A Preliminary Report of Developing Performer-Centered Vocal Injury Rehabilitation: An Interprofessional Collaborative Practice for Graduate Students in Speech-Language Pathology and Acting.

OBJECTIVES: Acting voice coaches (AVCs) and speech-language pathologists (SLPs) use dynamic teaching methods and intervene using motor learning principles. Both display instructional flexibility based on the actor/client's needs. With these criteria, we developed a virtual 3-hour professional voice lab to promote team-based learning between SLP graduate students and Master of Fine Arts (MFA) student actors. METHODS: The lab contained three phases: prebrief (50 minutes), case-study simulation (1.5 hours), and debrief (30 minutes). The students completed pre and postevaluation surveys to reflect on their learning experience. During the prebrief, the roles of AVCs and SLPs in actor's voice habilitation and rehabilitation, respectively, were discussed along with the special vocal needs of stage actors. The learners completed a comprehensive voice evaluation on "Maria Horseman," a 23-year-old professional actor with a voice disorder, in small interprofessional groups. The provided template offered a holistic approach to explore speaking-singing-acting vocal activities, vocal behaviors, physical demands/cardiorespiratory load, training/practice regimen, lifestyle changes including medication effect, and voice ergonomics. A customized client-centered voice intervention plan was developed by considering Maria's best interests and stimulability. RESULTS: Two different surveys, 15 items in Performance Voice Diagnostics for SLP students and Voice-Related Self-Perception for MFA students, and 20 items in modified Casey-Fink Readiness to Practice, were used to compare differences in self-confidence levels intervening professional voice disorders. Comparison of pre and postevaluation data revealed a statistically significant difference in learner self-confidence and readiness levels. CONCLUSIONS: A team-based, interprofessional learning approach on voice rehabilitation would help SLPs to consider special vocal demands of professional voice users in their evaluation methods. This may also lead to preventive early intervention by increasing vocal awareness and knowledge on phonatory function in professional actors from the beginning of their careers.

Development and Evaluation of a Metric-based Clinical Simulation Procedure for Assessing Ostomy Care in Nursing Practice.

Background: There is a need to understand the clinical decision-making and work practices within ostomy nursing care to support expanding nursing training. Objective: To develop and evaluate a new metric-based simulation for assessing ostomy nursing care using a human factors approach. Sample: This pilot study involved eleven stakeholders in the needs assessment, six nurse participants performing simulated ostomy care, and three independent observers assessing procedure reliability. Method: We conducted a needs assessment of ostomy nursing care and training, developed an enhanced metric-based simulation for ostomy appliance change procedures, and statistically evaluated its reliability for measuring the simulated tasks. Results: The enhanced metric-based simulation captured different tasks within four task categories: product selection; stoma and peristomal skin care; baseplate sizing and adhesion; and infection control strategies. The video review procedure was reliable for assessing continuous (average ICC≥0.96) and categorical (average κ>0.96) variables. Conclusion: The new metric-based simulation was suitable for characterizing a broad range of clinical decision-making and work practices in ostomy nursing care.

Student nurses' utilisation of self-directed simulation learning at a University in Gauteng.

BACKGROUND:  Self-directed simulation learning (SSL) is a globally accepted teaching and learning strategy wherein student nurses take the initiative in diagnosing their learning needs, formulate learning goals, identify resources for learning, and implement relevant strategies in response to their learning needs. This autonomous learning strategy will assist student nurses in taking ownership of their learning. Consequently, student nurses exit the training programme to become lifelong learners, safe and competent professional nurses. OBJECTIVES:  This study aimed to explore and describe the experiences of student nurses' utilisation of SSL at a University in Gauteng and to make recommendation(s) to enhance the use of SSL. METHOD:  A qualitative, exploratory, descriptive, and contextual research design was used to uncover the student nurses' experiences with the use of SSL at a University. Nineteen participants were purposively sampled. Data collection was conducted through focus group interviews. Tesch's method of data analysis was used to analyse, organise and interpret data. RESULTS:  Theme: student nurses experience time constraints, which hinder their utilisation of SSL. Subthemes: (1) a compacted academic timetable, and (2) limited access to the clinical simulation laboratory for self-directed learning. CONCLUSION:  Time constraints hinder the utilisation of SSL, and this challenge threatens the acquisition of clinical skills and knowledge during the training of student nurses.Contribution: Evidence-based recommendations to enhance the utilisation of SSL at a University.

