Teaching nursing students: As an umbrella review of the effectiveness of using high-fidelity simulation.

AIM: To conduct an umbrella review of the effectiveness of using high-fidelity simulation in nursing student teaching, thereby supporting continuous improvement in teaching practitioners' implementation of high-fidelity simulation intervention strategies. BACKGROUND: Several systematic reviews have investigated the effectiveness of high-fidelity simulation in nursing student teaching in recent years. However, conclusions vary and a systematic assessment is lacking. DESIGN: This review encompasses an umbrella review. METHODS: A search of PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted to retrieve data on an umbrella review of high-fidelity simulation effectiveness in nursing student teaching from database inception to November 2023. The quality of the included systematic reviews was independently assessed by two reviewers using the AMSTAR 2 and PRISMA scales. Outcome indicators from the included systematic reviews were graded using the GRADE system. RESULTS: Twelve systematic reviews focusing on high-fidelity simulation effectiveness in nursing student teaching were included. Notably, all 12 systematic reviews exhibited very-low methodological quality, with 9 exhibiting some degree of reporting deficiencies, 2 exhibiting severe information deficiencies and 1 reporting relatively complete information. A total of 22 outcome indicators and 53 pieces of evidence were included. The results revealed 15 pieces of low-quality evidence and 38 pieces of very-low-quality evidence. Mounting evidence suggests that high-fidelity simulation teaching effectively enhances nursing students' theoretical performance, practical skills and various clinical comprehensive abilities, highlighting a positive teaching effect. However, further validation through high-quality, large-sample studies is warranted. CONCLUSION: The overall evidence quality of the current systematic reviews evaluating high-fidelity simulation effectiveness in nursing student teaching is low. Additionally, the methodological quality and the degree of reporting standardization require further improvement. Therefore, high-quality, large-sample randomized controlled trials are essential for further substantiating high-fidelity simulation effectiveness in nursing student teaching.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study.

OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g. RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). CONCLUSION: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

Feasibility and evaluation of high-fidelity simulation education for acute clinical toxicology.

To prepare medical students appropriately for the management of toxicological emergencies, we have developed a simulation-based medical education (SBME) training in acute clinical toxicology. Our aim is to report on the feasibility, evaluation and lessons learned of this training. Since 2019, each year approximately 180 fifth-year medical students are invited to participate in the SBME training. The training consists of an interactive lecture and two SBME stations. For each station, a team of students had to perform the primary assessment and management of an intoxicated patient. After the training, the students completed a questionnaire about their experiences and confidence in clinical toxicology. Overall, the vast majority of students agreed that the training provided a fun, interactive and stimulating way to teach about clinical toxicology. Additionally, they felt more confident regarding their skills in this area. Our pilot study shows that SBME training was well-evaluated and feasible over a longer period.

Assessment of high fidelity simulation with actors in palliative care in nursing students: a mixed methods study.

OBJECTIVE: The most effective training methods are experiential, including those focused on experiences and emotions. Clinical simulation, especially high-fidelity simulation, is one of the most effective methodologies for the acquisition of competencies in care like palliative care. The simulation with actors can train future healthcare science professionals: in technical, intellectual, or interpersonal skills. The objective is to evaluate high-fidelity simulation with actors as a tool in palliative care training for nursing students. METHOD: Over three years, the study was conducted in a Faculty of Nursing of the south of Spain with nursing students. A mixed methods study with sequential explanatory design in three moments was conducted: (1) Quasi-experimental study in a single group (n = 12) before and after attending the palliative care course with Clinical Simulation with actors to assess the communication skills (CICAA scale), (2) Qualitative study with phenomenological perspective after Clinical Simulation (174 reflective students' narratives), (3) Cross-sectional observational study, one year later, to assess the transfer of knowledge and skills to the clinical practice (71 students). RESULTS: Students who interacted with actors in Clinical Simulation improved their communication skills and the ability to establish an effective helping relationship with both end-of-life patients and their families. The students perceived the Clinical Simulation as an innovative learning methodology that is useful to encourage reflection and transfer of learning during their clinical internship. CONCLUSIONS: Standardization of the use of active learning methodologies is recommended for a better acquisition of transversal skills such as communication skills in palliative care.

Great geriatric syndromes: Acquisition of nursing competencies and undergraduate nursing students' perceptions through high-fidelity simulation training.

