Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial.

BACKGROUND: Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS: We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS: Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS: A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.

Establishing Trust in Pharmaceutical Data with an Independent Verification and Validation Methodology.

Our aim is to demonstrate a general-purpose data and knowledge validation approach that enables reproducible metrics for data and knowledge quality and safety. We researched widely accepted statistical process control methods from high-quality, high-safety industries and applied them to pharmacy prescription data being migrated between EHRs. Natural language medication instructions from prescriptions were independently categorized by two terminologists as a first step toward encoding those medication instructions using standardized terminology. Overall, the weighted average of medication instructions that were matched by reviewers was 43%, with strong agreement between reviewers for short instructions (K=0.82) and long instructions (K=0.85), and moderate agreement for medium instructions (K=0.61). Category definitions will be refined in future work to mitigate discrepancies. We recommend incorporating appropriate statistical tests, such as evaluating inter-rater and intra-rater reliability and bivariate comparison of reviewer agreement over an adequate statistical sample, when developing benchmarks for health data and knowledge quality and safety.

Feasibility of an Interprofessional, Simulation-Based Curriculum to Improve Teamwork Skills, Clinical Skills, and Knowledge of Undergraduate Medical and Nursing Students in Uganda: A Cohort Study.

INTRODUCTION: Many deaths in Sub-Saharan Africa are preventable with provision of skilled healthcare. Unfortunately, skills decay after training. We determined the feasibility of implementing an interprofessional (IP) simulation-based educational curriculum in Uganda and evaluated the possible impact of this curriculum on teamwork, clinical skills (CSs), and knowledge among undergraduate medical and nursing students. METHODS: We conducted a prospective cohort study over 10 months. Students were divided into 4 cohorts based on clinical rotations and exposed to rotation-specific simulation scenarios at baseline, 1 month, and 10 months. We measured clinical teamwork scores (CTSs) at baseline and 10 months; CSs at baseline and 10 months, and knowledge scores (KSs) at baseline, 1 month, and 10 months. We used paired t tests to compare mean CTSs and KSs, as well as Wilcoxon rank sum test to compare group CS scores. RESULTS: One hundred five students (21 teams) participated in standardized simulation scenarios. We successfully implemented the IP, simulation-based curriculum. Teamwork skills improved from baseline to 10 months when participants were exposed to: (a) similar scenario to baseline {baseline mean CTS = 55.9% [standard deviation (SD) = 14.4]; 10-month mean CTS = 88.6%; SD = 8.5, P = 0.001}, and (b) a different scenario to baseline [baseline mean CTS = 55.9% (SD = 14.4); 10-month CTS = 77.8% (SD = 20.1), P = 0.01]. All scenario-specific CS scores showed no improvement at 10 months compared with baseline. Knowledge was retained in all scenarios at 10 months. CONCLUSIONS: An IP, simulation-based undergraduate curriculum is feasible to implement in a low-resource setting and may contribute to gains in knowledge and teamwork skills.

Sim for Life: Foundations-A Simulation Educator Training Course to Improve Debriefing Quality in a Low Resource Setting: A Pilot Study.

INTRODUCTION: Despite the importance of debriefing, little is known about the effectiveness of training programs designed to teach debriefing skills. In this study, we evaluated the effectiveness of a faculty development program for new simulation educators at Mbarara University of Science and Technology in Uganda, Africa. METHODS: Healthcare professionals were recruited to attend a 2-day simulation educator faculty development course (Sim for Life: Foundations), covering principles of scenario design, scenario execution, prebriefing, and debriefing. Debriefing strategies were contextualized to local culture and focused on debriefing structure, conversational strategies, and learner centeredness. A debriefing worksheet was used to support debriefing practice. Trained simulation educators taught simulation sessions for 12 months. Debriefings were videotaped before and after initial training and before and after 1-day refresher training at 12 months. The quality of debriefing was measured at each time point using the Objective Structured Assessment of Debriefing (OSAD) tool by trained, calibrated, and blinded raters. RESULTS: A total of 13 participants were recruited to the study. The mean (95% confidence interval) OSAD scores pretraining, posttraining, and at 12 months before and after refresher were 18.2 (14.3-22.1), 26.7 (22.8-30.6), 25.5 (21.2-29.9), and 27.0 (22.4-31.6), respectively. There was a significant improvement from pretraining to posttraining (P < 0.001), with no significant decay from posttraining to 12 months (P = 0.54). There was no significant difference in OSAD scores pre- versus post-refresher training at 12 months (P = 0.49). CONCLUSIONS: The Sim for Life Foundations program significantly improves debriefing skills with retention of debriefing skills at 12 months.

Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs.

STATEMENT: Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.

Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training.

STATEMENT: Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?

Co-debriefing for simulation-based education: a primer for facilitators.

STATEMENT: As part of simulation-based education, postevent debriefing provides an opportunity for learners to critically reflect on the simulated experience, with the goal of identifying areas in need of reinforcement and correcting areas in need of improvement. The art of debriefing is made more challenging when 2 or more educators must facilitate a debriefing together (ie, co-debriefing) in an organized and coordinated fashion that ultimately enhances learning. As the momentum for incorporating simulation-based health care education continues to grow, the need for faculty development in the area of co-debriefing has become essential. In this article, we provide a practical toolbox for co-facilitators by discussing the advantages of co-debriefing, describing some of the challenges associated with co-debriefing, and offering practical approaches and strategies to overcome the most common challenges associated with co-debriefing in the context of simulation-based health care education.

A simulation-based intervention teaching seizure management to caregivers: A randomized controlled pilot study.

OBJECTIVES: To examine the effect of simulation-based seizure management teaching on improving caregiver competence and reported confidence with managing seizures. The authors hypothesized that simulation-based education would lead to a higher level of demonstrated competence and reported confidence in family members and caregivers. Simulation has not been previously studied in this context. METHODS: A two-group pre- and post-test experimental research design involving a total of 61 caregivers was used. The intervention was a simulation-based seizure curriculum delivered as a supplement to traditional seizure discharge teaching. Caregiver performance was analyzed using a seizure management checklist. Caregivers' perception of self-efficacy was captured using a self-efficacy questionnaire. RESULTS: Caregivers in the experimental group achieved significantly higher postintervention performance scores than caregivers in the control group in both premedication and postmedication seizure management (P<0.01). Additionally, they achieved significantly higher scores on the self-efficacy questionnaire including items reflecting confidence managing the seizure at home (P<0.05). CONCLUSION: Caregivers receiving the supplemental simulation-based curriculum achieved significantly higher levels of competence and reported confidence, supporting a positive relationship between simulation-based seizure discharge education, and caregiver competence and confidence in managing seizures. Simulation sessions provided insight into caregiver knowledge but, more importantly, insight into the caregiver's ability to apply knowledge under stressful conditions, allowing tailoring of curriculum to meet individual needs. These findings may have applications and relevance for management of other acute or chronic medical conditions.

OBJECTIFS: Examiner l'effet de l'enseignement de la prise en charge des convulsions par simulation pour améliorer les compétences des soignants et leur confiance déclarée à traiter les convulsions. Les auteurs postulent que l'enseignement par simulation accroîtrait les compétences démontrées et la confiance déclarée des membres de la famille et des soignants. La simulation n'a jamais été étudiée dans ce contexte. MÉTHODOLOGIE: Une méthodologie de recherche expérimentale en deux groupes avant et après le test a été privilégiée auprès de 61 soignants. L'intervention consistait en un cours par simulation sur les convulsions donné en plus de l'enseignement habituel sur les convulsions présenté au congé. Le rendement des soignants a été analysé au moyen d'une liste de vérification de la prise en charge des convulsions. La perception d'auto-efficacité du soignant a été saisie au moyen d'un questionnaire d'auto-efficacité. RÉSULTATS: Les soignants du groupe expérimental ont obtenu des indices de rendement considérablement plus élevés après l'intervention que ceux du groupe témoin, tant avant qu'après la prise en charge des convulsions par médication (P<0,01). De plus, ils ont obtenu des indices considérablement plus élevés au questionnaire d'auto-efficacité, y compris les questions reflétant la confiance à soigner les convulsions à domicile (P<0,05). CONCLUSION: Les soignants qui avaient eu un cours par simulation ont obtenu des taux de compétence et de confiance déclarée beaucoup plus élevés. Ces résultats corroborent la relation positive entre l'enseignement sur les convulsions par simulation au congé et la compétence et la confiance des soignants envers la prise en charge des convulsions. Les séances de simulation donnaient un aperçu des compétences des soignants, mais, surtout, de leur capacité à appliquer leurs connaissances dans des conditions stressantes, ce qui permet d'adapter le cours à leurs besoins. Ces observations peuvent être utiles et pertinentes pour la prise en charge d'autres maladies aiguës ou chroniques.

