Using a Palliative Extubation Simulation-Based Learning Model to Teach Key Palliative Medicine Topics and Skills Across Graduate and Undergraduate Medical Education (Sch472)

Outcomes: 1. Self-report the ability to use a palliative extubation simulation curriculum to teach key palliative care topics to learners across various levels. 2. Self-report the ability to mitigate communication and procedural errors associated with suboptimal palliative extubations to provide maximum comfort for patients and families at end of life. Background(s): The COVID-19 pandemic revealed gaps in the provision of end-of-life (EOL) care. In particular, the high number of mechanically ventilated patients at the EOL highlighted the need to standardize evidence-based palliative extubation (PE) amidst significant practice variation. Suboptimal PE practices can worsen symptoms, inappropriately hasten death, and add undue stress on patients, families, and healthcare staff. Effective training models are needed to standardize evidence-based PE. Simulation-based learning (SBL) has been shown to effectively improve medical knowledge, procedural proficiency, and interprofessional communication, all of which are necessary to successfully perform a PE. Unfortunately, the use of SBL in palliative care (PC) education is sparse. Method(s): An innovative educational activity using high-fidelity simulation and SBL models was created to teach key PC topics and skills within the context of a simulated PE procedure. The curriculum consists of a 1-hour didactic followed by 2 hours of simulation, divided into 4 sections. The simulation is designed to teach complex symptom management, communication strategies, and leadership skills. Each section concludes with a debrief to provide feedback and teaching points. This curriculum was piloted over multiple years among palliative medicine fellows. It will expand to include medical students this academic year with the plan to be further incorporated into medical resident education in the future. The following validated questionnaires will be used to study the efficacy of this SBL model: Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire. Participants will complete the questionnaires following the simulation. Conclusion(s): Multiple specialties have adopted SBL as an effective modality to enhance training. The use of SBL in palliative medicine education is relatively sparse. An innovative PE-simulation educational activity may provide an optimal way to teach key PC concepts across graduate and undergraduate medical education.Copyright © 2023

High-fidelity simulation and nurse clinical competence-An integrative review.

AIM: The aim of this review was to synthesise current knowledge of high-fidelity simulation practices and its impact on nurse clinical competence in the acute care setting. BACKGROUND: There is no consensus or standardisation surrounding best practices for the delivery of high-fidelity simulation in the acute care setting. This is an understudied area. DESIGN: An integrative review using Johns Hopkins Nursing Evidence-Based Practice Model. METHODS: Medical subject heading terms 'Clinical Competence', AND 'High Fidelity Simulation Training', AND 'Clinical Deterioration' were systematically searched in PubMed, CINAHL and Embase databases for peer-reviewed literature published through September 2020. The current study was evaluated using PRISMA checklist. RESULTS: Seven studies met the inclusion criteria. Three main concepts were identified: modes of delivery, approach to learner participation and outcome measurement. CONCLUSIONS: This review substantiated the use of high-fidelity simulation to improve acute care nurses' early identification and management of clinical deterioration. Global variations in course design and implementation highlight the need for future approaches to be standardised at the regional level (i.e., country-centric approach) where differing scopes of practice and sociocultural complexities are best contextualised. RELEVANCE TO CLINICAL PRACTICE: These findings add to the growing body of evidence of simulation science. Important considerations in course planning and design for nursing clinical educators were uncovered. This is especially relevant given the current COVID-19 pandemic and urgent need to train redeployed nurses safely and effectively from other units and specialties to acute care.

A virtual reality platform for training in the management of acute respiratory diseases

Introduction: During the COVID-19 pandemic, alternatives to face-to-face teaching were on the urge. What's more, in the context of the respiratory support of COVID patients, the training and capacitation of personnel capable of taking care of these patients was critical. Aims and objectives: Develop a Virtual Reality (VR) app for remote training of medical staff in the management of different acute respiratory diseases, including COVID-19. Method(s): Pulmonologists and software developers designed an app based on a virtual hospital using VR glasses. The teacher programs different clinical scenarios, where the student can converse with the patient and explore him, observing the respiratory mechanics and the skin coloration, auscultating different noises in various cardiac and pulmonary foci, edema in the lower extremities, etc. The student can request different tests (blood analysis, radiography, etc.) and prescribe treatment, including oxygen therapy and respiratory support. The clinical situation of the patient can change during the simulation. Result(s): Different acute respiratory diseases were successfully simulated, with a correct interaction between the student and the teacher. Conclusion(s): VR can be used as a tool for the remote training of medical staff, and provide high fidelity simulations for training in a wide variety of clinical situations.