Large Language Models in Nursing Education: State-of-the-Art.

This study explores the integration of Large Language Models (LLMs) into nursing education, highlighting a paradigm shift towards interactive learning environments. We aimed to analyze the literature to identify how large language models are being implemented in nursing education, as well as key opportunities and limitations that need to be addressed. English records published since 2022 were retrieved from 4 databases including LLMs in nursing education. A total of 19 records were eligible. As LLMs advanced natural language processing capabilities enable interactive learning experiences, nursing educators are presented with unique opportunities to enhance curriculum delivery, foster critical thinking, and simulate complex clinical scenarios. Through a comprehensive analysis of current applications, limitations and future research, this paper navigates the complexities of adopting LLMs (eg ChatGPT) in nursing education. This paper concludes with a call for action to advance the integration of AI in nursing, enhancing educational outcomes while ensuring ethical, effective use.

Raising nurse educators' awareness regarding caring pedagogical relationships' barriers to foster inclusive simulation settings: Insights from a phenomenological study.

AIM: The purpose of this paper was to shed light on the main barriers to caring pedagogical relationships within simulation centers from the perspective of nursing students and offer targeted strategies to reduce these barriers. BACKGROUND: A caring pedagogical relationship is a powerful strategy to foster students' learning within simulation settings. However, the development of this relationship could be hindered if nurse educators are not aware of its barriers. Hence, this could affect students' learning and well-being within this academic context. According to our knowledge, no previous research has addressed the question of the barriers to caring pedagogical relationships within the context of simulation. DESIGN: This study employed a descriptive phenomenological method, entitled Relational Caring Inquiry, to collect and analyze data gathered from 19 students enrolled in an undergraduate nursing program. RESULTS: This paper focuses on one eidos-theme that emerged from our data analysis and interpretation entitled "Educator's conscientization regarding barriers to the development of a caring pedagogical relationship". According to data analysis and interpretation, this eidos-theme was the most emphasized by research participants. It emerged from the following themes: (a) educators' dehumanizing practices, (b) disruptive and stressful academic context, (c) lack of educators' experiences and (d) educators' disinterest in students' learning. CONCLUSIONS: Leaving caring pedagogical relationships' barriers unaddressed has shown adverse impacts on students' learning process and their mental and physical well-being. This paper brings to light the main barriers to caring pedagogical relationships and invites educators, managers and nurse leaders to be aware of these obstacles and collectively engage in humanizing nursing education. In other words, we emphasize the impact of these barriers on students' apprenticeship and suggest political actions to build caring and inclusive simulation environments. STUDY REGISTRATION NUMBER: CERSES-19-050-D.

Revolutionizing Nurse Practitioner Training: Integrating Virtual Reality and Large Language Models for Enhanced Clinical Education.

This project introduces an innovative virtual reality (VR) training program for student Nurse Practitioners, incorporating advanced 3D modeling, animation, and Large Language Models (LLMs). Designed to simulate realistic patient interactions, the program aims to improve communication, history taking, and clinical decision-making skills in a controlled, authentic setting. This abstract outlines the methods, results, and potential impact of this cutting-edge educational tool on nursing education.

Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study.

BACKGROUND: Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. OBJECTIVE: The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. METHODS: An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10% of the panelists deemed the criteria as "not important" or "not important at all" and >60% "important" or "very important." RESULTS: In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains-background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. CONCLUSIONS: This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges.

Simulation-Based Teaching and Learning in Respiratory Care Education: A Narrative Review.

Simulation-based pedagogy has become an essential aspect of healthcare education. However, there is a significant gap in the literature regarding the application of simulation-based modalities in respiratory care education. This review aims to address this gap by providing insight into the theory and current uses of simulation, its effectiveness in respiratory care education, and strategies to enhance faculty development. The study utilizes a narrative synthesis approach to review relevant literature and provide a comprehensive understanding of the topic. The research involved comprehensive searches of electronic databases, including PubMed and Google Scholar, to identify relevant literature, encompassing original articles, reviews, and other pertinent content, focusing on simulation-based teaching and learning in respiratory care education published between 1990 and 2022. Findings suggest that simulation-based education is an effective tool for improving respiratory care education and can enhance the clinical skills of learners. The study concludes by discussing the future of simulation in respiratory care education and the potential benefits it may offer.

