Socioemotional Skills in the Teaching-Learning Process Mediated by Medium- and High-Fidelity Clinical Simulation in Nursing Students: Protocol for a Scoping Review.

BACKGROUND: In nursing education, contact with real scenarios implies the design of favorable experiences to develop prioritization, reasoning, critical thinking, and management skills that support future practice. In the context of the teaching-learning process, simulation emerges as a support strategy, but its use and management require the knowledge and appropriation of teachers. Clinical simulation during education promotes growth in technical skills and aptitudes such as critical thinking, emotional management, organization, delegation, and teamwork. The culmination positively impacts the student, reflecting on their confidence, security, and adaptability to unexpected or unknown situations and risks. OBJECTIVE: The aim of this scoping review is to determine the socioemotional skills described during the teaching-learning process mediated by medium- and high-fidelity clinical simulation in nursing students. METHODS: The main concepts and limits of the research area will be determined according to the 5 phases of a scoping review proposed by Arksey and O'Malley. Research articles and postgraduate theses published between 2010 and 2023 in English and Spanish will be considered. Dissertation-type documents, book chapters, editorials, abstracts, and articles focused on clinical simulation among nursing professionals will be excluded. The articles will be retrieved from databases available at the Universidad Cooperativa de Colombia, along with CINAHL, Scielo, and PubMed. The search strategy will be based on the Population-Concept-Context framework. Article selection will be carried out by 2 independent evaluators who will review titles and abstracts in stage 1 and the full text in stage 2. A database of retrieved articles will be built with the variables of interest. A qualitative thematic analysis will be conducted by 5 independent reviewers to provide an overview of the literature, focusing on identifying similarities and contrasts between studies and contributions related to the aspects of social skills described in nursing students. RESULTS: The investigation has not yet started. The findings aim to focus on variables within the academic environment that, when correlated with the clinical simulation experience, may determine student learning. The working hypothesis is that students who experience greater satisfaction or possess better communication skills also demonstrate superior performance during high-fidelity simulation activities. The most relevant results will be contrasted considering the stated objective and knowledge gaps. Key aspects will also be compared with other reviews addressing related topics such as communication, self-efficacy, and self-confidence. Skills described by other authors that were not considered in the initial literature review will also be mentioned. CONCLUSIONS: Educational institutions are responsible for including learning experiences in controlled environments such as medium- and high-fidelity simulation to ensure the acquisition of technical capabilities and additional socioemotional skills. Recognizing and managing emotions is necessary to provide adequate care for users of health care services and for the increased effectiveness of professionals. TRIAL REGISTRATION: Open Science Framework p4ays; https://osf.io/p4ays. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56436.

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.

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.

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.

From FUSE to a hands-on electrosurgery course using a cadaveric model.

INTRODUCTION: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. METHODS: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. RESULTS: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). CONCLUSION: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.

Advancing Neurosurgical Skills: A Comparative Study of Training Models for Intra-Extracranial Cerebral Bypass.

BACKGROUND: Training in anastomosis is fundamental in neurosurgery due to the precision and dexterity required. Biological models, although realistic, present limitations such as availability, ethical concerns, and the risk of biological contamination. Synthetic models, on the other hand, offer durability and standardized conditions, although they sometimes lack anatomical realism. This study aims to evaluate and compare the efficiency of anastomosis training models in the intra-extracranial cerebral bypass procedure, identifying those characteristics that enhance optimal microsurgical skill development and participant experience. METHODS: A neurosurgery workshop was held from March 2024 to June 2024 with 5 vascular techniques and the participation of 22 surgeons. The models tested were the human placenta, the Wistar rat, the chicken wing artery, the nasogastric feeding tube, and the UpSurgeOn Mycro simulator. The scales used to measure these models were the Main Characteristics Score and the Evaluation Score. These scores allowed us to measure, qualitatively and quantitatively, durability, anatomical similarity, variety of simulation scenarios, risk of biological contamination, ethical considerations and disadvantages with specific infrastructure. RESULTS: The human placenta model, Wistar rat model, and UpSurgeOn model were identified as the most effective for training. The human placenta and Wistar rat models were highly regarded for anatomical realism, while the UpSurgeOn model excelled in durability and advanced simulation scenarios. Ethical and cost implications were also considered. CONCLUSIONS: The study identifies the human placenta and UpSurgeOn models as optimal for training in intra-extracranial bypass procedures, emphasizing the need for diverse and effective training models in neurosurgery.

