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Background and Aims: Traditional apprenticeship‐based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low‐risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three‐dimensional computer‐generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin‐based simulation. We hypothesised that VR would be as effective as mannequin‐based simulation in performance outcomes. Methods: This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin‐based simulation. Participants completed questionnaires and a 15‐min pneumothorax scenario. Quantitative metrics included overall score, time‐to‐critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. Results: VR participants scored significantly higher than mannequin‐based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin‐based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time‐to‐completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication‐learning compared to mannequin‐based simulation. Conclusion: Both VR and mannequin‐based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial. [ABSTRACT FROM AUTHOR]

Abstract Introduction Accidental extubation during prone position can be a life-threatening emergency requiring rapid establishment of the airway. However, there is limited evidence of the best airway rescue method for this potentially catastrophic emergency. The aim of this study was to determine the most effective method to recover the airway in case of accidental extubation during prone positioning by comparing three techniques (supraglottic airway, video laryngoscopy, and fiber-optic bronchoscopy) in a simulated environment. Methods Eleven anesthesiologists and 12 anesthesia fellows performed the simulated airway management using 3 different techniques on a mannequin positioned prone in head pins. Time required for definitive airway management and the success rates were measured. Results The success rates of airway rescue were 100% with the supraglottic airway device (SAD), 69.6% with the video laryngoscope (CMAC), and 91.3% with the FOB. The mean (SD) time to insertion was 18.1 (4.8) s for the supraglottic airway, 78.3 (32.0) s for the CMAC, and 57.3 (24.6) s for the FOB. There were significant differences in the time required for definitive airway management between the SAD and FOB (t = 5.79, p

Abstract Background and Aims Traditional apprenticeship‐based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low‐risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three‐dimensional computer‐generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin‐based simulation. We hypothesised that VR would be as effective as mannequin‐based simulation in performance outcomes. Methods This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin‐based simulation. Participants completed questionnaires and a 15‐min pneumothorax scenario. Quantitative metrics included overall score, time‐to‐critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. Results VR participants scored significantly higher than mannequin‐based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin‐based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time‐to‐completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication‐learning compared to mannequin‐based simulation. Conclusion Both VR and mannequin‐based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial.

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training. [ABSTRACT FROM AUTHOR]

For 300 years now, obstetrics has drawn on the concept of simulation training to not only teach anatomy and physiology theoretically, but to literally infuse it practically. In an 18th century scientific culture, which was predominantly patriarchal, the French royal midwife Angelique Marguerite Le Boursier du Coudray excelled in this field. Using La Machine, one of the first obstetric phantoms, she taught thousands of midwives and even physicians. The exponential increase in publications on obstetric simulations in recent years continues to underline their current relevance, and Madame du Coudray was once at the forefront with her mannequin, probably the most sophisticated phantom of its time, a symbiosis of practical-robust architecture and anatomical-theoretical accuracy. In retrospect, it is therefore worthwhile to take a closer look at this pioneer and her obstetric phantoms, applied in the first national simulation-based training course, and to evaluate them in the overall picture of the development of anatomically correct replicas for practice-oriented training with detailed, flexible exercise – back to the roots. [ABSTRACT FROM AUTHOR]

