Development of a simulation technical competence curriculum for medical simulation fellows.

BACKGROUND AND NEEDS: Medical educators with simulation fellowship training have a unique skill set. Simulation fellowship graduates have the ability to handle basic and common troubleshooting issues with simulation software, hardware, and equipment setup. Outside of formal training programs such as this, simulation skills are inconsistently taught and organically learned. This is important to address because there are high expectations of medical educators who complete simulation fellowships. To fill the gap, we offer one way of teaching and assessing simulation technical skills within a fellowship curriculum and reflect on lessons learned throughout the process. This report describes the instructional designs, implementation, and program evaluation of an educational intervention: a simulation technology curriculum for simulation fellows. CURRICULUM DESIGN: The current iteration of the simulation technical skill curriculum was introduced in 2018 and took approximately 8 months to develop under the guidance of expert simulation technology specialists, simulation fellowship-trained faculty, and simulation center administrators. Kern's six steps to curriculum development was used as the guiding conceptual framework. The curriculum was categorized into four domains, which emerged from the outcome of a qualitative needs assessment. Instructional sessions occurred on 5 days spanning a 2-week block. The final session concluded with summative testing. PROGRAM EVALUATION: Fellows were administered summative objective structured exams at three stations. The performance was rated by instructors using station-specific checklists. Scores approached 100% accuracy/completion for all stations. CONCLUSIONS: The development of an evidence-based educational intervention, a simulation technical skill curriculum, was highly regarded by participants and demonstrated effective training of the simulation fellows. This curriculum serves as a template for other simulationists to implement formal training in simulation technical skills.

Development, Validation, and Implementation of a Medical Judgment Metric.

Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM), a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987) as well as their evaluation of the expected patient outcome (Fleiss's Kappa 0.791 to 0.906). For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen's Kappa 0.851 to 0.880). Discussion: The MJM demonstrated preliminary evidence of reliability and validity.

A Pilot Curriculum to Integrate Standardized Patient Simulation into Clinical Pastoral Education.

INTRODUCTION: We describe a novel means of experiential learning for clinical pastoral care residents using standardized patient (SP) simulations. METHODS: A prospective cohort study involving 7 clinical pastoral care residents was performed. All residents underwent 2 verbatim SP sessions and 2 simulation sessions. After all sessions, residents completed a self-evaluation. Faculty completed an evaluation and then provided a debriefing session to all residents. RESULTS: Performance ratings were globally higher on simulated scenarios when compared to the verbatim sessions. CONCLUSIONS: More research in the field of pastoral care is needed to validate the learned professional skills that enhance a comprehensive training program through the use of medical simulation, verbatim reports, and clinical pastoral education (CPE) competencies. Medical simulation provides a promising teaching methodology for the training of CPE residents.

Teledebriefing: connecting learners to faculty members.

BACKGROUND: Simulation has become widespread among medical educators. Although simulation facilities are available at most teaching institutions, the number of qualified instructors to facilitate post-simulation debriefing is inadequate, resulting in sub-par educational experiences for learners. CONTEXT: Efforts to broaden medical curricula to include simulation have been successful. An integral component of simulation-based education is the debriefing stage, in which learning and reflection are believed to be greatest. To be maximally effective, debriefing should be performed by faculty members who have both expertise in the subject matter and a strong grasp of debriefing principles. Unfortunately, the debriefing portion of simulation exercises is often performed in a sub-par fashion because many simulation centres do not have access to trained debriefers. As a result, the overall experience of simulation training programmes is reduced, and the exercises have much less educational benefit to the learner. INNOVATION: This article outlines a novel use of videoconferencing technology for debriefing learners at remote locations, which we term teledebriefing. This can be accomplished in a cost-effective and straightforward manner using basic equipment: a smartphone and a television. Many simulation centres do not have access to trained debriefers IMPLICATIONS: Teledebriefing can create a mutually beneficial faculty instructor network between institutions. By connecting clinical educators from geographically distant areas or from specialties not available locally, learners are exposed to faculty that can provide content expertise and high-quality debriefing during simulation exercises. Evaluating the effectiveness and feasibility of teledebriefing is warranted.