Development and Assessment of Innovative High-Fidelity Simulation Vaccination Course Integrating Emergency Cases for Pharmacy Undergraduates-A Randomized Controlled Study.

Recently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. In order to adapt the pharmacy curriculum for clinical practice, an innovative, vaccination training course using a high-fidelity simulator (HFS) was developed, implementing clinical scenarios to manage adverse events. In a randomized controlled trial using a pre and post design with pharmacy undergraduates, the intervention group interacted with an HFS, while the control group was trained with low-fidelity injection pads. Before and after the respective training, each participant went through an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire and knowledge quiz. Both training methods showed a significant increase in skills, but there was also a significant greater increase in the intervention group when compared to the control group, particularly with respect to the vaccination process. Furthermore, every individual in the intervention group improved from the pre- to post-training OSCEs. Therefore, HFS has been proven to be an appropriate tool to train pharmacy students for the purposes of vaccine administration and to prepare for future challenges. Particularly, recognizing and managing adverse reactions can be addressed in a very effective way.

Learning effects of virtual versus high-fidelity simulations in nursing students: a crossover comparison.

BACKGROUND: Simulation is an alternative or complementary method for students who cannot obtain sufficient direct care experience, as they allow students to experience various clinical situations. Mixed learning is becoming increasingly common as a way to provide students with opportunities to experience real-life clinical scenarios. This study compared the learning effects of a virtual simulation and a high-fidelity simulation in a different order of presentation, with a focus on training for premature rupture of membranes in the field maternity nursing. Through this comparison, this study aimed to obtain evidence to support decision-making regarding the most effective way to utilize mixed simulation strategies. METHODS: A quasi-experimental, crossover-design study was performed with two randomly allocated groups of 26 junior nursing students each. The virtual simulation used the vSim® for nursing, and the high-fidelity simulation used a scenario developed by the research team. The learning effects were measured in terms of the problem-solving process, clinical reasoning, reflective thinking, satisfaction with the practicum, and self-confidence. The data collected with a structured questionnaire were analyzed using the Mann-Whitney test. RESULTS: The virtual simulation-first, high-fidelity simulation-second order led to significantly higher scores for reflective thinking (z = 3.53, p < .001) and self-confidence (z = 2.47, p = .013) than the other order. CONCLUSIONS: The initial application of virtual simulation seemed to improve students' thought processes, and then high-fidelity simulation seemed to allow them to perform actual practice better. Further trials of mixed learning methods are necessary to maximize learning effects in nursing education. TRIAL REGISTRATION: KCT0005767  at 2021-01-12 registered.

TRAINING THE LEADER: EFFECTIVENESS OF A SIMULATION AND CLINICAL SKILLS-BASED CURRICULUM ON RESIDENT COMFORT LEVEL AS CODE LEADERS