Patient safety, what does clinical simulation and teaching innovation contribute?

Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. in situ simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.

Situational simulation teaching effectively improves dental students' non-operational clinical competency and objective structured clinical examination performance.

BACKGROUND: Appropriate communication with dental patients enhances treatment outcomes and patient satisfaction. Implementing simulated patient interviews courses can improve patient-centered care and reduce conflict during clerkship training. Therefore, this study explored the relationship among student participation in a situational simulation course (SSC), academic performance, clerkship performance, and objective structured clinical examination (OSCE) performance. METHODS: This study was conducted with a sample of fifth-year dental students undergoing clerkship training. After implementing a situational simulation course to investigate the relationship among participation in SSC, academic performance, clerkship performance, and OSCE performance, a path analysis model was developed and tested. RESULTS: Eighty-seven fifth-year dental students were eligible for the SSC, and most (n = 70, 80.46%) volunteered to participate. The path analysis model revealed that academic performance had a direct effect on OSCE performance (ß = 0.281, P = 0.003) and clerkship performance (ß = 0.441, P < 0.001). In addition, SSC teaching had a direct effect on OSCE performance (ß = 0.356, P < 0.001). CONCLUSIONS: SSCs can enhance dental students' non-operational clinical competency and OSCE performance effectively. Simulated patient encounters with feedback, incorporated into the dental curricula, have led to improved communication. Based on our findings, we suggest implementing SSC teaching before the OSCE to improve communication and cognitive skills.

Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine.

INTRODUCTION: Sexual orientation and gender identity (SOGI)-diverse patients are marginalized and poorly cared for in the emergency department, yet well-designed educational interventions to meet this gap are lacking. We developed, implemented, and assessed a novel multi-modal SOGI curriculum on health and cultural humility for emergency medicine physician trainees. METHODS: We conducted a prospective, single-arm evaluation of our educational intervention. A convenience sample of emergency medicine resident physicians (n = 21) participated in the facilitated curriculum including didactic and clinical simulation components. Participants completed a pre- and post-curriculum evaluation that assessed clinical skills, preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients. The content of the module was based on a scoping literature review and national needs assessment of Canadian emergency physicians, educators, and trainees along with expert collaborator and input from patient/community partners. The curriculum included a facilitated pre-brief, didactic presentation, clinical simulation modules, and a structured de-brief. Participant clinical skills were evaluated before and after the educational intervention. Our primary outcome was change in clinical preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients pre- and post-intervention. RESULTS: Our patient-centered, targeted emergency medicine SOGI health and cultural humility training resulted in a significant improvement in resident self-rated clinical preparedness, attitudes, and knowledge in caring for SOGI-diverse patients. This training was valued by participants. CONCLUSION: We have designed an effective, patient-centered curriculum in health and cultural humility for SOGI-diverse patients in EM. Other programs can consider using this model and developed resources in their jurisdictions to enhance provider capacities to care for this marginalized group.

RéSUMé: INTRODUCTION: L'orientation sexuelle et l'identité de genre (OSIG) - des patients de diverses natures sont marginalisés et mal soignés dans les services d'urgence, mais des interventions éducatives bien conçues pour combler cette lacune font défaut. Nous avons élaboré, mis en œuvre et évalué un nouveau programme multimodal de l'OSIG sur la santé et l'humilité culturelle pour les médecins d'urgence stagiaires. MéTHODES: Nous avons effectué une évaluation prospective de notre intervention éducative à un seul bras. Un échantillon pratique de médecins résidents en médecine d'urgence (n = 21) a participé au programme facilité, y compris les composantes didactiques et de simulation clinique. Les participants ont effectué une évaluation avant et après le programme d'études qui évaluait les compétences cliniques, la préparation, la sensibilisation aux attitudes et les connaissances de base en matière de soins aux patients atteints de diverses OSIG. Le contenu du module était fondé sur une analyse documentaire de portée et une évaluation des besoins nationaux des médecins d'urgence, des éducateurs et des stagiaires canadiens, ainsi que sur un collaborateur expert et les commentaires des patients et des partenaires communautaires. Le programme comprenait un pré-briefing animé, une présentation didactique, des modules de simulation clinique et un débriefing structuré. Les compétences cliniques des participants ont été évaluées avant et après l'intervention éducative. Notre résultat principal était un changement dans la préparation clinique, la sensibilisation aux attitudes et les connaissances de base dans les soins aux patients atteints de diverses OSIG avant et après l'intervention. RéSULTATS: Notre formation sur la santé et l'humilité culturelle axée sur le patient et ciblée en médecine d'urgence SOGI a permis d'améliorer considérablement la préparation clinique, les attitudes et les connaissances auto-évaluées des résidents en matière de soins aux patients SOGI-divers. Cette formation a été appréciée par les participants. CONCLUSIONS: Nous avons conçu un programme efficace et centré sur le patient en matière de santé et d'humilité culturelle pour les patients SOGI-divers en EM. D'autres programmes peuvent envisager d'utiliser ce modèle et d'élaborer des ressources dans leur administration pour améliorer les capacités des fournisseurs de soins à ce groupe marginalisé.

