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1.
Medicine (Baltimore) ; 100(14): e25424, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832143

RESUMEN

BACKGROUND: Insulin is an essential therapy for treating diabetes, but many patients lack standard insulin injection skills. PURPOSE: We developed a standard training procedure based on a new simulation tool. Then we conducted a study to investigate the effect of this standard training on the ability of diabetic patients to inject themselves with insulin. METHODS: After follow-up, a total of 120 patients with diabetes mellitus were included. These patients needed insulin therapy depending on their condition and had not previously learned insulin injection. We randomly divided them into the intervention group (60 cases) and the control group (60 cases). The control group was trained on insulin injection before being discharged according to the traditional method, and the intervention group was trained based on an improved simulation tool. All participants were trained as individuals or groups. Finally, we evaluated the learning effects of both groups. RESULTS: The time spent at the training stage in the intervention group was shorter than the control group. We found that after applying simulation devices to mimic operations, the learning time for patients was reduced.The first subcutaneous injection success rate was 73.33% in the intervention group, which was significantly higher than that in the control group by 46.67%. The score of the first subcutaneous injection and pre-discharge score in the test group was significantly higher than that of the control group. One month later, the score for injection skills in the 2 groups was higher than that before discharge, and the score in the trial group was still higher than that in the control group. The incidence of subcutaneous fat hyperplasia in the trial group was lower than that in the control group (3.3% vs 15%, P < .05). Moreover, the incidence of hypoglycemia (16.7% vs. 26.7%) was higher in the control group, but the difference was not statistically significant (P = .184). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: After applying simulation tools plus operating video and guideline as the standard procedure to train diabetic patients on insulin injection, all patients had a good grasp of using the insulin injection technique. This education method is safe, efficient, and worth promoting worldly.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Educación del Paciente como Asunto/métodos , Entrenamiento Simulado/métodos , Materiales de Enseñanza , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemiantes/uso terapéutico , Inyecciones Subcutáneas , Insulina/uso terapéutico , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Adulto Joven
3.
Fam Med ; 53(4): 282-284, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33887050

RESUMEN

BACKGROUND AND OBJECTIVES: On March 17, 2020, the Association of American Medical Colleges recommended temporary suspension of all medical student clinical activities due to the COVID-19 pandemic, which required a rapid development of alternatives to traditional teaching methods. This study examines education changes spurred by COVID-19. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance survey of family medicine clerkship directors. Participants answered questions about didactic and clinical changes made to clerkship teaching due to the COVID-19 pandemic, how positive the changes were, whether the changes would be made permanent, and how prepared clerkship directors were for the changes. RESULTS: The response rate was 64%. The most frequent change made to didactic teaching was increasing online resources. The most frequent change made to clinical teaching was adding clinical simulation. Greater changes were made to clinical teaching than to didactic teaching. Changes made to didactic teaching were perceived as more positive for student learning than the changes made to clinical teaching. Clerkship directors felt more prepared for changes to didactic teaching than for clinical teaching, and were more likely to make the didactic teaching changes permanent than the clinical teaching changes. CONCLUSIONS: The COVID-19 pandemic caused nearly all clerkship directors to make changes to clerkship teaching, but few felt prepared to make these changes, particularly changes to clinical teaching. Clerkship directors made fewer changes to didactic teaching than clinical teaching, however, didactic changes were perceived as more positive than clinical changes and were more likely to be adopted long term.


Asunto(s)
Prácticas Clínicas/métodos , Educación a Distancia/métodos , Educación de Pregrado en Medicina/métodos , Medicina Familiar y Comunitaria/educación , Entrenamiento Simulado/métodos , Control de Enfermedades Transmisibles , Humanos , Encuestas y Cuestionarios , Telemedicina/métodos
5.
Medicine (Baltimore) ; 100(13): e24819, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787576

RESUMEN

BACKGROUND: Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools. OBJECTIVE: to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school. METHODS: 62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport. RESULTS: The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles. CONCLUSIONS: 11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.


