Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training.

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

The effects of normal vaginal birth simulation training on the clinical skills of midwifery students: a quasi-experiment study.

BACKGROUND: Vaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education. METHODS: This quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant. RESULTS: The mean score of midwives' skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p < .001). CONCLUSION: The results of the present study indicated that the simulation situation for critical skills, such as vaginal birth skills, was significantly more effective than workplace-based learning situations.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial.

AIM: This study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students. BACKGROUND: Clinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students' satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training. DESIGN: The study was designed as a pragmatic randomized controlled trial. SETTING: This study was conducted at a university in Turkey. PARTICIPANTS: A total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44). METHODS: The intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022. RESULTS: This study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05). CONCLUSION: The findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students' stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

An innovative virtual reality training tool for the pre-hospital treatment of cranialmaxillofacial trauma.

Virtual reality (VR) surgery using the High Technology Computer Corporation Very Immersive Virtual Experience professional 2(HTC VIVE Pro2) suite is a multi-sensory, holistic surgical training experience. A multimedia combination including videos and three-dimensional interaction in VR has been developed to enable trainees to experience a realistic battlefield environment. The innovation allows trainees to interact with the individual components of the cranialmaxillofacial(CMF) anatomy and apply surgical instruments while watching close-up stereoscopic three-dimensional videos of the surgery. In this study, a novel training tool for the pre-hospital treatment of CMF trauma based on immersive virtual reality (iVR) was developed and validated. Twenty-five CMF surgeons evaluated the application for face and content validity. Using a structured assessment process, the surgeons commented on the content of the developed training tool, its realism and usability and the applicability of VR surgery for CMF trauma rescue simulation training. The results confirmed the applicability of VR for delivering training in the pre-hospital treatment of CMF trauma. Modifications were suggested to improve the user experience and interactions with the surgical instruments. This training tool is ready for testing with surgical trainees.

How We Do It: Remediation Pathways in a Surgical Simulation Curriculum for Competency Improvement.

OBJECTIVE: Validated assessment of procedural knowledge and skills with formative remediation is a foundational part of achieving surgical competency. High-fidelity simulation programs provide a unique area to assess resident proficiency and independence, as well as to assist in identifying residents in need of further practice. While several studies have validated the use of simulation to attain proficiency of specific technical skills, few have validated remediation pathways for their trainees objectively. In this descriptive analysis, we review 2 remediation pathways within our simulation training curricula and how these are used in assessments of resident proficiency. MATERIALS AND METHODS: Two methods of remediation were formulated for use in high-fidelity simulation labs. One remediation pathway was a summative process, where ultimate judgment of resident competency was assessed through intra-operative assessments of a holistic skill set. The second remediation pathway was a formative "coaching" process, where feedback is given at several intervals along the pathway towards a specific technical skills competence. All general surgery residents are enrolled in the longitudinal, simulation curricula. RESULTS: Approximately one-third of surgical residents entered into a remediation pathway for either of the high-fidelity simulation curricula. Both residents and faculty expressed support for the summative and formative remediation pathways as constructed. Residents who entered remediation pathways believed it was a beneficial exercise, and the most common feedback was that remediation principles should be expanded to all residents. Interestingly, faculty demonstrated stronger support for the formative coaching feedback model than the summative assessment model. CONCLUSIONS: Through the complementary use of both formative and summative remediation pathways, resident competence can be enriched in a constructive, nonpunitive method for self-directed performance improvement. Both trainees and faculty express high satisfaction with programs explicitly organized to ensure that skills are rated through a standardized process.

Human Cadaveric Artificial Lung Tumor-Mimic Training Model.

