Effects of Simulation Fidelity on Health Care Providers on Team Training-A Systematic Review.

ABSTRACT: This systematic review, following PRISMA standards, aimed to assess the effectiveness of higher versus lower fidelity simulation on health care providers engaged in team training. A comprehensive search from January 1, 2011 to January 24, 2023 identified 1390 studies of which 14 randomized (n = 1530) and 5 case controlled (n = 257) studies met the inclusion criteria. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity prevented any metaanalysis. Limited evidence showed benefit for confidence, technical skills, and nontechnical skills. No significant difference was found in knowledge outcomes and teamwork abilities between lower and higher fidelity simulation. Participants reported higher satisfaction but also higher stress with higher fidelity materials. Both higher and lower fidelity simulation can be beneficial for team training, with higher fidelity simulation preferred by participants if resources allow. Standardizing definitions and outcomes, as well as conducting robust cost-comparative analyses, are important for future research.

Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients.

Purpose: Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients. Methods: A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States. Results: Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Conclusion: Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.

Effects of an Experiential Trauma Bootcamp on PGY 3 Anesthesiology Residents' Knowledge and Confidence Levels.

Background: Bootcamp-style education involves short, intense educational sessions and is a proven educational modality in anesthesia medical education. However, rarely has it been used with senior anesthesiology residents and never in exposing these residents to a curriculum aimed at care of the trauma patient. The purpose of this study was to design and implement an experiential bootcamp to prepare anesthesiology residents to take senior trauma call at a Level 1 trauma center in the Southeastern United States. Methods: Before taking senior trauma call, 21 postgraduate year 3 anesthesiology residents took part in an 8-hour trauma bootcamp that combined flipped classroom-style education with immersive, procedural, and augmented reality simulation facilitated by subject matter experts. Before and after the bootcamp, residents completed 17-item confidence and 20-item knowledge questionnaires developed by the study authors. Results were compared before and after the bootcamp to determine overall change in confidence and knowledge levels pertaining to caring for trauma patients and taking senior trauma call. Additionally, residents completed an evaluation measuring their perceptions of the benefit of the educational offering. Results: Statistically significant increases were seen in 16 out of 17 confidence questions (P < .001) and 12 out of 20 knowledge questions (P < .001). Additionally, respondents indicated that they found the content to be valuable and likely to improve their care delivery within the clinical setting. Conclusions: Following this bootcamp, postcourse surveys demonstrated that residents' knowledge and confidence increased significantly through simulation combined with a flipped-classroom approach in preparation for senior trauma call.

Rapid Cycle Deliberate Practice: Application to Adult Advanced Life Support.

Introduction: This curriculum includes three in-person simulation cases for Advanced Cardiac Life Support (ACLS) training using the rapid cycle deliberate practice (RCDP) technique. RCDP is a model for simulation-based medical education (SBME) that provides frequent feedback and opportunities to practice techniques until learning is cemented. The intent of these cases was to improve teamwork and communication, role designation, defibrillator operation, leadership, and clinical treatment of cardiac emergencies. Methods: Each case provided an ACLS scenario for an adult patient in the postanesthesia care unit setting. The curriculum required high-fidelity mannequins and instructors trained to provide SBME through RCDP. Learners worked in teams and were expected to perform appropriate steps per the ACLS algorithm, with facilitators pausing learners and providing expert feedback and opportunities for deliberate practice throughout. Results: Eighty-four postgraduate year 2 anesthesiology residents participated in the simulation curriculum over eight course offerings. Facilitators noted improved communication and teamwork among participants, as well as more accurate and effective defibrillator use. Feedback from learners was positive and indicated that they believed the experience would improve their clinical performance. Discussion: This curriculum provides instruction on using the RCDP variant of SBME to prepare health care providers to deliver effective care in situations necessitating ACLS. Because RCDP allows for repeated iterations of the same skill, knowledge can be cemented and muscle memory created. Given the positive feedback, we believe the curriculum can provide an effective framework for ACLS reinforcement through RCDP implementation across multiple types of learners and institutions.

Comparing traditional, immersive simulation with Rapid Cycle Deliberate Practice in postgraduate year 2 anesthesiology residents.

