Barriers to Engagement in Surgical Simulation Education

Introduction: The COVID-19 pandemic has negatively impacted clinical experience and case volumes. Surgical simulation is now an even more powerful training tool and, to maximize potential, we must ensure learner engagement. Our aim was to identify barriers to surgical simulation engagement and strategies to mitigate these. Method(s): Scoping search was performed with a trained librarian of PubMed, EMBASE and Web of Science. Title and screening were completed with inclusion criteria: articles describing barriers to engagement with surgical simulation. After full text screening, data was extracted from included articles: type of study, MERSQI score, type/number of participants, barriers to engagement and strategies to mitigate these. Result(s): Twenty-nine manuscripts were included with 951 faculty and 2,467 residents. The majority (86%) were in high income countries (HIC) and four in LMICs. Most were surveys (22/29), and five involved semi-structured interviews/focus groups. Mean adjusted MERSQI score was 8. Commonest barriers to HIC engagement were learner clinical duties (9/25), lack of learner time (13/25), lack of learner interest/motivation (9/25) and lack of faculty time or interest to participate (12/25). In LMIC, commonest barriers were lack of simulation lab/equipment (4/4), cost (3/4) and inadequate supervision (3/4). Strategies to improve HIC engagement were mandatory/protected resident simulation training (9/25) and, in LMIC, low cost simulators (4/4) and sharing resources (2/4). Conclusion(s): Identification of barriers to simulation engagement is crucial for successful learning. Given the increased importance of simulation education due to the COVID-19 pandemic, surgical educators should strategize to maximize engagement.

Analysis of Maternal Critical Care at the Mid Yorkshire Hospitals NHS Trust

Introduction: Perinatal admissions to Critical Care are increasing due to rising maternal age, obesity, and comorbid disease.1 The MBRRACE Report 2021 stated that of 191 maternal deaths in 2017-2019, only 17% had good care.2 Since the COVID-19 pandemic, there was a subjective increase in perinatal admissions to Mid Yorkshire Hospitals Critical Care. Objective(s): To investigate whether MYH Critical Care maternal admissions have increased, if there has been a change in admission trends and to evaluate the care of critically ill pregnant and postpartum women compared to FICM standards.3 Methods: Retrospective audit of notes of all pregnant and up to 6 weeks postpartum women admitted to critical care between 24/02/2019 and 05/09/2021. Data collected included gestation, duration of admission, organ support, days reviewed by obstetrics and mortality outcomes. Result(s): * There was 1 maternal death and 3 fetal deaths during the study period * 50% of the admissions were antenatal and 50% were postnatal * During the COVID-19 pandemic we have seen a 47% increased rate of admissions from 1 per 29 critical care bed days to 1 per 19 critical care bed days * 50% of patients were supported with ventilation and CPAP during admission, 13% with CPAP only. Prior to the COVID pandemic, no maternal admission required CPAP on our Critical Care unit during the data collection period * 63% of patients were reviewed by obstetrics at least one during their admission, but obstetric review was documented on only 37 of 112 patient days * There is no critical care SOP for perimortem Caesarean section * There is no specialist neonatal resuscitation equipment available on ICU * There is no named ICM consultant responsible for Maternal Critical Care * There is no SOP for support of maternal contact with baby * There is no critical care/obstetric services MDT follow-up Conclusion(s): This study shows that Critical Care admissions have increased, and that care does not follow all the FICM recommendations. Considering this, the following recommendations have been made: * Introduce an SOP and simulation training for peri-mortem section * Introduce neonatal resuscitation equipment box * Nomination of a named ICM Consultant lead for Maternal Critical Care to ensure quality of care and act as liaison * Train critical care staff in supporting contact between a mother and baby, with support from midwifery services * Introduction of Obstetric and Critical Care MDT follow-up.

Immersive Technologies - The future for tracheostomy education?

