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 All countries remain at high risk of re-importation depending on the level of the containment of the types vaccine withdrawn, the laboratory poliovirus isolates, and the population immunity induced by the vaccination program.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.

The alternative model of silicone for experimental simulation of suture of living tissue in the teaching of surgical technique.

PURPOSE: To develop a silicone alternative model of tissue suture simulation to be used in the teaching of surgical technique. METHODS: Twelve alternative models of silicone for tissue suture simulation were manufactured and implemented as a tool for suture pattern training of undergraduate medical students of Universidade Federal do Amazonas. Forty-eight students participated in the research. The evaluation of the proposed model was done through a questionnaire using the Likert scale, in order to verify the student satisfaction index of the alternative resource and its performance as opposed to the model historically used in the discipline, which is to suture in cloths. RESULTS: The alternative model showed satisfactory results, especially with respect to the structural aspect, such as, better perception of anatomical planes, handling and transport. About 89.58% of positive concordant responses demonstrating expressive approval for incorporation of a complementary form of the alternative methodological proposal of the discipline of surgical technique. CONCLUSIONS: The model developed for experimental simulation of tissue sutures has proved to be a fully feasible alternative method for the training of this surgical skill. It is a simple, reproducible and low-cost model.

A pilot study on the simulation-based training for Ethiopia skilled birth attendants.

This simulation-based Ethiopia Midwife Train-the-Trainer program for skilled birth attendants is one part of the China-UK Global Health Support Program (GHSP) activities and an approach to improving the Ethiopia trainers' midwifery teaching skills. This pilot study aimed to evaluate the effectiveness of a simulation-based training for Ethiopia skilled birth attendants. This program was divided into three stages. In Stage 1, Fudan team trained 5 trainers from Ethiopia. In Stage 2, Fudan team supervised and evaluated the 1st stage Ethiopia trainers to train their peers becoming the trainers in Fudan University. In Stage 3, Fudan team evaluated the training program implementation in established Advanced Midwifery Practice Center in Tirunesh Beijing General Hospital. The participatory observational method was used for process evaluation and the Kirkpatrick model was used for effectiveness evaluation. The Ethiopia staff's teaching skills for simulation-based midwifery training were strengthened and their abilities to deal with various complicated obstetric situations were improved by group explanation, questions, rehearsal, and step-by-step interactive teaching (p < .01). The mean score of total mastery degree was 3.48 ±â€¯0.16 by self-assessment and 3.63 ±â€¯0.16 by peer-assessment in stage 2, and 3.27 ±â€¯0.24 by self-assessment and 3.38 ±â€¯0.34 by peer-assessment in stage 3.The GHSP-OP4-V01 Ethiopia Midwife Train-the-Trainer Program has received positive response in Ethiopia by in-depth interview and questionnaire survey. This study demonstrated that the simulation-based training is an effective approach for midwifery Train-the-Trainer program in Ethiopia.

Integrating Spiritual Care During Interprofessional Simulation for Baccalaureate Nursing Students.

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication and collaborative interprofessional teamwork. The aim of this descriptive qualitative study was to understand the experience of baccalaureate nursing students utilizing the hospital chaplain while caring for a suicidal patient in the emergency department during simulation. The need for interprofessional education is documented in the literature, but there are very few comprehensive, successful projects integrating spiritual care for nurse educators to use as models. This project can serve as a model of a successful interprofessional education initiative involving preprofessional nursing students and chaplain services. Overall, nursing students found the learning experience to be beneficial in preparation for professional practice on a collaborative interprofessional health care team.

The alternative model of silicone for experimental simulation of suture of living tissue in the teaching of surgical technique

Abstract Purpose: To develop a silicone alternative model of tissue suture simulation to be used in the teaching of surgical technique. Methods: Twelve alternative models of silicone for tissue suture simulation were manufactured and implemented as a tool for suture pattern training of undergraduate medical students of Universidade Federal do Amazonas. Forty-eight students participated in the research. The evaluation of the proposed model was done through a questionnaire using the Likert scale, in order to verify the student satisfaction index of the alternative resource and its performance as opposed to the model historically used in the discipline, which is to suture in cloths. Results: The alternative model showed satisfactory results, especially with respect to the structural aspect, such as, better perception of anatomical planes, handling and transport. About 89.58% of positive concordant responses demonstrating expressive approval for incorporation of a complementary form of the alternative methodological proposal of the discipline of surgical technique. Conclusions: The model developed for experimental simulation of tissue sutures has proved to be a fully feasible alternative method for the training of this surgical skill. It is a simple, reproducible and low-cost model.

