Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Randomized Controlled Trial
Simulating extracorporeal membrane oxygenation emergencies to improve human performance. Part II: assessment of technical and behavioral skills.
Healthcare professionals are expected to make rapid, correct decisions in critical situations despite what may be a lack of real practical experience in a particular crisis situation. Successful resolution of a medical crisis depends upon demonstration not only of appropriate technical skills but also of key behavioral skills (eg, leadership, communication, and teamwork). We have developed a hands-on, high fidelity, simulation-based training program (ECMO Sim) to provide healthcare professionals with the opportunity to learn and practice the technical and behavioral skills necessary to manage ECMO emergencies. ⋯ After exposure to high-fidelity simulated ECMO emergencies, subjects demonstrated significant improvements in their technical and behavioral skills. ECMO Sim creates a learning environment that readily supports the acquisition of the technical and behavioral skills that are important in solving clinically significant, potentially life-threatening problems that can occur when patients are on ECMO.
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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.