Introduction: The need for standardised education on tracheostomy care is well recognised.1 Staff frequently report a lack of confidence in caring for those with tracheostomies, as well as the management of adverse events as they occur.2 Over the past decade, healthcare providers have developed strategies to educate staff, however, the covid-19 pandemic has severely hampered the ability to provide this necessary training due to restrictions on access to training rooms, the need for social distancing and the significant clinical demands placed on both trainers and trainees.3 The potential for immersive technologies to augment healthcare training is gaining interest exponentially.4 However, its effectiveness is yet to be clearly understood and as such it is not yet common within healthcare education.5 Based on the above, we aimed to explore the potential of these immersive technologies to overcome the current challenges of tracheostomy education, and to develop future strategies to use immersive technology in healthcare education. Method(s): We received a 400,000 grant from Cardiff Capital Region (CCR) to undertake a rapid innovation project overseen by the SBRI centre of excellence. The project consisted of 3 main phases: 1) feasibility;2) development;and 3) testing. The project was officially launched in April 2021 and lasted 12 months. Project governance was provided via the SBRI for clinical excellence, a project board with representation from Welsh Government, Cardiff University and Cardiff and Vale UHB, and a project team with clinical expertise in both the delivery of tracheostomy education and the provision of simulation training in healthcare. Result(s): Phase 1: During phase one 4 industries were successful and received up to 30,000 to explore the feasibility of immersive technology to support tracheostomy education. The industries were Rescape, TruCorp, Aspire2Be and Nudge Reality. During the feasibility phase all industries focused on the emergency management process utilising existing NHS Wales tracheostomy education resources and the national tracheostomy safety programme. Phase 2: For phase 2, Rescape and Nudge Reality were chosen to develop the technology. These industries continued to work in conjunction with the project team to capture the core elements of tracheostomy care, including multi-user emergency management scenarios. Additional content was also added for bronchoscopy and insertion of intercostal drains. Phase 3: Testing of both solutions was undertaken over an 8-week period, across 6 Health Boards in NHS Wales. The results of the testing will be analysed and available for presentation in due course. Provision findings demonstrate good face and content validity with high levels of user satisfaction. Discussion / Conclusion(s): The provision of essential tracheostomy education has been severely affected by the covid-19 pandemic. Evolving immersive technologies have the potential to overcome these challenges and improve the effectiveness and efficiency of education packages in tracheostomy care and wider. Through this CCR grant, in conjunction with industry, we have developed two solutions with the potential for widescale procurement and future research on the use of immersive technologies within healthcare.

Our journey from the Peripatetic Ultrasound Trainers to the Ultrasound Training Academy - HEE (South East)

In 2016, an innovative project of three ultrasound trainers evolved to support multi-professional trainees in Obstetric and Gynaecology ultrasound across the Wessex region. The aim of the project was to deliver a high-quality ultrasound training programme. One of the project's successes resulted in establishing the Sonographer Training Network Forum which allowed ultrasound leads from seven Trusts to meet and share ideas, which ultimately led to the development of regional ultrasound guidelines. From 2016 to early 2020, we have supported 75 trainees in O&G ultrasound. The vision was to create a dedicated ultrasound training centre to support trainees in a safe environment. Late 2019, with the support and funding from Health Education England South-East, the plans were set in motion to create the first Ultrasound Training Academy in the South- East Region. A briefing paper was submitted to the Trust Investment Group for approval. Approval from TIG acknowledged the Trust's support in the project as well as supporting the sonography workforce. This began the search for space that would accommodate the academy. Frustratingly, COVID stopped all activities, however, with reflection, COVID gave us the time to plan accordingly for the Ultrasound Training Academy. Without the normal pressure of a time frame, it was an opportunity to find an ideal location as well as purchasing the required equipment befitting the academy. The Ultrasound Training Academy - HEE (South-East) is based in the Princess Anne Hospital (University Hospital Southampton NHS FT). The advantages based within a hospital setting allowed the academy to follow the Trust's governance as well as absorbing some of the capacity from the ultrasound department. We have two ultrasound rooms and a dedicated space for simulation training. We have plans to create a third ultrasound room.

