Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Comparative Study
The effect of high-fidelity simulation on educational outcomes in an advanced cardiovascular life support course.
The use of high-fidelity simulation has been studied in many healthcare education areas. However, the use of this instructional technology in the American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course has not been extensively reported, despite this program being one of the most widely taught standardized medical courses in the United States. ⋯ Expert raters judged students in a high-fidelity simulation-based AHA ACLS course as more competent than students in a low-fidelity course. On item level analysis, items focused on manual tasks or actions in the first 1 to 2 minutes of the cardiac arrest event were more likely to be nonsignificant. As the scenario grew longer and more complex, expert rater scores of the high-fidelity trained team leaders' confidence, knowledge, and treatment decisions were higher than the low-fidelity team leaders' score at a statistically significant level.
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This study was performed to assess perioperative reevaluation of Do-Not-Resuscitate (DNR) orders by practicing anesthesiologists. ⋯ Inadequacies in perioperative reevaluation of DNR orders existed at all stages. Simulation of perioperative DNR orders is a useful way to elicit anesthesiologist's actions in the heat of the moment, which may bring us closer to understanding the actions of anesthesiologists during clinical practice.
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Residents train in a historically hierarchical system. They may be compelled to question their teachers if they do not understand or disagree with a clinical decision, have a patient safety concern, or when treatment plans are unclear. We sought to determine whether a debriefing intervention that emphasizes (1) joint responsibility for safety and (2) the "two-challenge rule" (a rubric for challenging others) using a conversational technique that is assertive and collaborative (advocacy-inquiry) can improve the frequency and effectiveness with which residents "speak up" to superiors. ⋯ This instructional intervention improves "speaking up" by residents to other physicians during simulated obstetric cases. Providing increased opportunities for resident learning, sharing responsibility for patient safety, and overcoming communication barriers within the medical hierarchy may improve teamwork and patient safety.
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Randomized Controlled Trial
Improving patient safety with ultrasonography guidance during internal jugular central venous catheter placement by novice practitioners.
This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model. ⋯ The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.