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Background Traditional simulation-based education prioritizes participation in simulated scenarios. The educational impact of observation in simulation-based education compared with participation remains uncertain. Our objective was to compare the performances of observers and participants in a standardized simulation scenario. Methods We assessed learning differences between simulation-based scenario participation and observation using a convergent, parallel, quasi-experimental, mixed-methods study of 15 participants and 15 observers (N = 30). Fifteen first-year residents from six medical specialties were evaluated during a simulated scenario (cardiac arrest due to critical hyperkalemia). Evaluation included predefined critical actions and performance assessments. In the first exposure to the simulation scenario, participants and observers underwent a shared postevent debriefing with predetermined learning objectives. Three months later, a follow-up assessment using the same case scenario evaluated all 30 learners as participants. Wilcoxon signed rank and Wilcoxon rank sum tests were used to compare participants and observers at 3-month follow-up. In addition, we used case study methodology to explore the nature of learning for participants and observers. Data were triangulated using direct observations, reflective field notes, and a focus group. Results Quantitative data analysis comparing the learners' first and second exposure to the investigation scenario demonstrated participants' time to calcium administration as the only statistically significant difference between participant and observer roles (316 seconds vs. 200 seconds, p = 0.0004). Qualitative analysis revealed that both participation and observation improved learning, debriefing was an important component to learning, and debriefing closed the learning gap between observers and participants. Conclusions Participants and observers had similar performances in simulation-based learning in an isolated scenario of cardiac arrest due to hyperkalemia. Findings support current limited literature that observation should not be underestimated as an important opportunity to enhance simulation-based education. When paired with postevent debriefing, scenario observers and participants may reap similar educational benefits.

The analysis of data from social media sites can provide useful decision-making information for businesses; however, can small businesses with limited budgets and limited technical expertise compete in this new social media driven market? This study provides a proof of concept for increasing a company’s competitive knowledge through the use of the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework model by gathering qualitative data about the use of social media from employee interviews. By increasing the competitive knowledge through evaluating the results of the SWOT analysis, this small start-up company will have a strategic plan for increasing their competitive advantage. The authors present the results of the study in the form of practical recommendations for short-term and long-term implementation. Several of the shortterm and long-term recommendations are substantiated through prior research studies. Future research could include a follow-up study of this company using a SWOT framework tool or other methodologies to indicate what social media tools and strategies provide the most beneficial competitive knowledge for a small business, and why. Additionally, comparing the results from this study with a similar study of a different small start-up business could lead to the design of a model for other small businesses trying to increase their competitive knowledge through the effective use of social media.

The approach to interventional airway management must be consistent and disciplined. This chapter will describe one method to assess the airway and potentially predict which ones could be difficult and require additional interventions to secure and protect. In addition, assessments for difficult bag mask ventilation, laryngoscopy, extraglottic devices, and surgical interventions will be discussed.

One of the most stressful events that a provider will encounter in the ICU is the inability to secure an airway. This chapter will focus on the “Plan B”—what techniques and devices could be used if the traditional placement of an endotracheal tube is unsuccessful.