Artificial Intelligence and the Simulationists.

SUMMARY STATEMENT: The recent introduction of ChatGPT, an advanced, easy-to-use, and freely available artificial intelligence (AI) program, created new possibilities across many industries and professions including healthcare simulation. ChatGPT has the potential to streamline healthcare simulation-based education while also providing insights for the scenario development process that conventional case development may miss. However, there are issues related to accuracy, relevance, and structure of the products produced by the ChatGPT AI program. This article examines 2 AI-generated simulation case examples highlighting strengths and weaknesses while providing guidance on the use of ChatGPT as a simulation resource.

Redefining Health-Care Simulation Facilitator Professional Development Through Online Learning.

Competition for nursing clinical sites has intensified as universities have increased enrollment to meet the growing demand for nurses. Hospital mandates have reduced opportunities for nursing students to practice clinical skills, leading nursing programs to use simulation to help learners gain the knowledge, skills, and attitudes needed for transition to clinical practice. Simulation offers a safe learning environment and a guarantee that every student will have experience with critical clinical encounters. To be effective, health-care simulation must be facilitated by trained educators knowledgeable in simulation pedagogy, including theory-based simulation frameworks and debriefing models. Training simulation facilitators is often challenged by financial and time constraints. The need for an easily accessible, asynchronous, cost-effective method of providing foundational simulation training led a group of experienced simulationists to develop a series of seven online educational modules grounded in simulation best practices.

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.

Rapid-cycle deliberate practice: death notification.

BACKGROUND: Death notification can be challenging for emergency medicine physicians, who have no prior established relationship with the patient or their families. The GRIEV_ING death notification curriculum was developed to facilitate the delivery of the bad news of a patient's death and has been shown to improve learners' confidence and competence in death notification. Rapid-cycle deliberate practice (RCDP), a facilitator-guided, within-event debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment. The aim of this study was to identify whether the use of this technique is an effective method of teaching the GRIEV_ING curriculum, as demonstrated by learners' improved confidence, cognitive knowledge and performance. Rapid-cycle deliberate practice (RCDP), a facilitator-guided within-event, debriefing technique, has demonstrated an improvement in learners' skills in a safe learning environment METHODS: A 4-hour pilot curriculum was developed to educate and assess residents on the delivery of death notification. The curriculum consisted of a pre-intervention evaluation, the intervention phase, and a post-intervention evaluation. The cognitive test, critical action checklist, and self-efficacy/confidence surveys were identical for both pre- and post-intervention evaluations. A Wilcoxon rank-sum test was used to evaluate differences in scores between pre- and post-intervention groups. RESULTS: Twenty-two emergency medicine residents participated in the study. We observed an increase in median self-efficacy scores (4.0 [4.0-5.0], p ≤ 0.0001), multiple-choice GRIEV_ING scores (90.0 [80.0-90.0], p ≤ 0.0001) and performance scores for death notification (48.5 [47.0-53.0], p = 0.0303). DISCUSSION: The RCDP approach was found to be an effective method to train emergency medicine residents in the delivery of the GRIEV_ING death notification curriculum. This approach is actionable with few resources except for content experts trained in RCDP methodology and the application of the GRIEV_ING mnemonic.

Interprofessional Simulation: From the Classroom to Clinical Practice.

Interprofessional simulation (IPS), frequently referred to in the literature as simulation-enhanced interprofessional education (IPE), has been widely studied in nursing and medical education. For decades, the literature has suggested IPE as a valuable strategy for enhancing communication and collaboration among health professionals. Interprofessional collaborative practice (IPCP) is foundational to developing high-functioning healthcare teams and can lead to reduced medical errors and increased patient safety. This chapter addresses IPS from both the academic and practice perspectives. The foundations of IPE and IPCP are reviewed, as well as the standards of best practice in simulation. Planning, development, and implementation will be discussed, including benefits, barriers, and possible solutions. Recommendations from relevant research on debriefing and evaluation of IPS are also reviewed. Outcomes from the growing body of research on IPS will be presented and include perceptions of interprofessional practice, better understanding of professional roles and responsibilities, development of communication and teamwork skills, and shared problem-solving and decision-making. Future implications and recommendations are provided based on the state of the science on IPS. Optimum design, implementation, and evaluation of IPS, along with a thorough understanding of the benefits, barriers, and opportunities, can help faculty and clinical educators prepare a collaborative healthcare workforce and reduce medical errors to ultimately improve patient outcomes.

