A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus.

BACKGROUND: Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. METHODS: A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. RESULTS: Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). DISCUSSION: Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. CONCLUSION: This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. LEVEL OF EVIDENCE: III.

Virtual reality versus low level simulation in newborn care teaching in Turkey.

The aim of this study is a virtual reality versus low level simulation in newborn care teaching in Turkey. Data were collected in 2019-2020 academic year in midwifery students in Turkey. In the first stage, virtual reality simulation software was developed. In the second stage, newborn care was provided with a virtual reality simulator to the experimental group and a low-fidelity simulator to the control group. Students' practice, self-confidence and satisfaction levels were compared using two different simulators. There was a difference between the two groups in terms of their skills, satisfaction and self-confidence. The simulator, which was developed and evaluated in the research, increased the students' satisfaction, self-confidence and skills. It was also found to be more effective than the classical method.

Le but de cette étude est une réalité virtuelle versus simulation de bas niveau dans l'enseignement des soins aux nouveau-nés en Turquie. Les données ont été collectées au cours de l'année universitaire 2019-2020 auprès d'étudiantes sages-femmes en Turquie. Dans un premier temps, un logiciel de simulation de réalité virtuelle a été développé. Dans la deuxième étape, les soins aux nouveau-nés ont été fournis avec un simulateur de réalité virtuelle pour le groupe expérimental et un simulateur basse fidélité pour le groupe témoin. Les niveaux de pratique, de confiance en soi et de satisfaction des étudiants ont été comparés à l'aide de deux simulateurs différents. Il existe une différence entre les deux groupes en termes de compétences, de satisfaction et de confiance en soi. Le simulateur développé et évalué dans le cadre de la recherche a accru la satisfaction, la confiance en soi et les compétences des étudiants. Elle s'est également révélée plus efficace que la méthode classique.

Obstetrics and Gynecology Hospitalists as Champions of Drills and Simulation.

Obstetrics and gynecology Hospitalists are not only skilled providers of emergency obstetric and gynecologic care but also safety officers who advocate for and maintain safety and quality in the hospital setting. In these areas and others, they play an essential role in championing and establishing simulation-based education in the hospital setting. The use of Simulations and Drills in maintaining quality and safety in patient care is nationally recognized by leading obstetric and gynecologic organizations.

Preparing for the next respiratory pathogen pandemic: using tabletop simulation exercises to strengthen national planning in Cook Islands, Costa Rica, Lebanon and Mongolia.

The Preparedness and Resilience for Emerging Threats (PRET) initiative takes an innovative mode-of-transmission approach to pandemic planning by advocating for integrated preparedness and response systems and capacities for groups of pathogens with common transmission pathways. The World Health Organization (WHO) launched this initiative in 2023 with the publication of PRET Module 1 addressing respiratory pathogens. Exercise PanPRET-1 is a customizable tabletop simulation exercise (TTX) package developed to complement PRET Module 1. The exercise scenario focuses on strengthening capacities for multisectoral coordination, risk communication and community engagement, and the triggers for operational decision-making. This article reports on the experiences of the first four countries to implement Exercise PanPRET-1: Cook Islands, Costa Rica, Lebanon and Mongolia. Exercise outcomes demonstrated that PanPRET-1 can be an effective tool for testing pandemic plans in a multisectoral forum and identifying opportunities to improve preparedness and response in key domains. In quantitative evaluations in Cook Islands, Costa Rica and Mongolia, high proportions of exercise participants indicated that multiple aspects of the exercise were well-designed and were beneficial for improving health emergency preparedness. Exercise participants in Lebanon provided qualitative feedback indicating that they found the exercise to be beneficial. Conducting a TTX and monitoring the implementation of action plans based on exercise findings facilitates a country-owned whole-of-society vision for pandemic planning. Countries are encouraged to incorporate TTX such as Exercise PanPRET-1 into a continuous cycle of activity to improve pandemic preparedness.

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.

Comparative study between high-fidelity simulation and medium-fidelity simulation in decision-making of nursing students: experimental study.

