The status of interprofessional education for healthcare students in South Korea: a scoping review focusing on simulation-based education.

Simulation-based education is gaining attention worldwide as it is recognized as effective in fostering collaborative skills in healthcare students. We conducted a comprehensive review of simulation-based interprofessional education (IPE) to examine the current state of simulation-based IPE. This scoping review systematically analyzed studies on simulation-based IPE in South Korean healthcare education, following established guidelines. Relevant articles were comprehensively searched, and key data on simulation methods, implementations, and educational effectiveness were extracted for analysis. The present study included nine quantitative studies and one mixed-methods study. The majority of participants were undergraduate nursing and medical students. The duration of IPE interventions ranged from 2 hours to 2 weeks. Education methods included standardized patients, high-fidelity simulators, and role-playing. Educational outcomes focused on measuring IPE competencies and satisfaction levels, concentrating on Kirkpatrick levels 1 and 2. While most studies reported high satisfaction levels, there is a need for objective evaluation of educational effectiveness. As simulation-based IPE in Korean healthcare education evolves, there is a need for greater inclusivity of diverse roles, multidisciplinary respect, and scenario development allowing active participation across professions. Establishing institutional frameworks, community linkages, and a deep understanding of IPE's purpose and essence among practitioners is crucial for its academic maturation.

Addressing Nursing Students' Anxiety During Simulation Sessions: A Pilot Intervention Study.

BACKGROUND: Although simulation-based education plays a vital role in nursing education, it consistently induces high levels of anxiety among nursing students. This study aimed to implement a mindfulness intervention to alleviate anxiety in nursing students during simulation sessions. METHOD: This randomized controlled trial study included 54 nursing students. Both survey and emotion track system data were collected and analyzed using multivariate analysis of covariance. RESULTS: The intervention effectively reduced anxiety among students in the experimental group compared with students in the control group during simulation sessions. The frequency (F[1, 53] = 6.145, p = .016), intensity (F[1, 51] = 3.771, p = .050), and duration of anxiety felt by students (F[1, 50] = 4.223, p = .017) decreased after the intervention. However, no long-term effects of the intervention were identified. CONCLUSION: The implementation of a mindfulness intervention successfully alleviated anxiety among nursing students during simulation. [J Nurs Educ. 2024;63(9):577-583.].

Life-Threatening Clinical Simulations for Nursing Students: Promoting Critical Thinking and Satisfaction.

BACKGROUND: Integrating life-threatening clinical simulations improves learning outcomes. This study assessed nursing students' critical thinking factors before and after simulation, evaluated nursing clinical reasoning ability and learning satisfaction at two time points, and explored relationships and predictions among critical thinking, clinical reasoning, and satisfaction before and after simulation. METHOD: Surveys and focus groups were used for this mixed-methods study. RESULTS: Quantitative findings revealed increased critical thinking scores for curiosity, skepticism, and systematicity; clinical reasoning; and satisfaction after simulation. Qualitative results supported these improvements and indicated enhanced curiosity for clinical knowledge and iterative phases of clinical reasoning. Students expressed satisfaction with the simulations. Objectivity significantly influenced clinical reasoning and satisfaction in nursing students following life-threatening simulations. CONCLUSION: Fostering a culture of critical thinking in life-threatening simulations is crucial. Educators must teach the importance of objectivity in clinical practice, encourage critical evaluation, and foster self-reflection in simulations. [J Nurs Educ. 2024;63(9):595-603.].

Construction and Surgical Training of Coronary Anastomosis on a Low-Cost Portable Simulator: Experience in a Peruvian Multicenter Study.

INTRODUCTION: The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study's aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator. METHODS: This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods. RESULTS: One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039). CONCLUSION: Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.

Too stressed to think? A scoping review of the literature for healthcare educators utilising high acuity clinical scenarios.