BACKGROUND: The constant increase in the aging population will lead to a greater demand for high-quality nursing care for this population over the coming years. Early detection and proper treatment of great geriatric syndromes are essential and, consequently, geriatric nurses must acquire the necessary competencies for their adequate management. OBJECTIVES: To evaluate the acquisition of the necessary nursing competencies for adequate management of great geriatric syndromes through high-fidelity simulation training and to explore undergraduate nursing students' perceptions about this training. METHODS: 80 undergraduate nursing students participated in a mixed methods study. The simulated scenarios recreated older patients with diagnoses of great geriatric syndromes using standardized patients. Nursing competencies were evaluated using a verification list. 10 focus groups were interviewed to explore their perceptions, conducting a qualitative study with an interpretative approach. RESULTS: Most of the students (86.55 %) acquired the necessary nursing competencies for adequate management of great geriatric syndromes. The nursing students stated that they improved their communication skills (provide solutions to older patients; facilitate and redirect the clinical interview; contrast the information given to the patient), psychological resources (psychological support; physical contact and accompaniment; empathy and persuasion), and geriatric knowledge (identify their lack of knowledge; recognize their limits in terms of healthcare and refer to other health professionals; know the patient's conditions) to provide quality care for older people diagnosed with great geriatric syndromes. CONCLUSIONS: The use of high-fidelity simulation training including standardized patients makes it easier for nursing students to acquire the necessary nursing competencies for adequate management of great geriatric syndromes and improve their clinical skills. Geriatric nursing education should focus on equipping nursing students with the necessary clinical skills, integrating high-fidelity simulation training in geriatric study plans to train students in the nursing care to be provided to older patients, and preparing them for real clinical practice.

Impact of high-fidelity simulation exposure of nursing students with their objective structured clinical examination: A quasi-experimental study.

AIM: The study aimed to establish the impact of high-fidelity simulation (HFS) in the objective structured clinical examination (OSCE) of nursing students enrolled in four undergraduate courses (medical-surgical, critical-care, maternal-health and paediatric nursing). DESIGN: This quasi-experimental research study was performed during the midterm and final OSCEs of nursing students at the institution, and their OSCE performance was assessed. METHODS: The students were divided into two: those who were exposed to HFS in addition to their clinical training and the other group who underwent clinical training without HFS exposure. RESULTS: The combined mean midterm and final OSCE results of the group of nursing students with HFS exposure and those without HFS exposure were 92.58 and 82.66, respectively, with a mean between-group difference of 9.92% (p < .01). Our findings reveal that the HFS exposure in addition to clinical training enhanced the students' OSCE performance.

The effect of high-fidelity simulation technology on the competency of nursing students in managing chemotherapy extravasation in patients with cancer.

BACKGROUND: Nursing education suffers from a lack of high-quality clinical experiences for students, especially among medical specialty groups such as cancer patients, in Saudi Arabia. A paucity of empirical evidence is supporting simulation in education and the transfer of psychomotor skills to patient care. In particular, although generally recognized as an essential oncology nursing skill, effective strategies for teaching the management of chemotherapy extravasation to students have not been investigated. PURPOSE: To investigate the effects of high-fidelity simulation (HFS) technology on the competency of nursing students in the management of chemotherapy extravasation and the transfer of this skill from traditional learning labs to clinical settings. METHODS: A quasi-experimental study comprising a two-group pretest-posttest with repeated measures was used. The intervention was a scenario-based, HFS. Third-year students (n = 68) from a nursing program were randomly allocated to either intervention or control groups. Competency was measured in both groups using the same standardized assessment checklist. RESULTS: Competency scores were lower in the control group compared to the intervention group at both posttesting times. These results, however, were not statistically significant. There was no statistically significant difference between the groups regarding skill transfer. CONCLUSIONS: Nursing faculty can use either HFS or traditional learning methods to effectively teach students how to manage chemotherapy extravasation and transfer this skill to clinical settings.

Can a high-fidelity simulation tutorial improve written examination results? Review of a change in teaching practice.

