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This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists' Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants' individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event "evaluation of plans" (0.5 [IQR 0.0-1.0] versus 1.0 [1.0-2.0], p = 0.049). Following the educational intervention, training participants' knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters., Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome., What Is Known: • In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers' actual work. • In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies., What Is New: • This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit. • There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance., (© 2024. The Author(s).)

Objectives: The objective of this study was to develop and validate 6 checklists for evaluating abdominal pain in clinical simulation scenarios; to assess student competencies in managing 6 clinical cases using OSCE, based on faculty evaluations; and to analyze discrepancies between faculty and student evaluations., Design: A practical workshop was designed to address 6 clinical scenarios of abdominal surgical conditions. Four scenarios employed medium fidelity simulators, while 2 scenarios employed standardized patient methodology. Prior to the workshop, students received theoretical audiovisual material. At the conclusion of the workshop, students were evaluated using checklists that assessed communication, privacy, anamnesis, and technical skills. Ten workshops were conducted over 3 years, using the OSCE (Objective Structured Clinical Examination) format for evaluation., Setting: In the statistical analysis, t-Student tests or ANOVA were employed to ascertain whether there were any significant differences between the groups. In the process of validating checklists for clinical scenarios, 6 experts were asked to evaluate each item on a scale of 1 to 9. To assess the degree of agreement among experts, the intraclass correlation coefficient (ICC) was employed., Participants: The study involved a total of 670 third-year medical students from the University of Murcia (UMU), Spain, who participated in the subject "Medical-Surgical Skills.", Results: High levels of appropriateness were observed for the checklist items, with mean scores above 7.5 points, as well as high levels of inter-expert agreement. Students obtained a mean score of 8 points in the evaluation of each clinical scenario. No significant differences were found between faculty and student scores (p < 0.05)., Conclusions: The learning method focused on clinical scenarios of abdominal surgical diseases effectively enhanced the clinical skills of third-year medical students. It used pre-existing audiovisual materials, hands-on workshops with medium-fidelity simulators, and standardized patients. Consistent evaluations from students and faculty confirmed the efficacy of these strategies., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Stress while operating is an important contributor to surgeon health and burnout. Measuring stress is key to improving surgeon and patient outcomes, however biological responses to stress during surgery are variable and difficult to interpret. Participant reported measures of stress have been suggested as an alternative, but the most appropriate measure has not been defined. This study's primary aim was to assess measures of anxiety, stress, and workload before and after surgical simulation and characterize the relationship between these measures., Methods: Surgeons completed three laparoscopic exercises from the fundamentals of laparoscopy program (peg transfer, pattern cutting, intracorporeal suturing) in a neutral environment and "stressed" environment (ergonomic, noise, or time pressure). State trait anxiety and self-reported stress on a visual analogue scale were collected prior to simulation and again immediately afterwards. The NASA task load index (TLX) was also administered post-simulation., Results: Of the 26 participants from gynecological and general surgery specialties, state anxiety increased in 98/148 simulations (62%) with a significant mean increase during simulation (32.9 ± 7.9 vs 39.4 ± 10.2, p < .001). Self-reported stress increased in 107/148 simulations (72%), with a significant increase in mean scores during simulation (38.7 ± 22.5 vs 48.9 ± 23.7, p < .001). NASA-TLX scores immediately after simulation ranged from 40 to 118 (mean 60.5 ± 28.7). Greater anxiety and stress scores were reported in "stressed" simulations (43.6 ± 23.1 vs 54.2 ± 23.3; 68.7 ± 27.0 vs 52.4 ± 28.2 respectively) with a significant interaction effect of the "stressed" environment and type of exercise. Anxiety and stress were moderately positively correlated prior to simulation (r = .40) and strongly positively correlated post-simulation (r = .70), however only stress was strongly correlated to workload (r = .79)., Conclusion: Stress and anxiety varied by type of laparoscopic exercise and simulation environment. Correlations between anxiety and stress are stronger post-simulation than prior to simulation. Stress, but not anxiety, is highly correlated with workload., (© 2024. The Author(s).)

Background: The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS)., Methods: We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data., Results: Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446)., Conclusion: Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Simulation training programs are essential for novice surgeons to acquire basic experience to master laparoscopic skills. However, current state-of-the-art laparoscopy simulators are still expensive, limiting the accessibility to practical training lessons. Furthermore, training is time intensive and requires extensive spatial capacity, limiting its availability to surgeons. New laparoscopic simulators offer a cost-effective alternative, which can be used to train in a digital environment, allowing flexible, digital and personalized laparoscopic training. This study investigates if training on low-cost simulators in a digital environment is comparable to in-person training formats., Materials and Methods: From June 2023 to December 2023, 40 laparoscopic novices participated in this multi-center, prospective randomized controlled trial. All participants were randomized to either the ‟distance" (intervention) or the "in-person" (control) group. They were trained in a standardized laparoscopic training curriculum to reach a predefined level of proficiency. After completing the curriculum, participants performed four different laparoscopic tasks on the ForceSense system. Primary endpoints were overall task errors, the overall time for completion of the tasks, and force parameters., Results: In total, 40 laparoscopic novices completed digital or in-person training. Digital training showed no significant differences in developing basic laparoscopic skills compared to in-person training. There were no significant differences in median overall errors between both training groups for all exercises combined (intervention 3 vs. control 4; p value = 0.74). In contrast, the overall task completion time was significantly lower for the group trained digitally (intervention 827.92 s vs. control 993.42; p value = 0.015). The applied forces during the final assessment showed no significant differences between both groups for all exercises. Overall, over 90% of the participants rated the training as good or very good., Conclusion: Our study shows that students that underwent digital laparoscopic training completed tasks with a similar number of errors but in a shorter time than students that underwent in-person training. Nevertheless, the best strategies to implement such digital training options need to be evaluated further to support surgeons' personal preferences and expectations., (© 2024. The Author(s).)