"We are actually being involved in management of the patient": A qualitative exploration of experiences of students and faculty regarding the use of clinical simulation in Busitema University and Lira University.

Introduction: Experiences regarding the use of simulation in low-resource settings like Uganda where it has not taken root have not been explored. The purpose of the study was to explore the experiences of students, clinical staff, and faculty regarding the use of clinical simulation in teaching undergraduate students. Materials and methods: The study was conducted at Busitema and Lira Universities in Uganda. We conducted 20 in-depth interviews with the faculty staff and 10 focused group discussions with undergraduate Nursing, Midwifery, Medical and Anesthesia students. The study obtained ethical clearance from the Busitema University Research and Ethics Committee (BUFHS-2023-78) and Uganda National Council of Science and Technology (HS3027ES). Thematic analysis was used to analyze the data. Results: Four themes emerged from the data. Simulation was seen to be about improvising and (return) demonstration. Concerns of realism were expressed including notions that simulation was not real, that simulation felt real and the extreme end that simulation tends to present the ideal setting. Perceived benefits of simulation include room for mistakes and immediate feedback, enhanced confidence and self-efficacy, enhanced acquisition of soft and clinical skills, prepares students for clinical placement, convenient and accessible. Concerns were expressed related to whether skills in clinical simulation would translate to clinical competence in the clinical setting. Conclusion: Students perceived simulation to be beneficial. However, concerns about realism and transferability of skills to clinical settings were noted. Clarifying preconceived notions against the use of clinical simulation will enhance its utilization in educational settings where simulation is not readily embraced.

A Mathematical Model Based on Stratifying the Severity of Medical Errors for Building Scenarios for Clinical Cases With Branching.

Background There are no mathematical models or score systems available for assessing and creating clinical case simulations based on branching scenario scripts. Objective This study aimed to develop a mathematical model based on stratifying the severity of medical errors for building clinical cases with branching scenarios for clinical simulation. Methods This study was undertaken from August 2020 to August 2023. To build a mathematical model for building scenarios of clinical cases with branching, the classification of the seriousness of medication errors was used. A mathematical model was built for predicting and modeling the development of a clinical situation and as an assessment strategy. The study recruited a total of 34 participants, with 16 participants assigned to the branching scenarios without the mathematical model group and 18 participants assigned to the branching scenarios with the mathematical model group. Results A simple diagram of score based on stratification of the severity of medical errors and correct decisions in clinical practice for building interactive training scenarios with branching was proposed. According to this score system algorithm, each clinical decision-making step is scored points with plus or minus, from 0 to 10. The sum of the points for each block in the decision-making process is then added up. Each step in the overall clinical decision-making strategy is stratified by the proposed algorithm, and finally, the results of internal validation and implementation are presented. Conclusion A mathematical model and score system for building clinical case scenarios based on branching and classification of the seriousness of medication errors was developed. This system could help in the prediction and modeling of the development of events in particular clinical situations and the assessment of competency formation in medical simulation as well.

A Staged Defragmented Simultaneous Debriefing Model As Integrated Micro-debriefing Components Inside Online Simulation for Competencies Formation.