OBJECTIVE: to compare the decision-making of Nursing students, before and after theoretical training on basic life support, using the practice of high-fidelity simulation and medium-fidelity simulation. METHOD: an experimental study was developed, pre- and post-test type, with quantitative, descriptive and inferential analysis, with theoretical training on basic life support and clinical simulation practices, and with evaluation of knowledge and decision-making of Nursing students, at three different moments - before the simulation scenario (T0), after the simulation scenario (T1) and after clinical teaching (T2). RESULTS: 51 students participated in the research, with an average age of 20.25±3.804, of which 92.2% were female. Statistically significant differences (F=6.47; p=0.039) were evident regarding the definition of the problem and development of objectives in decision-making in the experimental group. CONCLUSION: Nursing students demonstrate an adequate level of knowledge and a good decision-making process, based on the most current instruments produced by scientific evidence, in clinical simulation scenarios in basic life support, and this innovative methodology should be deepened in the Nursing teaching. HIGHLIGHTS: (1) Clinical simulation promotes good decision-making of Nursing students.(2) Students demonstrated adequate knowledge about basic life support.(3) Knowledge and practice define the fidelity of clinical simulation.(4) Basic life support can be developed by high-fidelity simulation.

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.

Rapid cycle deliberate practice versus postsimulation debriefing in pediatric cardiopulmonary resuscitation training: a randomized controlled study.

OBJECTIVE: Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents. METHODS: This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction. RESULTS: Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes. CONCLUSION: Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions.

An Accessible Nephrectomy and Cystotomy Simulator for Use in Teaching Small Animal Surgery.

The use of simulators in veterinary education has been increasing over the last few years. This is fundamental for surgical classes, as simulators can provide a better learning environment for the students. Two procedures commonly taught in veterinary surgical practical classes are nephrectomy and cystotomy. However, the lack of simulators for use in these classes limits the training options to the use of cadavers, which have a number of associated disadvantages, including the potential for autolysis. The aim of this study was to develop and assess the value of a simple nephrectomy and cystotomy simulator that could replace the use of cadavers in surgical practical classes. The simulator, which represented the abdominal cavity, bladder, kidneys, ureter, vessels and adipose tissue, was constructed by using synthetic materials. To evaluate its usefulness and acceptance by the students, the learning outcomes and student satisfaction, for both the simulator and an ethically sourced dog cadaver, were compared. The students completed a Likert scale questionnaire, and the answers were evaluated by using the Diagnostic Content Validation (DCV) model. The simulator was well accepted by the students, with the best scores achieved for the ureter divulsion and ligation procedures; good results were also recorded for the kidney vessel ligature and urinary bladder suture practice. The scores showed that the simulator provided an acceptable experience during the training process and increased the confidence of the students in performing the procedure.

Assessment of the evolution of psychomotor skills in the robotic surgery simulation process.

Robotic surgery is a rapidly expanding field, given the wide variety of new robotic platforms emerging. Looking at the training of surgeons in robotic surgery is of extreme necessity and urgency, considering the ongoing technological advancements. In this research, the performance during the virtual reality simulation phase of training for robotic surgery was analyzed. It was observed that, in addition to the lack of consensus among societies regarding the required simulation hours, there is no guidance on the best curriculum to be adopted. From the data in this study, it can be inferred that the more advanced skills have fewer proficient individuals, meaning that fewer surgeons in training have reached proficiency in all skill exercises. Even with differences in the number of exercises performed proficiently between groups that underwent varying amounts of simulation time, there is no statistically significant difference in the proportion between them.

Immersive simulation in nursing and midwifery education: a systematic review.

PURPOSE: Immersive simulation is an innovative training approach in health education that enhances student learning. This study examined its impact on engagement, motivation, and academic performance in nursing and midwifery students. METHODS: A comprehensive systematic search was meticulously conducted in 4 reputable databases-Scopus, PubMed, Web of Science, and Science Direct-following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research protocol was pre-registered in the PROSPERO registry, ensuring transparency and rigor. The quality of the included studies was assessed using the Medical Education Research Study Quality Instrument. RESULTS: Out of 90 identified studies, 11 were included in the present review, involving 1,090 participants. Four out of 5 studies observed high post-test engagement scores in the intervention groups. Additionally, 5 out of 6 studies that evaluated motivation found higher post-test motivational scores in the intervention groups than in control groups using traditional approaches. Furthermore, among the 8 out of 11 studies that evaluated academic performance during immersive simulation training, 5 reported significant differences (P<0.001) in favor of the students in the intervention groups. CONCLUSION: Immersive simulation, as demonstrated by this study, has a significant potential to enhance student engagement, motivation, and academic performance, surpassing traditional teaching methods. This potential underscores the urgent need for future research in various contexts to better integrate this innovative educational approach into nursing and midwifery education curricula, inspiring hope for improved teaching methods.

--------Comparison of Hybrid-Simulation-Based Teaching with Traditional Teaching of Pharmacology.