BACKGROUND: Rapid Cycle Deliberate Practice (RCDP) is an increasingly popular simulation technique that allows learners to achieve mastery of skills through repetition, feedback, and increasing difficulty. This manuscript describes the implementation and assessment of RCDP in an anesthesia residency curriculum. METHODS: Researchers describe the comparison of RCDP with traditional instructional methods for anesthesiology residents' application of Emergency Cardiovascular Care (ECC) and communication principles in a simulated environment. Residents (n = 21) were randomly assigned to either Traditional or RCDP education groups, with each resident attending 2 days of bootcamp. On their first day, the Traditional group received a lecture, then participated in a group, immersive simulation with reflective debriefing. The RCDP group received education through an RCDP simulation session. On their second bootcamp day, all participants individually engaged in an immersive simulation, then completed the "Satisfaction and Self-Confidence in Learning" survey. Application of ECC and communication principles during the simulation was scored by a blinded reviewer through video review. Participants ended the bootcamp by ranking the experiences they found most valuable. RESULTS: No significant differences were found in the different group members' individual performances during the immersive simulation, nor in the experiences they deemed most valuable. However, the Traditional education group reported higher levels of satisfaction and self-confidence in learning in 5 areas (p = 0.004-0.04). CONCLUSIONS: Regardless of RCDP or Traditional education grouping, anesthesia residents demonstrated no difference in ECC skill level or perceived value of interventions. However, members of the Traditional education group reported higher levels of satisfaction and self-confidence in numerous areas. Additional RCDP opportunities in the anesthesia residency program should be considered prior to excluding it as an educational method in our program.

PTSD Improvement Associated with Social Connectedness in Gerofit Veterans Exercise Program.

OBJECTIVE: Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN: Prospective clinical intervention. SETTING: Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS: Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS: Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS: Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION: Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19.

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.

Experience Is the Teacher of All Things: Prior Participation in Anesthesiology OSCEs Enhances Communication of Treatment Options With Simulated High-Risk Patients.

BACKGROUND: The objective of this study was to investigate whether previous experiences within an anesthesiology-based Objective Structured Clinical Examination (OSCE) assessing communication and professionalism skills was associated with improved performance in a subsequent anesthesiology-based OSCE scenario. METHODS: This retrospective multi-center study used the performance data of 44 Post Graduate Year 4 clinical anesthesia residents from 3 US anesthesiology residency programs on an OSCE scenario that assessed the residents' effectiveness of discussing anesthesiology-specific treatment options with a high-risk patient. Residents from 2 of the programs had no prior anesthesiology-based OSCE experience. Residents from the third program had previously participated in 4 separate multi-scenario anesthesiology-based OSCE sessions in the 2 years prior to this study. Participating residents completed the same scenario at their respective institutions' simulation center. Ten performances were randomly selected for double rating to assess the interrater reliability of the assessments. Interrater reliability was good for the scenario (intraclass correlation coefficient = 0.66, 95% confidence interval = 0.12-0.90). Performance difference between groups with different OSCE experience status were examined using an independent sample t test, with a Wilcoxon-Mann-Whitney test as a sensitivity analysis. RESULTS: Independent sample t test found prior OSCE experience was significantly associated with higher performance scores (t = 2.53, P = .02). The Wilcoxon-Mann-Whitney test result confirmed this finding (z = 3.28, P = .001). CONCLUSIONS: Findings from this study provide preliminary evidence that anesthesiology-based OSCE experience is associated with improved performance in an OSCE scenario, specifically regarding discussions of treatment options with high-risk patients.

Setting and Method of Measurement Affect Blood Pressure Readings in Older Veterans.

The present study demonstrated that standardized measurements of blood pressure were lower than the routine method used in most office settings.

Providing Rural Veterans With Access to Exercise Through Gerofit.

Clinical video telehealth can be used to deliver functional circuit exercise training to older veterans in remote locations.

Factors influencing physical therapists' involvement in preschool transitions.

BACKGROUND: Families and children receiving early intervention services benefit from service provider involvement during the transition to preschool special education services. OBJECTIVES: This study sought to determine the factors that physical therapists working in early intervention services and/or preschools identified as supportive of their involvement, and associated with their perceived involvement, in transition planning for young children with disabilities moving from early intervention to preschool services. DESIGN: A cross-sectional survey was used. METHODS: A survey was mailed to a random sample of 600 members of the American Physical Therapy Association's Section on Pediatrics. Physical therapists working with children transitioning out of early intervention and into preschool participated. Data from physical therapists providing services in preschools were included in this study. RESULTS: The response rate was 56.3%. The highest- and lowest-ranked facilitators of transition planning were: "Staff at my preschool program value my participation in transition planning activities" (highest ranked) (X=5.02, SD=1.36, n=142) and "I am encouraged to participate in transition planning activities by the early intervention service coordinator" (lowest ranked) (X=1.91, SD=3.50, n=143). Multivariate regression models demonstrated that physical therapists' perceived value and expertise in providing transition planning services were significantly associated with collaboration with professionals from early intervention programs (F(1,129)=207) and support of families during the transition process (F(1,134)=48). CONCLUSIONS: Physical therapists who identified implementing practices that supported communication, collaboration, and strong, positive relationships between early intervention and preschool programs had greater involvement in the transition planning process.