Impact of electronic and blended learning programs for manual perineal support on incidence of obstetric anal sphincter injuries: a prospective interventional study.

BACKGROUND: Obstetric anal sphincter injuries (OASIS) are associated with anal incontinence, dyspareunia and perineal pain. Bimanual perineal support technique (bPST) prevents OASIS. The aim of this study was to assess the effect of two different bPST training-methods on OASIS incidence. METHODS: This is a prospective-interventional quality improvement study conducted in two Palestinian maternity units between June 1 2015 and December 31 2016. Women having spontaneous or operative vaginal-delivery at ≥24 gestational-weeks or a birthweight of ≥1000 g (n = 1694) were recruited and examined vaginally and rectally immediately after vaginal birth by a trained assessor. Data on baseline OASIS incidence were collected during Phase-1 of the study. Subsequently, birth attendants in both maternity units were trained in bPST using two training modalities. A self-directed electronic-learning (e-learning) using an animated video was launched in phase-2 followed by a blended learning method (the animated e-learning video+ structured face-to-face training) in phase-3. OASIS incidence was monitored during phases-2 and 3. Variations in OASIS incidence between the three phases were assessed using Pearson-χ2-test (or Fisher's-Exact-test). The impact of each training-method on OASIS incidence was assessed using logistic-regression analysis. RESULTS: A total of 1694 women were included; 376 in phase-1, 626 in phase-2 and 692 in phase-3. Compared to Phase-1, OASIS incidence was reduced by 45% (12.2 to 6.7%, aOR: 0.56, CI; 0.35-0.91, p = 0.018) and 74% (12.2 to 3.2%, aOR, 0.29, CI; 0.17-0.50, p < 0.001) in phases-2 and 3, respectively. There was also a significant reduction in OASIS incidence by 52% from phase-2 to phase-3 (6.7% (42/626) to 3.2% (22/692), p = 0.003). These reductions reached statistical significance among parous-women only (aOR: 0.18, CI; 0.07-0.49, p = 0.001) after the first training method tested in phase-2. However, the reduction was significant among both primiparous (aOR: 0.39, CI; 0.21-0.74, p = 0.004) and parous-women (aOR: 0.11, CI; 0.04-0.32, p < 0.001) after implementing the blended learning method in phase-3. CONCLUSION: The animated e-learning video had a positive impact on reducing OASIS incidence. However, this reduction was enhanced by the use of a blended learning program combining both e- learning and face-to-face training modalities. STUDY REGISTRATION NUMBER: ClinicalTrialo.gov identifier: NCT02427854 , date: 28 April 2015.

Staff perception of the sustainability of a mature simulation program in nursing and midwifery education: A phenomenological analysis.

BACKGROUND: As an established pedagogy for teaching clinical nursing skills, the use of simulation in nursing and midwifery education continues to increase globally. In Australia, government incentives for staff development, capital equipment and scenario provided initial impetus for introducing simulation into nursing programs. However, a mature simulation program requires ongoing investment in staff and resources. Without appropriate commitment from educators and organisations, a likely decline in the quality of simulation activities may have a direct impact on student learning. PURPOSE: This study sought to explore the views and experiences of nursing and midwifery academics involved in delivering a simulation-based education program in a maturation phase. METHOD: In this qualitative study, interpretative phenomenological analysis was used to inform data collection and analysis. Data were collected through semi-structured audio-recorded interviews with 10 faculty staff in a tertiary school of nursing and midwifery. RESULTS: Four main themes related to simulated learning were abstracted from the data: perceptions and reactions, inconsistent customs, pedagogy of simulation-based education, and collateral opportunities. The findings are located within the context of a maturation, rather than introductory, phase of delivering simulation-based education in a tertiary education setting. CONCLUSIONS: A mature simulation program may be undermined by ageing equipment and scenarios, and facilitators whose skills have not been maintained. Existing simulation activities require ongoing organisational support and investment. The development and introduction of minimum competency levels for facilitators and standardised measures of quality in practice are indicated, to improve simulation practice in the education setting.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

Experience of lecturers with simulation training in midwifery education in Slovakia.

