Simulation in healthcare : journal of the Society for Simulation in Healthcare
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: The objective of this study was to describe the availability and current use of high-fidelity mannequin-based simulation (HFMB) in emergency medicine (EM) training programs. ⋯ : HFMB simulation technology has not been completely adopted by EM training programs even when it is available. Most EM training programs are using HFMB simulation less often than every month and curriculum development in EM training is still in the early phases.
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We report on our experience with an approach to debriefing that emphasizes disclosing instructors' judgments and eliciting trainees' assumptions about the situation and their reasons for acting as they did. To highlight the importance of instructors disclosing their judgment skillfully, we call the approach "debriefing with good judgment." The approach draws on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through "reflective practice." This approach specifies a rigorous self-reflection process that helps trainees recognize and resolve pressing clinical and behavioral dilemmas raised by the simulation and the judgment of the instructor. The "debriefing with good judgment" approach is comprised of three elements. ⋯ Advocacy is a type of speech that includes an objective observation about and subjective judgment of the trainees' actions. Inquiry is a genuinely curious question that attempts to illuminate the trainee's frame in relation to the action described in the instructor's advocacy. We find that the approach helps instructors manage the apparent tension between sharing critical, evaluative judgments while maintaining a trusting relationship with trainees.
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Anesthesiologists have long recognized that there is a sympathetic response to stimulation of the larynx, even in sedated patients. This response creates a rapid increase in blood pressure and heart rate in these patients. ⋯ Using several experienced anesthesiologists as subject matter experts, we have developed a scenario that mimics this response for several types of patients. This scenario runs on the Medical Education Technologies, Inc. (METI) patient simulators; however, the methodology used to develop this scenario applies to other patient simulator systems.
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Increasing time and resource constraints, and the potential for patient complications, has led to an emphasis on finding innovative ways to teach catheter-based procedures outside of the laboratory. Virtual reality (VR) simulator training has been proposed as a potential training solution. We report on the initial validation of a full procedural VR simulator for carotid angiography (CA) using the Vascular Interventional System Trainer (VIST). ⋯ VIST represents one of the most sophisticated VR simulators in medicine. Physicians reported that it looked, felt, and behaved similar to working on an actual patient. Future work is required to validate whether this simulator will improve catheter performance on actual patients.