BACKGROUND: The practise of paramedicine can be highly stressful particularly where urgent lifesaving decisions need to be made. Traditionally, educators have adopted the approach of placing students in simulated stressful situations as a way of learning to cope with these challenges. It is unclear from the literature whether traditional stress inoculation enhances or hinders learning. This scoping review aims to identify and examine both the peer-reviewed and grey literature reporting physiological stress responses to high-acuity scenarios in paramedicine and cognate healthcare disciplines. METHODS: Adhering strictly to JBI Evidence Synthesis Manual for conducting a scoping review, medical subject headings and areas, keywords and all other possible index terms were searched across EBSCOhost (Medline, CINAHL and APA PsycInfo), Scopus and, PubMed. English language articles both published (peer-reviewed academic papers, reports and conference proceedings) and unpublished (grey literature, Google Scholar reports) were included, and publications citing retrieved articles were also checked. RESULTS: Searches performed across five electronic databases identified 52 articles where abstracts indicated potential inclusion. From this, 22 articles which reported physiological or psychophysiological responses to stressful scenario-based education were included. CONCLUSION: This review identified that an acceptable level of stress during simulation can be beneficial, however a point can be exceeded where stress becomes a hinderance to learning resulting in underperformance. By identifying strategies to moderate the impact of acute stress, educators of paramedic and other healthcare students can utilise high-acuity clinical scenarios to their andragogical armamentarium which has the potential to improve real-world clinical outcomes.

A Qualitative Study on the Impact and Feasibility of a Simulation-Based Program for Shared Decision-Making in Non-Small Cell Lung Cancer Care.

BACKGROUND: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. METHODS: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. RESULTS: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. CONCLUSIONS: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

Building Frontline Capability for Shared Decision-Making (SDM) in a Major Academic Oncology Center Caring for People With Non-Small Cell Lung Cancer: Performance Outcomes of a SDM Simulation Training Program.

BACKGROUND: There is a growing body of evidence on shared decision-making (SDM) training programs worldwide. However, there is wide variation in program design, duration, effectiveness, and evaluation in both academia (ie, medical school) and the practice setting. SDM training has been slow to integrate in practice settings. METHODS: A pilot study of 6 multidisciplinary clinicians was conducted using quantitative and qualitative methods to evaluate changes in participant understanding and implementation of SDM in the practice setting. A 2-rater criterion-based evaluation method was used to assess a simulation-based case study role-play program using 7 domains of SDM pre and post training. The authors assessed whether clinicians addressed each of the 7 domains or what fraction of each domain was addressed as part of their simulation case study role-play performance. Focus groups were conducted pre- and postintervention to provide feedback to participants and to understand the clinician experience in greater detail. RESULTS: The increase in improvement in SDM ranged from 17% to 37%, and 7 of 8 domains for which participants were rated showed significant improvement. The areas of greatest improvement were seen in determining a patient's goals/preferences, including risk tolerance regarding treatments (+37%) and values and self-efficacy (+37%). CONCLUSION: The results of this study reveal a significant shift in clinician awareness of a patient's goals, preferences, and values. Postintervention, clinicians began to understand the value of building a partnership with their patients whereby the patient becomes an active participant in their clinical care.

Exploring ambulance clinicians' clinical reasoning when training mass casualty incidents using virtual reality: a qualitative study.

BACKGROUND: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality. METHODS: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs. RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

Developing a non-cadaveric brain tumour surgery lab in resource-constrained settings.

OBJECTIVE: To develop the country's first brain tumour surgery lab in resource-constrained settings, for training young neurosurgeons and residents. METHODS: A workshop was developed using mixed-fidelity models for assessing and training a participant's psychomotor skills, hand-eye coordination, and teaching the principles of brain tumour surgery. Affordable noncadaveric models were used to compare and contrast the benefit of each teaching model. Within the existing space for wet labs at our institution, 8 different dissection stations were set up with adequate space for 2 people to work at a time. Each station was equipped with an operating room-Caliber microscope, a lighting system and a camera linked to a screen and high-powered electric drills and basic surgical equipment. RESULTS: Our team was able to develop and use 3D-printed skull models and animal brain models for training in complex approaches and craniotomy. CONCLUSIONS: Surgical simulation training, in a cost-effective manner, provides the benefit of training residents and students in neurosurgical techniques in a safe, controlled environment leading to improvement in skills and technique.

