October 29, 2021By Lance Baily

Latest Clinical Simulation Research From Around the World | October 2021

As the use of healthcare simulation has increased across academic institutions and healthcare system facilities, clinical simulation research has remained paramount to assessing the training learning method’s effectiveness and overall means for improvement. To help compile updates and conclusions from this research, several research journals review and accept articles for publication to advance the science of healthcare simulation. These research articles range in focus from emergency simulation preparedness to medical simulation training and healthcare simulation scenarios. This HealthySimulation.com article highlights the most recent healthcare simulation research articles from numerous research journals.

“The Code Silver Exercise: a low-cost simulation alternative to prepare hospitals for an active shooter event” (Advances in Simulation): This research explored the ability to expand upon the existing active shooter training in place to improve healthcare provider preparedness and increase survivability in the event of a Code Silver situation. This is the hospital response to a person with a weapon such as an active shooter in many Provinces or States in North America. To prepare staff, a Code Silver Exercise (CSE) involves an independent mental practice exercise with written responses to scenarios and questions, followed by a facilitated debrief with all participants. The authors’ research involved the development of an active shooter CSE with objectives including to:

  1. Review the steps to activate and respond to a Code Silver in the hospital
  2. Have participants mentally practice various scenarios presented within an active shooter scenario
  3. Debrief and discuss logistical and ethical considerations with colleagues in a facilitated debrief by content experts.

Further, the CSE was piloted in three different settings: (1) an in situ exercise conducted in two EDs and one intensive care unit (ICU), (2) an exercise offsite at a conference workshop, and (3) an online virtual platform, with a virtual debrief within one week. Ultimately, total participation included n=9 for the in-situ CSE, n=24 for the workshop CSE, and n=25 for the virtual CSE. For the voluntary debrief portion of the virtual CSE, n=11 physicians participated in the facilitated debrief 1 week later via Zoom videoconference.

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“Obstetric neonatal emergency simulation workshops in remote and regional South India: a qualitative evaluation” (Advances in Simulation): Healthcare facilities in remote locations with poor access to a referral center have a high likelihood of health workers needing to manage emergencies with limited support. This study aimed to explore the factors, which influenced healthcare workers’ experience of attending birth emergencies in remote and regional areas of South India, and the perceived impact of attending the Obstetric and Neonatal Emergency Simulation (ONE-Sim) workshop on these factors.

Participants identified their relationship with the patient, the support provided by other health professionals, identifying their gaps in knowledge and experience, and the scarcity of resources as factors that influenced their experience of birth emergencies. Following the workshops, participant learning centered on improving team and personal performance and approaching future emergencies with greater confidence. Overall, the technical and interpersonal skills introduced through the ONE-Sim workshop are thought to help address some of the factors in practice.

“In-situ simulation to increase intensive care nursing staff during the second wave of COVID-19 pandemic in Italy: advantages and limitations” (Clinical Simulation in Nursing): The main objective of this research article was to describe the authors’ experience of a shortened training program for newly acquired ICU nurses at a tertiary level hospital in Italy, focusing on the advantages of simulation in a dedicated in-situ setting. This training aimed to prepare future health care professionals for an unfamiliar field so that they could face their first shift without being harmful to the patient in the first place. The authors’ organization tried, when possible, to maintain a mixed staff of experienced nurses and new nurses, to continue the mentoring process started during the training course, and to bring it into the everyday work environment.

“Transesophageal Echocardiography Simulator Training: A Systematic Review and Meta-analysis of Randomized Controlled Trials” (Simulation in Healthcare): The researchers of this article aimed to assess the learning effects of novice transesophageal echocardiography (TEE) simulator training and to identify gaps in existing studies. They performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the learning effects of novice TEE training with versus without simulators, searching published articles and proceedings in 6 major databases in June 2019. They included 9 RCTs, for a total of 268 participants. They concluded that additional well-designed studies with low risk of bias and large sample sizes are needed to provide reliable and robust findings and develop more effective TEE simulation-based training curricula.

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“Using Rapid Cycle Deliberate Practice to Up-Train Pediatric Providers for Adult COVID-19 Patients” (IPSS Cureus Channel): This technical report describes the use of the teaching method rapid cycle deliberate practice (RCDP) to train interprofessional teams unaccustomed to working together. We detail how sessions were developed and implemented, particularly noting the need for an extended pre-briefing to optimize psychological safety.

The RCDP model allowed for a high level of interaction throughout the simulations and the incorporation of new knowledge “on the go” during the sessions. Ultimately, the use of RCDP allowed the researchers to effectively train staff to function safely in a new environment. The ongoing dissemination of information is continuing to refresh and reinforce knowledge around COVID-19 protocols.

“Pediatric Rattlesnake Envenomation: A Simulation Scenario With Optional Health Equity, Virtual Facilitation, and Senior Learner Modifications” (IPSS Cureus Channel): Rattlesnake envenomation is an uncommon but urgent cause of presentation for emergency care. Recognition of envenomation, timely administration of antivenom when indicated, and recognition of antivenom reactions are of critical importance to mitigate the local, hematologic, and systemic effects of Crotaline venom.

The scenario described in this research article details the presentation of a child who has been bitten and reviews the presentation, initial stabilization, workup, treatment, and disposition of the envenomated child. We also include an optional health equity supplement to address insurance and parental refusal concerns as well as an optional inclusion of anaphylaxis to the antivenom for more senior learners. This scenario can be run in-person or virtually, and we include a resource for virtual facilitation.

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