Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Comparative Study
Professionalism and communication in the intensive care unit: reliability and validity of a simulated family conference.
An Objective Structured Clinical Exam was designed to assess physician's ability to discuss end-of-life (EOL) and disclose iatrogenic complications (DOC) with family members of intensive care unit patients. The study explores reliability and validity based on scores from contrasting rater groups (clinicians, SPs, and examinees). ⋯ The Family Conference Objective Structured Clinical Exam is a reliable exam with high content validity. It seems unique in the literature for assessing surgical trainees' ability to discuss "bad news" with family members in intensive care.
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Photorealistic simulations may provide efficient transfer of certain skills to the real system, but by being opaque may fail to encourage deeper learning of the structure and function of the system. Schematic simulations that are more abstract, with less visual fidelity but make system structure and function transparent, may enhance deeper learning and optimize retention and transfer of learning. We compared learning effectiveness of these 2 modes of externalizing the output of a common simulation engine (the Virtual Anesthesia Machine, VAM) that models machine function and dynamics and responds in real time to user interventions such as changes in gas flow or ventilation. ⋯ Schematic simulations that transparently allow learners to visualize, and explore, underlying system dynamics and relations among components may provide a more effective mental model for certain systems. This may lead to a deeper understanding of how the system works, and therefore, we believe, how to detect and respond to potentially adverse situations.
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Human factors and teamwork are major contributors to sentinel events. A major limitation to improving human factors and teamwork is the paucity of objective validated measurement tools. Our goal was to develop a brief tool that could be used to objectively evaluate teamwork in the field during short clinical team simulations and in everyday clinical care. ⋯ The CTS was developed to efficiently measure key clinical teamwork skills during simulation exercises and in everyday clinical care. It contains 15 questions in 5 clinical teamwork domains (communication, situational awareness, decision-making, role responsibility, and patient friendliness). It is easy to use and has construct validity with median ratings consistently corresponding with the intended teamwork level. The CTS is a brief, straightforward, valid, reliable, and easy-to-use tool to measure key factors in teamwork in simulated and clinical settings.
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Team performance measurement is a critical and frequently overlooked component of an effective simulation-based training system designed to build teamwork competencies. Quality team performance measurement is essential for systematically diagnosing team performance and subsequently making decisions concerning feedback and remediation. However, the complexities of team performance pose a challenge to effectively measuring team performance. This article synthesizes the scientific literature on this topic and provides a set of best practices for designing and implementing team performance measurement systems in simulation-based training.
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Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap. ⋯ Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.