Objective: To collect validity evidence for the use of the Anastomosis Objective Structured Assessment of Technical Skills (A-OSATS) instrument, which has been developed to evaluate performance of a minimally invasive side-to-side bowel anastomosis with hand-sewn common enterotomy., Design: Residents performed a robotic ileocolic anastomosis simulation on an ex vivo porcine model. Faculty scored each resident with the A-OSATS and performed a provocative leak test on the completed anastomoses. Residents were reassessed on the sewing sub-score 1 month later. Data were compared with parametric and nonparametric analysis., Setting: Single academic general surgery residency PARTICIPANTS: PGY-4 and -5 general surgery residents (n = 17) RESULTS: PGY-5s performed better than PGY-4s in repeat A-OSATS sewing sub-score (mean 55/55 ± 0 vs 43 ± 4.9, p < 0.001) and time to complete (minutes, mean 14.5 ± 4.9 vs 21.2 ± 3.9, p = 0.01). There was a strong correlation between A-OSATS score and time (r = -0.67, p = 0.005). For the initial assessment, there was no significant difference in mean A-OSATS score between anastomoses that leaked and those that did not leak (137.3 ± 14.5 vs 150.1 ± 11.2, p = 0.098), but on repeat assessment, intact anastomoses had a higher mean A-OSATS sewing sub-score than those that leaked (52.2 ± 4.7 vs 39 ± 3.5, p = 0.007). There was no significant difference between initial A-OSATS score and repeat score (p = 0.14)., Conclusions: We provide extrapolative validity evidence for the A-OSATS instrument by comparing A-OSATS score to time to sew, provocative leak test, and discrimination between PGY-4s and PGY-5s. Generalizability validity evidence is provided by test-retest reliability. Further refinement is needed for the A-OSATS tool to be used for high-stakes entrustment decisions in resident-performed robotic ileocolic anastomoses., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Fluoroscopic guided procedures are a mainstay for interventional radiology (IR) procedures. Practice is needed for the novice to interpret fluoroscopic images and simultaneously perform the procedure hands-on as well as control the foot pedal to screen. We describe the development of a training simulation model which simulates the human kidney, ureter, and bladder., Methods: Stereolithography (SLA) 3D print technology using SLA resin and Anycubic SLA printer were employed. A plastic tubing was used to connect the 3D printed kidney and bladder as the ureter. This simulation model permits fluoroscopic guided filling of "pelvicalyceal system" with contrast as well as ureteric stenting, guidewire, and drainage catheter manipulation. Effectiveness of the model to attain skills for nephrostomy exchange and ureteric stenting was obtained via questionnaire from trainees prior to and after utilizing the model., Results: The 3D printing simulation model of the kidney, ureter, and bladder system enables trainees to perform nephrostomy exchange, nephrostogram, and antegrade stenting. Participants felt more confident to perform the procedures as they were more familiar with the procedure. Besides that, participants felt their wire and catheter manipulation skills have improved after using the simulation model., Conclusions: Neph-ex simulation model is safe and effective for hands-on training in improving proficiency of fluoroscopy-guided nephrostomy exchange and antegrade ureteric stenting., Advances in Knowledge: As of our knowledge, there are no commercially available simulation models for fluoroscopic guided nephrostomy exchange and ureteric stent deployment. No article on nephrostomy exchange simulation model has been published before., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: As end-stage renal disease becomes more prevalent in the United States, the number of Americans with arteriovenous (AV) fistulas continues to increase. One of the most feared complications of AV fistulas is life-threatening hemorrhage, as patients can exsanguinate within minutes., Objectives: As frontline healthcare workers, emergency medicine (EM) providers need to be able to provide rapid and effective treatment for this rare presentation. We developed a task trainer model to simulate AV fistula hemorrhage to prepare and train EM residents., Methods: This task trainer model was constructed with readily available materials and takes about 30 minutes to make. Twenty-one EM residents participated in the training session. The session consisted of a brief didactic on AV fistula hemorrhage control followed by hands on usage of the task-trainer model. The participants filled out an anonymous survey afterwards rating the model., Results: Residents completed anonymous postcourse surveys rating the session on a five-point Likert scale. Both the overall teaching session and the task trainer were rated very highly. Compared to precourse ratings, residents reported statistically significant postcourse improvements in their level of confidence in managing AV fistula hemorrhage., Conclusions: To our knowledge, this is the first published task trainer model to simulate a bleeding AV fistula for EM residents. The model was well received by our trainees, is relatively inexpensive, and made from easily sourced materials. We believe this model can be used for trainees of all disciplines to prepare them for this potentially catastrophic patient presentation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Video-laryngoscopy is increasingly used during general anesthesia for emergency cesarean deliveries. Given the heightened risk of difficult tracheal intubation in obstetrics, addressing challenges in airway management is crucial. In this simulation study, we hypothesized that using a flexible bronchoscope would lead to securing the airway faster than the Eschmann introducer when either device is used in addition to video-laryngoscopy., Methods: Twenty-eight anesthesia trainees (n=14/group) were randomized to use either one of the rescue devices and video-recorded in a simulated scenario of emergency cesarean delivery. The primary outcome was the time difference in establishing intubation; secondary outcomes were the differences in incidence of hypoxemia, need for bag and mask ventilation, and failed intubation between the two rescue devices., Results: Mean (±SD) time to intubation using flexible bronchoscopy was shorter compared to using an Eschmann introducer (24 ± 10 vs 86 ± 35 s; P<0.0001; difference in mean 62 seconds, 95% CI 42 to 82 seconds). In the fiberoptic bronchoscopy group, there were no episodes of hypoxemia or need for bag and mask ventilation; in contrast both such events occurred frequently in the Eschmann introducer group (71%, 10/14); P=0.0002). All flexible bronchoscopy-aided intubations were established on the first attempt. The incidence of failed intubation was similar in both groups., Conclusions: Our data from simulated emergency tracheal intubation suggest that flexible bronchoscopy combined with video-laryngoscopy results in faster intubation time than using an Eschmann introducer combined with video-laryngoscopy., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Simulation-based education (SBE) provides enactive experiences for learners. This project explores the utility of SBE in GUM training., Methods: Phase 1 was a qualitative survey of GUM trainees across the UK exploring their views on SBE. Phase 2 involved roll-out of SBE to new GUM trainees. Feedback was subsequently obtained., Results: Twenty-three participants were surveyed in phase 1. When asked to rate the relevance of SBE to curriculum competencies on a scale of 1 to 5 (1 = not relevant, 5 = highly relevant), the highest ratings (score ≥4) were for proctoscopy (4.1), IUD insertion (4.1), SDI removal (4.1), SDI insertion (4.0), and punch biopsy (4.0). All curriculum items scored ≥3. Eighty-three percent ( n = 19) felt SBE will improve clinician confidence and competence. Following introduction of SBE, participants fed back on the relevance of the session. All 5 respondents rated the session ≥4 for addressing their clinical and curriculum goals. All respondents rated the session ≥4 for improving clinician confidence and competence. The session received an overall rating of 5, and respondents similarly rated 5 for more sessions., Conclusion: Trainees recognise the value of simulated learning experiences and its role in improving procedural competence and addressing bespoke human factor skills relevant to GUM., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Literature showed that learners' perceived usability and perspective toward a technology application affected their learning experience. Fewer studies have investigated immersive virtual reality (IVR) simulation learning of fundamental nursing skills learning (FNSL)., Purpose: The aim of the study was to explore the perceived usability of IVR simulations for FNSL among first-year nursing students and their perspectives toward this learning modality., Methods: This study used a mixed-methods design with an educational intervention. Sixty-five first-year nursing students participated in 2 IVR simulation procedures in complementary mode. Surveys and focus groups were conducted in the postintervention period., Results: The findings demonstrated students' positive inclinations toward IVR simulation learning. Two areas emerged: using IVR simulation as a complementary modality for FNSL and barriers affecting students' perceived usability toward this technology., Conclusions: With addressing the concerns from students' perceived usability, immersive virtual reality simulation could be a potential complementary modality for FNSL., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Closure of rural obstetric (OB) units has led to maternal care deserts, causing mothers to travel long distances for maternity care. Emergency departments (EDs) in hospitals where OB units have closed require regular training for personnel to maintain OB skills, as do rural Level-1 OB units with low volumes of maternity cases. We used a federal grant to develop an OB mobile simulation program to bring simulation-based training to rural providers. Our goal was to improve OB skills and standardize care through the framework of the Alliance for Innovation in Maternal Health (AIM) Patient Safety Bundles., Methods: We conducted needs assessments and built a mobile simulation unit. We defined 2 groups of learners: those in Level-1 OB units and those in EDs without OB units. For Level-1 OB units, we created a train-the-trainer curriculum, to create a statewide cohort of simulation experts to implement simulations in their facilities between our visits. We gifted each Level-1 unit an OB task trainer, implemented virtual train-the-trainer simulation and task trainer workshops, and conducted post-workshop assessments. We then traveled to each Level-1 unit and helped the cohort implement in situ simulations for their staff using facility-specific resources. We conducted assessments for the cohort and the hospital staff after the simulations. For EDs, we delivered virtual didactics to improve basic OB knowledge, then traveled to ED units, implemented in situ simulations, and conducted post-simulation assessments. We chose a postpartum hemorrhage (PPH) scenario for our first round of simulations., Results: After train-the-trainer simulation workshops, 98% of participants surveyed agreed that workshop goals and objectives were achieved. After the task trainer workshop, 95% surveyed agreed that their knowledge of using the simulator had improved. After implementing in situ simulations in Level-1 OB units, 98.8% of the train-the-trainer cohort found that their ability to implement simulations had improved. The hospital staff participating in the simulations identified a 30% increase in ability to manage PPH. For the ED staff, postdidactic evaluations identified that 95.4% of participants reported moderate improvement in basic OB knowledge and after participation in the simulations >95% reported better skills as an ED team member when caring for pregnant patients., Conclusions: These results demonstrate improved skills of hospital staff in simulated PPH in Level-1 OB units and simulated OB emergencies in EDs that no longer have OB units. Further studies are warranted to assess improvement in maternal outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Background and Objectives: Endoscopic skull base surgery is a subspecialty field which would benefit significantly from high-fidelity surgical simulators. Giving trainees the opportunity to flatten their learning curve by practicing a variety of procedures on surgical simulators will inevitably improve patient outcomes., Methods: Four neurosurgeons, 8 otolarynologists, and 6 expert course faculty agreed to participate. All participants were asked to perform a transsphenoidal exposure and resection of a pituitary adenoma, repair a cerebrospinal fluid (CSF) leak, control a carotid injury, and repair a skull base defect. The content, face, and construct validity of the 3-dimensional printed model was examined., Results: The heart rate of the participants significantly increased from baseline when starting the carotid injury simulation (mean 90 vs 121, P = .029) and significantly decreased once the injury was controlled (mean 121 vs 110, P = .033, respectively). The participants reported a significant improvement in anxiety in facing a major vascular injury, as well as an increase in their confidence in management of major vascular injury, resecting a pituitary adenoma and repair of a CSF leak using a 5-point Likert scale (mean 4.42 vs 3.58 P = .05, 2 vs 3.25 P < .001, 2.36 vs 4.27 P < .001 and 2.45 vs 4.0 P = .001, respectively). The mean Objective Structured Assessment of Technical Skills score for experienced stations was 4.4, significantly higher than the Objective Structured Assessment of Technical Skills score for inexperienced stations (mean 3.65, P = .016)., Conclusion: We have demonstrated for the first time a validated 3-dimensional printed surgical simulator for endoscopic pituitary surgery that allows surgeons to practice a transsphenoidal approach, surgical resection of a pituitary adenoma, repair of a CSF leak in the diaphragma sellae, control of a carotid injury, and repair of skull base defect., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Current medical simulators for extracorporeal membrane oxygenation (ECMO) are expensive and rely on low-fidelity methodologies. This creates a challenge that demands a new approach to eliminate high costs and integrate with critical care environments, especially in light of the scarce resources and supplies available after the COVID-19 pandemic., Methods: To address this challenge, we examined the current state-of-the-art medical simulators and collaborated closely with Hamad Medical Corporation (HMC), the primary healthcare provider in Qatar, to establish criteria for advancing the cutting-edge ECMO simulation. This article presents a comprehensive ambulatory high-realism and cost-effective ECMO simulator., Results: Over the past 3 years, we have surveyed relevant literature, gathered data, and continuously developed a prototype of the system modules and the accompanying tablet application. By doing so, we have successfully addressed the issue of cost and fidelity in ECMO simulation, providing an effective tool for medical professionals to improve their understanding and treatment of patients requiring ECMO support., Conclusions: This paper will focus on presenting an overall ambulatory ECMO simulator, detailing the various sub-systems and emphasizing the modular casing of the physical components and the simulated patient monitor., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives: Traditional neurosurgical education has relied heavily on the Halstedian "see one, do one, teach one" approach which is increasingly perceived as inefficient in contemporary settings marked by a steady decline in surgical caseload. In recent years, simulation training has emerged as an effective and accessible training alternative. To date, however, there is no standardized criterion pertaining to the quality and implementation of simulators in neurosurgical education and training. This research aims to compare the efficacy of virtual reality (VR) and Phantom-based simulation training in the context of neurosurgical skill acquisition, with a focus on middle cerebral artery aneurysm clipping., Methods: An immersive VR clipping tool and a haptic clipping simulator incorporating 3-dimensional printing, additive manufacturing, and rheological analyses were developed. Twenty-two participants, comprising 12 medical students, 6 neurosurgical residents, and 4 experienced neurosurgeons, tested and evaluated both simulators for face and content validity. Construct and predictive validity of the simulators were assessed using an objective structured assessment scale for aneurysm clipping, measuring participants' performances and progress., Results: Both modalities were deemed highly advantageous for educational purposes. Objective evaluations, however, revealed measurable differences in usability, efficacy, and transferability of the learned skills with VR excelling in procedural planning and visualization while Phantom simulation being noticeably superior in conveying surgical skills., Conclusion: Simulation training can accelerate the neurosurgical learning curve. The results of this study highlight the importance of establishing standardized criteria for the implementation and assessment of simulation modalities, ensuring consistent quality and efficacy in neurosurgical education., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: In nursing education, often dominated by instructor-led simulations (ILS), there is a growing demand to explore alternative approaches, such as peer-led simulation (PLS), in the training of post-registration nursing students. PLS shifts learners into leadership roles, fostering scenario design and facilitation among peers. Despite existing literature on ILS versus PLS, there remains a gap in the effectiveness of combined PLS and ILS for post-registration nursing students. This study aims to investigate the factors influencing the learning experience of post-registration nursing students and their perceptions of PLS as an instructional strategy., Methods: This qualitative study was implemented from October 2022 to April 2023. The entire student cohorts (n = 20) were recruited from the Advanced Diploma in Nursing (Peri-anaesthesia) programme. The students underwent both ILS (14h) and PLS (11h) as part of the mandatory activities within a 60-h module on "Crisis Management in Anaesthesia". Three semi-structured focus group discussions (FGDs) with 16 participants were conducted. The FGDs were guided by six questions on students learning experiences that were validated using the Delphi method., Results: The thematic analysis revealed four major themes concerning their learning experiences: the learning journey, enablers, barriers and perceived benefits of including PLS. Among the enablers, one notable finding was learners' appreciation for their ability to apply evidence-based practice (EBP) principles, which played a significant role in achieving conceptual fidelity in their developed scenarios., Conclusion: The qualitative findings underscore the importance of PLS in fostering dynamic learning environments, vital for educators across disciplines. By actively participating in scenario design and facilitation, students enhance their understanding of theoretical concepts and clinical competency. PLS implementation provides insights into students' learning needs and challenges, benefiting educators in refining teaching strategies and enhancing educational effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To determine the individual learning curves for cordocentesis in a low-cost simulator for maternal-fetal medicine (MFM) fellows., Methods: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM)., Results: Seven second-year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%)., Conclusion: CUSUM analysis to assess learning curves, in addition to using low-cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows., (© 2024 International Federation of Gynecology and Obstetrics.)