SESSION TITLE: Trainees: Mental Well-Being and Performance SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 am - 11:30 am PURPOSE: With the COVID-19 pandemic and hospital surges, our institution’s house staff was responsible for a significantly increased volume of critically ill patients while balancing residency training. In August 2020, a needs assessment survey was distributed among categorical Internal Medicine (IM) and Internal Medicine/Pediatrics (Med-Peds) residents. The results indicated low comfort levels in the evaluation of decompensating patients and in leading rapid response teams (RRTs). A grassroots initiative was started by two residents and a resuscitation nursing coordinator to address this need. Here, we describe the design and implementation of a resident-led simulation and clinical skills-based curriculum aimed at improving residents’ comfort in leading RRTs. METHODS: From August to September 2021, 56 senior level IM and Med-Peds residents attended a three-hour resuscitation workshop. A mixed educational format with high fidelity simulations, hands-on skills and small group debriefing discussions was implemented. Five scenarios were developed from retrospective hospital-wide RRT data;ventricular tachycardia (VT), supraventricular tachycardia (SVT), ventricular fibrillation, symptomatic bradycardia, and respiratory distress. Skills training included defibrillator use, transcutaneous pacing, adenosine administration, intraosseous line placement and low- and high-flow oxygen delivery devices. Participants were asked to complete a pre- and post-workshop questionnaire. The survey consisted of 7 questions about their comfort level on a 5-point Likert scale. A two-sample t-test was used to assess for difference in mean scores. RESULTS: Residents’ comfort level scores improved significantly in the following: from 3.49 to 4.36 (P< 0.0001) in the initial evaluation of an RRT patient, from 3.14 to 3.84 (P= 0.0026) in regard to thinking quickly during an emergency, and from 2.88 to 4.00 (P< 0.0001) in leading a RRT. There was also a global increase in comfort level scores with the scenarios: “VT” (P=0.0003), “SVT” (P< 0.0001), “symptomatic bradycardia” (P< 0.0001), and “respiratory distress” (P= 0.0324). CONCLUSIONS: Residents’ comfort levels as code leaders encountering various RRT scenarios significantly improved after our three-hour high-fidelity simulation and clinical skills workshop. CLINICAL IMPLICATIONS: Despite the challenges of COVID-19 group gathering restrictions and hospital surges, this training course became a well-received educational project to improve the effectiveness of resident-led RRTs. In response to its success, a pilot two-year curriculum involving more diverse RRT scenarios is currently being launched. The curriculum includes three workshop sessions per year for a multidisciplinary team of residents, pharmacy residents, and nurses aimed at improving code leader effectiveness and teamwork dynamics. DISCLOSURES: No relevant relationships by Tanja Barac No relevant relationships by Christie Brillante No relevant relationships by Lily Cheng No relevant relationships by Paul Cooper no disclosure on file for Cristina Diaz Pabon;No relevant relationships by Shaveta Khosla

Implementation of an Institutional Simulation Curriculum to Teach Team Leadership Skills, Management of Critically Ill Patients, and Emergent Procedures to Pediatric Residents

Background: Simulation in medical training is effective at increasing clinical knowledge, improving comfort with procedures, and teaching crisis resource management skills. Uniquely, simulation can also expose trainees to standardized cases independent of available clinical experience. This is especially important at a time when the COVID-19 pandemic has paradoxically led to decreased emergency department visits and hospitalizations, and, consequentially, decreased clinical opportunities for trainees. We developed and piloted a formal, longitudinal, high-fidelity simulation curriculum for pediatric residents, led by pediatric emergency medicine fellows in a unique, near-peer training program. The project goal was to assess the efficacy of this curriculum at increasing resident selfreported comfort in leading a team, managing critically ill patients, and performing essential emergent procedures. Methods: Six cases were designed by pediatric residents and emergency medicine fellows for the curriculum. Cases were reviewed by faculty members, focused on a critically ill pediatric patient, and included an associated emergent procedure. Three of the cases were used for the study, which was conducted over a four-month period in the 2021 academic year. Study participation was voluntary, and 27 pediatric residents participated, completing up to three cases each. Data was collected as self-reported Likert scales for questions regarding leadership, individual medical knowledge, and comfort with procedures. Surveys were completed prior to the curriculum implementation, following each case, and at study conclusion. To account for expected improvements during traditional residency training, data was also collected for two control cases not used in the study. Wilcoxon Signed-Rank test was used to compare pre- and post-intervention assessments. For significant results, the Dwass-Steel-Chritchlow-Fligner method was used to examine pair-wise comparisons by trainee post-graduate year. Results: Results are summarized in Table 1 and Table 2. There was a significant improvement in self-reported ability to function as team leader, identify and designate roles, effectively organize and minimize noise in the room, effectively use closed loop communication, and access additional resources. There was also an increase in self-reported comfort level with both medical knowledge and performing emergent procedures. There was no significant difference between responses based on trainee year. As expected, residents also reported an improvement in medical knowledge about control cases, although the improvement was less than with the implemented cases. When the size of this effect was compared between implemented and control cases, there was a trend towards significance favoring the simulated cases, suggesting that statistical significance may be achieved with a larger sample size. Conclusion: The implementation of a simulation curriculum can lead to improvements in pediatric resident's self-reported comfort with crisis resource management, team leadership, clinical knowledge, and emergent procedures. The effect on medical knowledge and comfort with procedures may be significantly different than the gains expected naturally over time in pediatric residency training.

