The Integration of Quality Improvement and Health Care Simulation: A Scoping Review.

BACKGROUND AND OBJECTIVES: Quality improvement (QI) and simulation employ complementary approaches to improve the care provided to patients. There is a significant opportunity to leverage these disciplines, yet little is known about how they are utilized in concert. The purpose of this study is to explore how QI and simulation have been used together in health care. METHODS: This scoping review includes studies published between 2015 and 2021 in 4 databases: CINAHL, Embase, PubMed, and Scopus. RESULTS: The search yielded 921 unique articles.18 articles met the inclusion criteria and specifically described QI and simulation collaborative projects. Of the 18 articles, 28% focused on improvements in patient care, 17% on educational interventions, 17% on the identification of latent safety threats (LSTs) that could have an impact on clinical care, 11% on the creation of new processes, 11% on checklist creation, and 6% on both LST identification and educational intervention. The review revealed that 61% of the included studies demonstrated a concurrent integration of simulation and QI activities, while 33% used a sequential approach. CONCLUSIONS: There is a paucity of studies detailing the robust and synergistic use of QI and simulation. The findings of this review suggest a positive impact on patient safety when QI and simulation are used in tandem. The systematic integration of these disciplines and the use of established reporting guidelines can promote patient safety in practice and in the literature.

Why We Want Our Students to Learn about Poverty and Health Care: Sharing Our Own Experiences from Poverty Simulations.

Poverty is a leading cause of numerous health and social inequities in the United States. Educators are increasingly searching for ways to create meaningful learning opportunities about poverty and its profound effect on individuals and communities. In this narrative, we explore our own perspectives as faculty who guide students through a simulated poverty experience. This essay unfolds primarily as a dialogue among us as we make sense of and clarify why we participate in the coordination and facilitation of poverty simulations on our campus and their anticipated benefits for future health care professionals and social service providers.

Why We Want Our Students to Learn about Poverty and Healthcare: Sharing Our Students' Experiences from Poverty Simulations.

Poverty contributes to acute illness, chronic disease and health inequity among millions of Americans, yet health care providers often do not understand the daily experiences of those who live below the poverty line and how it affects their interactions with the health care system. In this narrative, we share healthcare students' stories and reflect on how they account for their experiences of participating in a poverty simulation. Their words come from reflection assignments, and when we read their words, that for a moment, many of our students understand that as a healthcare practitioner, they can make a difference in the life of someone living in poverty. We believe that this experience will inspire our students to make meaningful change as future healthcare professionals. We also believe that the impact on these students goes toward our collective goal as teachers of future healthcare providers to make a difference in our world.

Rapid Development and Testing of a COVID-19 Vaccine Curriculum for Pediatricians.

BACKGROUND AND OBJECTIVES: As the coronavirus disease 2019 (COVID-19) pandemic evolves and vaccines become available to children, pediatricians must navigate vaccination discussions in the setting of rapidly changing vaccine recommendations and approvals. We developed and evaluated an educational curriculum for pediatricians to improve their knowledge about COVID-19 vaccines and confidence in communicating with patients and families about COVID-19 vaccines. METHODS: Five institutions collaborated to develop an online educational curriculum. Utilizing the collaboration's multidisciplinary expertise, we developed a 3-module curriculum focused on the SARS-CoV-2 virus and vaccine basics, logistics and administration of COVID-19 vaccine, and COVID-19 vaccine communication principles. Surveys administered to clinician participants before and after completion of the curriculum assessed knowledge and confidence; a follow-up survey 1 month after the post-survey assessed persistence of initial findings. RESULTS: A total of 152 pediatric providers participated; 72 completed both pre- and post-surveys. The median knowledge score improved from the pre-survey to the post-survey (79%-93%, P < .001). There was an increase in providers' confidence after completing the curriculum, which persisted in the follow-up survey. In the post-survey, 98% of participants had had the opportunity to discuss the COVID-19 vaccine with patients, and most clinicians reported that the modules decreased apprehension some or significantly. CONCLUSIONS: This project demonstrates rapid and feasible deployment of a curriculum providing up-to-date information to front-line clinicians responsible for having complex conversations about COVID-19 vaccine decision-making. Clinicians who completed this curriculum had sustained increased confidence and decreased levels of apprehension when discussing the COVID-19 vaccine.

An Investigation on the Perceptions of Practicing Interdisciplinary Health Professionals on Rapid Cycle Deliberate Practice Simulation.

INTRODUCTION: Rapid cycle deliberate practice (RCDP) is a relatively new method for delivering simulation for a structured algorithm-based clinical content. We sought to understand how a group of practicing emergency medicine healthcare professionals would perceive RCDP as a learning method. METHODS: This was a qualitative study of participants' reactions to RCDP simulation during an orientation process to a new freestanding emergency department using grounded theory. Focus groups were held after simulation sessions to investigate the participants reactions to RCDP as well as the experience of multiple professions participating. Two investigators independently coded the focus group transcripts to detect themes and developed a list of codes, which were then confirmed by consensus. Data were organized into themes with contributing codes. RESULTS: Thirty-one individuals participated in the focus groups including physicians, nurse practitioners, nurses, respiratory therapists, and patient care technicians. Four themes were detected: the procedural components of RCDP, the behavioral response to RCDP, learning through RCDP, and RCDP as interprofessional experience. The participants view of emotions and interruptions and pauses had discrepant interpretation. CONCLUSIONS: Participants received RCDP simulation positively. Initial negative reactions to the interruptions and pauses of RCDP dissipated as the simulation progressed. Ultimately, learners agreed that RCDP was extremely effective as compared with traditional simulation for medical resuscitation training because of the authenticity of the multidisciplinary aspect. This suggests that RCDP may be an effective tool for continuing education of practicing healthcare professionals.