The "Stop the Bleed" (StB) campaign aims to educate laypersons on performing bleeding control techniques in any setting that requires hemorrhage control, such as motor vehicle crashes or mass casualty incidents. Participants undergo a didactic and practical session, the latter incorporating a mannequin. We hypothesized that participants would increase content knowledge after StB participation and that the training could be improved by a more life-like bleeding modification of the mannequin. From July 2017 to January 2018, hospital and community members from a major metropolitan area participated in StB training. Participants provided demographic data regarding prior emergency training and were asked pre- and post-test questions (five-point Likert scale) regarding their response to hemorrhage. Individuals also evaluated the mannequin on bleeding simulation. Scores were reported as means with standard deviation or medians with interquartile ranges (IQRs) with subset analysis stratified by experience. Of 402 participants, 310 provided complete data. On the composite, pre-test self-assessment, participants had a median score of 24 of 30 points (IQR 16-30). Post-testing demonstrated a statistically significant increase with a median score of 29 (IQR 25-30, P < 0.05). Subset analysis by prior emergency training (n = 102) demonstrated that both those with prior emergency training and those with no prior emergency training had significant improvement. On evaluation of the mannequin, participants reported that a more realistic model would increase their confidence in technique. Both subgroups reported that training would be enhanced if the mannequins were more realistic. StB is an effective education program. Those without prior experience or training in hemorrhage cessation demonstrated the most improvement. Regardless of background, participants reported overwhelmingly that the training would be more effective if it were more realistic. Future work to design and develop cost-effective mannequins demonstrating pulsatile blood flow and cessation of hemorrhage could enable learners to actually "Stop the Bleed". [ABSTRACT FROM AUTHOR]

Ali A Alsaad,1 Swetha Davuluri,2 Vandana Y Bhide,3 Amy M Lannen,4 Michael J Maniaci3 1Department of Internal Medicine, Mayo Clinic, 2University of Miami, Coral Gables, 3Division of Hospital Internal Medicine, 4J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA Background: Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM) residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective: To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs) as compared to mannequin. Methods: Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis). Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score). Results: Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01). When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002). Conclusions: Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. Keywords: simulation, standardized patient, satisfaction, mannequin, assessment, resident education

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock is increasing, but questions remain about who to train and how best to train them. We developed a REBOA training curriculum and performed a pilot course teaching the technique to surgeons and non-surgeons using four different simulation models. Methods: A REBOA curriculum was created incorporating four simulation models: (1) virtual reality, (2) mannequin, (3) large animal live tissue, and (4) perfused cadaver. The course was taught to n = 6 military personnel, including two surgeons, two emergency medicine physicians, and two non-physicians, with no prior REBOA experience. Performance using each model was recorded, and pre and post-course tests and surveys were administered. Simulation models compared capabilities, learner preferences, and cost. Results: Learners gained confidence and performed REBOA successfully in the perfused cadaver models. Higherfidelity live tissue and cadaver models were preferred, and learners rated them as the most realistic. Virtual reality and mannequin simulation were rated the least realistic and most dispensable methods of learning. All simulation models required significant resource investment. Conclusions: A simplified curriculum, focusing only on the skills necessary to perform REBOA, shows promise in providing medical personnel with the confidence and competence to perform the procedure. Higher-fidelity perfused cadaver and live tissue models are preferred by learners, and future work is required to improve the usefulness of mannequin and virtual reality simulation for training. Although REBOA simulation education is expensive, it has the potential to help revolutionize military and civilian prehospital hemorrhage control.

Purpose Of the Study: Pleural diseases are common in clinical practice. Doctors in training often encounter these patients and are expected to perform diagnostic and therapeutic pleural procedures with confidence and safely. However, pleural procedures can be associated with significant complications, especially when performed by less experienced. Structured training such as use of training manikin and procedural skills workshop may help trainee doctors to achieve competence. However, high costs involved in acquiring simulation technology or attending a workshop may be a hurdle. We hereby describe a training model using a simple manikin developed in our institution and provide an effective way to document skill acquisition and assessment among trainee medical officers.Study Design: This was a prospective observational study. The need for training, competence and confidence of trainees in performing pleural procedures was assessed through an online survey. Trainees underwent structured simulation training through a simple manikin developed at our institute. Follow-up survey after the training was then performed to access confidence and competence in performing pleural procedures.Results: Forty-seven trainees responded to an online survey and 91% of those expressed that they would like further training in pleural procedure skills. 81% and 85% of responders, respectively, indicated preferred method of training is either practising on manikin or performing the procedure under supervision. Follow-up survey showed improvement in the confidence and competence.Conclusion: Our pleural procedure training manikin model is a reliable, novel and cost-effective method for acquiring competences in pleural procedures. [ABSTRACT FROM AUTHOR]

