Guillaume Alinier

Nursing Students' and Lecturers' Perspectives of Objective Structured Clinical Examination Incorporating Simulation.

Objective Structured Clinical Examination (OSCE) has been widely and increasingly used since it was developed. Research has shown that it is an effective evaluation tool to assess practical skills (Sloan et al. 1995). In many instances the OSCE process has been adapted to test trainees from different healthcare related disciplines. In nursing education, as presented in this paper, principles of OSCE can also be used in a formative way to enhance skill acquisition through simulation. The aim of this approach to teaching is safely to help students gain more confidence when confronted by technical instruments present in the hospital environment, and to encourage them to reflect on a range of skills and competences they need to acquire. The OSCE stations can be designed in the form of small scenarios where students have to set-up or interact with technical instruments, or communicate with patients. This type of simulation exercise can be varied as a whole and specifically within each station at the same time. The use of this hybrid formative OSCE is being assessed by nursing students and lecturers. The feedback received regarding this teaching method and the results of this study are useful and show that OSCE are favourably perceived.

A typology of educationally focused medical simulation tools

Background: The concept of simulation as an educational tool in healthcare is not a new idea but its use has really blossomed over the last few years. This enthusiasm is partly driven by an attempt to increase patient safety and also because the technology is becoming more affordable and advanced. Aims: Simulation is becoming more commonly used for initial training purposes as well as for continuing professional development, but people often have very different perceptions of the definition of the term simulation, especially in an educational context. This highlights the need for a clear classification of the technology available but also about the method and teaching approach employed. The aims of this paper are to discuss the current range of simulation approaches and propose a clear typology of simulation teaching aids. Method: Commonly used simulation techniques have been identified and discussed in order to create a classification that reports simulation techniques, their usual mode of delivery, the skills they can address, the facilities required, their typical use, and their pros and cons. Results: This paper presents a clear classification scheme of educational simulation tools and techniques with six different technological levels. They are respectively: written simulations, three-dimensional models, screen-based simulators, standardized patients, intermediate fidelity patient simulators, and interactive patient simulators. This typology allows the accurate description of the simulation technology and the teaching methods applied. Thus valid comparison of educational tools can be made as to their potential effectiveness and verisimilitude at different training stages. Conclusions: The proposed typology of simulation methodologies available for educational purposes provides a helpful guide for educators and participants which should help them to realise the potential learning outcomes at different technological simulation levels in relation to the training approach employed. It should also be a useful resource for simulation users who are trying to improve their educational practice.

Developing High-Fidelity Health Care Simulation Scenarios

The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteer to act as the patient, or even obtaining ready-made scenarios from another simulation center are rarely insurmountable challenges. The issue often lies in how to use or adapt these for your own purpose: with your team, facilities, and resources but primarily for your learners. Published information is limited in the area of scenario preparation for health care education and continuing medical education or continuing professional development. This article is a guide for clinical tutors, standardized patient trainers, and patient simulator operators on how to script scenarios and proposes a new detailed and reusable template for writing scenarios. It contains practical sections such as how to decide on the learning objectives to be addressed, how to script and organize your scenarios, and how to pitch the suitable level of details to make the scenarios appropriately realistic.

Redefining Simulation Fidelity for Healthcare Education

Background. Fidelity - an intrinsic property of simulation is crucial to simulation design and to educational effectiveness. Yet the term fidelity is inconsistently used, which makes it difficult to draw inferences from current literature and translate research into practice. Aim. In this article, we attempt to bring some clarity to the term simulation fidelity in healthcare education. Method. We are opposed to the notion that high-fidelity simulation requires complete and faithful replication of reality, and instead argue for an accurate representation of real-world cues and stimuli. We address a number of issues surrounding the term fidelity and how it is currently used in the literature. Result. In recognising the limitations of current methods of describing fidelity in the literature, we propose an alternative 3-dimensional framework for fidelity along the axes of the patient, clinical scenario, and healthcare facilities as a means for more precise and practical positioning of current healthcare simulation activities. Conclusion. All aspects of fidelity significantly hinge on the learners’ perceived realism of the context of the learning episode as opposed to any one particular element such as the technology used.