Introduction: Debriefing as a learning activity aims to elevate participants' competence through communicative interaction. This activity is an integral component of any formative simulation. Thus, the primary objective of this study was to explore debriefing as a communicative experience in nursing students within the context of interactive virtual simulation. The secondary objectives were: 1) To investigate the typology of interactions based on participants' discourse and 2) To identify the actions that students use to develop knowledge during debriefing., Method: A qualitative exploratory study design involving six debriefing groups was conducted with 105 s-year nursing students. The debriefing sessions were analyzed following interactive virtual simulations in an in-person setting in the classroom. All sessions were recorded and transcribed verbatim. A mixed (deductive and inductive) content analysis approach was used., Results: A total of 2187 units of meaning were identified and categorized into 3 themes (interaction by participant, interaction by communicative action, and interaction by participant's communicative goal); nine subthemes (facilitator-student, student-student and student-facilitator; declarative - unidirectional, reactive - bidirectional and multidirectional-interactive; individualistic, competitive, and collaborative), and 5 categories (providing information; generating creative solutions; processing critical and deliberative information; positive interdependence and psychosocial relationships)., Conclusion: The students developed knowledge and practical communication skills, particularly reinforcing soft skills through collaborative interactions, predominantly multidirectional-interactive in nature. The facilitator and the interpersonal relationships among the participants fostered a safe and positive environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aims to assess validity evidence of the new phacoemulsification module of the HelpMeSee [HMS] virtual reality simulator. Conducted at the Ophthalmology Department of Strasbourg University Hospital and Gepromed Education Department, Strasbourg, France, this cross-sectional study divided 20 surgeons into two groups based on their experience over or under 300 cataract surgeries. Surgeons filled out a background survey covering their phacoemulsification experience and prior simulator use before undergoing single-session simulations on the EyeSi [EYS] and HMS simulators. Handgrip strength was measured pre- and post-simulation to evaluate grip fatigue. Afterwards, surgeons rated the perceived realism on a seven-point Likert scale. Participants were predominantly right-handed males, with expert surgeons averaging 44 years and intermediate surgeons 29 years of age. Expert surgeons had completed around 2000 phacoemulsification surgeries compared to 150 by intermediates. Primary outcome was to assess the construct validity of HMS simulator based on the difference in total and modules scores between both groups. Significant performance differences were observed between the two groups, with experts scoring higher. HMS scores were 35.8 ± 1.5 out of 46 points for experts and 27.2 ± 2.3 for intermediates (p = 0.006). For EYS, scores were 405.2 ± 20.3 out of 500 points for experts and 327.8 ± 25.2 for intermediates (p = 0.028). Experts experienced significantly less grip fatigue post-simulation on HMS compared to intermediates. This research evaluates validity evidence of HMS's phacoemulsification modules for the first time. It emphasizes the potential to broaden simulation-based training by targeting diverse populations., (© 2024. The Author(s).)