Application of AI-empowered scenario-based simulation teaching mode in cardiovascular disease education.

BACKGROUND: Cardiovascular diseases present a significant challenge in clinical practice due to their sudden onset and rapid progression. The management of these conditions necessitates cardiologists to possess strong clinical reasoning and individual competencies. The internship phase is crucial for medical students to transition from theory to practical application, with an emphasis on developing clinical thinking and skills. Despite the critical need for education on cardiovascular diseases, there is a noticeable gap in research regarding the utilization of artificial intelligence in clinical simulation teaching. OBJECTIVE: This study aims to evaluate the effect and influence of AI-empowered scenario-based simulation teaching mode in the teaching of cardiovascular diseases. METHODS: The study utilized a quasi-experimental research design and mixed-methods. The control group comprised 32 students using traditional teaching mode, while the experimental group included 34 students who were instructed on cardiovascular diseases using the AI-empowered scenario-based simulation teaching mode. Data collection included post-class tests, "Mini-CEX" assessments, Clinical critical thinking scale from both groups, and satisfaction surveys from experimental group. Qualitative data were gathered through semi-structured interviews. RESULTS: Research shows that compared with traditional teaching models, AI-empowered scenario-based simulation teaching mode significantly improve students' performance in many aspects. The theoretical knowledge scores(P < 0.001), clinical operation skills(P = 0.0416) and clinical critical thinking abilities of students(P < 0.001) in the experimental group were significantly improved. The satisfaction survey showed that students in the experimental group were more satisfied with the teaching scene(P = 0.008), Individual participation(P = 0.006) and teaching content(P = 0.009). There is no significant difference in course discussion, group cooperation and teaching style of teachers(P > 0.05). Additionally, the qualitative data from the interviews highlighted three themes: (1) Positive new learning experience, (2) Improved clinical critical thinking skills, and (3) Valuable suggestions and concerns for further improvement. CONCLUSION: The AI-empowered scenario simulation teaching Mode plays an important role in the improvement of clinical thinking and skills of medical undergraduates. This study believes that the AI-empowered scenario simulation teaching mode is an effective and feasible teaching model, which is worthy of promotion in other courses.

Development and validation of a realistic type III esophageal atresia simulator for the training of pediatric surgeons.

BACKGROUND: The technical complexity and limited casuistry of neonatal surgical pathology limit the possibilities of developing the necessary technical competencies by specialists in training. Esophageal atresia constitutes the paradigm of this problem. The use of synthetic 3D models for training is a promising line of research, although the literature is limited. METHODS: We conceptualized, designed, and produced an anatomically realistic model for the open correction of type III oesophageal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content-validity questionnaires. RESULTS: The model was validated by nine experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 34.0 and 38.4 min, respectively. Two non-experts did not complete the procedure at the designed time (45 min). Regarding the face validity questionnaire, the mean rating of the model was 3.2 out of 4. Regarding the construct validity, we found statistically significant differences between groups for the equidistance between sutures, 100% correct in the expert group vs. 42.9% correct in the non-expert group (p = 0.02), and for the item "Confirms that tracheoesophageal fistula closure is watertight before continuing the procedure", correctly assessed by 66.7% of the experts vs. by 11.1% of non-experts (p = 0.05). Concerning content validity, the mean score was 3.3 out of 4 for the experts and 3.4 out of 4 for the non-experts. CONCLUSIONS: The present model is a cost-effective, simple-to-produce, and validated option for training open correction of type III esophageal atresia. However, future studies with larger sample sizes and blinded validators are needed before drawing definitive conclusions.