The simulation training in midwifery has a long tradition. It is aimed at acquiring basic and advanced practical skills such as performing a certain number of births, episiotomy and subsequent suture, assisting during breech birth etc. Midwifery education is currently based on the requirements of the Directives of the European Union exactly specifying number of performed practical procedures and approaches (World Health Organisation (WHO) Europe, 2009). The aim of this paper is to draw attention to the experience with the simulation training from the teacher's point of view in the study program Midwifery in Slovakia. The authors describe the locations for training of midwifery skills, training of basic and advanced midwifery skills using simulation, the types of simulators available and used and training approaches. They outline the advantages and disadvantages of using obstetric simulators based on their own experience.

Alternative Markers of Performance in Simulation: Where We Are and Where We Need To Go.

This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." There is a dearth of research on the use of performance markers other than checklists, holistic ratings, and behaviorally anchored rating scales in the simulation environment. Through literature review, group discussion, and consultation with experts prior to the conference, the working group defined five topics for discussion: 1) establishing a working definition for alternative markers of performance, 2) defining goals for using alternative performance markers, 3) implications for measurement when using alternative markers, identifying practical concerns related to the use of alternative performance markers, and 5) identifying potential for alternative markers of performance to validate simulation scenarios. Five research propositions also emerged and are summarized.

Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review.

AIM: To identify the theories used to explain learning in simulation and to examine how these theories guided the assessment of learning outcomes related to core competencies in undergraduate nursing students. BACKGROUND: Nurse educators face the challenge of making explicit the outcomes of competency-based education, especially when competencies are conceptualized as holistic and context dependent. DESIGN: Theoretical review. DATA SOURCES: Research papers (N = 182) published between 1999-2015 describing simulation in nursing education. REVIEW METHODS: Two members of the research team extracted data from the papers, including theories used to explain how simulation could engender learning and tools used to assess simulation outcomes. Contingency tables were created to examine the associations between theories, outcomes and tools. RESULTS: Some papers (N = 79) did not provide an explicit theory. The 103 remaining papers identified one or more learning or teaching theories; the most frequent were the National League for Nursing/Jeffries Simulation Framework, Kolb's theory of experiential learning and Bandura's social cognitive theory and concept of self-efficacy. Students' perceptions of simulation, knowledge and self-confidence were the most frequently assessed, mainly via scales designed for the study where they were used. Core competencies were mostly assessed with an observational approach. CONCLUSION: This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

Training student pharmacists to administer emergency pediatric influenza vaccine: A comparison of traditional vs. just-in-time training.

INTRODUCTION: This study compared traditional training (TT) and just-in-time training (JITT) of P3 student pharmacists regarding interest, confidence, and comfort pre- and post-training (primary objective); and assessment and administration competency (secondary objective) during a simulated influenza vaccination clinic. METHODS: Student pharmacists were randomized 1:1 to receive either TT or JITT, completed pre- and post-training surveys assessing interest, confidence and comfort; and evaluated on performance during a simulated emergency infant vaccination. An infant manikin simulated a child <1 year of age, and an actor role-played the mother. All students received a briefing about the simulated mass vaccination prior to their performance assessment. Survey differences between groups were analyzed by ANOVA. The competency assessment was analyzed by a Chi-square or Fisher's exact test for individual steps and Student t-test for mean scores. RESULTS: Pre-training interest was high and maintained post-training. Pre-training confidence and comfort levels were low and improved in both groups. Mean competency scores were comparable between the TT and JITT groups. Comparing groups, TT students more commonly missed proper injection site selection and care; while JITT missed distracting the infant and administration documentation. DISCUSSION AND CONCLUSIONS: JITT for student pharmacists to learn skills required to immunize infants elicits similar outcomes (interest, confidence, comfort, and administration competency) as TT for emergency pediatric influenza vaccination.

Creation of an active learning healthcare communications course using simulations relevant to pharmacy practice.

BACKGROUND AND PURPOSE: The purpose of this project was to design and develop a health care communications course built around practice-like simulations and active learning in the first year of a professional pharmacy program. EDUCATIONAL ACTIVITY AND SETTING: A three-credit health care communications course was divided into one didactic (two hours per week) and three simulation components (one hour per week). The simulation components consisted of one written patient education pamphlet, three group presentations, and three one-on-one patient counseling sessions. This was accomplished by breaking the class of approximately 75 students into eight separate sections, each consisting of 8-10 students and one instructor. Each week four sections were devoted to counseling role-plays: half in the role of pharmacists and half as patients. The other four sections were devoted to hour-long professional group presentations-half in the presenting group and half as audience. The students' performance in the simulated counseling sessions and group presentations has been tracked and analyzed to determine if the simulated exercises had a positive impact on the students' active communications skills. FINDINGS: Consistently, over the first four years of the implementation of the course, students' communications skills, as measured by faculty assessments, in both professional group presentations and one-on-one counseling sessions significantly improved. DISCUSSION AND SUMMARY: Incorporation of active-learning simulation exercises into a healthcare communications course has a positive impact on the development of students' communications skills. This creates a foundation upon which students can build over the remainder of the professional program and into their future careers.

