Putting the Horse Back in Front: Advancing Simulation Education With Implementation Science and Structured Research Processes.

This editorial explores the application of implementation science methodologies within simulation-based health professions education. It introduces two models, the adapted implementation model for simulation (AIM-SIM) and the implementation quality rubric for simulation (IQR-SIM), tailored to optimize educational simulation programs' development, implementation, and long-term sustainability in simulation contexts. These models are introduced against the backdrop of their development process, which notably lacked a formal needs assessment, highlighting a critical gap in their foundational preparation. To address this gap effectively, the editorial advocates for a scoping review as a strategic next step. The proposed scoping review will aim to comprehensively survey the landscape of existing literature, specifically probing the utilization of implementation science methodologies within simulation-based education. By identifying gaps and assessing the current state of research, the proposed scoping review will seek to substantiate the necessity for a simulation-specific model grounded in implementation science principles. The outcomes of the future scoping review are anticipated to validate the applicability and relevance of AIM-SIM and IQR-SIM in real-world educational settings. Moreover, it may provide insights crucial for refining these models to better meet the dynamic and nuanced needs of the field. By systematically scrutinizing the existing literature, the proposed scoping review may also elude to how effectively current methodologies address the complexities of simulation-based education. Ultimately, this process has the potential to inform future directions in research and practice, ensuring that simulation programs are not only effectively implemented but also sustained over time, thereby maximizing their impact on health professions education.

Strategic Realignment in Healthcare Simulation Education: Shifting Focus From Assistants to Technician Training Pathways.

Simulation is vital for healthcare training, yet workforce challenges persist. This article details the development of an undergraduate minor program to address these issues and enhance simulation education. Initially conceived for simulation assistants, the program shifted focus to training simulation technicians. Informed by industry insights, the curriculum aligns with accreditation standards, emphasizing practical knowledge. Integrated knowledge translation (iKT) fosters collaboration, ensuring program relevance. Stakeholder feedback guided program refinement, addressing concerns of role delineation and alignment with certification frameworks. The program's evolution involved enhancing competency frameworks, validation through surveys, and forming partnerships for practical training. A certification committee ensures ongoing alignment with industry standards. This collaborative effort aims to produce graduates prepared for the dynamic field of healthcare simulation technology, thereby improving patient outcomes and advancing simulation education.

Using a Delphi Method Approach to Select Theoretical Underpinnings of Crowdsourcing and Rank Their Application to a Crowdsourcing App.

INTRODUCTION: Since the catapult of online learning during the COVID-19 pandemic, most simulation laboratories are now completed virtually, leaving a gap in skills training and potential for technical skills decay. Acquiring standard, commercially available simulators is prohibitively expensive, but three-dimensional (3D) printing may provide an alternative. This project aimed to develop the theoretical foundations of a crowdsourcing Web-based application (Web app) to fill the gap in health professions simulation training equipment via community-based 3D printing. We aimed to discover how to effectively leverage crowdsourcing with local 3D printers and use these resources to produce simulators via this Web app accessed through computers or smart devices. METHODS: First, a scoping literature review was conducted to discover the theoretical underpinnings of crowdsourcing. Second, these review results were ranked by consumer (health field) and producer (3D printing field) groups via modified Delphi method surveys to determine suitable community engagement strategies for the Web app. Third, the results informed different app iteration ideas and were then generalized beyond the app to address scenarios entailing environmental changes and demands. RESULTS: A scoping review revealed 8 crowdsourcing-related theories. Three were deemed most suitable for our context by both participant groups: Motivation Crowding Theory, Social Exchange Theory, and Transaction Cost Theory. Each theory proposed a different crowdsourcing solution that can streamline additive manufacturing within simulation while applicable to multiple contexts. CONCLUSIONS: Results will be aggregated to develop this flexible Web app that adapts to stakeholder needs and ultimately solves this gap by delivering home-based simulation via community mobilization.

Applying and Testing a Crowdsourcing Platform to Support Home-Based Simulation.

The purpose of this report is to: (1) highlight challenges of transitioning the delivery of simulation from centralized, in-person laboratory to decentralized, home-based, online format; (2) suggest a solution that involves the use of crowdsourcing community-based 3-dimensional printers to produce affordable simulators; and (3) present exploratory research and a test case aiming to identify crowdsourcing frameworks to accomplish this. We present a test case that shows the potential of the proposed solution to scale up the decentralized simulation practices during and beyond the COVID-19 pandemic. As a largely uncharted territory, the test case highlighted successes and areas for improvement that need to be addressed through both theoretical and empirical research and testing before full implementation and scale-up.

Empowering Non-healthcare Students as Simulation Assistants in the Digital Era of Simulation-Based Healthcare Education: Bridging the Gap.

Simulation-based education plays a pivotal role in various high-stakes fields, notably in healthcare, where simulation technicians are crucial for the effective operation of simulation technology. Currently, these roles are often filled by healthcare professionals who transition from patient care, exacerbating shortages in the healthcare workforce. This editorial addresses the current gap by proposing an alternative solution, creating educational pathways for undergraduate students in science and health science programs to become "simulation assistants". Leveraging their foundational knowledge in biological and physical sciences, research skills, and attributes developed through health sciences programs, these students could support simulation activities while entering an ever-evolving field with copious growth opportunities. Paralleling the historical development of medical laboratory sciences, which saw the creation of distinct roles for technologists and assistants, the editorial suggests a collaborative model wherein simulation technicians and assistants work together to enhance simulation-based education in the healthcare sector. This paradigm shift has the potential to alleviate the growing healthcare personnel shortages. While acknowledging the challenges, the editorial envisions the transformative impact of integrating simulation assistants into the healthcare workforce, echoing the historical evolution of specialized roles in response to the changing demands of healthcare.

Hacking Intraosseous Infusion Skills Training With 3D Printing: maxSIMIO Drilling System.

Intraosseous (IO) infusion is an alternative way to access the vascular system to administer drugs and fluids, which is particularly helpful when the commonly used peripheral intravenous route is inaccessible. The IO procedure can be done using a drill that involves disinfecting the area, landmarking the insertion point, seating the needle in a firm and stable position in the bone, and then delivering a smooth fluid flush. However, in the current medical training landscape, access to commercially available IO drills such as the Arrow® EZ-IO® Power Driver (EZ-IO; Teleflex, Morrisville, North Carolina, United States) is difficult, especially for rural and remote areas, due to the high costs. Furthermore, the EZ-IO is not rechargeable and does not clearly indicate the remaining battery life, which could potentially put patients at risk during the IO procedure. This technical report aims to address these concerns by describing the development of an alternative, affordable, and reliable IO drilling system for training use: the maxSIMIO Drilling System. This system consists of a cordless and rechargeable IKEA screwdriver which connects to a conventional, hexagon-shaped 3D-printed drill bit needle adapter. Two needle adapters were created: Version A was designed to use a friction-based mechanism to couple the screwdriver with the EZ-IO training needle, while Version B relies on a magnetic mechanism. The major differences between the EZ-IO and the screwdriver are that a) the EZ-IO has only one rotation to advance the cannula while the screwdriver features both directions, b) the EZ-IO is not rechargeable while the screwdriver is, and c) the EZ-IO has a custom needle holder that can fit any EZ-IO training needle size while the screwdriver needs to have a custom needle adapter made to connect to the EZ-IO training needle. Overall, through this exploration, the features of the maxSIMIO Drilling System in comparison to the EZ-IO appear more accessible for IO training. Future considerations for this development include gathering clinical expertise through rigorous testing of this novel system.

Development and Initial Assessment of a Novel and Customized Bile Duct Simulator for Handsewn Anastomosis Training.

Simulation-based medical education allows for the training and maintenance of healthcare skills in a safe and controlled environment. In this technical report, the development and initial evaluation of a bile duct anastomosis simulator are described. The simulator was developed using additive manufacturing techniques such as three-dimensional (3D) printing and silicone work. The final product was produced by maxSIMhealth, a research lab at Ontario Tech University (Oshawa, ON, Canada), and included four individual silicone bile ducts, based on the expert opinions from surgeons at the Centre Hospitalier de l'Université de Montréal (Montreal, QC, Canada), and a 3D-printed maxSIMclamp, which was described in a previous report. The evaluation was conducted by nine individuals consisting of surgeons, surgical residents, and medical students to assess the fidelity, functionality, and teaching quality of the simulator. The results from the evaluation indicate that the simulator needs to improve its fidelity by being softer, thinner, and beige. On the other hand, the results also indicate that this simulator is extremely durable and can be used as a training tool for surgical residents with some minor improvements.

Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop.

Simulation-based education (SBE) is a sustainable method to allow healthcare professionals to develop competencies in clinical skills that can be difficult to maintain in rural and remote settings. Simulation-based skills training is necessary for healthcare professionals that experience difficulties accessing skills development and maintenance courses to address the needs of rural communities. However, simulators, a key element of simulation, are often prohibitively expensive and follow a "one-size-fits-all" approach. Using additive manufacturing (AM) techniques, more specifically three-dimensional (3D) printing, to produce inexpensive yet functional and customizable simulators is an ideal solution for learners to practice and improve their procedural skills anywhere and anytime. AM allows for the customization of simulators to fit any context while reducing costs and is an economic solution that moves away from the use of animal products to a more ethical, sustainable method for training. This technical report describes the delivery of a fundamental skills workshop to provide hands-on training to rural and remote healthcare professionals using 3D-printed simulators purposefully designed following design-to-cost principles. The workshop was delivered at a three-hour session hosted at a rural and remote medicine course in Ottawa, Canada. The workshop consisted of four technical skills: suturing, cricothyrotomy, episiotomy, and intraosseous infusion (tibial) (IO) and used a blended learning approach to train healthcare professionals and trainees who practice in rural and remote areas. In addition, the learners were granted access to a custom-designed learning management system, which provided a repository of instructional materials, and enabled them to record and upload personal practice sessions, review other learners' practice sessions, collaborate, and provide feedback to other learners. The feedback collected from participants, instructors, and observations on the delivery of the workshop will help improve the structure and training provided to learners. The delivery of this workshop annually is an ideal solution to ensure parsimonious delivery of simulation training for rural and remote healthcare professionals.

