John M. O'Donnell

Simulation for learning and teaching procedural skills: the state of the science.

Introduction: Simulation is increasingly used to support learning of procedural skills. Our panel was tasked with summarizing the “best evidence.” We addressed the following question: To what extent does simulation support learning and teaching in procedural skills? Methods: We conducted a literature search from 2000 to 2010 using Medline, CINAHL, ERIC, and PSYCHINFO databases. Inclusion criteria were established and then data extracted from abstracts according to several categories. Although secondary sources of literature were sourced from key informants and participants at the “Research Consensus Summit: State of the Science,” they were not included in the data extraction process but were used to inform discussion. Results: Eighty-one of 1,575 abstracts met inclusion criteria. The uses of simulation for learning and teaching procedural skills were diverse. The most commonly reported simulator type was manikins (n = 17), followed by simulated patients (n = 14), anatomic simulators (eg, part-task) (n = 12), and others. For research design, most abstracts (n = 52) were at Level IV of the National Health and Medical Research Council classification (ie, case series, posttest, or pretest/posttest, with no control group, narrative reviews, and editorials). The most frequent Best Evidence Medical Education ranking was for conclusions probable (n = 37). Using the modified Kirkpatrick scale for impact of educational intervention, the most frequent classification was for modification of knowledge and/or skills (Level 2b) (n = 52). Abstracts assessed skills (n = 47), knowledge (n = 32), and attitude (n = 15) with the majority demonstrating improvements after simulation-based interventions. Studies focused on immediate gains and skills assessments were usually conducted in simulation. Discussion: The current state of the science finds that simulation usually leads to improved knowledge and skills. Learners and instructors express high levels of satisfaction with the method. While most studies focus on short-term gains attained in the simulation setting, a small number support the transfer of simulation learning to clinical practice. Further study is needed to optimize the alignment of learner, instructor, simulator, setting, and simulation for learning and teaching procedural skills. Instructional design and educational theory, contextualization, transferability, accessibility, and scalability must all be considered in simulation-based education programs. More consistently, robust research designs are required to strengthen the evidence.

Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses.

Abstract Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one‐group pre‐to‐post‐intervention design. Educational interventions included faculty‐led, simulation‐based case presentations using the Harvey® cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer‐based CD‐ROM program. Outcome measures included a 31‐item cognitive written exam, a 13‐item skills checklist used in each of a three‐station objective structured clinical exam, learner self‐efficacy and satisfaction survey, instructor satisfaction and self‐efficacy survey, and a participant logbook to record practice time using the self‐learning materials. Thirty‐six students who received the simulation‐based training showed statistically significant pre‐to‐post‐test improvement in cognitive knowledge and cardiovascular assessment skills.

Use of personal protective equipment among health care personnel: Results of clinical observations and simulations

HighlightsAmong 130 simulations, contamination occurred in 79.2% during the doffing process.Despite feedback, contaminations still occurred in 82% of 22 follow‐up simulations.Devising better personal protective equipment education and protocols is necessary to ensure health care personnel safety. Background Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE). Methods The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions (simple and full‐body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an electronic survey. For a follow‐up evaluation simulation, 12 HCP were recruited among simulation participants. Results Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations during the doffing process with various PPE items: simple set (92.3%) and full‐body set (66.2%). Among 11 follow‐up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time‐consuming, cumbersomeness, and PPE effectiveness. Conclusions Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.

Perioperative dental injury at a tertiary care health system: An eight-year audit of 816,690 anesthetics

Among all complications of airway management, dental injury is the most common cause of patient complaints with medicolegal consequences. Over an 8-year period, data on dental injury were collected within a large university hospital system that included community, tertiary, and quaternary care centers. Patient characteristics were compared among all patients receiving anesthesia care using billing data collected from the same period. Of the 816,690 patients who received anesthesia care, there were 360 dental injuries, giving an overall incidence of 1:2,269 (0.044%). Patients receiving general anesthesia were at an increased risk for dental injuries, with an incidence of 1:1,754 (0.057%) compared with patients receiving monitored anesthesia care in whom the incidence was 1:12,500 (0.008%). Patients in the age group 18 to 65 years had a higher incidence of dental injuries of 1:1,818 (0.055%) compared with pediatric patients, who had an incidence of 1:7,692 (0.013%). Emergency procedures were not associated with an increased risk of dental injury in the 816,690 cases. However, of the 360 patients who sustained a dental injury, emergency procedures were associated with a higher incidence of injuring multiple teeth.

Procedural sedation: Safely navigating the twilight zone

Hovering somewhere between alertness and deep sedation, your patient relies on you for a smooth return to full consciousness. Heres how to make sure he has a safe, comfortable journey.

Overcoming barriers in online workshop development: an ELITE experience.

The Emerging Learning and Integrated Technologies Education (ELITE) Faculty Development Program created eight online workshops to assist nurse educators in using technology within their organizations nurse education program. Continuing education units were provided for completion of the individual online workshops. The ELITE program worked through several barriers to transform content that was previously presented during face-to-face workshops into standalone online offerings. Barriers and implementation strategies for the on-site to online transition included restructuring workshop objectives, keeping current with rapid technology changes, altering a course management system to meet the needs of the program and the learner, and crafting independent practice opportunities for the online learner. The online workshop development experience of the ELITE program may assist other continuing education and staff development professionals who are updating their program offerings or pursuing online education for the first time.

An Exploratory Study of Sectra Table Visualization Improves the Effectiveness of Emergency Bedside Echocardiography Training: Sectra Table Improves Echocardiography Training

Echocardiography is an essential tool in emergency medicine, and its training is the most challenging of all types of bedside ultrasound (US) training. This study investigated the effectiveness of the Sectra Table (Sectra AB, Linköping, Sweden), an anatomy visualization and collaboration tool, in improving the quality of echocardiography training for emergency medicine physicians.