Managing medical emergencies in mental health settings using an interprofessional in-situ simulation training programme: A mixed methods evaluation study.

BACKGROUND: In the UK, people with severe mental illness die up to 20years earlier than the general population, prompting increased focus on physical health in mental illness. However, training for mental health inpatient staff to meet patients' physical health needs has not received the same attention, with physical health training often being reactive and lacking evidence of effectiveness. OBJECTIVES: To evaluate an interprofessional, in situ, simulation training intervention for managing medical deterioration in mental health settings. Investigating the impact of training on: 1. Participants' knowledge, confidence, and attitudes towards managing medical deterioration; and 2. Incident reporting, as an objective index of incident management. Participants' perceptions of the impact on their practice were qualitatively explored. DESIGN: This evaluation employed a mixed-methods pre-post intervention design. PARTICIPANTS & SETTINGS: Fifty-three healthcare professionals participated including: mental health nurses, psychiatrists, healthcare assistants, and activity co-ordinators from two busy psychiatric triage wards in South London, UK. METHODS: The intervention comprised eight half-day sessions delivered weekly across two wards. Structured surveys assessed participants' knowledge, confidence, and attitudes towards medical deterioration pre and post training. Participants' experience of training was qualitatively captured through post-course surveys and focus groups three months post training. Incident reporting rates for seven-month periods pre and post training were compared. RESULTS: Following training, participants showed significant improvement in knowledge (p<0.001), confidence (p<0.001), and attitudes towards (p<0.02) managing medical deterioration. Incident reporting increased by 33% following training. Participants' reported improved confidence in managing medical deterioration, better understanding of effective communication, improved self-reflection and team working, and an increased sense of responsibility for patients' physical health. CONCLUSIONS: Interprofessional, in situ simulation training for medical deterioration yielded promising outcomes for individuals and teams. Simulation is an under-used training modality in mental health, offering a holistic training approach with the potential to provide educational and clinical benefits while supporting workforce resilience.

An Approach to Confederate Training Within the Context of Simulation-Based Research.

STATEMENT: Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of simulation-based research. The CPR CARES multicenter research study design included 2 confederate roles, in which confederates' behavior was tightly scripted to avoid confounding primary outcome measures. In this report, we describe our training process, our method of adherence assessment, and suggest next steps regarding confederate training scholarship.

A process evaluation of PRONTO simulation training for obstetric and neonatal emergency response teams in Guatemala.

BACKGROUND: Despite expanding access to institutional birth in Guatemala, maternal mortality remains largely unchanged over the last ten years. Enhancing the quality of emergency obstetric and neonatal care is one important strategy to decrease mortality. An innovative, low-tech, simulation-based team training program (PRONTO) aims to optimize care provided during obstetric and neonatal emergencies in low-resource settings. METHODS: We conducted PRONTO simulation training between July 2012 and December 2012 in 15 clinics in Alta Verapaz, Huehuetenango, San Marcos, and Quiche, Guatemala. These clinics received PRONTO as part of a larger pair-matched cluster randomized trial of a comprehensive intervention package. Training participants were obstetric and neonatal care providers that completed pre- and post- training assessments for the two PRONTO training modules, which evaluated knowledge of evidence-based practice and self-efficacy in obstetric and neonatal topics. Part of the training included a session for trained teams to establish strategic goals to improve clinical practice. We utilized a pre/post-test design to evaluate the impact of the course on both knowledge and self-efficacy with longitudinal fixed effects linear regression with robust standard errors. Pearson correlation coefficients were used to assess the correlation between knowledge and self-efficacy. Poisson regression was used to assess the association between the number of goals achieved and knowledge, self-efficacy, and identified facility-level factors. RESULTS: Knowledge and self-efficacy scores improved significantly in all areas of teaching. Scores were correlated for all topics overall at training completion. More than 60 % of goals set to improve clinic functioning and emergency care were achieved. No predictors of goal achievement were identified. CONCLUSIONS: PRONTO training is effective at improving provider knowledge and self-efficacy in training areas. Further research is needed to evaluate the impact of the training on provider use of evidence-based practices and on maternal and neonatal health outcomes. TRIAL REGISTRATION: NCT01653626.