Simulation in healthcare : journal of the Society for Simulation in Healthcare
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The aim of this study was to determine the number of ultrasound-guided (USG) central venous catheterization (CVC) of the internal jugular vein (IJV) residents had to perform, after a simulation-based training program, to achieve optimal clinical outcomes. ⋯ After a formal training program consisting of a simulation-based workshop and 5 supervised USG CVCs on critically ill adults, residents were able to achieve optimal clinical outcomes after performing 7 procedures.
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Management of pediatric cardiac arrest challenges the skills of prehospital care providers. Errors and error-producing conditions are difficult to identify from retrospective records. The objective of this study was to identify errors committed by prehospital care providers and the underlying causes of those errors during a simulated pediatric cardiopulmonary arrest followed by a structured debriefing. ⋯ We systematically observed many types of errors and identified some of the underlying causes during a simulated, prehospital, pediatric cardiopulmonary arrest. There were numerous, multifactorial, and sometimes, synergistic causes of medication dosing errors. Emergency medical service officials can use these findings to prevent future errors.
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Traditionally, pausing chest compressions during airway management in a cardiac arrest has been the accepted norm. However, updated American Heart Association and the European Resuscitation Council guidelines for Advanced Cardiac Life Support emphasize reducing pauses in chest compressions, often referred to as "no-flow time," to improve return of spontaneous circulation. We used simulation to evaluate whether placing a laryngeal mask airway versus endotracheal intubation via direct laryngoscopy would reduce no-flow times during a simulated cardiac arrest. ⋯ We conclude that although neither device was superior to the other with respect to the primary outcome of reducing no-flow time, effective ventilation was established more rapidly with the laryngeal mask airway in the hands of the RTs who participated in this study. These results may be affected by the differences between simulated and human airways.
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Specialty milestones and the next accreditation system: an opportunity for the simulation community.
The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty milestones-specific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain. ⋯ The simulation community has focused many graduate medical education efforts at training and formative assessment. Milestone assessment represents an opportunity for simulation modalities to offer summative assessment of milestone proficiencies, adding to the potential methods that residency programs will likely use or adapt. This article discusses the NAS, milestone assessment, and the opportunity to the simulation community to become involved in this next stage of graduate medical education assessment.