Asunto(s)
Reanimación Cardiopulmonar/educación , Entrenamiento Simulado/métodos , Estudiantes/estadística & datos numéricos , Niño , Desfibriladores , Evaluación Educacional , Femenino , Humanos , Masculino , Maniquíes , Evaluación de Programas y Proyectos de Salud , Servicios de Enfermería Escolar , España , Factores de Tiempo
6.
Arthroscopy ; 37(3): 1008-1010, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673956

RESUMEN

Simulation-based training has been widely adopted by surgical educators and is now an essential component of the modern resident's skills acquisition pathway and career progression. The challenges faced by residents because of lack of exposure as a result of working-time directives-and now the COVID-19 (coronavirus disease 2019) pandemic limiting nonurgent and elective operating-reinforce the need for evidence-based simulation training. Although a wide range of training platforms have been developed, very few have shown transfer of skills. Simulation is thought to enhance the initial phase of the procedural learning curve; however, this hypothesis is yet to be tested in a high-quality study. Nevertheless, in light of the current evidence, simulation-based procedural curricula should be developed using the strengths of multiple different training platforms while incorporating the essential concept of nontechnical skills.


Asunto(s)
Competencia Clínica , Curriculum , Internado y Residencia/métodos , Procedimientos Ortopédicos/educación , Entrenamiento Simulado/métodos , /epidemiología , Comorbilidad , Humanos , Pandemias
7.
MedEdPORTAL ; 17: 11114, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33768146

RESUMEN

Introduction: Given barriers to learner assessment in the authentic clinical environment, simulated patient encounters are gaining attention as a valuable opportunity for competency assessment across the health professions. Simulation-based assessments offer advantages over traditional methods by providing realistic clinical scenarios through which a range of technical, analytical, and communication skills can be demonstrated. However, simulation for the purpose of assessment represents a paradigm shift with unique challenges, including preservation of a safe learning environment, standardization across learners, and application of valid assessment tools. Our goal was to create an interactive workshop to equip educators with the knowledge and skills needed to conduct assessments in a simulated environment. Methods: Participants engaged in a 90-minute workshop with large-group facilitated discussions and small-group activities for practical skill development. Facilitators guided attendees through a simulated grading exercise followed by in-depth analysis of three types of assessment tools. Participants designed a comprehensive simulation-based assessment encounter, including selection or creation of an assessment tool. Results: We have led two iterations of this workshop, including an in-person format at an international conference and a virtual format at our institution during the COVID-19 pandemic, with a total of 93 participants. Survey responses indicated strong overall ratings and impactfulness of the workshop. Discussion: Our workshop provides a practical, evidence-based framework to guide educators in the development of a simulation-based assessment program, including optimization of the environment, design of the simulated case, and utilization of meaningful, valid assessment tools.


Asunto(s)
Competencia Clínica/normas , Toma de Decisiones Clínicas/métodos , Educación/organización & administración , Docentes/normas , Entrenamiento Simulado/métodos , /epidemiología , Curriculum , Educación Médica/métodos , Educación Médica/tendencias , Humanos , Educación Interprofesional/métodos , Educación Interprofesional/organización & administración , Medio Social , Enseñanza
8.
MedEdPORTAL ; 17: 11117, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33768149