Impact of high-fidelity simulation on confidence level of nursing students in the care of COVID-19 patients

The COVID-19 pandemic impacted the education of nursing students across the world. Nursing students were unable to care for patients with COVID-19 at the beginning and potentially throughout nursing school depending on the facility and nursing school restrictions. It was not known how the participation in a high-fidelity simulation will impact the confidence level of nursing students in the care of patients with COVID-19. A mixed methods phenomenological qualitative and survey design was utilized to determine the confidence level of nursing students after participation in a high-fidelity simulation of a patient diagnosed with COVID-19. A convenience sample of fifteen participants completed the research study from a population of second year nursing students at a community college in Northwest Arkansas. The data were collected from focus groups both before and after participation in a high-fidelity simulation and a questionnaire that was completed after participation in a high-fidelity simulation. The interview data were analyzed using NVivo after being transcribed into a Microsoft Word document. The questionnaire data were transferred into a Microsoft Excel spreadsheet and the mean and standard deviation were calculated. The theme related to the impact of participation in a high-fidelity simulation was the importance of communication. The themes related to concerns in caring for patients with COVID-19 was contracting the disease, care, and long-term effects. The theme related to preparation to care for COVID-19 was that the participants felt better prepared to care for patients. The participants of the pilot and research study stated that the participants had improved confidence in caring for patients with COVID-19 after participation in a high-fidelity simulation.Keywords: nursing education, nursing students, COVID-19, high-fidelity simulation, confidence level. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Satisfaction with high-fidelity clinical simulation in cardiopulmonary resuscitation during Covid-19

Objective: To assess the satisfaction of novel nurses with high-fidelity clinical simulation in CPR training, during Covid-19. Methods: Cross-sectional descriptive observational study. Satisfaction Scale in High Fidelity Clinical Simulation was used, a validated 33-item questionnaire with a Likert-type response. Descriptive statistics and non-parametric inferential statistics (Spearman's correlation) were used to analyze the correlation between the variables. Results: N = 35 (100%). The mean overal satisfaction was 4.97 ± 0.17. The items related to the adequacy of the cases to the knowledge of the participants, the ability to provide care to patients, the benefit of simulation and the impact on improving their technical skills were the best scored (mean of 4.97). A positive and strong relationship was found between items: 4-9, and 27-9 (rho = 0.804;p = 0.000). Conclusions: Satisfaction level of novel nurses with the high-fidelity clinical simulation was high, confirming its usefulness in the CPR learning process during Covid-19 or pandemic outbreaks of the same nature.

Neuroscience emergencies simulation teaching

Objectives: Simulation sessions were designed and introduced into the Cardiff University Clinical Neurosciences placement for 4th-year medical students. We present our approach to delivering these simulation sessions, student feedback and our recent experience in the context of the COVID19 pandemic. Design: Three emergency clinical neuroscience simulation scenarios were designed, aimed at final phase (Year 4-5) medical students. Subjects: Final phase (Year 4-5) medical students. Methods: The sessions are delivered weekly during the academic year by the Clinical Neurosciences teaching fellows at The University Hospital of Wales, (UHW) to groups of sixeight students. Student pairs work through each scenario in a high-fidelity simulation suite under the guidance of the tutor. Observing students remain engaged through participation as patient relatives or medical colleagues. Upon completion, learners are debriefed using the Pendleton Model for feedback/reflection, and anonymised feedback is then collected. Results: One year of collated feedback revealed that 90% (109/122) of respondents strongly stated that the sessions were enjoyable, achieved the desired learning outcomes, and advanced their clinical knowledge. One hundred percent of respondents (122/122) agreed that the sessions improved their confidence at managing medical emergencies. Due to the COVID19 pandemic, session modifications included: a larger simulation suite to facilitate social distancing;procurement of appropriate personal-protective-equipment, and a reduction in session size, (<6 students) offset by higher session frequency. Conclusions: Simulation sessions provide a safe, structured environment in which learners can gain confidence managing emergencies. Feedback confirms that our sessions achieve these goals for most students. The possibility of further restrictions on students' exposure to patients remains high due to rising medical student numbers and potential COVID19 resurgences. There may thus be a need to expand the volume and scope of these simulations to cover more scenarios and broader learning outcomes, to ensure future students gain necessary skills and confidence to manage neurological emergencies.

