First experience with multiple mini interview for medical school admission in Brazil: Does it work in a different cultural scenario?

PURPOSE: Evaluation of non-cognitive skills never has been used in Brazil. This study aims to evaluate Multiple Mini Interviews (MMI) in the admission process of a School of Medicine in São Paulo, Brazil. METHODS: The population of the study comprised 240 applicants summoned for the interviews, and 96 raters. MMI contributed to 25% of the applicants' final grade. Eight scenarios were created with the aim of evaluating different non-cognitive skills, each one had two raters. At the end of the interviews, the applicants and raters described their impressions about MMI. The reliability of the MMI was analyzed using the Theory of Generalization and Many-Facet Rasch Model (MFRM). RESULTS: The G-study showed that the general reliability of the process was satisfactory (coefficient G = 0.743). The MMI grades were not affected by the raters' profile, time of interview (p = 0.715), and randomization group (p = 0.353). The Rasch analysis showed that there was no misfitting effects or inconsistent stations or raters. A significant majority of the applicants (98%) and all the raters believed MMIs were important in selecting students with a more adequate profile to study medicine. CONCLUSIONS: The general reliability of the selection process was excellent, and it was fully accepted by the applicants and raters.

Appropriate Delivery Project: Impact of Simulation Training on the Increase in Vaginal Births in Hospitals in Brazil.

OBJECTIVE: This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries. METHODS: This retrospective observational study analyzed professionals' participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births. RESULTS: Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median. CONCLUSION: This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates.

Detecting latent safety threats in an interprofessional training that combines in situ simulation with task training in an emergency department.

BACKGROUND: During in situ simulation, interprofessional care teams practice in an area where clinical care occurs. This study aimed to detect latent safety threats (LST) in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an emergency department. We hypothesized this simulation-based training in actual care areas allows the detection of at least one LST per simulation scenario. METHODS: This prospective observational study (April 2015-March 2016) involved 135 physicians, nurses, and nurse technicians. Training themes selected were arrhythmia, respiratory insufficiency, shock, and cardiopulmonary resuscitation. Simulation weeks occurred every 3 months, with three 10-min scheduled in situ simulation scenarios alternating for each theme daily. The scenarios were followed by co-debriefing by two facilitators (a physician and a nurse). LST were identified by facilitators using a debriefing checklist. Additionally, a room was set up with task-trainers related to each theme. RESULTS: The number participants in scenarios was 114 (84% of the population) and in task-training, 101. The number of scenario cancelations was nine, making the final total number to 49 of 58 proposed. Fifty-six LST were observed, with an average of 1.1 per scenario. LST were divided into four categories: equipment (n = 23, 41.1%), teamwork (n = 12, 21.4%), medication (n = 11, 19.6%), and others (n = 10, 17.9%). There was a higher proportion in equipment-related LST (p < 0.01). CONCLUSIONS: The training allowed a high rate of detecting LST regardless of theme. Equipment-related LST were more frequently found.

Simulação in Situ, uma Metodologia de Treinamento Multidisciplinar para Identificar Oportunidades de Melhoria na Segurança do Paciente em uma Unidade de Alto Risco / In Situ Simulation, a Multidisciplinary Training Method to Identify Opportunities to Improve Patient Safety Improvement in a High Risk Unit

Introdução A simulação é uma metodologia usada para substituir ou amplificar experiências reais por experiências guiadas que evocam ou replicam aspectos do mundo real de maneira interativa. A simulação in situ leva essa técnica diretamente aos locais onde ocorrem atendimentos, com a própria equipe de saúde atuando em seu ambiente de trabalho em cenário simulado. Objetivo Descrever experiência piloto de simulação in situ realizada em unidade de pronto atendimento, destacando oportunidades de avaliação de sistema de atendimento, trabalho em equipe e detecção de ameaças latentes à segurança (ALS). Métodos Estudo aplicado na Unidade Ibirapuera do Hospital Israelita Albert Einstein e realizado pelo Centro de Simulação Realística Albert Einstein. Foi apresentado cenário de paciente de 45 anos com síndrome coronariana aguda que evolui para parada cardiorrespiratória. Simulação híbrida de 30 minutos com uso de ator e simulador de alta fidelidade (SimMan 3G®).Utilizado checklist e filmagem para avaliar habilidades e atitudes, usados em debriefing estruturado com uma hora de duração. Resultados A experiência proporcionou avaliação técnica, comportamental e sistemas. Detectou quatro ALS e permitiu reflexão guiada sobre trabalho em equipe. Conclusão Este piloto contribuiu para o alcance dos objetivos propostos com o cenário e demonstrou oportunidades de treinamento e melhoria. A simulação in situ pode ser usada no futuro sistematicamente para treinamento contínuo de equipes, visando à melhoria da qualidade de atendimento e à segurança do paciente. .

Introduction Simulation is a method used to substitute or enhance real experiences with guided, interactive experiences that are reminiscent of or replicate aspects of the real world.In situ simulation takes this technique directly to the places where health care is rendered, with the health team acting in a simulated scenario within their work environment. Objective To describe the pilot in situ simulation experience conducted at an accident and emergency unit, highlighting the opportunities to assess the care system, teamwork and detection of latent safety threats (LSTs). Methods The study was applied at the Ibirapuera Unit of the Hospital Israelita Albert Einstein and performed by the Albert Einstein Realistic Simulation Centre.A scenario was presented wherein a 45-year old patient whose acute coronary syndrome evolves into cardiac arrest.A 30-minute hybrid simulation involving the use of an actor and high fidelity simulator (SimMan 3G®).A checklist was used and the simulation was filmed in order to evaluate skills and attitudes in a structured 1-hour long debriefing. Results The experience provided a technical, behavioural and system assessment. Four LSTs were detected and it enabled a guided reflection on teamwork. Conclusion This pilot contributed to achieving the objectives proposed with the scenario and demonstrated opportunities for training and improvement.In situ simulation may be used systemically in the future for continuous team training, aimed at improving service quality and patient safety. .