Introduction: An important phase in surgical training is gaining experience in real human anatomical situations. When a cadaver is available it may complement the various artificial practice models. However, it is often necessary to supplement the characteristics of the cadavers with a simulation of a tumor. Our objective was to develop an easy-to-create, realistic artificial tumor-mimic model for peripheral lung tumor resection practice. Methods: In our work we injected barium sulphate enriched silicone suspension into 10 isolated, non-fixed lungs of human cadavers, through the puncture of the visceral pleura. Four lesions-apical, hilar and two peripheral-were created in each of ten specimens. After fixation CT scans were obtained and analyzed. The implanted tumor-mimics were examined after anatomical preparation and slicing. Also performed CT-guided percutaneous puncture was also performed to create the lesions in situ in two lungs of human cadavers. Results: Analyzing the CT data of 10 isolated lungs, out of 40 lesions, 34 were nodular (85.0%) and in the nodular group five were spiculated (12.5%). Satellite lesions were formed in two cases (5.0%). Relevant outflow into vessels or airway occurred in five lesions (12.5%). Reaching the surface of the lung occured in 11 lesions (27.5%). The tumor-mimics were elastic and adhered well to the surrounding tissue. The two lesions, implanted via percutaneous puncture, both were nodular and one also showed lobulated features. Conclusion: Our artificial tumor-mimics were easy to create, varied in shape and size, and with percutaneous implantation the lesions provide a model for teaching every step of a surgical procedure.

Percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral: simulação clínica / Perception of nursing technicians about care in enteral nutritional therapy: clinical simulation / Percepción de los técnicos de enfermería sobre el cuidado en terapia nutricional enteral: simulación clínica

Objetivo: analisar a percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral, durante um cenário de simulação clínica. Método: estudo qualitativo, com base em um cenário de simulação clínica, realizado com 64 técnicos de enfermagem, em um hospital universitário do Sul do Brasil, em agosto de 2017. As falas foram audiogravadas, transcritas e, posteriormente, submetidas a análise de conteúdo. Resultados: foram evidenciadas quatro categorias sobre o cuidado em terapia nutricional enteral nas etapas de: administração da TNE; manutenção da sonda nasoenteral; registros de enfermagem e orientações ao paciente em uso de TNE. Conclusão: refletir sobre o cuidado prestado, por meio de um cenário de simulação clínica, pode colaborar com melhorias acerca do processo de trabalho da equipe de enfermagem e com o fortalecimento e segurança dos cuidados prestados

Objective: to analyze the perception of nursing technicians about care in enteral nutritional therapy, during a clinical simulation scenario. Method: qualitative study, based on a clinical simulation scenario, carried out with 64 nursing technicians, at a university hospital in southern Brazil, in August 2017. The statements were audio-recorded, transcribed and, subsequently, submitted to content analysis. Results: four categories were highlighted regarding care in enteral nutritional therapy in the stages of: administration of NET; maintenance of the nasoenteral tube; nursing records and guidelines for patients using NET. Conclusion: reflecting on the care provided, through a clinical simulation scenario, can collaborate with improvements regarding the work process of the nursing team and with the strengthening and safety of the care provided

Objetivo: analizar la percepción de los técnicos de enfermería sobre el cuidado en la terapia nutricional enteral, durante un escenario de simulación clínica. Método: estudio cualitativo, basado en un escenario de simulación clínica, realizado con 64 técnicos de enfermería, en un hospital universitario del sur de Brasil, en agosto de 2017. Las declaraciones fueron grabadas en audio, transcritas y, posteriormente, sometidas a análisis de contenido. Resultados: se destacaron cuatro categorías con respecto a la atención en terapia nutricional enteral en las etapas de: administración de TNE; mantenimiento de la sonda nasoenteral; registros y pautas de enfermería para pacientes que utilizan NET. Conclusión: Reflexionar sobre el cuidado brindado, a través de un escenario de simulación clínica, puede colaborar con mejoras en el proceso de trabajo del equipo de enfermería y con el fortalecimiento y seguridad del cuidado brindado

The experiences of using polio outbreak simulation exercises to strengthen national outbreaks preparedness and response plans in sub-Saharan Africa.