Interprofessional Educator Development Course for Simulation.

As interprofessional teams and interprofessional practice become the norm in health care, there is an increasing need for interprofessional educator development to prepare health care students and staff for these new roles. This article describes the development, implementation, and results of an Interprofessional Educator Development Course (IPEDC) for simulation that was created to train clinical educators, practicing professionals, and academic faculty from all health care professions in simulation methodology. The authors, working across disciplines and professions, describe the benefits, limitations, and outcomes of this approach and explain how they met the needs of the involved stakeholders. [J Contin Educ Nurs. 2019;50(10):463-468.].

RX-3117 (fluorocyclopentenyl cytosine): a novel specific antimetabolite for selective cancer treatment.

INTRODUCTION: RX-3117 is an oral, small molecule cytidine analog anticancer agent with an improved pharmacological profile relative to gemcitabine and other nucleoside analogs. The agent has excellent activity against various cancer cell lines and xenografts including gemcitabine-resistant variants and it has excellent oral bioavailability; it is not a substrate for the degradation enzyme cytidine deaminase. RX-3117 is being evaluated at a daily oral schedule of 700 mg (5 days/week for 3 weeks) which results in plasma levels in the micromolar range that have been shown to be cytotoxic to cancer cells. It has shown clinical activity in refractory bladder cancer and pancreatic cancer. Areas covered: The review provides an overview of the relevant market and describes the mechanism of action, main pharmacokinetic/pharmacodynamic features and clinical development of this investigational small molecule. Expert opinion: RX-3117 is selectively activated by uridine-cytidine kinase 2 (UCK2), which is expressed only in tumors and has a dual mechanism of action: DNA damage and inhibition of DNA methyltransferase 1 (DNMT1). Because of its tumor selective activation, novel mechanism of action, excellent oral bioavailability and candidate biomarkers for patient selection, RX-3117 has the potential to replace gemcitabine in the treatment of a spectrum of cancer types.

Debriefing Interprofessionally: A Tool for Recognition and Reflection.

As the health care environment increases in complexity and patient acuity rises, health profession graduates need to be prepared to work collaboratively to improve patient outcomes. The interprofessional debriefing tool (Debriefing Interprofessionally: Recognition & Reflection) presented in this article allows any simulation to be transformed into an interprofessional learning opportunity. The debriefing tool frames questions for both uniprofessional and multiprofessional simulation and is aligned with the Core Competencies for Interprofessional Collaborative Practice and with Quality and Safety Education for Nurses.

An Innovative Role for Nursing Students Within a Student-Run Free Clinic.

Historically, the majority of nurses have been employed by hospitals. However, the changing landscape of health care has seen a shift to other areas of practice. Nursing graduates must be prepared to work collaboratively with a shared vision that is patientcentered and team-oriented. To better prepare students for collaborative practice, a School of Nursing developed a course for senior level nursing students that included a clinical experience within a student-run free clinic. Nursing students were able to enhance clinic services by providing health screening, patient navigation, patient education, health coaching, and patient follow-up.

TeamSTEPPS Virtual Teams: Interactive Virtual Team Training and Practice for Health Professional Learners.

Medical errors because of communication failure are common in health care settings. Teamwork training, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), improves team performance and patient outcomes. Academic institutions seek high-quality, low-cost curricula for interprofessional education (IPE) to prepare learners for clinical experiences before and after graduation; however, most IPE curricula involve lectures, simple tabletop exercises, and in-person simulations and are not readily accessible to geographically distributed and asynchronously engaged learners. To address this need, interprofessional faculty from multiple institutions and specialties created a series of eight screen-based interactive virtual simulation cases featuring typical clinical situations, with the goal of preparing learners to provide safe and effective care in clinical teams. Virtual simulations permit flexible, asynchronous learning on the learner's schedule and allow educators an opportunity to identify gaps in knowledge and/or attitudes that can be addressed during class or forum discussions. In 2016, 1,128 unique users accessed the scenarios. As a result of such virtual activities, learner selection of the appropriate TeamSTEPPS tool increased with progression through the scenarios.

Tips for Conducting the Pre-Brief for a Simulation.

The pre-brief is an important part of a simulation. It offers participants an orientation to the simulation environment and enables them to reach the intended goals and objectives of the learning activity. This article describes the components of the pre-brief and provides practical tips on how to conduct this step using a simulation. These teaching strategies will help provide a positive learning experience for participants. J Contin Educ Nurs. 2016;47(8):353-355.