BACKGROUND: Undergraduate nursing students prefer technology-based learning. Simulation has been used in nursing education to provide skills acquisition and clinical exposure. Can high-fidelity simulation (HFS) be used to teach tutorial content to prepare students for a written examination? AIMS: To design a pilot HFS tutorial. METHOD: 203 second year undergraduate nurses were timetabled to attend an HFS tutorial. Examination results at first attempt were compared with the previous cohort's results. RESULTS: 81% of the students from the HFS tutorial cohort passed at the first attempt compared with 85% from the previous cohort. CONCLUSION: The HFS tutorial needs to be developed further, incorporating simulation standards, to further assess its ability to improve a student's written examination results. Students found the post-simulation discussion difficult and wanted guidance in how to participate. Involvement of the university's skills and simulation team would be recommended for future cohorts to assist with design and facilitation.

High-fidelity simulation duration and learning outcomes among undergraduate nursing students: A systematic review and meta-analysis.

OBJECTIVES: To explore the effects of different lengths of the three key steps (prebriefing, simulation, and debriefing) of high-fidelity simulation (HFS) on the knowledge and skills of undergraduate nursing students. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A systematic search was conducted for Chinese and English publications from the Web of Science, PubMed, Embase, Cochrane, and two Chinese databases (Wanfang and CNKI) up to November 24, 2021. REVIEW METHODS: Two independent raters screened the retrieved studies and extracted data based on a coding protocol from the studies that met the inclusion criteria. Data were synthesized using meta-analytic procedures based on a random-effect model and computing effect sizes by standard mean differences (SMD) with a 95% confidence interval (CI). RESULTS: Forty-four studies were included, and 23 studies were analyzed. High-fidelity simulation (HFS) with debriefing of 10 min or less (SMD = 1.18), simulation of 15-20 min (SMD = 1.43), and debriefing of 11-30 min (SMD = 1.19) showed larger effect sizes for knowledge, while HFS with debriefing of >10 min (SMD = 0.91), simulation of 15 min or less (SMD = 0.89), and over 30 min of debriefing cultivation (SMD = 0.84) showed larger effect sizes for skill. CONCLUSIONS: During the prebriefing, simulation, and debriefing, shorter sessions are more effective for improving knowledge in BSN students, whereas longer sessions are most effective for improving skills in BSN students. Nurse educators can schedule HFS to meet the expectations of learning outcomes based on the actual situation.

Multidisciplinary, multisite trauma team training during COVID-19: lessons from the first virtual E-S.T.A.R.T.T. course.

Trauma care delivery is a complex team-based task that requires deliberate practice. The COVID-19 pandemic has not diminished the importance of excellent trauma team dynamics. However, the pandemic hampers our ability to gather safely and train together. A mitigating solution is the provision of high-fidelity simulation training in a virtual setting. The Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course has provided multidisciplinary trauma team members with skills in crisis resource management (CRM) for nearly 10 years. It has promoted collaborative learning from coast to coast, as the course typically runs at our national surgical and trauma meetings. In response to COVID-19 challenges, the course content has been modified to virtually connect 2 centres in different provinces simultaneously. High participant satisfaction suggests that the new virtual E-S.T.A.R.T.T course is able to continue to help providers develop important CRM skills in a multidisciplinary setting while remaining compliant with COVID-19 safety precautions.

Stress responses in high-fidelity simulation among anesthesiology students.

Simulation sessions can produce high-fidelity emergency situations that facilitate the learning process. These sessions may also generate a complex stress response in the learners. This prospective observational study assessed psychological, physiological, immunological, and humoral levels of stress during high-fidelity simulation training. Fifty-six undergraduate medicine students who took part in a medical simulation session were assigned team roles (physician, nurse or assistant). Subsequently, each participant was assessed before the scenario (T0), after the procedure (T1), and two hours later (T2). Psychological stress and anxiety were measured at T0 and T1, using the State-Trait Anxiety Inventory (STAI) and Dundee Stress State Questionnaire (DSSQ). Cortisol, testosterone, secretory immunoglobulin class A (sIgA), alpha-amylase, and oxygen saturation level were measured at T0, T1, and T2, as was the physiological response indicated by heart rate (HR) and blood pressure (BP). It was found that the onset of task performance was related to increased anticipatory worry and higher oxygen saturation. The participants reported decreased worry, followed by increased emotional distress after the simulation training (T1). Participants trait anxiety predicted the intensity of worry, distress and task engagement. In contrast, no clear relationships were found between trait anxiety and biological stress markers. Testosterone levels were growing significantly in each phase of measurement, while physiological responses (BP, HR) increased at T1 and declined at T2. The levels of stress markers varied depending on the assigned roles; however, the trajectories of responses were similar among all team members. No evidence for prolonged cortisol response (T1, T2) was found based on psychological stress at the onset of simulation (T0). Regression analysis followed by receiver operating characteristics analyses showed uncertain evidence that initial state anxiety and worry predicted the levels of sIgA. Medical students are relatively resilient in terms of stress responses to medical simulation. The observed stress patterns and interrelationships between its psychological, physiological, hormonal, and immunological markers are discussed in accordance with theoretical concepts, previous research work, and further recommendations.