INTRODUCTION: globally, by 2020 the paralytic poliomyelitis disease burden decreased to over 99% of the reported cases in 1988 when resolution 41.8 was endorsed by the World Health Assembly (WHA) for global polio eradication. It is clearly understood that, if there is Wild Poliovirus (WPV) and circulating Vaccines Derived Poliovirus (cVDPV) in the world, no country is safe from polio outbreaks. All countries remain at high risk of re-importation depending on the level of the containment of the types vaccine withdrawn, the laboratory poliovirus isolates, and the population immunity induced by the vaccination program. In this regard, countries to have polio outbreak preparedness and response plans, and conducting the polio outbreak simulation exercises for these plans remain important. METHODS: we conducted a cross-section qualitative study to review to 8 countries conducted polio outbreak simulation exercises in the East and Southern Africa from 2016 to 2018. The findings were categorized into 5 outbreak response thematic areas analyzed qualitatively and summarized them on their strengths and weaknesses. RESULTS: we found out that, most countries have the overall technical capacities and expertise to deal with outbreaks to a certain extent. Nevertheless, we noted that the national polio outbreak preparedness and response plans were not comprehensive enough to provide proper guidance in responding to outbreaks. The guidelines were inadequately aligned with the WHO POSOPs, and IHR 2005. Additionally, most participants who participated in the simulation exercises were less familiar with their preparedness and response plans, the WHO POSOPs, and therefore reported to be sensitized. CONCLUSION: we also realized that, in all countries where the polio simulation exercise conducted, their national polio outbreak preparedness and response plan was revised to be improved in line with the WHO POSOPs and IHR 2005. we, therefore, recommend the polio outbreak simulation exercises to be done in every country with an interval of 3-5 years.

Effect of ß-Alanine Supplementation on Monocyte Recruitment and Cognition During a 24-Hour Simulated Military Operation.

Wells, AJ, Varanoske, AN, Coker, NA, Kozlowski, GJ, Frosti, CL, Boffey, D, Harat, I, Jahani, S, Gepner, Y, and Hoffman, JR. Effect of ß-alanine supplementation on monocyte recruitment and cognition during a 24-hour simulated military operation. J Strength Cond Res 34(11): 3042-3054, 2020-Sustained military operations (SUSOPs) result in psychological stress and cognitive dysfunction, which may be related to the recruitment of classical monocytes into the brain. This study examined the effect of beta-alanine (BA) on cognition and monocyte recruitment during a simulated 24-hour SUSOP. Nineteen healthy men ingested 12-g/d BA or placebo for 14 days before an SUSOP. Monocyte chemoattractant protein-1 (MCP-1), C-C chemokine receptor-2 (CCR2), and macrophage-1-antigen (CD11b) expression were assessed through multiplex assay and flow cytometry. Psychological stress and cognition were assessed through Automated Neuropsychological Assessment Metrics (ANAM). A composite measure of cognition (COGcomp) was generated from throughput scores extracted from 7 ANAM cognitive tests. Assessments occurred at baseline (0H), 12 hours (12H), 18 hours (18H), and 24 hours (24H). Significance was accepted at p ≤ 0.05. No significant effect of BA was noted for any variable (p's > 0.05). The frequency and severity of symptoms of psychological stress increased significantly at 18 and 24H compared with 0 and 12H (p's < 0.05). COGcomp decreased significantly at 18 and 24H compared with 0 and 12H (p's ≤ 0.001). MCP-1 peaked at 18H was significantly lower at 24H compared with 18H but remained elevated at 24H compared with 0H (p's < 0.001). CCR2 expression was significantly lower at 12 (p = 0.031), 18, and 24H (p's < 0.001). CD11b expression was significantly higher at 12H (p = 0.039) and 24H (p's = 0.003). MCP-1 was negatively associated with COGcomp (ß = -0.395, p = 0.002, r2 = 0.174). Neither CCR2 or CD11b was related to COGcomp (p's > 0.05). Cognitive dysfunction during SUSOPs is related to serum concentrations of MCP-1 but is not influenced by BA supplementation.

In-situ simulation for the detection of latent risk threats in a hyperbaric medicine department.