Perception of Knowledge Transfer from Clinical Simulations to the Care Practice in Nursing Students.

Objective: This work sought to assess the perception of knowledge transfer from clinical simulations to the care practice in nursing students through effective debriefing. Methods: An observational, descriptive, and cross-sectional study was conducted with a sample of 281 students during the 2020-2021 course, through una ad hoc survey from the Debriefing Assessment for Simulation in Healthcare (DASH) in Spanish, to assess competence areas that undergraduate students must reach to complete their studies. Results: The survey conducted after each simulation showed that the students valued positively the debriefing sessions conducted by experts, with a mean score of 6.61 over 7 [6.56%-6.65%] based on 675 surveys analyzed, given that each student conducted more than one simulation within the academic course. It was observed in 221 completed answers that what was learned in the simulation was transferred to the practice in 89.23% [86.39%-92.06%], specifically in areas of Communication, Patient safety, Teamwork, and Leadership. Conclusion: In the perception by the participating students, the use of effective debriefing in clinical simulation enabled knowledge transfer to the care practice, proving to be a crucial tool that helps to improve the formation of the future nurses.

Association between cortisol levels and performance in clinical simulation: a systematic review.

OBJECTIVE: To identify how stress measured by salivary cortisol during clinical simulation-based education, or simulation and another teaching method, impacts performance. METHOD: Systematic review of the association between cortisol and performance in simulations. The following databases were used: PubMed, LIVIVO, Scopus, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS) and Web of Science. Additional searches of gray literature were carried out on Google Scholar and Proquest. The searches took place on March 20, 2023. The risk of bias of randomized clinical trials was assessed using the Cochrane Collaboration Risk of Bias Tool (RoB 2). Inclusion criteria were: simulation studies with salivary cortisol collection and performance evaluation, published in any period in Portuguese, English and Spanish. RESULTS: 11 studies were included which measured stress using salivary cortisol and were analyzed using descriptive synthesis and qualitative analysis. CONCLUSION: Some studies have shown a relationship between stress and performance, which may be beneficial or harmful to the participant. However, other studies did not show this correlation, which may not have been due to methodological issues.

Cultural adaptation and evaluation of the measurement properties of the Facilitator Competency Rubric for clinical simulation facilitators.

OBJECTIVE: translate and adapt the Facilitator Competency Rubric to the Portuguese language and the Brazilian culture, and analyze the measurement properties. METHOD: methodological study that completed the steps of translation, synthesis of translations, back translation, review by a Committee of Experts composed of 7 professionals, testing of the pre-final version with 33 simulation facilitators, and submission to the author of the original instrument. For content validation, the Content Validity Index and the modified Kappa Coefficient were calculated. For reliability, Cronbach's α and the Intraclass Correlation Coefficient were evaluated by 52 and 15 simulation facilitators, respectively. RESULTS: two rounds of content evaluation were carried out, resulting in changes to 19 items in the first evaluation and 3 items in the second. The overall scale achieved a Cronbach's α of 0.98 and an Intraclass Correlation Coefficient of 0.95 to 0.97. CONCLUSION: the Facilitator Competency Rubric was translated and culturally adapted to the Brazilian reality and presented content validity, reliability and stability, with safe results for use in teaching and research.

Construction and validation of a scenario for sedation training in the emergency room for pediatric surgical procedures by in-situ simulation.

INTRODUCTION: sedation and analgesia are fundamental procedures for children undergoing invasive interventions, and complications must be avoided during their implementation. In situ simulation allows, in turn, training in real practice environments to improve the technical and non-technical skills of professionals for such procedures. Although it is a very useful tool, it is often not used due to lack of preparation for its planning and application. OBJECTIVE: develop and validate an in situ simulation scenario in pediatric emergency care using sedation to perform an invasive procedure. METHOD: descriptive study of construction and content validation of an in situ simulation scenario, using the Delphi method, following the following steps: 1) definition of the problem and selection of experts; 2) development of the initial document; 3) rounds for validation with analysis of responses and feedback (until consensus is reached by the Content Validation Index); 4) final report. Results: The experts indicated suggestions that were duly used and the scenario obtained, in all items, a CVI greater than 80.0%, demonstrating its high validity and reliability. By using experts to validate the scenario, their insights guarantee greater precision and reliability in scenario construction engineering. CONCLUSION: It is expected that this study will allow the replication of the scenario in different training contexts, facilitating and encouraging professional training based on a scenario model based on best evidence and practices.