Background Currently, there are no separate debriefing models for online simulation training, and existing models simply imitate the traditional models used in on-site simulation training (the physical presence of individuals, such as students or trainees, in a simulation center). This involves hands-on, in-person training within a simulated environment to enhance practical skills and knowledge in a controlled setting. This scenario does not fully meet the requirements and capabilities of distance learning. Objective To develop a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation to support the development of clinical decision-making and competencies formation within medical education and offer recommendations to support the use of this debriefing model as a teaching strategy. Methods This descriptive study was conducted from August 2020 to September 2023. To build a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation for competencies formation the traditional debriefing model's components for on-site simulation training, simulation type, and structure, modern concepts of e-learning, and classification of the seriousness of medication errors were used. The main focus of this study was on providing a detailed account of the debriefing components for online simulation training, features, and implementation of this new teaching model. A total of 38 participants, healthcare professionals, were recruited for this study. The participants were randomly assigned to two groups: one experiencing the staged defragmented debriefing model (n = 20) and the other control group, which received traditional debriefing following simulation training (n = 18). Results The results allowed us to successfully develop a staged defragmented debriefing model inside the simulation that integrates micro-debriefing components located at different points of the simulation scenarios. This teaching approach was successfully implemented in online clinical case scenarios in the "ClinCaseQuest" Simulation Training Platform for continuous medical education. Additionally, an internal validation experiment comparing the effectiveness of the staged defragmented debriefing model with the traditional debriefing method demonstrated superior learning outcomes and participant satisfaction in the staged debriefing group. Conclusions The staged defragmented debriefing model, when integrated into online simulations, represents a promising strategy for advancing clinical decision-making skills and competencies formation in medical education. Implementation of this debriefing model as a teaching strategy holds promise for enhancing learning outcomes in medical education settings. Further research, validation, and implementation are recommended to maximize the model's potential impact on medical education and training.

CyPVICS: A framework to prevent or minimise cybersickness in immersive virtual clinical simulation.

Cybersickness is a global issue affecting users of immersive virtual reality. However, there is no agreement on the exact cause of cybersickness. Taking into consideration how it can differ greatly from one person to another, it makes it even more difficult to determine the exact cause or find a solution. Because cybersickness excludes so many prospective users, including healthcare professionals, from using immersive virtual reality as a learning tool, this research sought to find solutions in existing literature and construct a framework that can be used to prevent or minimise cybersickness during immersive virtual clinical simulation (CyPVICS). The Bestfit Framework by Carrol and authors were used to construct the CyPVICS framework. The process started by conducting two separate literature searchers using the BeHEMoTh (for models, theories, and frameworks) and SPIDER (for primary research articles) search techniques. Once the literature searches were completed the models, theories and framework were used to construct a priori framework. The models' theories and frameworks were analysed to determine aspects relevant to causes, reducing, eliminating, and detecting cybersickness. The priori framework was expanded by, first coding the findings of the primary research study into the existing aspects of the priori framework. Once coded the aspects that could not be coded were added in the relevant category, for example causes. After reviewing 1567 abstracts and titles as part of the BeHEMoTh search string,19 full text articles, a total of 15 papers containing models, theories, and frameworks, were used to construct the initial CyPVICS framework. Once the initial CyPVICS was created, a total 904 primary research studies (SPIDER) were evaluated, based on their titles and abstracts, of which 100 were reviewed in full text. In total, 67 articles were accepted and coded to expand the initial CyPVICS framework. This paper presents the CyPVICS framework for use, not only in health professions' education, but also in other disciplines, since the incorporated models, theories, frameworks, and primary research studies were not specific to virtual clinical simulation.

Exploring How Evidence-Based Practice, Communication, and Clinical Simulation Outcomes Interact in Nursing Education: A Cross-Sectional Study.

(1) Background: Clinical simulation is an educational approach that aims to replicate real-life scenarios. Its primary goal is to help nursing students acquire the necessary knowledge and skills to perform effectively in clinical settings. This study focuses on the relationship between communication skills, evidence-based practice (EBP), and clinical simulation. We aimed to assess how communication skills and EBP competencies affect nursing students' performance in simulated clinical scenarios. (2) Methods: We conducted an observational, cross-sectional study with 180 third-year nursing students at the University of Murcia. We used validated instruments to evaluate the students' EBP competencies, communication skills, non-technical skills, and nursing interventions in simulated scenarios. (3) Results: The results showed that the students had varying competencies in EBP and communication skills. However, there was a positive and statistically significant correlation (p < 0.001) between these variables, non-technical skills, and the simulated clinical scenario nursing interventions. Our regression models revealed that communication skills and EBP competence significantly influenced the performance of the student nurses regarding their clinical and non-technical skills in the simulated scenarios. (4) Conclusions: Communication skills and EBP competencies predict performance in simulated scenarios for nursing students.