Introduction Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. Intervention Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. Methods Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. Results Students who participated in the simulation activity identified and reported significantly increased confidence , knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning . There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. Discussion This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care. [ABSTRACT FROM AUTHOR]

The training of medical students demands practice of skills in scenarios as close as possible to real ones that on one hand ensure acquisition of competencies, and on the other, avoid putting patients at risk. This study shows the practicality of using high definition mannequins (SimMan 3G) in scenarios of first attention in neurological emergencies so that medical students at the Faculty of Medicine of the University of Salamanca could acquire specific and transversal competencies. The repetition of activities in simulation environments significantly facilitates the acquisition of competencies by groups of students ( p < 00.5). The greatest achievements refer to skills whereas the competencies that demand greater integration of knowledge seem to need more time or new sessions. This is what happens with the competencies related to the initial diagnosis, the requesting of tests and therapeutic approaches, which demand greater theoretical knowledge. [ABSTRACT FROM AUTHOR]

There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 ± 15% to 93 ± 4%) and behaviors (from 65 ± 18% to 85 ± 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department.

This article explores the evolution and history of interprofessional education (IPE) using healthcare simulation (HCS). The evolution described here demonstrates an achievement of patient safety efforts as a consequence of the historical roots of healthcare and highlights HCS as a progressive method synergistic with IPE. This paper presents a descriptive review that covers the HCS and IPE literature, indicating factors that led to the use of HCS in IPE. Understanding the history of simulation-enhanced IPE provides healthcare educators with fertile ground to support future IPE. A number of benefits in using HCS to address common challenges to IPE are outlined, including natural relevance and engagement for learners, faculty attraction to its use, and the opportunity to explore socio-historical issues in teams. Several promising directions for future research are suggested. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are multiple techniques for face-mask (FM) ventilation. To our knowledge, the one-handed vs. two-handed C-E technique has been compared in children and adults, but no studies have compared the various two-handed methods. Objective: To compare the effectiveness of mask seal using three different FM techniques on a model intended to simulate difficult FM ventilation and measure ventilation performance. Methods: This was a prospective randomized study of health care providers. A standard airway-training mannequin was modified to produce variable airway resistance and allow measurements of ventilation volume and pressure. Each subject performed FM ventilation for 3 min per technique (30 breaths) in a randomized order. Median exhaled tidal volume and proximal peak flow pressure were determined and compared. Results: Seventy subjects were enrolled. Both two-handed ventilation techniques were more effective than the one-handed technique by both volume and pressure measurements. The one-handed C-E technique yielded a median volume of 428.4 mL, vs. the two-handed C-E technique with 550.8 mL, and the two-handed V-E technique with 538 mL (p < 0.001). Peak pressure measurements revealed a median of 54.6 cm H2O for the one-handed C-E technique, 66 cm H2O for the two-handed C-E technique, and 66.6 cm H2O for the two-handed V-E technique (p < 0.001). There was not a difference between the various two-handed techniques. Conclusions: This model for FM ventilation is able to differentiate the efficacy of FM techniques. Both two-handed ventilation methods were superior to one-handed ventilation, both of which should perhaps be included in airway training for health care providers. [Copyright &y& Elsevier]