Postresuscitation debriefing in the pediatric emergency department: a national needs assessment.

OBJECTIVES: The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. METHODS: A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. RESULTS: Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. CONCLUSION: PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.

Helping without harming: the instructor's feedback dilemma in debriefing--a case study.

INTRODUCTION: Simulation instructors often feel caught in a task-versus-relationship dilemma. They must offer clear feedback on learners' task performance without damaging their relationship with those learners, especially in formative simulation settings. Mastering the skills to resolve this dilemma is crucial for simulation faculty development. METHODS: We conducted a case study of a debriefer stuck in this task-versus-relationship dilemma. DATA: The "2-column case" captures debriefing dialogue and instructor's thoughts and feelings or the "subjective experience." ANALYSIS: The "learning pathways grid" guides a peer group of faculty in a step-by-step, retrospective analysis of the debriefing. The method uses vivid language to highlight the debriefer's dilemmas and how to surmount them. RESULTS: The instructor's initial approach to managing the task-versus-relationship dilemma included (1) assuming that honest critiques will damage learners, (2) using vague descriptions of learner actions paired with guess-what-I-am-thinking questions, and (3) creating a context she worried would leave learners feeling neither safe nor clear how they could improve. This case study analysis identified things the instructor could do to be more effective including (1) making generous inferences about the learners' qualities, (2) normalizing the challenges posed by the simulation, (3) assuming there are different understandings of what it means to be a team. CONCLUSIONS: There are key assumptions and ways of interacting that help instructors resolve the task-versus-relationship dilemma. The instructor can then provide honest feedback in a rigorous yet empathic way to help sustain good or improve suboptimal performance in the future.

Development of a team performance scale to assess undergraduate health professionals.

PURPOSE: Interprofessional simulation-based team training is strongly endorsed as a potential solution for improving teamwork in health care delivery. Unfortunately, there are few teamwork evaluation instruments. The present study developed and tested the psychometric characteristics of the newly developed KidSIM Team Performance Scale checklist. METHOD: A quasi-experimental research design engaging a convenience sample of 196 undergraduate medical, nursing, and respiratory therapy students was completed in the 2010-2011 academic year. Multidisciplinary student teams participated in a simulation-based curriculum that included the completion of two acute illness management scenarios, resulting in 282 independent reviews by evaluators from medicine, nursing, and respiratory therapy. The authors investigated the underlying factors of the performance checklist and examined the performance scores of an experimental and a control team-training-curriculum group. RESULTS: Participation in the supplemental team training curriculum was related to higher team performance scores (P < .001). All teams at Time 2 achieved higher scores than at Time 1 (P < .05). The reliability coefficient for the total performance scale was α = 0.90. Factor analysis supported a three-factor solution (accounting for 67.9% of the variance) with an emphasis on roles and responsibilities (five items) and communication (six items) subscale factors. CONCLUSIONS: When simulation is used in acute illness management training, the KidSIM Team Performance Scale provides reliable, valid score interpretation of undergraduates' team process based on communication effectiveness and identification of roles and responsibilities. Implementation of a supplementary team training curriculum significantly enhances students' performance in multidisciplinary simulation-based scenarios at the undergraduate level.