Immersive medical training: a comprehensive longitudinal study of extended reality in emergency scenarios for large student groups.

Young healthcare professionals and medical graduates often fall short in the practical experience necessary for handling medical emergencies. This can not only lead to strained feelings of inadequacy and insecurity among future physicians and less experienced healthcare providers in general, but also to detrimental outcomes for patients as emergency medicine demands rapid decision-making with low tolerance for errors. New didactic modalities and approaches may be needed to effectively address this shortcoming. Immersive technologies are powerful novel educational tools with untapped potential in medical training, and may be particularly suitable for simulation trainings in the high-stakes field of emergency medicine.Herein, we systematically explored the educational potential of extended reality (XR) technology, particularly virtual reality (VR), in the management of patients presenting as medical emergencies, combining the use of the STEP-VR application with an untethered hardware setup.Importantly, we aimed at studying multiple, large cohorts of senior medical students involving a total of 529 participants and collecting data over a period of two years. We assessed students' acceptance of the training through a modified questionnaire measuring device handling, content complexity, degree of immersion, learning success, and seminar design.Our results show high, sustained acceptance and ease of use across different student cohorts and subgroups, with most students finding XR/VR engaging and beneficial for acquiring emergency medicine skills. Importantly, the prevalence of simulation sickness was minimal. Moreover, no major effect of the head-mounted displays (HMDs) price range was noted with regard to the learning experience. The results underscore the potential of XR/VR capabilities in effectively enhancing medical education, particularly in areas of high-stakes clinical scenarios and emergency care, by providing realistic and reproducible immersive training environments.In summary, our findings suggest that XR/VR-based training approaches could significantly contribute to preparing future physicians for the complexities of emergency medical care, encouraging the integration of such technologies into medical curricula. However, careful consideration must be given to its suitability for all students and the practical challenges of its implementation, highlighting the need for further research to harness its full potential for medical education.

Significance of a Simulation for the Relocation of an Intensive Care Unit.

There have been few reports concerning simulation drills for the relocation of severely ill or injured patients treated in intensive care units (ICUs). We herein report our experience of one such simulation drill. It is a Narrative method. A simulation drill was performed on a weekday 2 weeks prior to the actual relocation. We selected 3 mock patients. The first one was a severely ill and unstable patient, the second had severe stroke, and the third had severe trauma. After the simulation, the average transportation time was 15 minutes. The simulation revealed that mock patients with a percutaneous cardiopulmonary support system and intra-aortic balloon pumping in a standard ICU bed could not be accommodated in the elevator. Furthermore, working the elevator controls resulted in wasted time while transferring the patients. As a result, the number of people, who controlled the elevator, was therefore increased during the actual relocation. During the actual relocation, all patients were transported safely and more quickly than predicted based on the results of the simulation drill. Most physicians and paramedical staff have little experience with relocating ICUs, so a simulation drill was necessary to ensure the safe and prompt transport of patients.

Palliative care competence development through simulation: Excellence & innovation to meet the AACN essentials.

BACKGROUND: The updated American Association of Colleges of Nursing: The Essentials: Core Competencies for Professional Nursing Education (2021) outlines competence requirements for entry-to-practice nurses. Hospice and palliative care (PC) are identified as one of four spheres of care, emphasizing that nursing knowledge and proficiency in primary PC are critical for all nurses. PURPOSE: This article identifies key elements for nursing educators to consider when adopting, adapting, or designing practical primary PC simulations to meet The AACN Essentials. METHODS: Using Healthcare Simulation Standards of Best Practice™ (HSSBP) as a framework, a panel of nursing education researchers identified and compared key elements of four PC simulations from varied evidence-based exemplars across the U.S. RESULTS: Overarching elements in simulation development include choosing modalities, assessing resources, and simulation logistics, creating opportunities for difficult conversations with interprofessional team engagement, and validating scenarios with expert input. Simulation implementation should include tailored pre-briefing to address psychological safety in caring for the dying patient, piloting scenarios, and maximizing observer/vicarious learner roles. Finally, evaluation is vital for competency assessment, scenario enhancement, and logistical changes. Limitations included variability in PC simulation scenarios, learners/learner level, curricula, and geography across selected exemplars, which may affect the general applicability of these findings. CONCLUSIONS: Simulations developed according to HSSBP™ provide effective practical experience in PC, affording active and vicarious learners the knowledge and skills essential for baseline nursing competence.