Background: Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course., Methods: This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution ( n = 39). The second group was instructed in using a web-based simulator, VentSim ( n = 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points., Results: There was no significant difference in the mean ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; P = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI -7.0 to ∞; P non-inferiority = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest - pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; P non-inferiority < .001 [non-inferiority confirmed])., Conclusions: In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator., Competing Interests: Dr Safadi is the creator of the web-based mechanical ventilation simulator that was used in this study. The remaining authors have reported no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Simulation-based education is a key aspect of health professions education used to aid healthcare providers in developing and maintaining clinical skills. Rural and remote healthcare providers have limited access to skills development opportunities. Training tools such as simulators are primarily limited to university and hospital-based research centers in urban areas. This scoping review aimed to examine current literature to identify a partnership model involving academic institutions and non-profit organizations (NPOs) that focuses on facilitating the wider distribution of simulators. The five-stage Arksey and O'Malley methodological framework for conducting scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis was used to guide the scoping review. The search was conducted on five literature databases, three grey literature databases and through manual reference searching with an applied time frame of 2000 to 2022. The search identified 15 articles that met the eligibility criteria and were included in the study. Analysis of the articles revealed that no partnership model currently exists that facilitates the production and distribution of simulators through a partnership between academic institutions and NPOs. Establishing the partnership, acquiring funding, implementation, monitoring and evaluation, and dissemination were identified as key stages of a multi-institutional partnership. Further research is necessary to fill the gaps of the partnership process pertaining to the development and production of simulators to train healthcare providers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Siraj et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Virtual reality (VR) simulation technology was rapidly integrated into pre-registration adult nursing programmes in response to the pandemic and a reduction in clinical placements. The UK's regulatory body for nursing has recognised its value in nursing education by increasing the possible number of simulated practice hours that can replace clinical placements to 600 hours. This article reports on an evaluation study of a novel approach using screen-based VR simulations for groups of students in a classroom setting., Objectives: This study aims to evaluate student and lecturer experiences of screen-based VR with the aim of informing and sharing insights from this approach., Design: Students and lecturers responded to an evaluation survey comprising both closed- and open-ended questions., Setting: A large approved education institute in the East of England., Participants: Pre-registration adult nursing master's students and adult nursing lecturers who had experience of screen-based VR with groups., Methods: Quantitative data were analysed using descriptive methods, and qualitative data using thematic analysis., Results: Student and lecturer experiences of screen-based VR were overwhelmingly positive, overcoming many challenges of simulation documented in the literature. The group-working approach promoted development of non-technical or essential 'soft' skills such as communication, decision-making and teamwork., Conclusions: Screen-based VR for classroombased learning offers an effective, engaging and cost-effective method of incorporating VR simulation scenarios in adult nursing education. Thoughtful consideration of pedagogical aspects are key to its successful and effective integration into the pre-registration adult nursing curriculum.