Simulation (SIM) can be used in the quality improvement process to discover latent risk threats (LRTs) by running in-situ simulation cases in the clinical environment. We utilized this methodology in the hyperbaric chamber to run six in-situ SIM sessions between February 2017 and January 2019. The debriefing portion of each SIM was used to discuss and document all discovered LRTs. These safety threats were aggregated and categorized, resulting in a total of 22 unique LRTs. LRTs included problems or challenges with equipment, team education, policy/processes, communications, and medications. At a three-month follow-up, the hyperbaric leadership team had addressed each of the 22 unique LRTs. SIM can be used to identify, categorize and prioritize LRTs in an effective manner, in order to improve the health care delivery system in a hyperbaric medicine department.

Home Surgical Skill Training Resources for Obstetrics and Gynecology Trainees During a Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has created a unique educational circumstance in which medical students, residents, and fellows find themselves with a gap in their surgical training. We reviewed the literature, and nine categories of resources were identified that may benefit trainees in preventing skill decay: laparoscopic box trainers, virtual reality trainers, homemade simulation models, video games, online surgical simulations, webinars, surgical videos, smartphone applications, and hobbies including mental imagery. We report data regarding effectiveness, limitations, skills incorporated, cost, accessibility, and feasibility. Although the cost and accessibility of these resources vary, they all may be considered in the design of remote surgical training curricula during this unprecedented time of the COVID-19 pandemic.

Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing.

INTRODUCTION: Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes. METHODS: Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR). RESULTS: Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively "commingling" theoretical knowledge with practical experience to reflect on actions and judgements. DISCUSSION: The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial.

BACKGROUND: Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy. METHODS: In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor's and master's students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale. DISCUSSION: The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education.

INTRODUCTION: Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. METHODS: Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. RESULTS: After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. CONCLUSIONS: Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care.

Benefits and Limitations of Transurethral Resection of the Prostate Training With a Novel Virtual Reality Simulator.

PURPOSE: Profound endourological skills are required for optimal postoperative outcome parameters after transurethral resection of the prostate (TURP). We investigated the Karl Storz (Tuttlingen, Germany) UroTrainer for virtual simulation training of the TURP. MATERIALS AND METHODS: Twenty urologists underwent a virtual reality (VR) TURP training. After a needs analysis, performance scores and self-rated surgical skills were compared before and after the curriculum, the realism of the simulator was assessed, and the optimal level of experience for VR training was evaluated. Statistical testing was done with SPSS 25. RESULTS: Forty percent of participants indicated frequent intraoperative overload during real-life TURP and 80% indicated that VR training might be beneficial for endourological skills development, underlining the need to advance classical endourological training. For the complete cohort, overall VR performance scores (P = 0.022) and completeness of resection (P < 0.001) significantly improved. Self-rated parameters including identification of anatomical structures (P = 0.046), sparing the sphincter (P = 0.002), and handling of the resectoscope (P = 0.033) became significantly better during the VR curriculum. Participants indicated progress regarding handling of the resectoscope (70%), bleeding control (55%), and finding the correct resection depth (50%). Although overall realism and handling of the resectoscope was good, virtual bleeding control and correct tissue feedback should be improved in future VR simulators. Seventy percent of participants indicated 10 to 50 virtual TURP cases to be optimal and 80% junior residents to be the key target group for VR TURP training. CONCLUSIONS: There is a need to improve training the TURP and VR simulators might be a valuable supplement, especially for urologists beginning with the endourological desobstruction of the prostate.

Simulated employment interviews: A collaborative approach to gaining understanding of the graduate midwife employment process.

Graduating midwives unsuccessful in gaining employment in their preferred model/location; or finding a job within a year of graduation are more likely to leave the profession. Obtaining post-graduate midwifery employment is competitive with midwifery students needing to confidently sell themselves to potential employers. Whilst midwifery students may be prepared with the requisite midwifery skills and knowledge, there is no guarantee of attaining a midwifery position upon graduation. Increasingly employers are requiring 'soft skills' including communication, teamwork, reflexivity and personal attributes of the individual to be able to effectively respond within different contexts. Demonstrating these skills within an employment interview requires confidence and knowledge in how to prepare. Designed with health service partners, simulated employment interviews were introduced into the final year of a Bachelor of Midwifery program as part of a suite of employability strategies connected to the student lifecycle. An exploratory evaluation study of students 'experiences of a simulated employment interview was undertaken. The simulated interview emulated real employment interviews with students receiving immediate written and oral feedback. Evaluation through surveys, focus groups and individual interviews provided rich data around the effectiveness of this approach. Students, health service partners and academics found the simulated employment interview provided a valuable learning experience, assisting students to reflect, explore and further develop skills sought by employers. Collaboration with health service partners created an authentic process enabling students to receive feedback relevant to the real world of practice. Students were able to work through anxiety, gain confidence and exposure to employers in preparation for employment interviews.