RESUMEN

Introduction: Triggered by the COVID-19 pandemic, medical education has moved online, tasking medical educators with developing virtual learning experiences. This is particularly challenging for less-represented disciplines, such as ophthalmology. We designed a red eye clinical reasoning case for preclinical medical students, which can be delivered virtually, using video conference software. Methods: We developed a 90-minute red eye/clinical reasoning workshop for which prereading was assigned to students. We then delivered a virtual development session to nonophthalmologist copreceptors and provided a session faculty guide. The entire first-year medical student class (No. = 140) participated in one of four identical workshops, which included virtual small- and large-group discussions. Students completed a knowledge pre- and posttest, and an optional session postsurvey. Results: Knowledge gains from pretest (No. = 94) to posttest (No. = 73) were statistically significant (p < .05), with average scores improving from 57% to 70%. Overall, students were satisfied, rating the following items 4 or 5 out of 5: session (86%, No. = 31), virtual format (83%, No. = 30), and if they recommended future use (69%, No. = 35). Discussion: This novel, virtual clinical reasoning case simulated small- and large-group learning, achieved knowledge gains, and was well received by students. Minor technical challenges were encountered but successfully remedied, without apparent disruption to learning. This virtual medical education model can be used to enhance ophthalmology education in preclinical medical students and can be adapted for virtual design of other curricular content.


Asunto(s)
Educación a Distancia/métodos , Oftalmología/educación , Aprendizaje Basado en Problemas/métodos , Entrenamiento Simulado/métodos , /epidemiología , Competencia Clínica , Educación de Pregrado en Medicina , Oftalmopatías/diagnóstico , Humanos , Satisfacción Personal , Estudiantes de Medicina/psicología
9.
BMC Surg ; 21(1): 139, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33736639

RESUMEN

BACKGROUND: There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented. METHODS: Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups' performance over two sessions. RESULTS: Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices. CONCLUSION: This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.


Asunto(s)
Laparoscopía , Entrenamiento Simulado , Cirujanos , Competencia Clínica , Ingeniería , Humanos , Laparoscopía/educación , Entrenamiento Simulado/métodos , Cirujanos/educación
10.
J Nurs Educ ; 60(3): 172-176, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33657237

RESUMEN

BACKGROUND: The nature of a nurse's job is changing dramatically. Nurses are assuming expanded roles for a broad range of patients in community-based care. Nurse educators have a responsibility to teach nursing students about the needs of patients and families in the home care setting. METHOD: To describe how the creation of a home care video series and a medication reconciliation simulation scenario were used as a teaching strategy in a simulation center. RESULTS: The teaching strategy supported senior-level nursing students' understanding of the complexity of home care nursing and the nurse's role and responsibilities in care coordination, care transitions, and interprofessional practice. CONCLUSION: The home care video scenario was received favorably by nursing students. Additional simulation video scenarios are needed that address the health disparities among underrepresented and vulnerable groups. There is potential to offer the simulation in a virtual-online format during the COVID-19 pandemic and social distancing mandates. [J Nurs Educ. 2021;60(3):172-176.].


Asunto(s)
Difusión de Innovaciones , Educación en Enfermería/organización & administración , Cuidados de Enfermería en el Hogar/educación , Entrenamiento Simulado/métodos , Educación a Distancia , Humanos , Aprendizaje , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Estudiantes de Enfermería/psicología , Estados Unidos/epidemiología , Grabación de Cinta de Video
11.
Med Educ Online ; 26(1): 1892017, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33602053

RESUMEN

Introduction: Telesimulation may allow simulationists to continue with essential simulation-based training programs during the COVID-19 pandemic. Hence, we investigated the feasibility of telesimulation for neonatal resuscitation training, assessed participants' attitudes towards telesimulation as well as its effect on neonatal resuscitation knowledge, and compared results between medical students and neonatal nurses. Methods: For this prospective observational pilot study, medical students and neonatal nursing staff were recruited on a voluntary basis. Pre- and post-training knowledge was assessed using a 20-question questionnaire. Following the educational intervention, participants further answered a six-item questionnaire on their perception of telesimulation. For the telesimulation session, participants received a simulation package including a low-fidelity mannequin and medical equipment. The one-hour telesimulation session was delivered by an experienced instructor and broadcasted via Cisco Webex for groups of 2-3 participants, covering all elements of the neonatal resuscitation algorithm and including deliberate technical skills practice. Results: Nine medical students and nine neonatal nurses participated in a total of seven telesimulation sessions. In general, participants enjoyed the telesimulation session, acknowledged a positive learning effect and found telesimulation suitable for neonatal resuscitation training, but were critical of potential technical issues, training logistics, and the quality of supervision and feedback. Neonatal resuscitation knowledge scores increased significantly after the educational intervention both for medical students and nurses. Conclusions: Telesimulation is feasible for neonatal resuscitation training and associated with significant improvements in knowledge of current resuscitation guidelines, without differences between medical students and neonatal nurses.