Improving Knowledge and Confidence in the Resuscitation of the Peripartum Patient Through Simulation

Rationale Per the CDC, Since the COVID-19 pandemic, at least 25,000 pregnant women have been hospitalized in the USA, with almost 4% requiring ICU admission. Care of the critically ill pregnant patient is distinct and complex due to changes in physiology, cardiovascular demands, and changes in immune system function. Though cardiac arrest in a pregnant patient is fortunately rare, a poor outcome can be devastating. Existing literature suggests that providers have knowledge deficits regarding recommended resuscitation practices of parturients (Cohen). Additionally, in simulated scenarios, teams exhibit significant deficiencies when scored on Advanced Cardiac Life Support (ACLS) metrics when responding to a simulated pregnant patient in cardiopulmonary arrest (Lipman). We developed a high fidelity simulation in accordance with the 2020 American Heart Association (AHA) ACLS guidelines, with the hope that deliberate practice would improve response to future resuscitation efforts (Panchal). Methods Between October and December 2021, we recruited eighty-six Internal Medicine residents at a large university hospital program to complete knowledge (multiple choice) and confidence (Likert scale) assessment before and after participation in a maternal arrest simulation. For the knowledge assessment component, we utilized questions relating to the resuscitation of a pregnant patient previously published in the anesthesia literature (Cohen). Questions were derived from high yield practices highlighted in the 2020 AHA guidelines for ACLS in the peripartum patient. Data were compared using a two-tailed t-test with unequal variance. Results Regarding clinical knowledge, participants showed significant improvement in correct patient positioning (+34.5%, P = 0.00), epinephrine dosing (+10.53%, P = 0.01), and timing of perimortem delivery (+22.5%, P = 0.00). Participants also had significantly improved confidence in approaching peripartum scenarios (+53%, P = 0.00) and general ACLS scenarios (+63%, P = 0.00). Conclusions Following participation in our simulation, residents demonstrated increased confidence and increased medical knowledge related to the resuscitation algorithm utilized when caring for pregnant patients. In the future, we plan to survey residents to determine if this knowledge and confidence persists or decays over time. (Table Presented).

Training professionals through clinical simulation during the first covid-19 wave

In this article, we share the experience in training healthcare professionals from the Hospital General Universitario of Ciudad Real (HGUCR) through theoretical-practical training with clinical simulation, and the evaluation of its results. Sessions were set with high and low complexity simulation for 40 persons and in reduced groups. The evolution of needs led to an increase in the number of sessions, and the suppression of the Advanced Simulation Room. A 64-session program was held between March and April 2020, in morning and afternoon shifts and for groups of 15 persons, with participation by 41.5% (n= 852) of the healthcare staff from the Integrated Care Management of Ciudad Real. The evaluation questionnaire was answered by 91 persons, who reported high satisfaction with the activity (4.32 scores over 5 at overall level);they valued particularly its utility for work, the clarity of the information, and the practical aspect of the session (simulation). Likewise, 80.6% reported an increase in confidence, and 65.9% reported a reduction in anxiety regarding management of patients with COVID. Even though other causes should be analysed, the proportion of contagion among professionals (10%) was similar to that among the general population. The availability of training spaces with simulation and professionals trained in the design of this type of activities represents a useful and flexible resource for any healthcare demands that might arise. © 2021 DAE Editorial, Grupo Paradigma. All rights reserved.