Simulation in midwifery education: A descriptive explorative study exploring students' knowledge, confidence and skills in the care of the preterm neonate.

Undergraduate midwifery programs across Australia have embedded simulation into their curriculum although there is limited but emerging evidence to support the use of simulation as an effective teaching strategy. The purpose of this study was to evaluate the impact that a simulated learning activity (insertion and management of a neonatal nasogastric tube), had on midwifery students' knowledge, confidence and skills post-simulation, and on completion of a clinical placement. A descriptive explorative study was undertaken in two phases. Phase 1: Midwifery students (n = 60) completed a purpose-designed questionnaire to assess their knowledge, confidence and skills, pre and post simulation. Phase 2: Students (n = 46) repeated the questionnaire to reassess their knowledge, confidence and skills after the completion of a neonatal nursery placement. The findings demonstrate that simulation is an effective learning strategy in an undergraduate midwifery program. Students' knowledge, confidence and skills increased significantly post-simulation activity (p0.001). A further increase in these areas was noted post-placement. Key aspects that contributed to student learning included; the demonstrators' level of knowledge, expertise and currency of practice, as well as the role the student assumes in the simulation activity.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department.

INTRODUCTION: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. METHODS: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. RESULTS: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. CONCLUSION: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

Counterbalancing the Uncertainties of Medical Nutrition Education with Effective Online Instruction.

Practicing physicians need to recognize nutrition problems in their patients and know what to do about them. It takes at least 25-30 h of medical school instruction to achieve just basic nutrition competencies. Because most medical students get significantly less than this minimum, they are not adequately prepared to deal with common nutrition-related challenges in practice. The majority of all accredited US medical schools require <25 h of nutrition instruction across the entire 4-year curriculum and a few still fail to require any nutrition education at all. Medical schools in other countries struggle with the same instructional deficits and many fail altogether to address the need for proper nutrition training. The greatest deficits exist in teaching clinical practice and practical problem solving. The Nutrition in Medicine (NIM) project (nutritioninmedicine.org), with materials used by a majority of US medical schools as well as institutions in >20 countries, has demonstrated that computer-based nutrition instruction is effective and efficient, particularly as an integral component of clinical training. Interactive components, skill-building exercises, and practice challenges with video-realistic patients allow learners to progress at their own pace and ensure that all of them learn what they need to know.

Hyperbaric medicine simulation education curriculum: CNS toxicity during Treatment Table 6 and intubated ICU patient with mucous plugging.

INTRODUCTION/BACKGROUND: The incidence of complications and number of critically ill patients in hyperbaric medicine is relatively low [1]. This poses a challenge to those tasked with educating trainees as well as maintaining the skills of staff. Hyperbaric medicine fellows may not be exposed to critical patient scenarios or complications of hyperbaric medicine during a one-year fellowship. Additional staff may be unfamiliar with these situations as well. The purpose of hyperbaric simulation curriculum is to train health care providers for rare situations. To our knowledge, this hyperbaric simulation curriculum is the first published use of simulation education in the specialty of undersea and hyperbaric medicine. MATERIALS AND METHODS: Two simulation cases have been developed that involve a patient with oxygen toxicity during hyperbaric treatment as well as an ICU patient with mucous plugging. RESULTS: Medical training simulations are an effective method of teaching content and training multiple roles in Undersea and Hyperbaric Medicine. SUMMARY/CONCLUSIONS: A hyperbaric simulation curriculum is an achievable educational initiative that is able to train multiple team members simultaneously in situations that they may not encounter on a regular basis. We believe that this could be easily exported to otherinstitutions for further education.