Three-step clinical simulation model: An initiative to guide its implementation. / Modelo de simulación clínica en 3 pasos: una iniciativa para guiar su implementación.

The design and implementation of simulation-based learning is a major institutional challenge. It involves planning the activity and preparing information and resources, as well as accompanying and guiding participants towards the achievement of learning outcomes. There are currently different global recommendations that contribute to a high-quality implementation of simulations. The objective of this article is to present a simulation model that both integrates these guidelines and serves as a guide for those who are in the early stages of this educational strategy.

El diseño y la implementación de la enseñanza basada en simulación resulta un gran desafío institucional. Supone planificar la actividad, preparar información y recursos, así como acompañar y guiar a los participantes hacia el logro de los resultados de aprendizaje. Actualmente, existen diferentes recomendaciones globales que contribuyen a una implementación de calidad de la simulación. El propósito de este artículo consiste en presentar un modelo de simulación que integre dichos lineamientos y sirva de guía para quienes se inician en el uso de esta estrategia educativa.

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study.

BACKGROUND: cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. OBJECTIVE: To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. DESIGN AND SETTING: This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. METHODS: Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. RESULTS: In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. CONCLUSIONS: The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Effect of three training programs on surgical performance in single-port laparoscopic surgery.

OBJECTIVE: The aim of this study was to evaluate the effect of three training methodologies on the acquisition of psychomotor skills for laparoendoscopic single-site surgery (LESS), using straight and articulating instruments. METHODS: A prospective study was conducted with subjects randomly divided into three groups, who performed a specific training for 12 days using three laparoscopic tasks in a laparoscopic simulator. Group-A trained in conventional laparoscopy setting using straight instruments and in LESS setting using both straight and articulating instruments. Group-B trained in LESS setting using straight and articulating instruments, whereas Group-C trained in LESS setting using articulating instruments. Participants' performance was recorded with a video-tracking system and evaluated with 12 motion analysis parameters (MAPs). RESULTS: All groups obtained significant differences in their performance in most of the MAPs. Group-C showed an improvement in nine MAPs, with a high level of technical competence. Group-A presented a marked improvement in bimanual dexterity skills. CONCLUSIONS: Training in LESS surgery using articulating laparoscopic instruments improves the quality of skills and allows smoother learning curves.

OBJETIVO: Evaluar el efecto de tres métodos de entrenamiento en la adquisición de habilidades psicomotrices para la cirugía laparoendoscópica por puerto único (LESS, laparoendoscopic single-site surgery) utilizando instrumental recto y articulado. MÉTODO: Se realizó un estudio prospectivo con sujetos divididos aleatoriamente en tres grupos, quienes realizaron un entrenamiento específico durante 12 días utilizando tres tareas laparoscópicas en un simulador laparoscópico. El grupo A entrenó en el entorno laparoscópico convencional con instrumentos rectos, y en el entorno LESS con instrumentos rectos y articulados. El grupo B entrenó en el entorno LESS con instrumentos rectos y articulados. El Grupo C entrenó en el entorno LESS con instrumentos articulados. El desempeño de los participantes se registró con un sistema de seguimiento en video y fue evaluado con 12 parámetros de análisis de movimiento (MAP, motion analysis parameters). RESULTADOS: Todos los grupos obtuvieron diferencias significativas en su desempeño para la mayoría de los MAP. El grupo C mostró una mejora en nueve MAP, con un alto nivel de competencia técnica. El grupo A mostró una marcada mejora en la habilidad de destreza bimanual. CONCLUSIONES: El entrenamiento en cirugía LESS con instrumentos articulados mejora la calidad de las habilidades adquiridas y permite curvas de aprendizaje más suaves.