Design, assembly and validation of a low-cost, high-fidelity simulator for heart exploration.

INTRODUCTION: Heart exploration is an essential clinical competence that requires continuous training and exposure. Low availability and accessibility to patients with heart disease constitutes a barrier to acquiring this competence. Inadequate cardiac auscultation skills in medical students, residents, and graduate physicians have been documented. OBJECTIVE: To develop and validate a low-cost, high-fidelity simulator for heart exploration. METHODS: A low-cost, high-fidelity heart examination simulator capable of reproducing normal cardiac sounds was designed and developed. Subsequently, the simulator was validated by a group of experts who gave their opinion according to a Likert scale. RESULTS: Ninety-four percent agreed that the simulator motivates the learning of heart exploration, and 92 % considered it to be a realistic model; 91 % considered that the simulator is an attractive tool to reinforce learning and 98 % recommended its further use. CONCLUSIONS: The use of the simulator facilitates the acquisition of skills and stimulates learning in the student, which can be attributed to repeated practice, longer exposure time and cognitive interaction.

INTRODUCCIÓN: La exploración cardiaca es una competencia clínica fundamental que requiere exposición o entrenamiento continuo. La baja disponibilidad y accesibilidad de pacientes con patología cardiaca constituye una barrera para adquirir esta competencia. Se han documentado inadecuadas habilidades de auscultación cardiaca en estudiantes de medicina, residentes y médicos graduados. OBJETIVO: Elaborar y validar un simulador de alta fidelidad y bajo costo para exploración cardiaca. MÉTODOS: Se diseñó y elaboró un simulador para exploración cardiaca, realista y de bajo costo capaz de reproducir ruidos cardiacos normales. Posteriormente se realizó la validación del simulador por un grupo de expertos que emitieron su opinión de acuerdo con una escala tipo Likert. RESULTADOS: El 94 % afirmó que el simulador motiva el aprendizaje de la exploración cardiaca y 92 % lo consideró un modelo realista; 91 % consideró que el simulador es una herramienta atractiva para fortalecer el aprendizaje y 98 % recomendó seguir utilizándolo. CONCLUSIONES: El uso del simulador facilita la adquisición de competencias y estimula el aprendizaje en el estudiante, lo cual puede ser atribuido a la práctica deliberada, a un mayor tiempo de exposición y a la interacción cognitiva.

Advanced Modular Manikin and Surgical Team Experience During a Trauma Simulation: Results of a Single-Blinded Randomized Trial.

BACKGROUND: Our aim was assess whether an integrated Advanced Modular Manikin (AMM) provides improved participant experience compared with use of peripheral simulators alone during a standardized trauma team scenario. Simulation-based team training has been shown to improve team performance. To address limitations of existing manikin simulators, the AMM platform was created that enables interconnectedness, interoperability, and integration of multiple simulators ("peripherals") into an adaptable, comprehensive training system. METHODS: A randomized single-blinded, crossover study with 2 conditions was used to assess learner experience differences when using the integrated AMM platform vs peripheral simulators. First responders, anesthesiologists, and surgeons rated their experience and workload with the conditions in a 3-scene standardized trauma scenario. Participant ratings were compared and focus groups conducted to obtain insight into participant experience. RESULTS: Fourteen teams (n = 42) participated. Team experience ratings were higher for the integrated AMM condition compared with peripherals (Cohen's d = .25, p = 0.016). Participant experience varied by background with surgeons and first responders rating their experience significantly higher compared with anesthesiologists (p < 0.001). Higher workload ratings were observed with the integrated AMM condition (Cohen's d = .35, p = 0.014) driven primarily by anesthesiologist ratings. Focus groups revealed that participants preferred the integrated AMM condition based on its increased realism, physiologic responsiveness, and feedback provided on their interventions. CONCLUSIONS: This first comprehensive evaluation suggests that integration with the AMM platform provides benefits over individual peripheral simulators and has the potential to expand simulation-based learning opportunities and enhance learner experience, especially for surgeons.

