Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial.

BACKGROUND: History taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents. METHODS: Postgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time. RESULTS: The mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group. CONCLUSION: VPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.

Nursing evaluation of pediatric preoperative anxiety: a qualitative study / Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo? / Evaluación enfermera de la ansiedad prequirúrgica pediátrica: estudio cualitativo

Abstract Objective: to explore and describe how perioperative nurses assess and interpret the child's behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. Method: descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. Results: four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. Conclusion: nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse's experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.

Resumo Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.

Resumen Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.

Employing High-Fidelity Simulation for the High-Risk, Low-Frequency Diagnosis and Management of Acute Radiation Syndrome (ARS).

Introduction: Acute radiation syndrome (ARS) is a high-risk, low-frequency diagnosis that can be fatal and is difficult to diagnose without an obvious history of ionizing radiation exposure. Methods: Twenty-two emergency medicine residents and one pharmacy resident participated in an hour-long simulation session. To accommodate all learners, the simulation was conducted eight times over a block of scheduled time (two to four learners/session). Sessions included a prebriefing, pre/post questionnaires, the ARS case, and a debriefing. Learners evaluated and managed a 47-year-old male (manikin) with the hematopoietic and cutaneous subsyndromes of ARS who presented with hand pain/erythema/edema and underlying signs of infection 2 weeks after an unrecognized radiation exposure. Learners had to perform a history and physical, recognize/manage abnormal vitals, order/interpret labs, consult appropriate disciplines, and initiate supportive care. Results: There was a mean reported increase in ability to recognize signs and symptoms of ARS (p < .001) and appropriately manage a patient with this condition (p = .03) even after controlling for baseline confidence in ability to make and manage uncommon diagnoses, respectively. Learners rated this simulation as a valuable learning experience, effective in teaching them how to diagnose and treat ARS, and one they would recommend to other health care professionals. Discussion: This simulation aimed to teach the diagnosis and initial management of the hematopoietic and cutaneous subsyndromes of ARS. It should be used to increase awareness of the potential for ionizing radiation exposure under less obvious conditions and raise the index of suspicion for ARS in the undifferentiated patient.

Evaluation of the effectiveness of artificial intelligence assisted interactive screen-based simulation in breast self-examination: An innovative approach in nursing students.

BACKGROUND: Breast self-examination is important in the early diagnosis of breast cancer. The use of traditional education methods is insufficient for student nurses to gain breast self-examination skills in nurse education. New and different education methods are needed to gain skills in nurse education. OBJECTIVE: The aim of this study was to evaluate the effectiveness of artificial intelligence-assisted screen-based simulations practice and standard patient simulation in teaching breast self-examination skills in nursing undergraduate students. DESIGN: This study was a comparative intervention trial. SETTINGS: This study was conducted at a university in XX, in XXX in the first semesters of the academic years 2022-2023. METHODS: This study enlisted 103 students enrolled in first year in a nursing department. Students were randomized into artificial intelligence-assisted screen-based simulations practice group (n = 52) and standard patient simulation group (n = 51). Data were collected using student description form, breast self-examination checklist, student satisfaction and self-confidence in learning scale, Spielberger's state and trait anxiety inventory. RESULTS: The highest score regarding the total score means of breast self-examination skills belonged to the standard patient simulation group, and the differences between the groups were found to be statistically significant (p < 0.05). Although the mean score of anxiety levels of the students' artificial intelligence-assisted screen-based simulations practice group was higher than the standard patient simulation (p < 0.05). The mean score of the students' satisfaction with the simulation was higher in artificial intelligence-assisted screen-based simulations practice group than the standard patient simulation group (p < 0.05). CONCLUSIONS: The results of the research showed that the use of artificial intelligence-assisted simulation learning increased students' satisfaction, but at the same time students' anxiety increased. In addition, artificial intelligence-assisted simulation learning is not as effective as standard patient simulation learning in gaining breast self-examination skills.

Virtual trauma patient simulation design using the McGill Simulation Complexity Score (MSCS): a breakthrough in trauma education.