Low Frequency, High Complexity: Skill Retention Following Proficiency-Based Transesophageal Echocardiography Simulation Training

Study Objectives: Focused transesophageal echocardiography (TEE) is now recommended during cardiac arrest in the emergency department. Implementation of TEE in cardiac arrest management requires additional training for a relatively low frequency and high complexity procedure. Thus, focused TEE curricula requires high proficiency retention rates to succeed. Retention rates of newly acquired TEE knowledge and skill after high fidelity simulation in emergency physicians (EMPs) are unknown. This study’s primary objective was to determine retention of TEE proficiency. Methods: This is an observational study at an academic medical center of TEE naïve EMP faculty using high fidelity TEE simulation. EMP were trained in TEE using web-based didactics and monthly hands-on sessions with a TEE simulator (HeartWorks®) for 4 months. Skills were assessed monthly via direct observation from a TEE expert until proficiency was achieved. Proficiency was defined as the ability to name, describe, and obtain 8 hands-on TEE images during the monthly examinations. The COVID-19 pandemic created a natural wash-out phase where EMPs did not perform any actual or simulated TEE for 6 months after initial TEE training. Unadvertised assessment of TEE skill occurred at months 7 and 8 after initial TEE training to test skill decay. During the assessment, EMPs had two attempts to recall the name of each TEE view, describe probe manipulation needed to achieve the view, and then obtain each view on the TEE simulator. No memory aids, discussion, or feedback were provided during the assessment. Time to obtain all 8 TEE views on the simulator was measured. This analysis is limited to the three most critical TEE views in cardiac arrest: midesophageal 4 chamber (4Ch), midesophageal long axis (LAX), and transgastric left ventricular short axis (TG). Results: Seven EMP were evaluated individually at both 7 and 8 months after initial training. At month 7, correct name recall of the 3 views (4Ch, LAX, TG) was 71%, 57%, and 86% respectively. Correct probe manipulation description of the 3 views (4Ch, LAX, TG) was 86%, 29% and 29%. On the simulator, all three views were obtained by all participants on the first attempt. The average time to obtain all 8 TEE views was 7.3 minutes and 4.6 minutes during the first and second attempts, respectively. During the 8th month assessment, correct name recall of the 3 views (4Ch, LAX, TG) was 100%, 71%, and 100% respectively. Correct probe manipulation description of the 3 views (4Ch, LAX, TG) were 100%, 71%, and 86%. On the hands-on simulator, the three views (4Ch, LAX, TG) were correctly obtained 100%, 86%, and 100% on the first attempt and all participants obtained all three views correctly on the second attempt. The average time to obtain all 8 TEE views was 5.7 minutes and 4.0 minutes during the first and second attempts respectively. Conclusions: Focused, proficiency-based training on a TEE simulator results in durable skills after 6 months. Hands-on image acquisition skills were retained at a greater rate than the names of each view or probe manipulation recall. Time to obtain TEE views decreases over time as participants continued testing on the TEE simulator. These findings can inform curriculum design as widespread utilization of TEE increases. [Formula presented]