Effects of high-fidelity simulation education on medical students' anxiety and confidence.

INTRODUCTION: Psychological factors such as anxiety and confidence that students have in the patient care situation are important in that this affects the actual clinical performance. Students who are just starting clinical practice have a lack of clinical knowledge, skill proficiency, and patient communication skills, so they experience anxiety and lack of confidence in clinical setting. Practice in a safe environment, such as simulation education, can help students perform more settled and competently in patient care. The purpose of this study was to analyze the effect of high-fidelity simulation experience on anxiety and confidence in medical students. MATERIALS AND METHODS: This study enrolled 37 5th-year students at Ajou University School of Medicine in 2020. Two simulation trainings were implemented, and a survey was conducted to measure students' level of anxiety and confidence before and after each simulation. Based on the research data, a paired t-test was conducted to compare these variables before and after the simulation, and whether this was their first or second simulation experience. RESULTS: Students had a significantly lower level of anxiety and a significantly higher level of confidence after the simulation than before. In addition, after one simulation experience, students had less anxiety and more confidence before the second simulation compared to those without simulation experience. CONCLUSIONS: We confirmed that medical students need to be repeatedly exposed to simulation education experiences in order to have a sense of psychological stability and to competently deliver medical treatment in a clinical setting. There is a practical limitation in that medical students do not have enough opportunities to meet the patients during clinical practice in hospitals. Therefore, in order to produce excellent doctors, students should have the expanded opportunities to experience simulation education so they can experience real-world medical conditions.

Can't simply roll it out: Evaluating a real-world virtual reality intervention to reduce driving under the influence.

Driving under the influence (DUI) increases the risk of crashes. Emerging technologies, such as virtual reality (VR), represent potentially powerful and attractive tools for the prevention of risky behaviours, such as DUI. Therefore, they are embraced in prevention efforts with VR interventions primed to grow in popularity in near future. However, little is known about the actual effectiveness of such DUI-targeting VR interventions. To help fill the knowledge gap, this study explored the effects of one VR intervention as delivered in the real world. Using pre and post test design, including an intervention group (n = 98) and a control group (n = 39), the intervention evaluation examined young drivers' (aged 18 to 25, no known history of DUI) intention and self-reported behaviour three months after the intervention as compared to the baseline. The results did not provide evidence for statistically significant effects of the VR intervention on self-reported DUI behaviour during the three months post intervention and DUI intention at three months post intervention. Such results might be due to the fact that the recruited participants generally self-reported little DUI behaviour, i.e. positively changing behaviour that is already positive is inherently challenging. Nevertheless, the results question the utility of funding the roll-out of arguably attractive technologies without a thorough understanding of their effectiveness in particular settings. To improve the potential for future positive outcomes of such interventions, we provide suggestions on how VR software might be further developed and, subsequently, leveraged in future research to improve the likelihood for behavioural change, e.g. by collecting, analysing and presenting objective driving performance data. Alternatively, future endeavours might focus on participants with known DUI history and examine the effects of the VR intervention for this particular higher-risk group.

Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study.

BACKGROUND: Failures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations. METHODS: We conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9. RESULTS: We analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96-1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83-1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13-2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=-23.0; 95% CI, -27.2 to -18.8; P<0.0001) and split-screen (-6.7; 95% CI, -10.9 to -2.4; P=0.002) compared with conventional. CONCLUSIONS: This study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.

Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial.

TRIAL DESIGN: This was a randomized controlled trial. BACKGROUND: Intraoperative errors correlate with surgeon skill and skill declines with intervals of inactivity. The goals of this research were to identify the optimal virtual reality (VR) warm-up curriculum to prime a surgeon's technical skill and validate benefit in the operating room. MATERIALS AND METHODS: Surgeons were randomized to receive six trial sessions of a designated set of VR modules on the da Vinci Skills Simulator to identify optimal VR warm-up curricula to prime technical skill. After performing their curricula, warm-up effect was assessed based on performance on a criterion task. The optimal warm-up curriculum was chosen from the group with the best task time and video review-based technical skill. Robot-assisted surgery-experienced surgeons were then recruited to either receive or not receive warm-up before surgery. Skill in the first 15 min of surgery was assessed by blinded surgeon and crowdworker review as well as tool motion metrics. The intervention was performing VR warm-up before human robot-assisted surgery. Warm-up effect was measured using objective performance metrics and video review using the Global Evaluative Assessment of Robotic Skills tool. Linear mixed effects models with a random intercept for each surgeon and nonparametric modified Friedman tests were used for analysis. RESULTS: The group performing only a Running Suture task on the simulator was on average 31.3 s faster than groups performing other simulation tasks and had the highest Global Evaluative Assessment of Robotic Skills scores from 41 surgeons who participated. This was chosen as the optimal curriculum. Thereafter, 34 surgeons completed 347 surgeries with corresponding video and tool motion data. No statistically significant differences in skill were observed with the warm-up intervention. CONCLUSIONS: We conclude that a robotic VR warm-up before performing the early stages of surgery does not impact the technical skill of the surgeon.