BACKGROUND: Virtual patient simulations are interactive, computer-based cases. We designed scenarios based on the McGill Simulation Complexity Score (MSCS), a previously described objective complexity score. We aimed to establish validity of the MSCS and introduce a novel learning tool in trauma education at our institution. METHODS: After design of an easy and difficult patient scenario, we randomized medical students and residents to each perform 1 of the 2 scenarios. We conducted a 2-way analysis of variance of training level (medical student, resident) and scenario complexity (easy, difficult) to assess their effects on virtual time, the number of steps taken in the scenario, beneficial and harmful actions, and the ratio of beneficial over harmful actions. RESULTS: Virtual patient scenarios were successfully designed using the MSCS. Twenty-four medical students and 12 residents participated in the easy scenario (MSCS = 3), and 27 medical students and 12 residents did the difficult scenario (MSCS = 18). Though beneficial actions were similar between students and residents, sudents performed more harmful actions, particularly when the scenario was difficult. One virtual patient died in the easy scenario and 3 died in the difficult one (all medical students). Performance varied with level of complexity and there was significant interaction between level of training and number of steps, as well as with number of harmful actions. Decreasing performance with increasing level of complexity, as defined by the MSCS, suggests this score can accurately quantify difficulty. CONCLUSION: We established validity of the MSCS and showed its successful application on virtual patient scenario design.

Percepción de la simulación en obstetricia y ginecología en el pregrado y posgrado de una universidad privada chilena / Perception of simulation in obstetrics and gynecology at the undergraduate and postgraduate levels of a private Chilean university

INTRODUCCIÓN: La simulación es una herramienta que promueve la confianza y desarrollo de habilidades en los participantes. En la evaluación de programas formativos la percepción de utilidad se vincula a la confianza y aprendizaje, y corresponde al primer nivel de evaluación según Kirkpatrick. OBJETIVO: Evaluar la percepción de internos y residentes de obstetricia y ginecología en escenarios de simulación. MATERIAL Y MÉTODOS: Investigación descriptiva cuantitativa, en una muestra a conveniencia de internos y residentes, quienes contestaron una escala de valoración global y de preferencias sobre sus simulaciones. RESULTADOS: Se obtuvieron 63 respuestas de internos (63%) y 7 de residentes (78%). La valoración promedio de las simulaciones fue de 6,42 en los internos y de 6,64 de los residentes. El 67% de los internos y el 86% de los residentes no eliminaría ninguna simulación. Los internos repetirían todas las simulaciones, en tanto que los residentes repetirían tres simulaciones de un total de 11. CONCLUSIONES: La valoración de las simulaciones fue alta en ambos grupos, difiriendo en las actividades que prefieren repetir, lo cual puede relacionarse con las competencias inherentes al rol de especialista en comparación al rol del médico general o a las diferencias en autoconfianza de internos y residentes.

INTRODUCTION: Clinical simulation is a training tool that promotes confidence and the development of procedural skills in participants, from initial training to the training of professional teams. In the evaluation of training programs, the measurement of perceived usefulness is linked to confidence and learning and corresponds to a first level of evaluation of the quality of training according to Kirkpatricks model. OBJECTIVE: To evaluate the perception of medical interns and Obstetrics and Gynecology fellows regarding simulation scenarios. MATERIAL AND METHODS: Quantitative descriptive research, in a convenience sample of interns and fellows, who answered a scale of global assessment and preferences about simulations. RESULTS: The average score was 6.42 for the interns and 6.64 for the scholarship recipients. With odd answers about the repetition of scenarios. 67% of the interns and 86% of the fellows responded that they would not eliminate any simulation. Conclusions: The evaluation of the scenarios was excellent and satisfactory by the participants.

Simulação in situ com a equipe de enfermagem de terapia intensiva: relato de experiência / Situ simulation with an intensive therapy reference team: experience report / Simulación in situ con un equipo intensivo de referencia de terapia: informe de experiencia

Objetivo: relatar a implementação de simulações in situ na educação permanente dos profissionais de enfermagem de uma unidade de terapia intensiva. Métodos: relato de experiência realizada de dezembro de 2018 a fevereiro de 2019 com 37 profissionais de enfermagem. Aplicou-se dois cenários de simulação. As simulações foram gravadas em áudio e vídeo, seguidas de debriefing com Bom Julgamento. Resultados: O cenário da assistência ao paciente em parada cardiorrespiratória foi realizado sete vezes e teve a participação de 28 profissionais. O cenário assistencial voltado ao paciente em choque séptico ocorreu três vezes e envolveu nove participantes. O debriefing com Bom Julgamento associado às imagens videogravadas favoreceu a reflexão dos profissionais sobre suas ações durante as simulações. Conclusão: a simulação in situ em terapia intensiva demonstrou ser uma prática efetiva e inovadora para a educação permanente com a equipe de enfermagem. (AU)

Objective: to relate an implementation of simulations in situ in the permanent education of nursing professionals in an intensive care unit. Methods: relationship of experience carried out from December 2018 to February 2019 with 37 nursing professionals. Two simulation scenarios were applied. As simulations were recorded in audio and video, follow the debriefing with Bom Judgamento. Results: the scenario of assistance to patients in cardiorespiratory arrest was performed seven times and had the participation of 28 professionals. The care scenario aimed at the patient in septic shock occurred three times and involved nine participants. Debriefing with Good Judgment associated with video images favored a reflection by professionals about their actions during the simulations. Conclusion: an in situ simulation in intensive care demonstrated an effective and innovative practice for continuing education with the nursing team. (AU)

Objetivo: relacionar una implementación de simulaciones in situ en la educación permanente de profesionales de enfermería en una unidad de cuidados intensivos. Métodos: relación de experiencia realizada entre diciembre de 2018 y febrero de 2019 con 37 profesionales de enfermería. Se aplicaron dos escenarios de simulación. Como las simulaciones se grabaron en audio y video, siga el informe con Bom Judgamento. Resultados: el escenario de asistencia a pacientes en paro cardiorrespiratorio se realizó siete veces y contó con la participación de 28 profesionales. El escenario de atención dirigido al paciente en shock séptico ocurrió tres veces e involucró a nueve participantes. El debate con buen juicio asociado con las imágenes de video favoreció la reflexión de los profesionales sobre sus acciones durante las simulaciones. Conclusión: una simulación in situ en cuidados intensivos demostró una práctica efectiva e innovadora para la educación continua con el equipo de enfermería. (AU)

Pronação de pacientes com Síndrome do Desconforto Respiratório Agudo: criação e validação de cenário simulado / Pronation of patients with Acute Respiratory Distress Syndrome: creation and validation of a simulated scenario

Resumo: Trata-se de um estudo metodológico para construção e validação de um cenário simulado com abordagem interprofissional, que permitirá a utilização no ensino e na educação permanente de profissionais da saúde por meio da metodologia ativa de simulação clínica. Este estudo foi realizado em uma universidade pública da região Sul do Brasil, objetivando construir e validar um cenário simulado para a pronação de pacientes críticos com Síndrome do Desconforto Respiratório Agudo (SDRA). Para isto, o estudo ocorreu em duas etapas: revisão de conteúdo, construção do cenário e de validação de conteúdo e de aparência por juízes. A revisão da literatura permitiu conhecer melhor sobre o manejo do paciente com SDRA, bem como subsidiar o desenvolvimento do caso clínico para o cenário. Um protocolo de pronação segura de um hospital universitário foi adotado. A partir desta revisão, a construção do cenário foi realizada considerando um roteiro validado. Como parte desta construção, surgiram como resultados: a descrição do cenário; a relação de materiais e equipamentos necessários para o desenvolvimento do cenário; o roteiro para o ator simulado; o guia de apoio ao facilitador; o guia de apoio ao participante; o quadro de apoio para tomada de decisão e o checklist de observação do desenvolvimento de competências e habilidades para cada profissão envolvida no cenário. Onze juízes participaram do estudo. Em relação ao perfil sociodemográfico dos juízes, a amostra foi predominantemente de enfermeiros (63,6%), seguido por fisioterapeutas (18,1%), médico (9%) e docente de enfermagem (9%). Para medir o percentual de concordância entre os juízes, adotou-se o Índice de Validade de Conteúdo (IVC) para os itens, que foram agrupados de acordo com unidades de significância. Após a leitura do cenário, os juízes responderam a um questionário do tipo Likert com 37 itens, que abordaram sobre a "Experiência Prévia do Participante/Briefing", "Conteúdo/Objetivos"; "Recursos Humanos"; "Preparo do Cenário", "Desenvolvimento do Cenário" e "Avaliação". Todos os itens obtiveram IVC superior ao desejável (0,80) e, portanto, foram considerados válidos. Além disso, os juízes realizaram sugestões de melhorias no cenário, aos quais foram acatadas ou rejeitas e discutidas com a literatura disponível. Este estudo permitiu criar e validar um cenário que reflete a prática real, ao mesmo tempo que oportuniza um ambiente seguro para os participantes e responde aos objetivos da aprendizagem.

Abstract: This is a methodological study for the construction and validation of a simulated scenario with an interprofessional approach, which will allow the use in the teaching and continuing education of health professionals through the active methodology of clinical simulation. This study was carried out in a public university in the South region of Brazil, aiming to build and validate a simulated scenario for the pronation of critically ill patients with Acute Respiratory Distress Syndrome (ARDS). To this end, the study occurred in two stages: content review, scenario construction, and content and appearance validation by judges. The literature review provided a better understanding of the management of the ARDS patient, as well as a basis for developing the clinical case for the scenario. A safe pronation protocol from a university hospital was adopted. Based on this review, the scenario was built using a validated script. As part of this process, the following results emerged: the description of the scenario; the list of materials and equipment needed for the development of the scenario; the script for the simulated actor; the facilitator support guide; the participant support guide; the decision support framework; and the checklist for observing the development of competencies and skills for each profession involved in the scenario. Eleven judges participated in the study. Regarding the sociodemographic profile of the judges, the sample was predominantly nurses (63.6%), followed by physical therapists (18.1%), physicians (9%), and nursing professors (9%). To measure the percentage of agreement between the judges, the Content Validity Index (CVI) was adopted for the items, which were grouped according to significance units. After reading the scenario, the judges answered a Likert-type questionnaire with 37 items, which addressed "Prior Participant Experience/Briefing", "Content/Objectives"; "Human Resources"; "Scenario Preparation", "Scenario Development", and "Evaluation". All items scored higher than desirable CVI (0.80) and were therefore considered valid. In addition, the judges made suggestions for improvements in the scenario, which were accepted or rejected and discussed with the available literature. This study made it possible to create and validate a scenario that reflects actual practice, while providing a safe environment for participants and meeting the learning objectives.

Implementación de docencia de postgrado y pregrado presencial y remota con pacientes simulados en psiquiatría / Implementation of postgraduate and undergraduate teaching with simulated patients in Psychiatry

BACKGROUND: Clinical simulation is a strategy with broad support especially when face-to-face medical attention is difficult. In Psychiatry, the use and availability of simulation is lower than in other medical specialties, even for remote teaching. AIM: To report a pedagogical experience whose objective was to develop and implement the simulated patient technique as a teaching strategy for psychopathology and face-to-face Psychiatry for Psychiatry residents and remote for undergraduate medical students. MATERIAL AND METHODS: Six residents and 115 medical students participated in the activity. A descriptive qualitative-quantitative study was designed. Surveys were used to measure the quality and satisfaction of clinical simulation and simulation in psychopathology and psychiatry. In addition, an opinion was requested about the activity. All residents and 104 students participated in the assessment. RESULTS: The simulations were satisfactorily evaluated. The participants perceived that the pedagogical activity favored the development of generic competencies and specific skills for general Psychiatry. CONCLUSIONS: Simulation in Psychiatry does not replace face-to-face practical teaching, but it is a transitional and complementary method for clinical activities.

An online case-based teaching and assessment program on clinical history-taking skills and reasoning using simulated patients in response to the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has created unprecedented challenges for medical students and educators worldwide. Groups 1, 2 and 3 of year 3, semester 2 medical students at the Royal College of Surgeons in Ireland (n = 275) had only completed 2, 5 and 7 weeks, respectively, of their scheduled 10-week clinical medicine and surgery attachments, prior to the Irish shutdown of all in-person non-essential activities, including medical student education. METHODS: We developed and delivered an online case-based program, focused on history-taking skills and clinical reasoning, using simulated patients and video technologies. 12 tutorials were delivered over 6 weeks to 35 subgroups of 8 students in line with program learning outcomes. Both simulated patients (n = 36), and tutors (n = 45, from retired clinical professors to newly graduated physicians), were rapidly upskilled in Blackboard Collaborate and Microsoft Teams, and also in the provision of constructive feedback. We evaluated this newly developed program by the following three criteria: student attendance, achieved grades, and student feedback. RESULTS: Attendance at the 12 tutorials was higher amongst group 1 and 2 students (75 and 73%) by comparison with group 3 students (60%) (p = < 0.001). Of the 273 students that sat the Year 3 Semester 2 online long case assessment, 93% were successful. Despite group 1 students having the least prior clinical experience, results were similar to those of groups 2 and 3 (1st honors, 2nd honors, pass, and fail grades for group 1, 39%, 33%, 23% and 6%; group 2, 34%, 41%, 17% and 8%; group 3, 39%, 25%, 28% and 7%) (p = 0.48). An increased attendance rate at tutorials was associated with higher numbers of honors grades (p = < 0.001). Anonymous feedback from the students demonstrated considerable satisfaction with program: > 85% agreed that the online program was interactive and very educational. CONCLUSIONS: Use of online video technology, tutors of varied experience, and simulated patients were demonstrated to replicate patient encounters, and to facilitate the development of clinical skills remotely during the COVID-19 pandemic.

A population-based study on the risk of prescription opioid abuse in patients with chronic opioid use and cost-effectiveness of prescription drug monitoring program using a patient simulation model in South Korea.

BACKGROUND: Concerns regarding the burden of inappropriate opioid use are growing. We examined the association between prescription opioid abuse and patient characteristics and estimated the cost-effectiveness of the prescription drug monitoring program (PDMP) implemented in South Korea, considering patient-level information. METHODS: A retrospective cohort study was conducted to explore the association between opioid abuse and patient characteristics using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. We selected non-cancer patients with chronic opioid use and investigated the incidence of opioid abuse between 2010 and 2015. The association between opioid abuse and patient characteristics was assessed using the Cox proportional hazards model. The cost-effectiveness of the PDMP was assessed using discrete event simulation (DES) with a time horizon of 30 years from a societal perspective. Time-to-event data and event costs were obtained from the NHIS-NSC database. The abuse rate was adjusted for each patient based on the baseline characteristics and history of abuse experienced in the model. Program effectiveness, program costs, and health-state utilities were obtained from the published literature. The incremental cost-utility ratio (ICUR) was estimated at a discount rate of 5% for both costs and quality-adjusted life-years (QALYs). RESULTS: We identified 22,524 patients with chronic opioid use in the NHIS-NSC database. Every one-year increase in age (hazard ratio: 1.002 [95% CI: 1.000-1.003]), medical aid program (1.130 [95% CI: 1.072-1.191]), high Charlson Comorbidity Index (1.054 [95% CI: 1.044-1.065]), and history of opioid abuse (1.501 [95% CI: 1.391-1.620] and 3.005 [95% CI: 2.387-3.783] for 1-2 and ≥3 abuse events, respectively) significantly increased the risk of opioid abuse. In the DES, the PDMP was cost-effective, with an estimated ICUR of $2,227/QALY, which was most affected by the program's effectiveness. CONCLUSION: Patient characteristics and history of opioid abuse affected the risk of opioid abuse. Considering patient-level information, the PDMP implemented in South Korea is likely to be cost-effective.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study.

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

Cuidados paliativos em idosos com dispneia: estudo de validação / Cuidados paliativos en el adulto mayor con disnea: estudio de validación / Palliative care in elderly people with dyspnea: A validation study

Objetivo: validar o conteúdo do cenário de simulação clínica sobre assistência ao paciente idoso hospitalizado em cuidados paliativos com dispneia, como ferramenta de ensino para estudantes de graduação em enfermagem. Materiais e método: estudo metodológico desenvolvido em três fases: revisão integrativa da literatura; entrevista com enfermeiros da área de gerontologia e cuidados paliativos; e validação do conteúdo do cenário de simulação. A validação contou com cinco juízes especialistas na área de simulação, gerontologia e cuidados paliativos entre abril e maio de 2022. O cenário criado foi baseado no pressuposto da Fabri: objetivos, material de estudo prévio, preparação, desenvolvimento, debriefing e avaliação. Utilizaram-se estatística descritiva e índice de validade de conteúdo. Resultados: foi identificado que os itens "duração do cenário", "características do paciente", "descrição do caso clínico", "caracterização do ator", "prebriefing" e "avaliação" obtiveram 0,80. O cenário de simulação obteve um valor geral de 0,91. Foram realizados ajustes no cenário referente à clareza da redação, às funcionalidades e à pertinência segundo as sugestões dos juízes. Conclusões: o cenário validado é uma ferramenta que auxilia no ensino da graduação em enfermagem, proporcionando uma formação nas áreas de gerontologia e de cuidados paliativos com um olhar diferenciado, o que pode levar a uma assistência humanizada e de qualidade.

Objetivo: validar el escenario de simulación clínica sobre la asistencia al adulto mayor hospitalizado en cuidados paliativos con disnea como herramienta de enseñanza para estudiantes de pregrado en enfermería. Materiales y método: estudio metodológico desarrollado en tres fases: revisión integrativa de la literatura; entrevista con profesionales de enfermería en el área de gerontología y cuidados paliativos; y validación del escenario de simulación. La validación contó con la participación de cinco jueces expertos en el área de simulación, gerontología y cuidados paliativos, y se llevó a cabo entre abril y mayo de 2022. El escenario creado se basó en el referencial de Fabri: objetivos, material de estudio previo, preparación, desarrollo, debriefing y evaluación. Esta investigación acudió al uso de estadística descriptiva y el índice de validez de contenido. Resultados: se identificó que los ítems "duración del escenario", "características del paciente", "descripción del caso clínico", "caracterización del actor", "prebriefing" y "evaluación" obtuvieron un valor de 0,80. El escenario de simulación obtuvo un valor general de 0,91. Se incorporaron algunos ajustes al escenario con respecto a la claridad de la escritura, las funcionalidades y su relevancia, de acuerdo con las sugerencias de los jueces. Conclusiones: el escenario validado se constituye en una herramienta que contribuirá al proceso de enseñanza del estudiante de enfermería, particularmente a la formación en las áreas de gerontología y cuidados paliativos, proporcionando una mirada diferente que redundará en cuidados de calidad y humanizados.

Objective: To validate the content of a clinical simulation scenario on the care provided to elderly patients with dyspnea hospitalized in palliative care as a teaching tool for undergraduate nursing students. Materials and method: Methodological study developed in three phases, namely: integrative literature review; interviews with nurses in the gerontology and palliative care area; and validation of the simulation scenario content. The validation phased engaged five specialist judges in the area of simulation, gerontology, and palliative care, and was conducted between April and May 2022. The scenario created was based on Fabri's assumption: objectives, previous study material, preparation, development, debriefing, and evaluation. Descriptive statistics and the content validity index were used. Results: The items "duration of the scenario", "patient characteristics", "description of the clinical case", "characterization of the actors", "prebriefing" and "evaluation" obtained a score of 0.80. The simulation scenario obtained an overall value of 0.91. Adjustments on the clarity in writing, functionalities, and the relevance of the scenario were incorporated, according to the judges' suggestions. Conclusions: The validated scenario could become a tool in the training process of undergraduate nursing courses, providing a different perspective for gerontology and palliative care training and fostering humanized and quality care.

The design, implementation and evaluation of hybrid cancer clinic simulations: Escaping the norm.

INTRODUCTION: Simulation and gamification are two popular educational tools utilized to enhance student learning and engagement. This study aimed to evaluate the effectiveness of integrating a hybrid cancer clinic simulation into the curricula for third-year pharmacy (P3) students. METHODS: This prospective, single-arm pilot study incorporated a mixed-method learning activity involving patient simulation and escape room elements. Two cancer clinic simulations were developed by faculty members. For each clinic, students were randomly divided into 6 groups and tasked with completing a series of Pharmacist Patient Care Process (PPCP) activities involving patient actors. The PPCP activities were interwoven with engaging puzzles and games to simulate an escape room. Student learning and retention was measured by pre- and post-simulation quizzes and course level exams. A perceptions survey was administered after each simulation activity. RESULTS: Thirty-six students participated in both cancer clinic simulations, with 100% completing all aspects of the study. Mean student quiz scores improved from 61.4% to 81.7% (p < 0.0001) and 52.6% to 81.8% (p < 0.0001) following the first and second simulations, respectively. Exam performance improved for 16 out of 19 exam questions, with a significant increase in 4 questions (p < 0.05). Students overwhelmingly agreed that the cancer clinic simulations 1) reinforced knowledge, 2) facilitated PPCP, 3) improved their ability to make chemotherapeutic recommendations, 4) enhanced problem-solving skills, and 5) encouraged collaboration. CONCLUSION: This innovative hybrid simulation enhanced oncology-related knowledge and supported an interactive environment that improved student confidence and teamwork. Students enjoyed the simulations and recommended continuation for all future cohorts.

Standardized Patient Simulation in an Oncology Symptom Management Seminar-Style Course: Prelicensure Nursing Student Outcomes.

A critical role of the professional nurse is to manage symptoms associated with cancer and its treatments. Currently, prelicensure nursing curricula lack adequate oncology content and associated opportunities for clinical application. Thus, many graduate nurses do not possess the requisite knowledge and skills required to effectively manage cancer-related symptoms upon entry to practice. The purposes of this study were to evaluate the effect of standardized patient simulation on nursing students' knowledge, confidence, and competence (objective and self-perceived) related to oncology evidence-based symptom management principles, and to determine nursing students' perceptions, satisfaction, and self-confidence with learning using standardized patient simulation in a seminar-style course. A longitudinal, one-group, convergent mixed-methods design with questionnaire variant was used. Data were collected at three time points: (T1) pre-seminar, (T2) pre-simulation, and (T3) post-simulation. A convenience sample of sixty-three senior baccalaureate nursing students in an oncology symptom management seminar participated in two standardized patient simulation scenarios. There was a significant increase in students' knowledge, confidence, and self-perceived competence over time with a large effect size. All student groups (n = 14) demonstrated objective competence in the colorectal cancer scenario and all participants, with the exception of one student group, demonstrated objective competence in the breast cancer scenario. Participants also reported positive perceptions of, a high level of satisfaction with, and self-confidence in learning with the standardized patient simulations. Qualitative themes identified included unique focus, realism, and application of knowledge. Standardized patient simulation holds promise to enhance nursing students' knowledge, confidence, and competence related to oncology evidence-based symptom management principles.

Tactics for hemorrhagic shock: A virtual course and visual aid for improved resuscitation.

BACKGROUND: Our trauma performance improvement initiative recognized missed treatment opportunities for patients undergoing massive transfusion. To improve patient care, we developed a novel cognitive aid in the form of a poster entitled "TACTICS for Hemorrhagic Shock." We hypothesized that this reference and corresponding course would improve the performance of trauma leaders caring for simulated patients requiring massive transfusion. METHODS: First, residents and physician assistants participated in a one-on-one, socially distanced, screen-based virtual patient simulation. Next, they watched a short presentation introducing the TACTICS visual aid. They then underwent a similar second virtual simulation during which they had access to the reference. In both simulations, the participants were assessed using a scoring system developed to measure their ability to provide appropriate predetermined interventions while leading a trauma resuscitation (score range, 0-100%). Preintervention and postintervention scores were compared using a one-group pre-post within-subject design. Participants' feedback was obtained anonymously. RESULTS: Thirty-two participants (21 residents and 11 physician assistants) completed the course. The median score for the first simulation without the use of the visual aid was 43.8% (interquartile range, 33.3.8-61.5%). Commonly missed treatments included giving tranexamic acid (success rate, 37.5%), treating hypothermia (31.3%), and reversing known anticoagulation (28.1%). All participants' performance improved using the visual aid, and the median score of the second simulation was 89.6% (interquartile range, 79.2-94.8%; p < 0.001). Ninety-two percent of survey respondents "strongly agreed" that the TACTICS visual aid would be a helpful reference during real-life trauma resuscitations. CONCLUSION: The TACTICS visual aid is a useful tool for improving the performance of the trauma leader and is now displayed in our emergency department resuscitation rooms. This performance improvement course, the associated simulations, and visual aid are easily and virtually accessible to interested trauma programs. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Tecnologias tridimensionais na aquisição de paciente virtual para planejamento digital: revisão sistemática / Three-dimensional technologies in the acquisition of virtual patient for digital planning: systematic review

Os avanços nas técnicas de digitalização permitem o registro e a integração das estruturas ósseas, dentárias e faciais. A tomografia computadorizada e os escaneamentos intraoral, laboratorial e extraoral da face fornecem dados aplicáveis do diagnóstico ao tratamento e fomentam a atual renovação da terapêutica odontológica. Nesse âmbito, atribuiu-se a esta revisão sistemática o objetivo de avaliar se as referidas tecnologias tridimensionais podem ser associadas para aquisição do paciente virtual, com a finalidade de planejamento digital otimizado. A coleta da evidência foi realizada sem restrição de tempo e língua e detalhada estratégia de busca foi aplicada às bases de dados Cochrane, PubMed e Web of Science, resultando na amostra total de 1.267 artigos. Pesquisas adicionais foram efetuadas no Google Acadêmico e as listas de referências dos artigos selecionados foram analisadas na procura por estudos compatíveis com os critérios de elegibilidade. Após duas fases de seleção, conduzidas por revisores independentes, 23 artigos foram incluídos para análise descritiva. Os trabalhos foram submetidos à análise do risco de viés individual através das ferramentas do Instituto Joanna Briggs e a certeza da evidência cumulativa geral foi avaliada pelo instrumento GRADE. O padrão do conteúdo científico reunido indica que o efeito estimado por esta pesquisa é potencialmente próximo ao real. A revisão revelou que a associação das tecnologias é efetiva para a completa geração do paciente virtual. Para o propósito de planejamento digital, os protocolos demonstraram otimização e viabilidade clínica, com desfechos caracterizados pela acurácia, previsibilidade, tempo e custos minimizados. Trabalhos acerca desse tema estão em desenvolvimento e espera-se que a evidência futura corrobore e amplie os achados desta pesquisa sistematizada.

Gender-Affirming Care With Transgender and Genderqueer Patients: A Standardized Patient Case.

Introduction: Transgender and gender-diverse (TGD) patients experience health disparities and bias in health care settings. To improve care for TGD patients, medical trainees can practice gender-affirming care skills such as inclusive communication and discussing hormone therapy through patient simulation. Systematically evaluating these simulation outcomes also helps educators improve training on gender-affirming care. Methods: A standardized patient case with a patient establishing primary care was developed for rising third-year medical students. The case featured multiple patient iterations to portray individuals with the same health history but a different gender identity and/or sex assigned at birth. Each student was randomly assigned to one patient encounter. Gender-affirming care skills were assessed through standardized patient checklists, postencounter notes, and preventive care recommendations. Results: Over 2 years, 286 students participated in the simulation. Transgender men and women, cisgender men and women, and genderqueer patients were portrayed. Performance gaps such as misgendering patients and incorrect cancer screening recommendations based on perceived gender identity (rather than sex assigned at birth) were documented. Ninety-eight percent of students agreed that the encounter helped them practice clinical skills needed to see actual patients, and students described the case as challenging but important. Discussion: This case served dual roles for medical training: (1) Students working with TGD patients practiced skills for gender-affirming care, and (2) portraying TGD patients along with cisgender patients allowed educators to identify biased recommendations that necessitated additional training. The outcomes further highlighted the importance of students routinely practicing gender-inclusive communication with all patients during simulation.

Construção e validação de simulação clínica sobre testagem e aconselhamento para o hiv em gestantes / Construction and validation of a clinical simulation on hiv testing and counseling in pregnant women / Construcción y validación de un simulacro clínico sobre pruebas y asesoramiento del vih en mujeres embarazadas

RESUMO Objetivo: construir e validar um cenário de simulação clínica sobre a testagem rápida e aconselhamento para o HIV em gestantes. Método: estudo metodológico, de validação de aparência e conteúdo, desenvolvido no período de junho a outubro de 2020 por meio da técnica Delphi. Para a validação, foram incluídos os juízes que obtiveram cinco ou mais pontos segundo os critérios de Fehring adaptados. Os dados foram analisados mediante o cálculo do Índice de Validade de Conteúdo (IVC). Resultados: depois da primeira rodada Delphi, dois itens (5,7%) não atingiram o I-CVI necessário para validação em todos os critérios avaliados, que foram: comportamental, objetividade, simplicidade, clareza, relevância, precisão, variedade, modalidade, tipicidade e credibilidade. Ao final da segunda rodada Delphi, todos os itens (100%) atingiram o I-CVI necessário para validação. Conclusão: o roteiro se mostrou válido, contribuindo para subsidiar o ensino da testagem e do aconselhamento de gestante sobre o HIV.

ABSTRACT Objective: to construct and validate a clinical simulation scenario on rapid HIV testing and counseling in pregnant women. Method: methodological study, of appearance and content validation, developed between June and October 2020 through the Delphi technique. For validation, the judges who obtained five or more points according to the adapted Fehring criteria were included. The data were analyzed by calculating the Content Validity Index (CVI). Results: After the first Delphi round, two items (5.7%) did not reach the I-CVI required for validation in all the criteria evaluated, which were: behavioral, objectivity, simplicity, clarity, relevance, accuracy, variety, modality, typicality, and credibility. At the end of the second Delphi round, all items (100%) reached the I-CVI required for validation. Conclusion: the script proved to be valid, contributing to subsidize the teaching of HIV testing and counseling of pregnant women.

RESUMEN Objetivo: construir y validar un escenario de simulación clínica sobre pruebas rápidas y asesoramiento para el VIH en mujeres embarazadas. Método: estudio metodológico, de valoración de la apariencia y el contenido, desarrollado en el período de junio a octubre de 2020 mediante la técnica Delphi. Para la validación, se incluyeron los jueces que obtuvieron cinco o más puntos según los criterios adaptados de Fehring. Los datos se analizaron calculando el Índice de Validez del Contenido (IVC). Resultados: Tras la primera ronda Delphi, dos ítems (5,7%) no alcanzaron el I-CVI requerido para la validación en todos los criterios evaluados, que fueron: comportamiento, objetividad, simplicidad, claridad, relevancia, precisión, variedad, modalidad, tipicidad y credibilidad. Al final de la segunda ronda Delphi, todos los ítems (100%) alcanzaron el I-CVI requerido para la validación. Conclusión: el rodillo se mostró válido, contribuyendo a subvencionar la enseñanza de la prueba y el asesoramiento de gestores sobre el VIH.