High fidelity simulation suite for respiratory physiotherapists

Keywords: Simulation;Respiratory;Education Purpose: On-call physiotherapy can be a daunting and stressful experience. The aim of the high fidelity simulation suite in clinical education is to practice true to life on-call scenarios in a safe, supported and non-judgemental environment. The objectives included: increasing confidence in assessing and treating acutely unwell deteriorating patients;improving communication between physiotherapy colleagues and the MDT and escalating care appropriately. Methods: Six case studies were designed to replicate a true to life situation to challenge clinical reasoning and help improve confidence in an on-call situation. A simulation co-ordinator was present during the simulation to act as the nurse on duty. The participants were encouraged to communicate with each other and work together. They could ask the nurse questions and the control room could feedback the information. The facilitators in the control room observed the simulation, changed clinical observations in response to treatments and responded as the patient through a microphone. The simulation was fluid and whilst it was designed to target specific clinical skills, if clinically reasoned the participants could use any treatments that they felt were appropriate. Colleagues watched the simulation from a viewing room and made notes to feedback to their peers. After the simulation, a de-brief was carried out to enable participants to reflect on the scenario in the form of facilitated discussion to share learning from each other. Results: We have successfully completed 6 scenarios with 20 physiotherapists. Reflections were completed via a group de-brief and participants were given the opportunity to complete a structured reflection for continuing professional development. Participants’ feedback in response to the simulation was very positive, reporting to be “just right” in terms of skill level and beneficial to their clinical and professional development. It has increased participants confidence in assessing and treating acutely unwell patients as well as highlighting the importance of escalating care to the appropriate members of the multi-disciplinary team, identifying strategies for effective communication. Conclusion(s): The experiences created an open learning environment in which mistakes were not judged but lead to a greater potential for continuing professional development via self-reflection and peer reviews. Whilst some found the experience daunting and uncomfortable it has the potential to increase skills, knowledge and confidence, similar to the findings by Mansell, Harvey and Thomas, 2019. High fidelity simulation could increase skills of non-on-call physiotherapy staff quickly to help meet workforce requirements demanded by surges to service demand such as the COVID-19 pandemic. This has highlighted the need to transform clinical education to improve service provision and delivery of on-call physiotherapy service and enhance patient experience. Further investigation is warranted to identify how high fidelity simulation could also enhance collaborative working within the multi-disciplinary team in acutely unwell patients. Impact: The project can be used as evidence for the use of high fidelity simulation I on-call physiotherapy training for: increasing respiratory competence of newly qualified physiotherapists and students;upskilling non-on-call physiotherapists according to workforce requirements and improving multi-disciplinary team working. Funding acknowledgements: Not funded.

Resident acute deterioration simulation series: Does repetition equal improvement?

INTRODUCTION: In 2018, we implemented the Resident Acute Deterioration Simulation Series. High-fidelity simulation is now an integral part of our intern curriculum. This study was an effort to assess this curriculum. Our primary hypothesis was that repeat exposure to the same clinical scenario through simulation would increase critical action completion rate, decrease the time to critical action, and improve intern comfort in dealing with these acute clinical situations. METHODS: Interns completed four high-fidelity simulations over the course of the academic year. For each simulation, a critical action checklist was developed. During each session, interns were timed with the action completion rate and time to each critical action recorded. Interns were debriefed after the scenario. They completed the same scenario within a one month period, again with their action completion rate and time to critical actions recorded. They also completed pre and post session surveys measuring comfort managing acute patient deterioration. RESULTS: Due to the COVID-19 pandemic, we were able to complete and record data for 2 simulation scenarios in their entirety- status epilepticus and status asthmatics. For both scenarios, there was an improvement in action completion rate, with the status epilepticus scenario increasing by 40% (40% of critical actions completed in the first simulation and 80% on repeat) and the status asthmaticus scenario increasing by 60% (40% vs. 100% action completion). There was no statistically significant mean difference in time to action before and after repeat simulation exercise for either simulation scenario. A paired t-test was conducted and we found a statistically significant mean increase of 1.23 in the comfort levels of interns before and after repeat simulation exercise (95% CI [0.47 - 0.84], p < 0.001). CONCLUSIONS: Repeat exposure to simulation improved overall resident critical action completion, however there was no statistically significant improvement in the time to critical action completion. In reviewing this data we can reconcile this, as the more critical actions that are completed, the more time that will take. We were also able to support that repeat simulation exposure increase rate comfort in managing acute patient deterioration.

Improving Humanization Skills through Simulation-Based Computers Using Simulated Nursing Video Consultations.