Résumé: L’apprentissage d’une technique de traitement nécessite des connaissances théoriques permettant de porter la bonne indication pour le bon traitement, mais aussi des connaissances pratiques permettant de réaliser ce geste thérapeutique dans les meilleures conditions pour un résultat optimal dans un contexte de sécurité maximale. L’évolution des techniques en curiethérapie nécessite la mise en place de formations spécifiques à la fois théoriques et pratiques. Le présent article fait le point sur l’importance de la formation en curiethérapie ainsi que les moyens actuellement mis à la disposition des oncologues radiothérapeutes juniors pour parfaire leur apprentissage de cette technique. Les enseignements nationaux et internationaux sont présentés. L’intérêt de l’utilisation du principe de simulation en curiethérapie est aussi présenté. Même si la curiethérapie n’est pas toujours une technique facile, son efficacité et son intérêt médicoéconomique nécessitent d’être transmis à des étudiants motivés avec la mise en œuvre de moyens pédagogiques pertinents. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to assess airway management by emergency physicians in case of a simulated situation where intubation and ventilation were both impossible. Study design: Observational manikin study. Methods: A manikin (Airman®; Laerdal) allowing simulating difficult airway situations was used. The scenario assessed concerned a patient needing tracheal intubation for severe traumatic brain injury. The manikin was settled to make tracheal intubation under direct laryngoscopy impossible at the first attempt and to make facemask ventilation impossible after the second attempt. Manikin could initially be ventilated through the intubating laryngeal mask Airway (ILMA) but became impossible few seconds after its insertion. With impossible ventilation through the ILMA, arterial oxygen saturation decreased during 2minutes before an hypoxic cardiac arrest occurred. Physicians could use classic laryngoscope with Macinthosh blade, a Gum Elastic Bougie, an ILMA and a cricothyrotomy set. Adhesion to the national airway management algorithm was assessed. Time to cricothyroidotomy decision after ventilation through ILMA became impossible was measured. Results: Twenty-five emergency physicians were assessed. For 14 of them, national expert conference algorithm was perfectly followed. For ten physicians, cricothyroidotomy decision was taken after hypoxic cardiac arrest occurred. Conclusion: Simulation with a manikin is useful to assess the adhesion rate to difficult intubation algorithms. Our study shows that the decision making process for cricothyrotomy is too often delayed as soon as ventilation became impossible and oxygenation compromized. [Copyright &y& Elsevier]

Purpose: Communicating unexpected news of a patient death is rarely encountered in urology. We evaluated resident performance during an unexpected patient death scenario involving high fidelity simulation. We also studied simulation as a tool to teach and assess nontechnical skills in urology. Materials and Methods: An unexpected patient death scenario was developed at a simulation center using high fidelity mannequins, urology residents, critical care fellows, nurses, hospital chaplains and actors. Scenario objectives addressed Accreditation Council for Graduate Medical Education core competencies. The 19 urology residents in training years 2 to 6 participated in the scenario. Performance was evaluated using 5-point Likert scale questionnaires and checklists completed by residents, faculty and actors. Results: Overall resident performance was satisfactory in the simulation scenario. Verification of code status was identified as an area requiring improvement. Euphemisms for death were more commonly used in the initial delivery (16 residents or 84.2%) than the preferred words died or death (3 or 15.8%). After completing the scenario the perceived competency of residents increased from 73.7% before to 94.7% after the scenario. In addition, all residents agreed that the simulation experience was useful and overall realistic, and it should be part of the training curriculum. Conclusions: Evaluation of urology resident performance was possible during an unexpected patient death scenario. Upon completion of the scenario perceived competency of the simulation task was increased. High fidelity simulation was found to be an effective method for teaching and assessing the acquisition of nontechnical skills. All residents agreed that the simulation was useful and should be included in urological training. [Copyright &y& Elsevier]

The spectrum of uses of high-fidelity simulation in emergency medicine has increased in the past 10 years and ranges from teaching isolated skills to improving complex team behaviours in critical situations. This review will describe these published uses and explore the evidence supporting the use of high-fidelity simulation, as well as the future directions and difficulties of using this technology in our specialty. [ABSTRACT FROM AUTHOR]

The paper considers the application of design technologies, where engineering calculations of the equipment are carried out on the basis of simulation of the dynamic behavior of the equipment to be controlled. A pneumatic nozzle example has been shown, simulation is carried out with the MatLab Simulink software. ManneQuin software is recommended for ergonomic analysis of the project. [ABSTRACT FROM AUTHOR]