Latest Simulation in Healthcare Research from SSH

The June 2019 – Volume 14 – Issue 3 edition of the Simulation in Healthcare Journal became available yesterday, and here today we summarize the index which is linked below to highlight the latest research in medical simulation. For a complete list of the global research publications, visit our Simulation Research Journal Listings Page!

Editorial – The Relationship Between Emotions and Learning in Simulation-Based Education (Vicki R. LeBlanc): In this issue, Rogers et al present the results of a study looking at the interplay of emotions and learning during simulation-based education. The role of emotions in learning, particularly simulation, has been of growing interest to educators. Medical education involves significant emotional experiences for the learners, and these emotions can have important effects on the cognitive and learning processes of individuals. Given that stress has been associated not only with greater memory consolidation (process of solidifying transient memory traces into long-term memory) but also with greater biases and inaccuracies in what is recalled, simulation educators are increasingly concerned with understanding and quantifying stress for learners during simulations.

The goal of this editorial is to highlight possible directions for future research building on the work of Rogers et al. I first present arguments for looking at the role of appraisals as well as motivation when studying emotions. Second, I discuss the potential importance of individual roles as potential modifiers of emotional responses during team-based simulation sessions. Finally, I discuss the possible benefits of physiological and behavioral measures in the study of emotions.

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Empirical Investigations

Self-Reported Emotions in Simulation-Based Learning: Active Participants vs. Observers (Timothy Rogers, Carly Andler, Bridget O’Brien, Sandrijn van Schaik): Experiential learning through active participation is thought to be a key benefit of simulation-based education. Recent research has challenged this assumption, suggesting that active participants learn just as well as observers. Studies report that active participants experience stress and anxiety during simulation, which may hamper learning by active participants. We undertook the current study to examine whether active participation results in different emotional arousal than observing during simulation. We hypothesized that participants in active roles experience higher levels of negative emotions than those observing and looked for evidence that this may impact learning.

A Simulation-Based Pilot Study of a Mobile Application (NRP Prompt) as a Cognitive Aid for Neonatal Resuscitation Training (Natalie H. Chan, Niraj Mistry, Douglas M. Campbell): Despite standardized neonatal resuscitation program (NRP) training, retention and adherence to the NRP algorithm remain a challenge. Cognitive aids can potentially improve acquisition and application of NRP knowledge and skills. The objective of this study was to determine whether an interactive mobile application providing audiovisual prompts, NRP Prompt, can help novice NRP providers learn the NRP algorithm more effectively and therefore improve their NRP performance.

“Nightmares–Family Medicine” Course Is an Effective Acute Care Teaching Tool for Family Medicine Residents (Filip Gilic, Karen Schultz, Ian Sempowski, Ana Blagojevic): Simulation is an effective method for teaching acute care skills but has not been comprehensively evaluated with family medicine (FM) residents. We developed a comprehensive simulation-based approach for teaching acute care skills to FM residents and assessed it for effectiveness.

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Learning Curves for Two Fiberscopes in Simulated Difficult Airway Scenario With Cumulative Sum Method (Demet Altun, Tulay Ozkan-Seyhan, Emre Camci, Nukhet Sivrikoz, Mukadder Orhan-Sungur): The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves.

The Effect of Variations in Force Feedback in a Virtual Reality Environment on the Performance and Satisfaction of Dental Students (Ilse R. de Boer, Maxim D. Lagerweij, Paul R. Wesselink, Johanna M. Vervoorn): The aim of this study was to investigate the transfer of skills between various levels of force feedback (FFB) using the Simodont dental trainer (Moog, Nieuw-Vennep, the Netherlands). Students practiced a manual dexterity exercise in a virtual reality environment at a standard level of FFB and then were tested at the standard and an altered level of FFB. In addition, the students’ satisfaction with the training exercise was evaluated.

FIRES Articles

Balancing Deliberate Practice and Reflection: A Randomized Comparison Trial of Instructional Designs for Simulation-Based Training in Cardiopulmonary Resuscitation Skills (Emily Diederich, Matthew Lineberry, Michael Blomquist, Vanessa Schott, Chelsi Reilly, Megan Murray, Pooneh Nazaran, Meghan Rourk, Rachel Werner, Julie Broski): A key question in simulation-based education is how to maximize learning within time and resource limits, including how best to balance hands-on practice versus reflective debriefing. Several instructional design frameworks suggest setting the balance according to the type of learning objective(s); however, broad professional activities such as team-based cardiopulmonary resuscitation include several interrelated component skills. This study experimentally manipulated hands-on practice versus reflective debriefing for cardiopulmonary resuscitation skills, hypothesizing that the former best supports learning taskwork (eg, compression quality), whereas the latter best supports learning teamwork.

Reducing Perineal Lacerations Through Team-Based Simulation (Emily K. Marko, Merlin B. Fausett, Shad Deering, Barton C. Staat, Stephanie Stormes, Elizabeth Freund, G. Larry Maxwell): Vaginal deliveries that result in perineal trauma involve significant morbidity to women. Multiple strategies have been identified to reduce the risk of severe perineal lacerations. The objective of this study was to evaluate the effectiveness of an interprofessional simulation-based teams-training program aimed at reducing severe perineal lacerations during childbirth.

Review Article: Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals: A Systematic Review (Marie-Stéphanie Bracq, Estelle Michinov, Pierre Jannin): This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, is aimed to review current research in virtual reality (VR) for healthcare training, specifically pertaining to nontechnical skills. PsycInfo and Medline databases were queried for relevant articles published through December 2017. Of the 1377 publications identified, 80 were assessed for eligibility and 26 were finally included in the qualitative synthesis. Overall, the use of virtual training for nontechnical skills is recent in healthcare education and has increased since 2010. Screen-based VR simulators or virtual worlds are the most frequently used systems. The nontechnical skills addressed in VR simulation include mainly teamwork, communication, and situation awareness. Most studies evaluate the usability and acceptability of VR simulation, and few studies have measured the effects of VR simulation on nontechnical skills development.

Concepts and Commentary: Using Mirror Patients to Enhance Patient Safety (Ilana Harwayne-Gidansky, Kathleen Culver, Sean Cavanaugh, Rahul Panesar): Unannounced, in situ simulations offer opportunities for interprofessional teams to train for pediatric emergencies and uncover latent safety threats (LST). Simulation fidelity is an important component of in situ simulations. Threats to fidelity include creating a fictional patient vignette, which limits realism and the opportunity for patient handoffs. The “mirror patient” model may enhance in situ simulation fidelity by using actual patient profiles, thereby removing vignettes and allowing for handoffs. This model may also aid in discovering LSTs. The mirror patient was positively received by participants, who reported realistic and useful simulation experience that provided a safe and supportive learning environment. Uncovering, recording, and reviewing LSTs into an institutional safety event reporting system allowed for tracking and accountability, including process improvement, equipment changes, and provider training without risk to any real patient. This model may further improve means to enhance hospital patient safety.

Technical Report: Breast Cancer Detection: The Development and Pilot Study of a “Tactile Landscape” as a Standardized Testing Tool (Daisy E. Veitch, Melissa Bochner, Johan F. M. Molenbroek, Richard H. M. Goossens, Harry Owen): There is still a need for competent breast lump detection palpation skills, especially in developing countries. Our goal is to design, develop, and establish a test to determine whether students can, by touch alone, identify and discriminate between a range of different simulated lesions at different adiposity levels.

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