The objective of pilot training is to equip trainees with the knowledge, judgment, and skills to maintain control of an aircraft and respond to critical flight tasks. The present research aims to investigate changes in trainees' cognitive control levels during a pilot training process while they underwent basic flight maneuvers. EEG microstate analysis was applied together with spectral power features to quantitatively monitor trainees' cognitive control under varied flight tasks during different training sessions on a flight simulator. Not only could EEG data provide an objective measure of cognitive control to complement the current subjective assessments, but the application of EEG microstate analysis is particularly well-suited for capturing rapid dynamic changes in cognitive states that may happen under complex human activities in conducting flight maneuvers. Comparisons were conducted between two types of tasks and across different training stages to monitor how pilot trainees' cognitive control responds to varied flight task types and training stages. The present research provides insights into the changes in trainees' cognitive control during a pilot training process and highlights the potential of EEG microstate analysis for monitoring cognitive control., (© 2024. The Author(s).)

With the increasing complexity of intracranial aneurysm surgery and the reduced opportunities for hands-on training, there is a need for effective simulation-based training methods. This systematic review examines 26 studies on various simulation training approaches for intracranial aneurysm clipping, including ex vivo methods, virtual reality platforms, and 3D-printed models. The review evaluates these methods based on their effectiveness, realism, usability, and validation, highlighting that current simulation models are heterogeneous and lack standardization. Most existing simulations fail to replicate the complete microsurgical workflow, and their validation methods vary widely, limiting generalizability. The review recommends developing a standardized, comprehensive, and cost-effective simulation model that incorporates advanced haptic feedback and detailed anatomical features. Future research should focus on creating a universal validation framework to reliably assess simulation efficacy and ensure that neurosurgical trainees receive consistent, high-quality training experiences., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Exposure of the hepatic artery is a fundamental step in many surgeries, during which iatrogenic hepatic artery injury may occur. Although the incidence of hepatic artery haemorrhage is low, its occurrence can lead to life-threatening haemorrhage. It is difficult and dangerous to accumulate clinical experience in laparoscopic hepatic artery repair in actual patients, and simulation training models for laparoscopic hepatic artery repair are currently lacking. In this study, a 3D printed model was designed to simulate the training curriculum for sudden hepatic artery haemorrhage, but whether training with the 3D printed model could yield superior skill improvement for surgeons remained to be determined., Methods: A new 3D printed model was designed for this study. Surgeons from the General Surgery Department of Sir Run Run Shaw Hospital participated in this simulation training. The surgical performance of each model was compared, and the authenticity of the model was evaluated and mechanically tested., Results: Experienced surgeons performed better on the 3D printed model. After repeated training, inexperienced surgeons showed significant improvement of their laparoscopic hepatic artery repair skills. The authenticity of the model was generally satisfactory, but shortcomings persisted in the mechanical testing of artery wall tearing, necessitating further improvement., Conclusions: Few studies have investigated laparoscopic simulation training for sudden hepatic artery haemorrhage. This simulation model distinguishes surgeons with different levels of experience and allows those with less experience to improve their laparoscopic hepatic artery repair skills through training on the model., (© 2024. The Author(s).)

Introduction: Virtual simulation (VS) can be an effective learning strategy in the context of nursing education on cardiovascular disease; however, its use in teaching cardiology in nursing is less studied. The objective of this scoping review is to map the use of VS for teaching cardiology in nursing., Methods and Analysis: This scoping review will be conducted according to the Joanna Briggs Institute methods, and the results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Eight databases will be searched: MEDLINE (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature, Web of Science, Latin American and Caribbean Literature in Health Sciences, Spanish Bibliographic Index of Health Sciences, Database of Nursing, EMBASE and Google Scholar from inception to 31 July 2024. This study will include any existing peer-reviewed literature and grey literature. There will be no time or language restrictions. Two reviewers will screen and select the articles independently, and when there are differences, they will be resolved with a third opinion. When appropriate, broad themes and categories derived from the review questions will be accompanied by other illustrative formats (eg, tables or graphs, word clouds and infographics)., Ethics and Dissemination: This research project does not require ethical committee approval. The study is part of a cooperative research project between researchers from the Federal University of Piauí, Northeast of Brazil, and Queen's University, Ontario, Canada, to develop and seek evidence of content validity of a VS game about valvular heart disease. The protocol and review will be published in peer-reviewed journals., Registration Details: Open Science Framework (https://doi.org/10.17605/OSF.IO/S3UMH)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Simulation-based learning is essential for health care providers to prepare for rare obstetric emergencies, such as severe trauma and maternal cardiac arrest. These situations demand rapid and prompt actions, often testing the skill of emergency physicians. Resuscitative hysterotomy (RH), a critical procedure in maternal cardiac arrest, requires technical expertise, coordination, and anatomical knowledge. The high cost of commercial trainers and complex existing models restricts accessibility. This resource introduces a low-cost anatomically accurate RH task trainer and assesses its effectiveness in improving skills and confidence among trainee emergency physicians., Methods: A 20-minute-long case scenario depicted the resuscitation of a pregnant trauma patient with tension pneumothorax and uterine rupture, culminating in maternal cardiac arrest necessitating RH. Residents performed RH on the task trainer under faculty guidance. Feedback followed the Pendleton model, and an online questionnaire gauged the residents' experiences., Results: Thirty emergency medicine residents participated in the simulation. The questionnaire revealed positive responses, confirming the session's relevance and enhancement of clinical skills and confidence., Discussion: Our results underscore the RH task trainer's critical role in improving residents' skills and confidence during obstetric trauma simulations. Its realism and effectiveness were notably well received. Future refinements aim to augment fidelity while preserving affordability and integrating regular reinforcement sessions. This innovative educational approach equips health care professionals to respond adeptly to rare and challenging obstetric emergencies, ultimately elevating outcomes for mothers and infants during critical situations., (© 2024 Chin and Ng.)