Hand Surgical Simulation in the Pandemic Era: A Systematic Review

Introduction: The COVID-19 pandemic and duty hour restrictions have illuminated a role for surgical simulation in trainees that permits meaningful technical experience outside the operating room. There is a need for the implementation of surgical simulation infrastructure adjacent to clinical training with practical considerations for complexity and cost. This systematic review analyzes surgical simulations that train hand surgical techniques and procedures with subjective or objective competency assessment. Method(s): A systematic review was conducted according to PRISMA- P guidelines using the PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane databases. Selected search terms included procedures relevant to the field of hand surgery and various types of simulation training. Data, including skills and techniques taught and assessed, model type, equipment, cost, and emphasis placed in training for each article, were extracted. Result(s): Of 2,519 articles, 40 met inclusion criteria. Models were described as: synthetic benchtop/3D-printed (40.0%), animal (22.5%), cadaveric (20.0%), augmented and virtual reality (AR/ VR;12.5%), and other computer simulation (12.5%). Three models incorporated both a physical benchtop component and an AR/ VR component. The procedures most represented included tendon repair (30.0%), fracture fixation (27.5%), wrist arthroscopy (15.0%), and carpal tunnel release (15.0%). Sixty-five percent of articles emphasized the importance of surgical simulation in a surgeon's training. Conclusion(s): A diversity of surgical simulation models exist for the practice of various aspects of hand surgery. The existing literature demonstrates their utility for increasing expertise with surgical techniques and procedures in a low-risk setting.

Implications of practical activities in the Skills and Simulation Laboratory on students' motivation and feelings

Objective: to verify the implications of practical activities in the Skills and Simulation Laboratory on the motivation and feelings expressed by undergraduate students when returning to face-to-face activities after the social isolation caused by COVID-19 pandemic. Method: a quasi -experimental study, with a single group and of the pre-and post-test type, carried out through an educational intervention based on skills training on medication administration and venipuncture, with medical students from a Brazilian public university. The sample was comprised by 47 students. The instruments of students' characterization and self-perceived feelings and the Situational Motivation Scale were used for data collection. Results: in the sample, 98% mentioned the lack of practical activities during the pandemic. The most frequently described feeling was anxiety. After carrying out the activity, there was a change in the frequency of expressed feelings, although there was no significant change in motivational levels. External Regulation (5.1 -5.6), Identified Regulation (6.1 -6.4) and Intrinsic Motivation (5.6 -6.0) presented high results, showing similarity to the feelings reported by the learners. Conclusion: motivation is essential for effective learning and the use of active methodologies reinforces skills built in an affective way in the students facing the learning process.

The comparative perceived effectiveness of simulation versus case study learning methods in the company training of digital marketers

Marketers must adapt to the challenges created by the COVID-19 pandemic, which accelerated innovation and changes across the world, but specifically in the digital marketing industry.Consumer demand and purchasing behaviors have changed fundamentally, and these current trends are affecting how marketers utilize digital marketing. As a result, firms must rely on innovation in marketing strategies for survival. The new expectations from consumers result in marketers determining what learning method for their staff offers a higher retention and implementation advantage to stay abreast of changes in their industry. This study analyzedemployees' preferred learning methods in the digital marketing sphere. This study adds to the body of knowledge on determining the retention and implementation of two learning methods:simulation training and case study learning. These two learning methods in relation to marketing professionals led to the generation of recommendations for employers to improve learning retention for their employees. To this end, a primary research question was identified: How does the selection of a learning method for marketing professionals improve the employees' retention and implementation of new material taught? Other related research areas were also explored,namely, whether age, experience, or gender impact the preferred learning material and whether different marketing categories resonate with different learning methods, resulting in more productive results. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Virtual-Reality Simulation Can Teach VATS Lobectomy to Lobectomy-Naive Trainees Within 4 Weeks: A Cross-Over Study

Objective: The aim of the cross-over study was to evaluate skill acquisition in lobectomy-naive surgical trainees completing a 4-week program to learn VATS lobectomy on a virtual reality surgical simulator (LapSim). Method(s): Lobectomynaive surgical trainees (year 1 and 2 postgraduation) were enrolled during the COVID pandemic from March to June 2021 for a 4-week course on basic VATS skills and right upper lobectomy. They were divided into 2 groups. Both groups completed an initial assessment, Group 1 completed the course first, then both groups completed a second assessment. Then Group 2 completed the course, and both groups completed a final assessment. Skill acquisition was assessed using instrument movement, procedure time, and blood loss for both the trained operation and an untrained operation (left lower lobectomy). Result(s): 16 trainees were enrolled, 10 completed the training program. There was no difference in baseline assessment. After Group 1 completed the training, they outperformed Group 2 in all metrics but this did not reach statistical significance. After training Group 2 at week 8, there was no longer difference in performance from Group 1. After completing the training program, the entire cohort showed a significant improvement in basic VATS tasks as well as lobectomies. There was statistically significant improvement in both right upper lobectomy instrument movement (P=0.002) and time (P=0.009) and left lower lobectomy time (P=0.047). Conclusion(s): This study showed that VATS simulation training on LapSim allowed junior trainees to learn advanced VATS resection during a pandemic and within 4 weeks. The acquired skills is transferrable to untrained operations. (Table Presented).

Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training.

The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.

Virtual Reality simulator's effectiveness on the spine procedure education for trainee: a randomized controlled trial.

Background: Since the onset of the coronavirus disease 2019 pandemic, virtual simulation has emerged as an alternative to traditional teaching methods as it can be employed within the recently established contact-minimizing guidelines. This prospective education study aimed to develop a virtual reality simulator for a lumbar transforaminal epidural block and to demonstrate its efficacy. Methods: We developed a virtual reality simulator using patient image data processing, virtual x-ray generation, spatial registration, and virtual reality technology. For a realistic virtual environment, a procedure room, surgical table, C-arm, and monitor were created. Using the virtual C-arm, X-ray images of the patient's anatomy, the needle, and indicator were obtained in real time. After simulation, trainees could get feedback from adjusting the visibility of the structures (such as skin and bones). The training of lumbar transforaminal epidural block using the simulator was evaluated in 20 inexperienced trainees. Trainees' procedural time, rating score, number of C-arm taken, and overall satisfaction were recorded as primary outcomes. Results: The group using the simulator showed a higher global rating score (p = 0.014), reduced procedural time (p = 0.025), reduced number of C-arm uses (p = 0.001), and higher overall satisfaction score (p = 0.007). Conclusions: We created an accessible and effective virtual reality simulator that can be used to teach a lumbar transforaminal epidural block, without radiation exposure, for inexperienced trainees. The results of this study indicate that the proposed simulator will prove to be a useful aid for teaching a lumbar transforaminal epidural block.

[Simulators and other tools in orthopedic-trauma surgery training]. / Simulatoren und andere Hilfsmittel in der orthopädisch-unfallchirurgischen Weiterbildung.

INTRODUCTION: The classic paradigm of "learning on the patient in the operating room" is more and more in conflict with the growing requirements of cost-efficient work and patient safety. With the technology available today for simulator systems, the accessibility of digital tools and the development of a metaverse as a digital meeting place result in various application scenarios and alternatives to classic orthopedic training. SIMULATORS: First VR-desktop simulations in orthopedics and traumatology were developed more than 20 years ago. VR-desktop simulators consist of a computer with a video screen and a joint model. Different instruments can be paired with this system and allow haptic feedback. With innovative software, numerous training programs can be selected, and the user receives precise feedback on their performance. Immersive VR simulators have also played an increasingly important role in recent years. OTHER DIGITAL TOOLS: The use of digital media such as audio and video podcasts as learning and information sources increased in the context of COVID-19. There is also an increasing number of orthopedic and trauma surgery topics on social media platforms. In all fields, however, there is a risk of the spread of misinformation. A quality standard must be maintained. EFFECTIVENESS AND UTILITY OF THE TRAINING: In order to evaluate simulators and their value as a training tool, it is important to comply with various validity criteria. Transfer validity plays an essential role for clinical application. Various studies demonstrate that the skills learned on simulators can also be successfully transferred to real clinical scenarios. DISCUSSION: A lack of availability, costs and high effort are limitations of classic training methods. In contrast, there are versatile use cases of VR-based simulations that are individually adapted to the trainees and cannot endanger patients. The still high acquisition costs, technical obstacles and the not yet widespread availability are limiting factors. The metaverse still offers unimaginable possibilities today to transfer VR-based applications to experimental learning methods.

PROFESSIONAL TRAINING OF MASTERS OF DENTISTRY WITHIN QUARANTINE RESTRICTIONS AND MARTIAL LAW: A COMPARATIVE ANALYSIS OF EDUCATIONAL PROCESS.