The Development and Initial End-Point User Feedback of a 3D-Printed Adult Proximal Tibia IO Simulator.

Intraosseous infusion (IO) remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients. In rural and remote areas, shortage of training equipment and human capacity (i.e., simulators) are the main contributors to the shortage of local training courses aiming at the development and maintenance of IO skills. Specifically, current training equipment options available for trainees include commercially available simulators, which are often expensive, or animal tissues, which lack human anatomical features that are necessary for optimal learning and pose logistical and ethical issues related to practice on live animals. Three-dimensional (3D) printing provides the means to create cost-effective, anatomically correct simulators for practicing IO where existing simulators may be difficult to access, especially in remote areas. This technical report aims to describe the development of maxSIMIO, a 3D-printed adult proximal tibia IO simulator, and present feedback on the design features from a clinical co-design team consisting of 18 end-point users.  Overall, the majority of the feedback was positive and highlighted that the maxSIMIO simulator was helpful for learning and developing the IO technique. The majority of the clinical team responders also agreed that the simulator was more anatomically accurate compared to other simulators they have used in the past. Finally, the survey results indicated that on average, the simulator is acceptable as a training tool. Notable suggestions for improvement included increasing the stability of the individual parts of the model (such as tightening the skin and securing the bones), enhancing the anatomical accuracy of the experience (such as adding a fibula), making the bones harder, increasing the size of the patella, making it more modular (to minimize costs related to maintenance), and improving the anatomical positioning of the knee joint (i.e., slightly bent in the knee joint). In summary, the clinical team, located in rural and remote areas in Canada, found the 3D-printed simulator to be a functional tool for practicing the intraosseous technique. The outcome of this report supports the use of this cost-effective simulator for simulation-based medical education for remote and rural areas anywhere in the world.

Development and Initial Assessment of a Novel Customized Deep Laceration Simulator for Suturing Training.

Suturing of different layers, such as deep lacerations, is a challenging clinical skill for residents. Currently, there is a lack of general suturing instructions and practice in undergraduate medicine curricula which would add to the education required during residency and could be impactful to patient safety. Therefore, in order to adequately prepare trainees for clinical practice, training in suturing needs to be made more robust and executable. One way to facilitate this is to provide easy access to equipment that can offer good educational value while allowing for adequate repetition of suturing deep lacerations outside of clinical settings, similar to how it has been done for superficial lacerations. Simulation-based medical education addresses this by training residents in healthcare skills in a safe and controlled environment. Our technical report aims to describe the development and initial evaluation of a deep laceration simulator designed to train residents in suturing. The simulator was made using additive manufacturing techniques such as three-dimensional printing and silicone. Feedback on the simulator was provided by Centre Hospitalier de l'Université de Montréal clinicians from various specialties and residents. The simulator was assessed mainly as being easy to use, durable, and having anatomically accurate characteristics. The main improvements suggested were to make the skin thinner, divide the epidermis and dermis, add a fascia, and create a looser and friable layer of fat. Overall, the respondents rated the simulator as a good educational tool with a few minor adjustments.

Constructing a Multidisciplinary Network That Relies on Disruptive Technologies to Design, Test, and Implement Simulation Training.

MaxSIMhealth is a multidisciplinary network of manufacturing, design, and simulation labs at Ontario Tech University combining expertise in health sciences, business and information technology (IT), and engineering while building community partnerships to advance simulation training. It discovers existing simulation gaps, provides innovative solutions that change systems, and leads to improved healthcare outcomes. Specifically, it utilizes disruptive technologies, including 3D printing, gaming, and extended reality, as innovative solutions that deliver cost-effective, portable, and realistic simulation, which is currently lacking. MaxSIMhealth is a novel collaborative innovation with aims to develop future cohorts of scholars with strong competencies ranging from technology application, to collaborating in new environments, communicating professionally, and problem-solving. Its work will transform current health professional education landscapes by providing novel, flexible, and inexpensive simulation environments. This editorial aims to showcase maxSIMhealth's innovative strategy focusing on collaborations of expertise in order to develop new simulation solutions that advance the health industry.