Introduction: Hypoxia training is mandatory for military pilots, but variability in hypoxia symptoms challenges the training. In a previous study we showed that 64% of pilots recognized hypoxia faster in their second normobaric hypoxia session conducted 2.4 yr after the first. Our aim here was to evaluate whether a third session conducted 5.0 yr after the first would provide further benefit., Methods: This study was conducted under normobaric conditions in a tactical F/A-18C Hornet simulator in three sessions in which the pilots performed visual identification missions and breathed 21% oxygen in nitrogen. The breathing gas was changed to a hypoxic mixture containing either 8%, 7%, or 6% oxygen in nitrogen without the pilot's knowledge. Data were collected from 102 military pilots. The primary outcome was the time taken for initial identification of hypoxia symptoms., Results: Hypoxia symptoms were recognized on average in the first session in 8% oxygen in 100 s, 7% oxygen in 90 s, and 6% oxygen in 78 s; in the second in 87 s, 80 s, and 71 s, respectively; and in the third in 79 s, 67 s, and 64 s, respectively. In 2 sessions 20 pilots and in each 3 training sessions 3 pilots had slow recognition times., Discussion: Hypoxia symptom recognition improved the further the repeated normobaric hypoxia training went. More emphasis should be put on the 23% group of slow hypoxia symptom recognizers and more customized hypoxia training for them should be offered. Leinonen AM, Varis NO, Kokki HJ, Leino TK. Normobaric hypoxia symptom recognition in three training sessions. Aerosp Med Hum Perform. 2024; 95(10):758-764.

Simulation has proven to be one of the most powerful forms of enactive experience in medical sciences, which enhances the efficacy of both direct and vicarious learning. At the undergraduate level, community health nurses are expected to be inclusively knowledgeable about population-based nursing practices with diverse communities; so, they prepare well to establish partnership skills with stakeholders and make collaborative decisions that promote awareness and understanding of the community's health needs. Problem prioritisation is an essential step of the planning cycle. It is one of the advanced concepts in community health nursing which needs in-depth knowledge and contemplation about the dynamics of the community. This paper highlights the students' perspectives regarding the impeccable effects of simulation pedagogy on students' learning in terms of improving their communication skills and alleviating the fear of dealing with community stakeholders before the actual problem-priority setting exercise for the clinical community project. Key Words: Community health nursing, Simulation-based learning, Problem prioritisation, Stakeholders.

Background: Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia., Methods: This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media., Results: One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene., Conclusion: Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

There have been few reports concerning simulation drills for the relocation of severely ill or injured patients treated in intensive care units (ICUs). We herein report our experience of one such simulation drill. It is a Narrative method. A simulation drill was performed on a weekday 2 weeks prior to the actual relocation. We selected 3 mock patients. The first one was a severely ill and unstable patient, the second had severe stroke, and the third had severe trauma. After the simulation, the average transportation time was 15 minutes. The simulation revealed that mock patients with a percutaneous cardiopulmonary support system and intra-aortic balloon pumping in a standard ICU bed could not be accommodated in the elevator. Furthermore, working the elevator controls resulted in wasted time while transferring the patients. As a result, the number of people, who controlled the elevator, was therefore increased during the actual relocation. During the actual relocation, all patients were transported safely and more quickly than predicted based on the results of the simulation drill. Most physicians and paramedical staff have little experience with relocating ICUs, so a simulation drill was necessary to ensure the safe and prompt transport of patients., Competing Interests: The authors declare no conflicts of interest in association with the present study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Declaration of competing interest Authors RS, JL, LK and MS report no relevant conflicts of interest. JE has received an unrestricted research grant from Medtronic and WL Gore. TR is consulting for COOK and Bentley, has received research grants from COOK, W.L GORE & Associates, Bentley and sits on the advisory board for Artivion. IvH has received honoraria for consulting and training from Medtronic, Tolochenaz, Switzerland

Purpose: Our aim was to develop practical training for laparoscopic surgery using Thielembalmed cadavers. Furthermore, in order to verbalize experts' motion characteristics and provide objective feedback to trainees, we initiated motion capture analyses of multiple surgical instruments simultaneously during the cadaveric trainings. In the present study, we report our preliminary results., Methods: Participants voluntarily joined the present cadaveric simulation trainings, and performed laparoscopic radical nephrectomy. After the trainings, scores for tissue similarity (face validity) and impression of educational merit (content validity) were collected from participants based on a 5-point Likert scale (tissue similarity: 5: very similar, 3: average, 1: very different; educational merit: 5: very high, 3: average, 1: very low). In addition, after the additional IRB approval, we started motion capture (Mocap) analyses of 6 surgical instruments (scissors, vessel sealing system, grasping forceps, clip applier, right-angled forceps, and suction), using an infrared trinocular camera (120-Hz location record). Mocap-metrics were compared according to the previous surgical experiences (experts: ≧50 laparoscopic surgeries, intermediates: 10-49, novices: 0-9), using the Kruskal-Wallis test., Results: A total of 9 experts, 19 intermediates, and 15 novices participated in the present study. In terms of face validity, the mean scores were higher than 3, other than for the Vena cava(mean score of 2.89). Participants agreed with the training value (usefulness for future skill improvement: mean score of 4.57). In terms of Mocap analysis, faster speed-related metrics (e.g., velocity, the distribution of tip velocity, acceleration, and jerk) in the scissors and vessel sealing system, a shorter path length of grasping forceps, and fewer dimensionless squared jerks, which indicated more purposeful motion of 4 surgical instruments (vessel sealing system, grasping forceps, clip applier and suction), were observed in the more experienced group., Conclusions: The Thiel-embalmed cadaver provides an excellent training opportunity for complex laparoscopic procedures with participants' high level of satisfaction, and may become a promising tool for a better objective understanding of surgical dexterity. In order to enrich formative feedback to trainees, we are now proceeding with Mocap analysis., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest Authors RS, JL, LK, TR, and JE report no relevant conflicts of interest. EA and CM have co-founded a start-up company, WARD247 ApS, intending to pursue the regulatory and commercial activities of the WARD project (a research project that develops a clinical support system using wireless monitoring of cardiopulmonary function). WARD247 ApS has obtained license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD), EP 21184712.4 and EP 21205557.8”.