International overview of high-level simulation education initiatives in relation to critical care

The use of simulation in health care education has become very topical across all professions and specialties in order to improve patient safety and quality of care. In the last decade, the adoption of more realistic simulation-based teaching methodologies, which serves as a bridge between the acquisition and application of clinical skills, knowledge, and attributes, has been accompanied by the development of a multitude of international and national simulation societies. These serve as important exchange fora for educators, clinicians, researchers, and engineers who desire to learn and share their experience and knowledge around simulation-based education. Several countries have derived their own strategy in order to promote the use of such training methodology. Current key national strategies will be presented in this paper alongside a discussion of their expected impact. Various approaches have been adopted and each has their own place and the potential to be adopted by other nations depending on their political, economic or even geographic context. Within the critical care arena, simulation has generated considerable interest and there is a growing evidence base for its use as a learning and teaching strategy within this environment. A number of critical care-related associations and societies are now recognizing simulation as an appropriate pedagogical approach and acknowledging its potential to improve patient care and clinical outcomes. Its implementation should be carefully considered to ensure that developments are based on current best educational practice to maximize the efficiency of these educational interventions.

Setting Conditions for Productive Debriefing

Background. Debriefing is a fundamental step in simulation, particularly in the medical field. Simulation sometimes even serves as a pretext for debriefing. Most often, debriefing takes place easily, producing a qualitative feedback and an optimal learning transfer. But sometimes, the facilitator faces difficulties. An unproductive debriefing can be described as follows: the debriefing of a clinical simulation session is unproductive when facilitators or learners perceive the occurrence of an obstacle that has hindered the learning process. Objectives & method. Considering the difficulties encountered in this type of debriefing, we believe it is necessary to investigate the topic in depth in order to bring out some theoretical principles. Based on a Nominal Group Technique involving the authors of this article, this project aimed at drawing up and proposing informed recommendations for ensuring productive debriefing in simulation-based education in healthcare. Results. The authors make the following recommendations: Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Conclusion. Six key recommendations are proposed. They have been deemed as core skills required of every simulation facilitator to prepare for productive debriefing and so the set learning objectives of a simulation session can be achieved successfully.

A path to better healthcare simulation systems: leveraging the integrated systems design approach.

This article addresses the necessary steps in the design of simulation-based instructional systems. A model for designing instructional systems is presented which stipulates that the outcome metrics be defined before the simulation system is designed. This ensures integration of educational objectives and measures of competency into the design and development process. The article ends with a challenge to simulator users and instructors: become involved in the integrated system design process by the daily collection of standardized data and working with the simulation engineers throughout the design process.

Opening of an Enhancing Trainees' Learning Experiences through the Advanced Multiprofessional Simulation Training Facility at the University of Hertfordshire

Original article can be found at: http://journals.cambridge.org/action/displayJournaljid=ARN Copyright Cambridge University Press

Learning Through Play: Simulation Scenario= Obstacle Course+ Treasure Hunt

Interactive computer-based games are a form of simulation and are often categorized as screen-based simulators. An example of such a game includes flight simulators that can help would-be pilots become familiar with the instrumentation and flight characteristics of a range of airplanes. Similar applications are now becoming available for the training of health care professionals. They are now rapidly developing to the extent that they allow several team members to interact with each other (even if they are in different locations) and with one or more model-based computer-generated entities. An obstacle course challenges and rewards by requiring participants to overcome difficulties near the limits of their maximal performance, and offers the opportunity to return for improvement. Simulation allows clinical instructors to “schedule disasters,” to challenge their students and to do so safely for all involved. Treasure hunts consist of cues and clues requiring both detection and deduction if the participants ever expect to find the reward. Simulation allows clinical instructors to intentionally craft and present clinical “triggers” that they wish their students to gain familiarity with sensing and interpreting.

Design and implementation of a modular ECMO simulator

Background: Extracorporeal membrane oxygenation (ECMO) is a high-complexity life-saving procedure riddled with mechanical complications that can place the patient in a critical state where fast and coordinated actions are required to avoid mortality. Thus, patients on ECMO are supervised round the clock by highly trained nurses and perfusionists. Currently, ECMO training programs include patient emergency simulations performed with different levels of success. Some training facilities use mannequins that have computer-controlled physiological parameters such as heart rate and oxygen saturation. The circuit parameters such as pressure are manually adjusted per scenario; air and artificial blood are manually injected to indicate problems such as air embolism, and hypovolemia. 1 Despite being realistic, using an actual ECMO circuit for simulation training purposes has disadvantages such as the use of expensive disposable equipment (oxygenation membrane), lack of oxygenation color differentials, and manual ci...