OBJECTIVE: To compare the outcome of traditional teaching with hybrid simulation-based teaching for undergraduate medical students. Place and Duration of the Study: Department of Pharmacology, Jinnah Medical and Dental College, Karachi, Pakistan, from June to August 2023. STUDY DESIGN: Quasi-experimental study. METHODOLOGY: One hundred students from MBBS 3rd year were included in the study after taking the informed consent. Participants were divided into two cross-over groups and sampling was done randomly. Group A: (even roll numbers, n = 50) was the control group, taught by traditional lecture on positive inotropic medicines. Group B: (with odd roll numbers, n = 50) was the intervention group, taught the same topic by simulation-based teaching through 5 case scenarios. The teaching of this group was reinforced by role plays. Scores of post-test and retention test were compared by applying the Student's t-test. RESULTS: Students taught by traditional lectures i.e., Group A, their post-test mean scores were 30.7 ± 5.6, whereas Group B scored 45.7 ± 3.3, taught by hybrid stimulation (p <0.001). Retention test (MCQs based) was conducted after one month in which Group A obtained a mean score of 18.8 ± 9 with a passing percentage of approximately 30, whereas Group B obtained a score of 41.3 ± 5.6 (p <0.001). CONCLUSION: Hybrid-simulation-based teaching improved the immediate test scores as well as retention. KEY WORDS: Traditional teaching, Hybrid-simulation, MCQs, Retention test, Intervention group.

RoboticSurgery4all: are discovery courses important for robotic surgery skills acquisition?

Cost, logistics, and availability of robotic simulation opportunities suppose a real challenge for robotic surgery training. We aimed to test a new methodology for introduction to robotic surgery pre-congress courses. Two different "introduction to robotic surgery" pre-congress courses were developed. A new methodology using a sleeve/bypass, a ventral TAPP and an inguinal TAPP silicone models was implemented. After the session, the trainees answered a questionnaire to evaluate the course and the methodology using 1-5 Likert scales. A total of 21 participants participated in the courses and (72.2%) had no experience in robotic surgery. All trainees rated the course as good or excellent. There was a strong agreement between participants regarding the adequacy of the silicone models for this type of simulation/course. Trainees agree that the course gave them more confidence to perform a real robotic procedure, increased their interest in robotic surgery and made them feel ready to start their robotic surgery pathway. Congresses are a frequent way of contact between surgeons and robotic systems, mostly in the form of technical demonstrations or pre-congress courses. Our methodology showed that it is possible to allow for this contact in a low-cost way. This kind of courses is well received by congress delegates and have a positive educational impact. Despite of being "Discovery" courses, they have a positive impact on the congress, on the acquisition of robotic surgery skills and increase the interest in robotic surgery.

A study on the impact of open source metaverse immersive teaching method on emergency skills training for medical undergraduate students.

BACKGROUND: In recent years, the traditional simulation-based medical teaching approach has faced challenges in meeting the requirements of practical emergency medicine education. This study utilized open-source tools and software to develop immersive panoramic videos using virtual reality technology for emergency medical teaching. It aims to investigate the efficacy of this novel teaching methodology. This transformation shifted the focus from physical simulation to virtual simulation in medical education, establishing a metaverse for emergency medical teaching. METHODS: In accordance with the curriculum guidelines, the instructors produced panoramic videos demonstrating procedures such as spinal injury management, humeral fracture with abdominal wall intestinal tube prolapse, head and chest composite injuries, cardiopulmonary resuscitation, and tracheal intubation. Using Unity software, a virtual training application for bronchoscopy was developed and integrated into the PICO4 VR all-in-one device to create a metaverse teaching environment. Fourth-year medical undergraduate students were allocated into either an experimental group (n = 26) or a control group (n = 30) based on student IDs. The experimental group received instruction through the metaverse immersive teaching method, while the control group followed the traditional simulation-based medical teaching approach. Both groups participated in theoretical and practical lessons as usual. Subsequently, all students underwent a four-station Objective Structured Clinical Examination (OSCE) to assess the effectiveness of the teaching methods based on their performance. Additionally, students in the experimental group provided subjective evaluations to assess their acceptance of the new teaching approach. RESULTS: Before the training commenced, there were no significant statistical differences in the first aid test scores between the experimental and control groups. Following the training, the experimental group outperformed the control group in the four-station OSCE examination, with all P-values being less than 0.05. The satisfaction rate among the experimental group regarding the new teaching method reached 88.46%, reflecting levels of satisfaction and extreme satisfaction. CONCLUSION: The open-source metaverse immersive teaching method has demonstrated a positive impact on enhancing the emergency skills of medical undergraduate students, with a high level of acceptance among students. In comparison to traditional simulated medical teaching methods, this approach requires less time and space, incurring lower costs, and is deemed worthy of wider adoption.

Implementation of simulation training in the Intensive Care Units (ICU) during the COVID-19 pandemic: A scoping review.