High-Fidelity simulation-based program improves flow state scale in the perinatal team.

BACKGROUND: We aimed to evaluate the degree of realism and involvement, stress management and awareness of performance improvement in practitioners taking part in high fidelity simulation (HFS) training program for delivery room (DR) management, by means of a self-report test such as flow state scale (FSS). METHODS: This is an observational pretest-test study. Between March 2016 and May 2019, fourty-three practitioners (physicians, midwives, nurses) grouped in multidisciplinary teams were admitted to our training High Fidelity Simulation center. In a time-period of 1 month, practitioners attended two HFS courses (model 1, 2) focusing on DR management and resuscitation maneuvers. FSS test was administred at the end of M1 and M2 course, respectively. RESULTS: FSS scale items such as unambiguous feed-back, loss of self consciousness and loss of time reality, merging of action and awareness significantly improved (P < 0.05, for all) between M1 and M2. CONCLUSIONS: The present results showing the high level of practitioner involvement during DR management-based HFS courses support the usefulness of HFS as a trustworthy tool for improving the awareness of practitioner performances and feed-back. The data open the way to the usefulness of FSS as a trustworthy tool for the evaluation of the efficacy of training programs in a multidisciplinary team.

Diseño, elaboración y validación de un simulador realista y de bajo costo para exploración cardiaca / Design, assembly and validation of a low-cost, high-fidelity simulator for heart exploration

Resumen Introducción: La exploración cardiaca es una competencia clínica fundamental que requiere exposición o entrenamiento continuo. La baja disponibilidad y accesibilidad de pacientes con patología cardiaca constituye una barrera para adquirir esta competencia. Se han documentado inadecuadas habilidades de auscultación cardiaca en estudiantes de medicina, residentes y médicos graduados. Objetivo: Elaborar y validar un simulador de alta fidelidad y bajo costo para exploración cardiaca. Métodos: Se diseñó y elaboró un simulador para exploración cardiaca, realista y de bajo costo capaz de reproducir ruidos cardiacos normales. Posteriormente se realizó la validación del simulador por un grupo de expertos que emitieron su opinión de acuerdo con una escala tipo Likert. Resultados: El 94 % afirmó que el simulador motiva el aprendizaje de la exploración cardiaca y 92 % lo consideró un modelo realista; 91 % consideró que el simulador es una herramienta atractiva para fortalecer el aprendizaje y 98 % recomendó seguir utilizándolo. Conclusiones: El uso del simulador facilita la adquisición de competencias y estimula el aprendizaje en el estudiante, lo cual puede ser atribuido a la práctica deliberada, a un mayor tiempo de exposición y a la interacción cognitiva.

Abstract Introduction: Heart exploration is an essential clinical competence that requires continuous training and exposure. Low availability and accessibility to patients with heart disease constitutes a barrier to acquiring this competence. Inadequate cardiac auscultation skills in medical students, residents, and graduate physicians have been documented. Objective: To develop and validate a low-cost, high-fidelity simulator for heart exploration. Methods: A low-cost, high-fidelity heart examination simulator capable of reproducing normal cardiac sounds was designed and developed. Subsequently, the simulator was validated by a group of experts who gave their opinion according to a Likert scale. Results: Ninety-four percent agreed that the simulator motivates the learning of heart exploration, and 92 % considered it to be a realistic model; 91 % considered that the simulator is an attractive tool to reinforce learning and 98 % recommended its further use. Conclusions: The use of the simulator facilitates the acquisition of skills and stimulates learning in the student, which can be attributed to repeated practice, longer exposure time and cognitive interaction.