Simulation in healthcare : journal of the Society for Simulation in Healthcare
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High-fidelity simulation-based training is often avoided for early-stage students because of the assumption that while practicing newly learned skills, they are ill suited to processing multiple demands, which can lead to "cognitive overload" and poorer learning outcomes. We tested this assumption using a mixed-methods experimental design manipulating psychological immersion. ⋯ High-environmental fidelity simulation engendered immersion and a sense of urgency in students, whereas LF(en)S created assessment anxiety and slower performance. We conclude that once early-stage students have learned the basics of a clinical skill, throwing them in the "deep end" of high-fidelity simulation creates significant additional cognitive burden but this has considerable educational merit.
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Better debriefing practices may enhance the impact of simulation-based education. Emerging literature suggests that learner-centered debriefing may be effective in helping instructors identify and address learner needs while building learner's engagement and sense of responsibility for learning. ⋯ Although different approaches to debriefing for simulation-based education exist, the simulation literature is largely mute on the topic of learner-centered debriefing. In this article we will (1) compare and contrast learner- versus instructor-centered approaches to teaching; (2) provide a rationale for applying more learner-centered approaches to debriefing; (3) introduce a conceptual framework that highlights the key dimensions of learner- versus instructor-centered debriefing; (4) describe key variables to consider when managing the balance between learner- and instructor-centered debriefing; and (5) describe practical learner-centered strategies for various phases of debriefing.
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As educators, we are charged with preparing emergency medicine residents for successfully intubating patients with even the most troublesome anatomy. This situation is encountered during the intubation of patients with angioedema. These patients are uncommon in the emergency department, and as a result, it is difficult to ensure that each resident is well trained in this intubation scenario before graduation. ⋯ Participants included 29 emergency medicine residents, with participants from all year groups. In response to the statement, "The angioedema model was high fidelity," 12 residents strongly agreed, whereas the remaining respondents agreed. In response to the statement, "The angioedema model was a good training model for angioedema," 13 residents strongly agreed, whereas the remaining respondents agreed. When solicited for comments on the model, one participant wrote, "Awesome opportunity, I will be markedly less terrified when I get an angioedema/anaphylaxis case."We have developed an angioedema training model using air insufflation in a fresh frozen cadaver. Our participants uniformly expressed positive impressions of both the fidelity and training quality of this model.
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Randomized Controlled Trial
Simulation Improves Procedural Protocol Adherence During Central Venous Catheter Placement: A Randomized Controlled Trial.
Simulation training may improve proficiency at and reduce complications from central venous catheter (CVC) placement, but the scope of simulation's effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. ⋯ Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety.