Accreditation of Simulation Fellowships and Training Programs: More Checkboxes or Elevating the Field?

SUMMARY STATEMENT: As the field of healthcare simulation matures, formal accreditation for simulation fellowships and training programs has become increasingly available and touted as a solution to standardize the education of those specializing in healthcare simulation. Some simulation experts hold opposing views regarding the potential value of simulation fellowship program accreditation. We report on the proceedings of a spirited debate at the 20th International Meeting on Simulation in Healthcare in January 2020. Pro arguments view accreditation as the logical evolution of a maturing profession: improving training quality through standard setting, providing external validation for individual programs, and enhancing the program's return on investment. Con arguments view accreditation as an incompletely formulated construct; burdensome to the "financially strapped" fellowship director, misaligned with simulation fellows' needs and expectations, and confusing to administrators mistakenly equating accreditation with credentialing. In addition, opponents of accreditation postulate that incorporating curricular standards, practice guidelines, and strategies derived and implemented without rigor, supporting evidence and universal consensus is premature. This narrative review of our debate compares and contrasts contemporary perspectives on simulation fellowship program accreditation, concluding with formal recommendations for learners, administrators, sponsors, and accrediting bodies.

Optimising expert dyad performance in acute care settings: a scoping review protocol.

INTRODUCTION: When there is miscommunication and poor coordination between experienced clinician dyads, teamwork suffers. Research on expert learning practices for the smallest team, and arguably the most important team, the healthcare dyad, is limited. The objective of this study is to map the extent and range of evidence available on learning practices which experienced dyads use, to achieve excellent performance, and to identify the gaps in effective practice. This will guide future research, policy and practice. METHODS AND ANALYSIS: We are using the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Extension Fillable Checklist, searching for literature that meets the inclusion criteria. The searches will be conducted using Maastricht University's Libsearch, which includes MEDLINE, Education Resources Information Center and PsycINFO and a second search on Web of Science online databases. We will search grey literature and references of selected sources. Search limits include sources from 2016 to 2021, using English language only. A data extraction tool was developed, and charting will use a thematic analysis approach. IMPLICATIONS AND DISSEMINATION: This review will be the first to examine the learning practices that experienced dyads use, which ensures excellent performance in acute care settings. The findings will be used to develop best-practices and shared with New York City hospital system. Dissemination will occur through peer-reviewed publications and at healthcare conferences.

Simulation Fellowships: Survey of Current Summative Assessment Practices.

INTRODUCTION: The simulation fellowship training community has commenced efforts toward the development of core curricular elements for healthcare simulation fellowships but has not deployed the same effort to create evaluation strategies to monitor fellows' progress. The authors present a current view of simulation fellowship assessment strategies, their relative validity evidence using Kane's theoretical framework, and consider new approaches for defining expertise after training. METHODS: Fellowship directors in North America were surveyed to identify what competencies are being used by the simulation fellowship community to monitor fellows' progress. A follow-up survey was sent to further clarify which tools with published validity evidence were being applied by current programs. RESULTS: Of the 61 programs contacted, 44 (72.1%) responded and completed the first survey. Of the 44 programs, 32 (72.7%) reported using some formal assessment of their fellows. The most commonly assessed skill was debriefing. Twenty-three (37.7%) of the 61 programs contacted responded to the secondary survey. These reported that the most common published tool used was the Debriefing Assessment for Simulation in Healthcare, with only a few other tools mentioned. CONCLUSIONS: There is a paucity of tools with published validity evidence being used to monitor a fellow's progression. The authors agree that further research needs to focus on creating validated assessment tools to assist in refining fellowship training.

Social pairing and female mating fidelity predicted by restriction fragment length polymorphism similarity at the major histocompatibility complex in a songbird.

Female birds often copulate outside the pair-bond to produce broods of mixed paternity, but despite much recent attention the adaptive significance of this behaviour remains elusive. Although several studies support the idea that extra-pair copulations (EPCs) allow females to obtain 'good genes' for their offspring, many others have found no relationship between female mating fidelity and traits likely to reflect male quality. A corollary to the good genes hypothesis proposes that females do use EPCs to increase the quality of young, but it is the interaction between maternal and paternal genomes - and not male quality per se - that is the target of female choice. We tested this 'genetic compatibility' hypothesis in a free-living population of Savannah sparrows (Passerculus sandwichensis) by determining whether females mated nonrandomly with respect to the major histocompatibility complex (Mhc). During both the 1994 and 1995 breeding seasons, female yearlings (but not older birds) avoided pairing with Mhc-similar males (P < 0.005). The Mhc similarity between mates also predicted the occurrence of extra-pair young in first broods (P < 0.007) and covaried with estimates of genome-wide levels of similarity derived from multilocus DNA fingerprinting profiles (P = 0.007). The overall genetic similarity between adults tended to predict female mating fidelity, but with less precision than their Mhc similarity (P = 0.09). In contrast, females appeared insensitive to the size, weight or age of males, none of which explained variation in female mating fidelity. Taken together, these results are consistent with the hypothesis that females sought complementary genes for their offspring and suggest either that the benefits of heterozygosity (at the Mhc) drive female mating patterns or that the avoidance of inbreeding is an ultimate cause of social and genetic mate choice in Savannah sparrows.