Using healthcare simulation in space planning to improve efficiency and effectiveness within the healthcare system.

Healthcare professionals are continuously being challenged to address the triple aim necessary for effective patient care: improving the quality and satisfaction of patients, improving the health of populations, and reducing per capita cost of healthcare. Today, innovation and cost-effective methods are a requirement to meet the triple aim given the current economic climate and financial limitations. Healthcare simulation is currently underutilised, particularly during the space or facility planning process in healthcare. This position paper will describe the process of implementing space simulations that were conducted between 2016 and 2018 in six different clinical settings that identified patient and provider safety concerns, and patient and provider needs. Simulation design and development along with the methodology for data collection and data analyses will be presented. Qualitative results will be presented to demonstrate the impact of the use of simulation to prevent critical and non-critical safety events.

A Simulation Course Focusing on Forensic Evidence Collection Improves Pediatric Knowledge and Standardizes Curriculum for Child Abuse.

OBJECTIVES: Our hypothesis was that pediatric residents and medical students who participated in a structured forensic evidence collection course would have improved knowledge of prepubertal evidence collection practices and pubertal genital anatomy. METHODS: The course curriculum included a forensic evidence collection video created by the sexual assault nurse examiner directors. After watching the video, the participants simulated forensic evidence collection using forensic evidence collection kits and chain of evidence protocols in a hybrid simulation setting under the supervision of a pediatric sexual assault nurse examiner. The participants completed a multiple-choice test and a fill-in-the-blank anatomical diagram test before and after the course. RESULTS: Of an eligible 48 participants, 42 completed the course; therefore, our participant response rate was 87.5%. There was significant improvement in knowledge, with an average pretest score of 62% ± 20% and the average posttest score of 86% ± 9% (P < 0.001). Qualitative evaluations were overwhelmingly positive, with consistent scoring of 6/6 in a 6-point agree scale. Learning themes, which emerged from open-ended questions on the evaluations, included knowledge gained on evidence collection processes (n = 26), how to appropriately interact with abused patients (n = 8), hands-on nature of the experience and the benefits of walking through the examination (n = 7), and pubertal genital anatomy knowledge (n = 3). Participants suggested that more instruction on anatomy would be helpful. CONCLUSIONS: We found that pediatric residents' and medical students' knowledge of pediatric sexual abuse may be improved with a short simulation course focusing on forensic evidence collection.

Students' Evaluations of Simulations in Dentistry: A Multiple Cohort Study at a U.S. Dental School.

Simulation may help translate didactic learning to patient care in areas such as communication skills and medical emergency management. The aims of this study were to investigate how multiple cohorts of dental students evaluated simulations utilizing standardized patients and manikins and to explore evaluations of a simulation that combined social determinants of health with oral health education. All approximately 600 second- and fourth-year dental students at one U.S. dental school participated in simulation activities for five years (2014-18). The activities involved clinical communication skills with an urgent care patient, medical emergency management, and communication skills with a parent with low income. After the simulations, students were invited to complete an evaluation of the experience. Questionnaire items addressed perceived applicability to patient care, value of the experience, and fulfillment of objectives; and open-ended questions asked for comments specific to the parent with low income simulation. A total of 497 responses from D2 and D4 students were collected over the five-year period, as well as from all 12 periodontics residents in 2017, for an overall 91.7% response rate. The vast majority (>90.6%) positively evaluated all items for each simulation. The positive ratings ranged from a mean of 99.3% for the urgent care simulation to 93.8% for the parent with low income simulation. Positive student comments often related to learning from/with others and effective practice of teach back and patient education tactics. Students' most frequent suggestions for improvement called for better preparation. In this study, simulations with both standardized patients and manikins led to positive evaluations as well as anticipated improvement of clinical performance. These results suggest that incorporating simulation into an already-crowded curriculum is worth it from the student perspective, especially for reinforcement of clinical skills not easily amenable to classroom instruction.

Development of a Simulation-Based Interprofessional Teamwork Assessment Tool.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Milestone projects required each specialty to identify essential skills and develop means of assessment with supporting validity evidence for trainees. Several specialties rate trainees on a milestone subcompetency related to working in interprofessional teams. A tool to assess trainee competence in any role on an interprofessional team in a variety of scenarios would be valuable and suitable for simulation-based assessment. OBJECTIVE: We developed a tool for simulation settings that assesses interprofessional teamwork in trainees. METHODS: In 2015, existing tools that assess teamwork or interprofessionalism using direct observation were systematically reviewed for appropriateness, generalizability, adaptability, ease of use, and resources required. Items from these tools were included in a Delphi method with multidisciplinary pediatrics experts using an iterative process from June 2016 to January 2017 to develop an assessment tool. RESULTS: Thirty-one unique tools were identified. A 2-stage review narrowed this list to 5 tools, and 81 items were extracted. Twenty-two pediatrics experts participated in 4 rounds of Delphi surveys, with response rates ranging from 82% to 100%. Sixteen items reached consensus for inclusion in the final tool. A global 4-point rating scale from novice to proficient was developed. CONCLUSIONS: A novel tool to assess interprofessional teamwork for individual trainees in a simulated setting was developed using a systematic review and Delphi methodology. This is the first step to establish the validity evidence necessary to use this tool for competency-based assessment.