Reserving the human touch in nursing education while integrating virtual reality and simulation.

In the ever-evolving landscape of nursing education, the integration of virtual reality (VR) and simulation technologies presents both promise and challenges. Although these innovative tools offer unparalleled opportunities for skill acquisition and clinical reasoning, concerns have arisen regarding the potential erosion of compassionate care at the core of nursing practice. The article explores the balance between technical proficiency and compassionate care in nursing education. The importance of comprehensive educator training in utilizing VR and simulation to instill humanistic values, along with the need for curriculum development that seamlessly integrates compassionate care throughout nursing programs, is underscored. By emphasizing the integration of empathy, emotional intelligence, and reflection into VR and simulation experiences, nursing education can ensure that graduates possess the skill sets and values essential for patient-centered practice. The preservation of human touch remains a priority and a cornerstone in the preparation of nursing professionals equipped to deliver holistic and empathetic care in an increasingly technology-driven healthcare landscape.

Elevating competency-based education in baccalaureate nursing: A simulation integration project.

Simulation offers a mechanism for scaffolded learning in a safe environment and affords opportunities for students to integrate nursing knowledge, skills, and behaviors into patient care activities. Faculty applied a structured change model and utilized simulation theory and the AACN Essentials framework for competency-based education to integrate simulation across the pre-licensure curriculum at a large school of nursing. A series of clinical learning activities were implemented including one revised scenario, a computer-based simulation adapted from an existing manikin-based activity, and a multi-patient simulation developed by modifying three textbook publisher simulation resources. Students were provided with opportunities to develop competencies across multiple Essentials domains, and congruence between course and simulation objectives was achieved. The purpose of this article is to describe the processes and outcomes of a faculty-driven effort to advance competency-based education in baccalaureate nursing curricula.

Nurse Practitioner Education: Recommending Theories and Frameworks for Simulation-Based Experiences and Research.

Simulation-based education is an evidence-based strategy to address learning and evaluation of outcomes in the updated American Association of Colleges of Nursing Essentials. Currently, there is a dearth of rigorous research on nurse practitioner education simulation. Studies on the topic often neglect a sound theoretical or conceptual framework beyond the National League of Nursing Jeffries Simulation Theory. This article aims to explore and distinguish the implementation of various theories and frameworks to determine how these elements can be stand-alone or used in combination to explore simulation-based experience competency outcomes. Specific recommendations for simulation research are (a) to include learning theories, (b) level learning and track competency progression using a framework, and (c) use a framework for measuring outcomes. Simulation science for nurse practitioner education can be advanced through united and consistent use of established theories and frameworks. These efforts will inform emerging best practices of simulation-based learning to address competition-based learning initiatives, validity of high-stakes simulation evaluation, and how to credit learners for simulation activities.

Stillbirth Simulation for Nursing and Midwifery.

Collaboration is necessary to design and execute a nursing simulation that meets undergraduate and graduate competency expectations for communication, effective relationships, and stillbirth care. This simulation plan aligns with the ten international healthcare simulation standards published by the International Nursing Association for Clinical Simulation and Learning (INACSL). Course faculty work with simulation faculty, staff, and volunteer actors to plan and implement a consistent experience for pre-licensure and or graduate nursing students to develop critical clinical skills and attitudes across spheres of care while caring for parents experiencing pregnancy loss.