During the COVID-19 confinement, we converted our clinical simulation sessions into simulated video consultations. This study aims to evaluate the effects of virtual simulation-based training on developing and cultivating humanization competencies in undergraduate nursing students. A quasi-experimental study was conducted with 60 undergraduate nursing students. A validated questionnaire was used to evaluate the acquisition of humanization competencies (self-efficacy, sociability, affection, emotional understanding, and optimism). The development of humanization competencies in this group composed of undergraduate nursing students was evaluated using virtual simulation-based training, comparing the levels obtained in these competencies at baseline (pre-test) and after the virtual simulation experience (post-test). After the virtual simulation sessions, students improved their levels in humanization total score and the emotional understanding and self-efficacy competencies, obtaining large effects sizes in all of them (rB = 0.508, rB = 0.713, and rB = 0.505 respectively). This virtual simulation modality enables training in the humanization of care with the collaboration of standardized patients in the form of simulated nursing video consultations and the performance of high-fidelity simulation sessions that comply with the requirements of best practices. Therefore, this methodology could be considered as another choice for virtual simulation. Additionally, this virtual modality could be a way to humanize virtual simulation.

Assessing Learning Outcomes in Extracorporeal Membrane Oxygenation Simulations With a Novel Simulator and Instructor Application

Simulation plays an important part in enhancing the outcomes of clinical training worldwide. In particular, extracorporeal membrane oxygenation (ECMO) is a life-saving procedure that utilizes a cardiopulmonary bypass circuit to offer short or mid-term respiratory and circulatory assistance to seriously ill patients. After the current Coronavirus (COVID-19) pandemic hit the world, in-person simulations became quite challenging to organize, due to the precautionary physical distancing practices. Due to ECMOs reliance on hands-on training, there is a need for a physical distancing-compatible solution that does not compromise on learning fidelity. Consequently, an assessment application has been developed to assist ECMO centers in carrying out simulations while being assessed by ECMO educators remotely. In this article, we conceptually introduce a revolutionary tablet-based assessment application for convenient, yet sophisticated and structured assessment of ECMO learners as a companion to an ECMO simulator and instructor application. The proposed application allows real-time assessment of the ECMO simulation experience and creates standardized simulation assessment curricula synced with a high-realism ECMO simulator. Initial app prototype showcases basic functionality, low communication latency, and a prototype simulation system that can simulate various ECMO emergencies. IEEE

The Impact of Simulation-Based Education on Nurses' Perceived Predeployment Anxiety During the COVID-19 Pandemic Within the Cultural Context of a Middle Eastern Country.

Anxiety related to the COVID-19 pandemic is prevalent among the nursing workforce and has the potential to affect well-being and performance in the workplace. This paper reports on a joint education/nursing and midwifery workforce quality improvement initiative in the State of Qatar to address an urgent need for COVID-19 preparedness during the second wave of infection. A Simulation-Based Education (SBE) program was developed and delivered over a period of 2 months (February to April 2021) to prepare nurses for deployment to COVID-19 facilities. Perceived anxiety scores related to COVID-19 deployment were collected from 121 nurses before and after SBE attendance. The data demonstrates that SBE is an effective method to reduce deployment-related anxiety among registered nurses.

Satisfaction and Beliefs on Gender-Based Violence: A Training Program of Mexican Nursing Students Based on Simulated Video Consultations during the COVID-19 Pandemic.

The increase in gender-based violence in light of the COVID-19 pandemic is a public health problem that needs to be addressed. Our study aimed to describe the satisfaction with a training program in gender violence victim's attention through simulated nursing video consultations, analyze the beliefs on gender violence in Mexican undergraduate nursing students, and understand the skills that need to be improved. A descriptive cross-sectional study using a mixed-method was carried out with 27 students using a validated satisfaction questionnaire (quantitative data) and conducting scripted interviews (qualitative data) analyzed through the interpretive paradigm. All nursing students expressed a high overall satisfaction with simulated nursing video consultations and positive perceptions about this training program. From the students' perceptions, three first-level categories and their related second-level and specific categories emerged: belief and myths, skills to improve, and learning improvements. A training program in gender violence victim's attention through simulated nursing video consultations, in the middle of a pandemic, was a satisfactory experience for nursing students and beneficial for them, as they gained new knowledge and socioemotional skills. This training program mainly improved the acquisition of communication and emotional management skills for an adequate gender violence victim's attention.

Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic.

Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.