OBJECTIVE: The aim: To present a comparative analysis of the educational technologies effectiveness that were used in the process of professional training of masters of dentistry during quarantine restrictions and martial law. PATIENTS AND METHODS: Materials and methods: To perform the set tasks, the following the empirical methods of scientific research were used: quantitative data were collected based on analyzing the results of students' educational achievements, as well as implementing special questionnaire that was sent to the students of the Faculty of Dentistry of NMU; qualitative data were collected with the help of several focus groups formed from students and teachers of the faculty. Analysis was undertaken using statistical methods (Pearson's test), and qualitative data were analyzed descriptively. RESULTS: Results: This paper analyzes the effectiveness of educational technologies used during quarantine restrictions and martial law, the role of phantom classes in providing professional training of dentistry specialists, summarizes the results of a comprehensive analysis of scientific literature, teaching experience at the dental faculty and the results of sociological research (student surveys, discussion in focus groups). CONCLUSION: Conclusions: The outbreak of the COVID-19 pandemic and the full-scale war unleashed by the russian federation in Ukraine forced to quickly find and implement mixed forms of teaching future masters of dentistry, which, in combination with digital technologies, enables implementing high-quality and effective training.

Incorporating Simulation Based Training in the Initial Training of New Graduate Registered Nurses in a Blood and Marrow Transplant (BMT) Unit

Topic significance and study purpose/background/rationale: Nursing schools today have placed greater emphasis on online learning leading to limitations in clinical experience and communication skills. Staff turnover has also led to an increase in novice nurses entering the BMT specialty who are then trained by those with limited experience themselves emphasizing the need to incorporate new teaching methods in our nursing residency programs. Methods, intervention, and analysis: An orientation program was developed incorporating nursing competencies, communication skills, critical thinking, and oncology/BMT knowledge aligned with the hospital's new graduate RN residency program. In addition to formal classroom education covering basic nursing skills, institutional protocols, and foundational oncology/BMT knowledge, simulation scenarios were developed reviewing multiple complications often seen in a BMT unit, including febrile neutropenia, septic shock, and cellular therapy infusion reactions. Debriefing and surveys were conducted evaluating the nurse's level of comfort with the scenarios prior to and after simulation. Findings and interpretation: Each simulation lasted thirty minutes followed by one hour of debriefing, analysis, and evaluation. Individual nursing interventions utilized in the scenario were aligned with appropriate hospital policies and best nursing clinical practices. A survey was conducted rating the level of comfort before and after the simulation. 100% of the nurses reported feeling more comfortable with the situations reviewed after undergoing the simulation. Feedback also included novice nurses' lack of experience with oncologic emergencies during their orientation as preceptors often felt compelled to intervene leaving the resident with less hands-on experience. The novice nurses also felt the simulation provided them with the practical clinical experience that had been limited during the COVID-19 pandemic when more novice nurses were training simultaneously with less numbers of cellular therapy patients. Discussion and implications: Simulation provides a safe and effective way of teaching novice nurses about the cellular therapy specialty and common complications when hands-on experience is limited. By incorporating simulation into training, the nurse residents feel more comfortable practicing independently. Greater confidence, enhanced critical thinking, and improved patient outcomes were advantages noted with this educational method. The benefits and success of these simulations will lead to more scenarios being incorporated into training as the BMT specialty continues to evolve.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Integrating Virtual Simulation into Nursing Education: A Roadmap

Background: Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulation (VS). The COVID-19 pandemic further highlighted the need for educators to investigate alternative learning opportunities.Methods: A quantitative cross-sectional study was conducted with pre-licensure and advanced practice nursing students. They participated in a VS learning experience that was evaluated using the System Usability Scale (SUS)(R), the Clinical Learning Environment Comparison Survey (CLECS 2.0), and the Simulation Effectiveness Tool-Modified (SET-M).Result: 197 pre-licensure and 11 advanced nursing practice students completed post-simulation eval-uations. The results from the SUS scale found the overall virtual system effective. Evaluating the CLECS tool found students' perceived experience was relatively similar for face-to-face simulation and screen-based simulation. The SET-M indicated students rated the VS simulation experience positively. Conclusion: VS for nursing education can be an effective experiential learning tool.

