were included in the study with 86.5% of those being fourth year students. There was a significant increase in both knowledge (pre-training 3.17 vs. 4.11 post-training, p<0.001) and comfort scores (pre-training 2.54 vs. 3.74 post-training, p<0.001) after the ACLS simulation training. Overall, 77.5% of students reported an increase in knowledge and 83.1% reported an increase in confidence after the training session. 

Conclusions: The study revealed a statistically significant increase in both perceived knowledge and comfort and confidence of medical students after high-fidelity simulation using ACLS scenarios.

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<![CDATA[Assembly Line Education: A Novel Educational Technique for Today's Learners]]> https://www.researchpad.co/article/N79e255b8-b9a7-48ff-90a6-c3d23aaa81f3

Background

Education is undergoing a transformation. The traditional passive lectures are failing to capture and inspire the new generation of learners who value more active and collaborative learning techniques.

Objective

We sought to create a novel educational technique to integrate into our curriculum that would be more personalized, employ more active learning and collaboration, and allow for an effective assessment of resident strengths and weaknesses.

Discussion

We created a monthly assembly line education academic half-day that evolved to replace one of the typical in-classroom didactics each month. Faculty run small-group simulation rooms, procedure workshops, competitive ultrasound, and wellness stations through which residents and medical students rotate.

Conclusion

This novel education technique resulted in a more personalized approach that increased resident interest, sparked the creation of a very popular MedEd-Simulation elective, and allowed the faculty to gain a better sense of resident strengths and deficiencies.

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<![CDATA[Piloting Simulations: A Systematic Refinement Strategy]]> https://www.researchpad.co/article/N4c78013e-9284-4231-926c-5b65a2760e99

Introduction

Few approaches articulate a systematic way to address confusing, missing, or underdeveloped simulation design features prior to implementing into coursework. To address this gap, we tested a novel, systematic refinement strategy to improve the design elements of two simulations.

Methods

Forty eligible participants (Year 3 undergraduate nursing students) evaluated two simulation scenarios (each followed by a debriefing session) through a novel and systematic refinement strategy across five iterations. Each simulation was evaluated using the validated Simulation Design Survey (SDS). Ratings were analyzed using descriptive data. Students also responded to an open-ended question in order to provide qualitative feedback regarding how to improve its features, i.e., scenario design and debriefing components. Written comments by students were analyzed using the principles of qualitative content analysis. 

Results

Descriptive statistics revealed a gradual increase in the mean scores of the SDS over each of the simulation refinement periods. For the first simulation, the SDS mean score reached a high on Day 5 of 4.86 (standard deviation (SD) = 0.14) in contrast to a score of 3.45 (SD = 0.17) on Day 1. For the second simulation, the SDS mean score was 4.75 (SD = 0.16) on Day 5, which represented a mean score increase of 1.01 from the score on Day 1. 

Conclusions

This novel refinement strategy improved the overall design elements of each of the simulations. The potential use of the SDS and open-ended feedback, guided by a refinement approach, merits further investigation.

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<![CDATA[Construction of an Affordable Lumbar Neuraxial Block Model Using 3D Printed Materials]]> https://www.researchpad.co/article/N0a2a1cc1-615b-42f6-aa83-ae0abbe5a21c

Access to affordable 3D printing technology has resulted in increased interest in the creation of medical phantom task trainers. Recent research has validated the use of these trainers in simulation education. However, task trainers remain expensive, limiting their availability to medical training programs. We describe the construction of a low-cost task trainer using fused filament fabrication (FFF) printed spinal vertebrae placed in a synthetic gelatin matrix. Additionally, our model contains a realistic simulated ligamentum flavum, a removable silicone skin, as well as spinal fluid reservoir that provides a positive endpoint for intrathecal blocks. The total cost of this model was less than $400 USD. The time to 3D print the bony anatomic parts was approximately 26 hours. While we have not formally validated our model, initial impressions of tactile feel and realism were deemed positive by experienced anesthesia providers. Future work will focus on continued refinement of the model features and construction.

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<![CDATA[Cross-specialty Collaboration and Education for Neurosurgical Trainees: Teaching Arterial Line Placement Under Ultrasound Guidance]]> https://www.researchpad.co/article/N4dd0884f-6727-482f-beb1-776da1786169

Introduction

Interprofessional collaboration (IPC) increases patient safety. IPC is learned through task-based exercises, such as ultrasound (U/S)-guided arterial lines. We set out to teach U/S-guided arterial lines as a framework to improve IPC between emergency medicine and neurosurgery residents. The objectives of the study were to provide a U/S session to teach the proper arterial line placement technique, to assess post-workshop arterial line placement competency and attitude toward U/S for procedural guidance, and to improve interdepartmental relationships through IPC.

Methods

The course was completed in 2018 and consisted of pre-workshop assignments, the workshop, a competency assessment, and a post-workshop survey for neurosurgical residents. After a didactic and hands-on training session, trainees completed a simulated U/S-guided arterial line placement. Trainees then completed a post-workshop assessment.

Results

There were a total of 21 participants out of 24 total residents, an 87.5% participation rate. Prior to the workshop, on a 5-point Likert scale, where 1 is not at all likely and 5 is very likely, the residents reported they would use U/S 1.7/5, with 57% of respondents answering 1 out of 5. After the workshop, on the same Likert scale, the residents reported using U/S first 3.6/5 (P < 0.05) with 52% of the respondents answering 4 out of 5. After the course, the belief that the landmark technique is non-inferior decreased to 28.6% of respondents.

Conclusions

The overall goal of this workshop was to improve patient care through continuing education. Using IPC as the framework, the workshop significantly increased the reported likelihood of using U/S for arterial line placement.

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<![CDATA[A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training]]> https://www.researchpad.co/article/5c47a898d5eed0c484c841b2

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation.

We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom.

The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of “see one, do one, teach one” is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection.

3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model.

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<![CDATA[Autonomic Dysreflexia in the Peripartum Patient: A Multidisciplinary and Interprofessional Simulation Scenario]]> https://www.researchpad.co/article/5b4389cb463d7e2a0b8ba537

This case is one of an eight-case multidisciplinary curriculum designed and implemented at the University of Ottawa by simulation educators with specialty training in obstetrics and gynecology (ob/gyn) and anesthesiology. Consultation with a nurse educator maintained quality and relevance of objectives for nursing participants.

The curriculum was prepared to train ob/gyn and anesthesiology residents and nurses to hone crisis resource management skills and to recognize and manage rare/critical medical events in an obstetrical setting. Obstetricians, anesthesiologists, and nurses often work together in acute, high-stakes situations and this curriculum provides a safe environment to practice team-based management of such emergencies.

Over an eight-year period, this curriculum has been executed in scenario couplets on a four-year cycle to allow ob/gyn and anesthesiology residents exposure to all scenarios during a five-year residency beginning in their second year. Prospective evaluation data has been positive. For example, over 90% of participants rated these simulations to be 5 out of 5 for “Was an effective use of my educational time” and “Will influence/enhance my future practice”.

In this scenario, participants must recognize and manage a parturient with spinal cord injury in active labour who develops autonomic dysreflexia. The fetal heart tracing becomes abnormal and the team must respond with urgent delivery. This scenario requires a mannequin for a pelvic exam and a pregnant abdomen.

This simulation case includes a case template, critical actions checklist, debriefing guide, summary of key medical content, and an evaluation form for learners to provide feedback.

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