INTRODUCTION: In response to the important influx of critically ill patients as well as resources limitation, simulation would be a tool ensuring the continuum of medical training. AIM: To assess the impact of simulation training on both education and performance related to protocol development during COVID-19 pandemic, in critical care. METHODS: This scoping review was written in accordance with the PRISMA Guideline. Data sources and studies were identified by searching "MEDLINE", "Cochrane library" databases and "Clinical trial.gov". Study inclusion adhered to the PICO criteria: Population, Intervention, Comparison, and Outcomes. The Kirkpatrick Model, is a tool for evaluating the level of impact of training results according to four levels Results: The search algorithm yielded sixteen articles of which eight were meeting criteria for inclusion and finally seven were available. The number of participants ranged from 12 to 108 with a median of 61 (IQR: 8-76). The length of intervention ranged from 12 min to three hours with a median of 38 min (IQR: 12-135). Studies reported that incorporating simulation yields a more pronounced impact compared to theoretical and clinical training alone in enhancing knowledge and confidence. Regarding the role of simulation in protocol development, results have shown that in the pre-test, all the participants failed donning and doffing Personal Protective Equipment (PPE), the mean cognitive load was high (7.43±0.9 points) and the performance was low (2.5±0.8) while in the post-test, 100% of participants were successful in donning the PPE, the mean of the cognitive load decreased (4.1±1.4 points), and the performance substantially increased (7.9±1.1). In addition, five studies showed behavioral changes after training and thus the simulation reached Kirkpatrick level three. CONCLUSION: Results supported the impact of simulation, in critical care, as an effective method to enhance knowledge and confidence, and to improve protocol development during pandemics such as COVID-19.

Development and evaluation of scenario-based e-simulation for humanitarian health training: a mixed-methods action research study.

OBJECTIVES: This study aimed to develop and evaluate a scenario-based e-simulation (SBES) to address the limited avilability of accessible and practical training for humanitarian public health responders. The objectives included SBES customisation, effectiveness evaluation, and identifying learning-enhancing design elements. DESIGN: A university-based, mixed-methods action research design. SETTING: The study was conducted at an international university's academic centre in Italy, and at a university-based master's programme in Yemen. PARTICIPANTS: The study involved 20 multidisciplinary global health and education experts and 66 international medical and health sciences students. RESULTS: Between September 2020 and July 2022, four SBES modules were developed, implemented and evaluated using a rapid prototype model. The modules, which targeted health professionals new to or with limited experience in the humanitarian field, included health needs assessment, essential health services, communicable diseases and health system. Formative evaluation improved the design and implementation of the SBES, which was found to be effective in the summative evaluation, evident from positive student reactions (the overall mean satisfaction rate was 6.03 out of 7, 95% CI 5.95 to 6.47) and the significant improvement in knowledge scores (p<0.001, effect size: 1.179). The identified effective design of SBES includes overlapping elements among content, strategy and technology. Poor internet access was recognised as a potential barrier to delivering the training in the humanitarian context, highlighting the need to develop an offline version in the next phase. CONCLUSION: The developed SBES met the training needs of the academic institution involved. The study findings will contribute to advancing future SBES training initiatives for disaster medicine and global health. Further studies are recommended to evaluate and address the challenges associated with SBES implementation beyond the study setting.

Simulators in urology resident's training in retrograde intrarenal surgery.

PURPOSE: To evaluate the impact of simulators on the training of urology residents in retrograde intrarenal surgery (RIRS). METHODS: The study involved training eight urology residents, using two artificial simulators; one developed by the Universidade Estadual do Pará, using three-dimensional printing technology, and the other one patented by the medical equipment manufacturer Boston Scientific The qualification of residents took place through a training course, consisting of an adaptation phase (S0), followed by three training sessions, with weekly breaks between them (S1, S2 and S3). Study members should carry out a RIRS in a standardized way, with step-by-step supervision by the evaluator using a checklist. The participants' individual performance was verified through a theoretical assessment, before and after training (pre- and post-training), as well as by the score achieved in each session on a scale called global psychomotor skill score. In S3, residents performed an analysis of the performance and quality of the simulation, by completing the scale of student satisfaction and self confidence in learning (SSSCL). RESULTS: At the end of the course, everyone was able to perform the procedure in accordance with the standard. The training provided a learning gain and a considerable improvement in skills and competencies in RIRS, with p < 0.05. SSSCL demonstrated positive feedback, with an overall approval rating of 96%. CONCLUSIONS: Artificial simulators proved to be excellent auxiliary tools in the training of urology residents in RIRS.