The Development and Implementation of Online Video-based Simulation Training on Strengthening Pre-service Teachers' Competence in Bullying Intervention

COVID-19 has severely impacted the world since December 2019, and because of its highly infectious nature, many countries around the world have taken lockdown measures to prevent the virus from spreading unchecked, resulting in ramifications for higher education as many institutions have been forced to implement distance education. The question of how to develop a teaching method suitable for teacher education programs that place particular importance on practice in classroom settings warrants particular concern. Online video-based simulation training (OVST) as a teacher training method holds promise for addressing this issue by allowing learners to increase their opportunities to apply theory-based knowledge in real educational practice, reducing the theory-practice gap. OVST can also be distributed through online learning environments that offer easily repeated large-scale usage at lower cost to a variety of introvert/extravert learners through individual learning trajectories. In this vein, this study aims to introduce a method for developing OVST used to enhance pre-service teacher competence (by immediately intervening during school bullying, or CIISB) and clarifying the efficacy of types of OVST (with and without debriefing) on strengthening pre-service teachers' CIISB skills. A total of 98 pre-service teachers from four Taiwanese universities and colleges participated in this study that adopted a quasi-experimental design approach. Each of these pre-service teachers was assigned to one of three groups: OVST with debriefing, OVST without debriefing, and an OVST control condition, with a video-based instrument used to map pre-service teachers' CIISB-related perception, interpretation, and decision-making skills (PID skills). The results of a mixed-model two-way ANOVA analysis indicated that both types of OVST were more effective than the control condition in improving pre-service teachers' CIISB. OVST with debriefing was also more effective than the OVST without debriefing, suggesting that OVST with debriefing is a promising way to develop pre-service teachers' clinical competencies, while also offering a valuable resource for teacher education training methods, particularly when conducted under pandemic conditions.

[Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students].

PURPOSE: This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. METHODS: A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. RESULTS: The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. CONCLUSION: The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

The Importance of Simulation in Vascular Training: A Literature Review

Funding: None. Synopsis: Once a subspecialty of general surgery, vascular surgery has transitioned to an entity with its own training paradigms and board certification. Part of this transition is due to many advances in technology, devices, and techniques. The management of vascular pathology that was at one time relegated to open procedures has now shifted to a field where endovascular options can be performed. These advances come with the concern of training competent vascular surgeons who are already under stringent duty hours restrictions, deal with heightened scrutiny associated with patient safety, and recently have had their operative volumes decreased due to COVID-19-related cancellations and shut downs. Simulation has been offered as a possible means to mitigate these limitations and shift the learning curve to competency. Despite this, little is known regarding the efficacy and best practices of incorporating simulation into vascular training. Method(s): A literature review was performed of English language articles on the EBSCO database without publication date restrictions on vascular surgery simulation. Search terms included vascular surgery simulation, endovascular surgery simulation and vascular education simulation. Additional studies were found by searching reference lists of relevant articles. All study designs were included if they pertained to simulation for open vascular or endovascular procedures. Simulator fidelity, educational efficacy, validity of the simulator, transfer of skill, and cost and time effectiveness were assessed. With endovascular simulation we assessed the amount of handling error, procedure time, fluoroscopy time, and the amount of contrast used. Result(s): Using these methods, twenty-two articles were identified. In regards to simulation used for open procedures in vascular surgery, the analysis showed that the most important factors in determining efficacy were the involvement of expert level (attending) proctors and the use of high fidelity (cadaver) simulators. Other important determinants were the use of trainee-specific models and the employment of specific learning objectives. The use of virtual endovascular simulators in enhancing trainee competence is supported by better quality data in the literature. Specifically measured and proven outcomes are a decrease in catheter handling errors, a reduction in both procedure and fluoroscopy time, and a diminished volume of contrast used. Endovascular simulators also allowed for reliable and consistent assessment of operator performance and showed a good transfer of skill to actual cases. Conclusion(s): Simulation is an important tool for both the assessment and training of vascular residents. The use of expert proctors, appropriate simulators, and well-designed curricula are the keys to success. Further studies connecting simulation training to patient-centered outcomes are still needed to define the true potential of these tools and methods. Institution: Lousiana State University HSC, New Orleans, LACopyright © 2022

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.

Telesimulation in healthcare education: A scoping review.

OBJECTIVES: To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN: A scoping review. DATA SOURCES: A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS: Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS: 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION: Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.