Introduction: Continuous performance improvement (PI) programs are essential for excellent trauma care. We incorporated PI identified from trauma cases into an in-situ simulation-based medical education curriculum. This is a proof-of-concept study exploring the efficacy of high-fidelity pediatric trauma simulations in improving self-reported provider comfort and knowledge for identified trauma PI issues., Methods: This study was performed at an American College of Surgeons-verified Level I Pediatric Trauma Center. Several clinical issues were identified during the trauma PI process, including management of elevated intracranial pressure in traumatic brain injury and the use of massive transfusion protocol. These issues were incorporated into a simulation-based medical education curriculum and high-fidelity in-situ trauma mock codes were held. In-depth debriefing sessions were led by a senior faculty member after the simulations. The study participants completed pre- and postsimulation surveys. Univariate statistics are presented., Results: Twenty three providers completed surveys for the pediatric trauma simulations. Self-reported provider confidence Likert scale improved from pre- to postsimulation (P = 0.02) and trauma experience and knowledge scores improved from 82% presimulation to 93% postsimulation (P = 0.02)., Conclusions: High-fidelity pediatric trauma simulations enhance provider comfort, knowledge, and experience in trauma scenarios. By integrating high-fidelity trauma simulations to address clinical issues identified in the trauma PI process, provider education can be reinforced and practiced in a controlled environment to improve trauma care. Future studies evaluating the implementation of clinical pathways and patient outcomes are needed to demonstrate the effectiveness of simulations in PI pathways., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection., (© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)

Background: There are limited opportunities to practice surgical skills and techniques in residency. Therefore, it is important to explore strategies which optimize surgical simulation experiences to enhance learning outcomes and skill retention., Methods: Novice medical students (n = 29) were recruited to participate in a Fundamentals of Laparoscopic Surgery (FLS) peg transfer task training. Participants were randomly assigned to a control group, practicing the peg transfer task independently, or an experimental group, practicing with time pressure. Participant skill assessments were completed before the training, after the training, and 8-weeks after the training. Subjective and objective stress measurements were taken in the form of self-report surveys and heart rate variability data, respectively., Results: For all the skill assessment measurements, there was no difference between groups in performance on the FLS task. Both groups showed improvement in performance after the training compared to before. The experimental group reported higher stress during and after the training period compared to the control group; however, there was no difference between groups on heart rate variability metrics., Conclusion: Time pressure while practicing an FLS task did not significantly impact learning acquisition or retention. However, the experimental group reported higher levels of stress. This preliminary study suggests time pressure does not confer an enhanced surgical skill learning experience for novices., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Nowadays, video-assisted thoracic surgery (VATS) lobectomy represents the treatment of choice for early-stage lung cancer. Over the years, different methods for VATS training have evolved. The aim of this study is to present an innovative beating-heart filled-vessel cadaveric model to simulate VATS lobectomies., Methods: Via selective cannulation of the cadaver heart, the pulmonary vessels were filled with a gel to improve their haptic feedback. An endotracheal tube with a balloon on its tip then allowed movement of the heart chambers, transmitting a minimum of flow to the pulmonary vessels. A simulated OR was created, using all instrumentation normally available during surgery on living patients, with trainees constantly mentored by experienced surgeons. At the end of each simulation, the participants were asked 5 questions on a scale of 1 to 10 to evaluate the effectiveness of the training method ("1" being ineffective and "10" being highly effective)., Results: Eight models were set up, each with a median time of 108 min and a cost of €1500. Overall, 50 surgeons were involved, of which 39 (78%) were consultants and 11 (22%) were residents (PGY 3-5). The median scores for the 5 questions were 8.5 (Q1; IQR 1-3 8-9), 8 (Q2; IQR 1-3 7-9), 9 (Q3; IQR 1-3 8-10), 9 (Q4; IQR 1-3 8-10), and 9 (Q5; IQR 1-3 8-10). Overall, the model was most appreciated by young trainees even though positive responses were also provided by senior surgeons., Conclusions: We introduce a new beating-heart filled-vessel cadaveric model to simulate VATS lobectomies. From this initial experience, the model is cost effective, smooth to develop, and realistic for VATS simulation., (© 2024. The Author(s).)

Introduction: Practical simulation training with proper haptic feedback and the fragility of the human body is required to overcome the long learning curve associated with laparoscopic inguinal hernia repair (LIHR). However, few hernia models accurately reflect the texture and fragility of the human body. Therefore, in this study, we developed a novel model for transabdominal preperitoneal (TAPP) LIHR training and evaluated its validity., Methods: We developed a high-quality mock peritoneum with a hydrated polyvinyl alcohol layer and a unique two-way crossing cellulose fiber layer. To complete the simulation, the peritoneum was adhered to a urethane foam inguinal base with surgical landmarks. Participants could perform all the procedures required for the TAPP LIHR. Twenty-four surgeons performed TAPP LIHR simulation using a novel simulator. Their opinions were rated on a 5-point Likert scale. Additionally, 6 surgical residents and 10 surgical experts performed the procedure. Their performance was evaluated using the TAPP checklist score and procedure time., Results: Most participants strongly agreed that the TAPP LIHR simulator with an exchangeable peritoneum model was useful. The participants agreed on the model fidelity for tactile sensation, forceps handling, and humanlike anatomy. In comparisons between surgical residents and experts, the experts had significantly higher scores (10.6 vs. 17.2, p < 0.05) and shorter procedure times (92.3 vs. 55.9 min; p < .05) than did surgical residents., Conclusions: We developed a high-quality exchangeable peritoneal model that mimics the human peritoneum's texture and fragility. This model enhances laparoscopic simulation training, potentially shortening TAPP LIHR learning curves., (© 2024 The Author(s). Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