Evolution of Clinical Simulation Training and Pandemic-Led Acceleration: The International Medical University (IMU), Malaysia Journey.

In many universities, simulation-based learning has finally been inducted as a member of 'the accepted teaching modality community'. This paper is to share the challenges and successes in the journey towards the inclusion of simulation-based learning in the medical curriculum at the authors' university which saw a steep surge during the COVID-19 pandemic. Our teaching and learning that was heavily traditional based went through a dramatic change to adapt to the new norm when the actual environment and patients became out of reach. We followed five factors (5 Fs) that significantly influenced the successful change: fast, force, fellowship, flexibility, and favourable reception.

Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study.

BACKGROUND: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. OBJECTIVE: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. METHODS: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. RESULTS: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. CONCLUSIONS: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.

Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial.

AIM: We aimed to compare the debriefing experience, simulation assessment, reflection, anxiety and simulation satisfaction of using oral debriefing versus video-assisted debriefing after a simulated clinical session in an interdisciplinary cohort of health sciences students. BACKGROUND: Debriefing is a reflective process that takes place after a clinical simulation and that can be performed either in a traditional way (oral) or using video-assisted debriefing. DESIGN: A randomized controlled trial was conducted in 143 health sciences students (35.7% male, 61.5% female). METHODS: The simulation scenario was designed to evaluate the procedure for donning and doffing personal protective equipment. Differences in debriefing experience, simulation assessment, reflection, anxiety and satisfaction were assessed. RESULTS: Regarding debriefing experience, significant differences were observed for the category "learning" (34.9 (6.13) vs. 36.7 (3.89); p = 0.039). For simulation assessment, significantly higher scores for all categories were identified in video-assisted debriefing compared with oral debriefing (p<0.001). There were also significant differences between the oral debriefing versus video-assisted debriefing for the overall score of reflection ability (86.97 (10.55) vs. 90.74 (9.67); p=0.028) as well as for the category "reflective communication" (24.72 (3.77) vs 26.04 (4.07); p=0.047). Perceived satisfaction was significantly higher in the video-assisted debriefing group compared with oral debriefing group (p <0.001). For anxiety, no significant differences were observed between debriefing groups. CONCLUSION: Video-assisted debriefing after a simulated clinical session improves debriefing experience, simulation assessment, reflection and simulation satisfaction, but does not increase anxiety compared with oral debriefing among health sciences students.

Comparative Analysis of the Impact of Training through Simulation Using the Crisis Resource Management Tool for Primary Care Professionals.

This was a prospective observational study based on clinical simulation courses taught in 2017 at the IDEhA Simulation Center of Alcorcón Foundation University Hospital. Two courses in metabolic emergencies (MEs) and respiratory emergencies (REs) were offered to primary care physicians all over Spain. The main objective was to teach nontechnical skills (crisis resource management). Using a modified five-level Kirkpatrick-Phillips education evaluation model, level I (reaction, K1), level II (learning, K2) and level III (behavioral change, K3) changes were evaluated through surveys at the end of the courses and one year later. Thirty courses were held (15 ME courses and 15 RE courses) with 283 primary care physicians. The overall satisfaction (K1) was high: ME courses, 9.5/10; RE courses, 9.6/10. More than 80% of the participants rated the organization, resources, content, debriefing and scenarios as excellent, with no significant differences between the two courses. After one year (156 responses), the respondents for both courses reported that they would repeat the training annually (K2), encourage debriefing with colleagues (K3) and have modified some aspects of their workplace (K3), citing improvements in procedures and in the organization of the health team as the most important. After the ME course, few participants, i.e., 5 (6%), reported providing improved care to patients; after the RE course, 15 (19%) participants reported providing improved care; the difference between groups was significant (p < 0.05). Compared with the ME course, the RE course imparted greater knowledge about patient safety (K2) (38 (49%) vs. 24 (31%) (p < 0.05)) and more useful tools for daily clinical practice (K3) (67% vs. 56.4%) and resulted in participants paying more attention to personal performance and to colleagues when working as a team (K2) (64% vs. 50%). Clinical simulation courses are highly valued and potentially effective for training primary care physicians in patient safety and CRM tools. Future studies with objective measures of long-term impact, behavior in the workplace (K3) and benefits to patients (K4) are needed. Based on the results of our study, the areas that are important are those aimed at improving procedures and the organization of health teams.