The sigmoid colon simulator was designed to accurately reproduce the anatomical layer structure and the arrangement of characteristic organs in each layer, and to have conductivity so that energy devices can be used. Dry polyester fibers were used to reproduce the layered structures, which included characteristic blood vessels, nerve sheaths, and intestinal tracts. The adhesive strength of the layers was controlled to allow realistic peeling techniques. The features of the Sigmaster are illustrated through a comparison of simulated sigmoidectomy using Sigmaster and actual surgery. We developed a laparoscopic sigmoidectomy simulator called Sigmaster. Sigmaster is a training device that closely reproduces the membrane structures of the human body and allows surgeons to experience the entire laparoscopic sigmoidectomy process., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Background: A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot., Methods: Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework., Results: Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments)., Conclusions: Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Immersive simulation is used increasingly in medical education, and there is increasing awareness of the impact of simulation scenarios on emotional state and cognitive load and how these impact learning. 1 There is growing awareness of the requirement to equip veterinarians with skills for managing high-pressure environments and provide training on human factors., Methods: Veterinary students participated in a high-fidelity immersive simulation of a road traffic collision involving multiple casualties. The students took part in the same simulation twice, the second time after a debrief. Each participant's emotional state and cognitive load were assessed after participating in each simulation. Each participant was asked to score the effect of pressure on their performance., Results: One hundred twenty-five students participated and demonstrated a higher cognitive load with more positive emotional states during the second scenario after the completion of a structured debrief and discussion focusing on pressure relief techniques (cognitive load - ¯ μ Scenario run 1 = 4.44 ± 1.85 [SD], ¯ μ Scenario2 = 5.69 ± 1.74 [SD]). Most (63%) participants described being in a low-performance state of frazzle during the first scenario compared with most (61%) who described being in a high-performance state of flow during the second., Conclusion: Immersive simulation scenarios, with structured debriefing, may allow the measurement of emotional state and cognitive load in participants. Furthermore, this study suggests that curriculum training in human factors and pressure relief techniques, coupled with immersive simulation and debrief, may improve future performance in high-stakes and high-pressure scenarios., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Society for Simulation in Healthcare.)

Objective: The Kielland's forceps is the most used forceps for assisting rotational operative births. There are various maneuvers described for blade insertion. Among these, the most used ones are the direct, first posterior, and wandering maneuver. The objective of this study was to compare these three maneuvers using a simulator., Study Design: In this experimental study, 144 rotational forceps-assisted births were conducted using a simulation model, with 72 starting in a right occiput-transverse position and 72 in a left occiput-transverse position. Each of the three maneuvers (direct, first posterior, or wandering) for blade insertion was performed 48 times by a total of 6 operators, comprising 3 obstetricians with over 10 years of experience and 3 trainees. The assessment of forceps application included evaluating the placement of the blades in terms of asymmetry and the distance from the lock to the posterior fontanelle. Additionally, the study evaluated the number of reinsertions and relocations required, the perceived difficulty of the procedure, and the operator's level of experience., Results: There were no statistically significant differences in terms of asymmetry with the three maneuvers. Regarding the distance from the lock to the posterior fontanelle, the best results were obtained with the direct maneuver. There were no differences in the number of reinsertions, relocations, and the perceived difficulty by the operators among the three maneuvers. Experienced obstetricians had better outcomes in terms of the need for reinsertions., Conclusion: The direct maneuver offer advantages in the insertion of blades for rotational forceps., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills., Objective: The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings., Methods: The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses., Results: Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes., Conclusions: Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes., Registration: PROSPERO Registration Number CRD42020151002., Tweetable Abstract: Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate the effectiveness of a "telestration" system in which the mentor annotates the view of the surgical field, for endoscopic transsphenoidal surgery (ETS)., Methods: The use of telestration was evaluated for sellar floor-opening during ETS and for a task performed using ETS simulation training. During ETS, the mentor outlined the opening area of the sella turcica on the monitor and then the trainee surgeon opened the sella, either with the telestration displayed (telestration (+) group, n = 8) or without (telestration (-) group, n = 7). In the task using an ETS training model, 18 subjects were asked to touch the indicated targets with the forceps, once with the instructions given via telestration and once with verbal instructions only., Results: During ETS, the telestration (+) group had a significantly higher concordance rate between the planned bone window and actual bone window than the telestration (-) group (92.97 ± 4.16% vs. 77.57 ± 10.51%, P = 0.014). In the ETS model, the time required to finish the task was significantly less with telestration than with verbal instructions alone (P = 0.002). None of the subjects had errors when telestration was used, while subjects made an average of 0.33 ± 0.59 errors and had to re-listen to the instructions 0.27 ± 0.46 times when only verbal instructions were given., Conclusions: The use of the telestration system during ETS facilitated the communication of the mentor's intentions to the trainee surgeon and contributed to safer, more accurate surgery. The system was also thought to be useful in reducing operative time., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study employed a randomized controlled trial to assess the efficacy of virtual-reality (VR) simulators and physical model simulators on colonoscopy training to explore the optimal and evidence-based simulation training., Design: Forty participants were divided into 2 groups and randomized as dyads: the VR simulator group and the physical model simulator group. All the participants performed a baseline test through porcine colonoscopy. After a 6 h simulation training, each participant underwent a post-test on a pig after bowel preparation, and the procedures were video-recorded. Both the baseline test and the post-test were blindly assessed by 2 experienced assistant director physicians based on the GAGES-C scoring system., Setting: Simulation center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai., Participants: Forty surgical residents without colonoscopy experience., Results: Both the VR simulator group and the physical model simulator group improved significantly over the baseline test. The VR simulator group performed significantly better than the physical model simulator group, p=0.042. The participants in both groups expressed a high level of simulator satisfaction., Conclusions: Novice residents can benefit from both VR simulators and physical model simulators. The VR simulator was shown to be more effective for colonoscopy training. VR simulators were more recommended for novices conducting basic colonoscopy training., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Simulation-based education (SBE) is common in healthcare education and is increasingly being incorporated in preclinical curriculum. Preclinical students typically have had little exposure to the clinical setting (i.e. hospital patient rooms, equipment) and often feel uncomfortable when first placed in the simulated clinical environment. Prebriefing, a standard of best practice in simulation, prepares learners for simulation exercises. To successfully integrate SBE in preclinical education, we recommend expanding the prebriefing to include: multiple activities that orient learners to the learning space and the structure of a simulation activity, the goals of simulation as a learning process, faculty modeling of a simulated patient encounter, and expected learner outcomes. This approach increases student familiarity with the simulation learning environment and performance expectations, which can reduce cognitive load and improve learning outcomes. We describe 12 tips for increasing the scope of the prebriefing to promote effective learner participation and development during preclinical SBE.