Asunto(s)
/epidemiología , Resucitación/educación , Entrenamiento Simulado/métodos , Estudiantes de Medicina/psicología , Estudiantes de Enfermería/psicología , Telemedicina/métodos , Adulto , Actitud del Personal de Salud , Competencia Clínica , Femenino , Humanos , Recién Nacido , Aprendizaje , Masculino , Pandemias , Proyectos Piloto , Estudios Prospectivos , Encuestas y Cuestionarios
12.
Medicine (Baltimore) ; 100(6): e24666, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578597

RESUMEN

BACKGROUND: Cardiopulmonary resuscitation (CPR) performance depends on individual ability and training. Well-trained or professional rescuers can maintain high-quality CPR for longer than laypeople. This study aimed to examine the effects of reducing resting intervals on CPR performance, physiological parameters, and hemodynamic parameters during prolonged CPR in well-trained providers. METHODS: The study enrolled 90 volunteers from the paramedic students of our institution. They were randomly divided into 3 groups: 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds rest groups. Each participant performed 5 cycles of chest compression only CPR (2 min/cycle) with different resting intervals according to grouping. CPR quality, physiological variations, and hemodynamic variations were measured for each cycle and compared across the groups. RESULTS: Of the 90 volunteers, 79 well-trained providers were finally included. The variation of the average chest compression depth across the 5 cycles showed significant differences between the 3 groups: from cycle 1 to 2: 1.2 (3.1) mm, -0.8 (2.0) mm, and -2.0 (3.0) mm in the 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds groups, respectively (P < .001); from cycle 1 to 3: 0.0 (3.0) mm, -0.7 (3.2) mm, and -2.6 (3.9) mm, respectively (P = .030). However, all 3 groups maintained the recommended rate and chest compression depth for all 5 cycles. Physiological and hemodynamic parameters showed no significant differences between the groups. CONCLUSIONS: Well-trained providers were able to maintain high-quality CPR despite reducing rest intervals. Adjusting the rest interval may help maintain overall CPR quality in special situations or where layperson rescuers are involved.


Asunto(s)
Reanimación Cardiopulmonar/educación , Hemodinámica/fisiología , Calidad de la Atención de Salud/estadística & datos numéricos , Descanso/fisiología , Técnicos Medios en Salud/educación , Técnicos Medios en Salud/estadística & datos numéricos , Reanimación Cardiopulmonar/estadística & datos numéricos , Oscilación de la Pared Torácica/estadística & datos numéricos , Oscilación de la Pared Torácica/tendencias , Auxiliares de Urgencia/educación , Auxiliares de Urgencia/estadística & datos numéricos , Fatiga , Femenino , Humanos , Masculino , Fenómenos Fisiológicos/fisiología , Estudios Prospectivos , Entrenamiento Simulado/métodos , Estudiantes , Factores de Tiempo , Adulto Joven
13.
PLoS One ; 16(1): e0244915, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33439895

RESUMEN

BACKGROUND: Technical proficiency of the operating surgeons is one of the most important factors in the safe performance of pancreaticoduodenectomy. The objective of the present study was to investigate whether surgical simulation of pancreatico-jejunostomy (PJ) using an inanimate biotissue model could improve the technical proficiency of hepato-biliary pancreatic (HBP) surgical fellows. METHODS: The biotissue drill consisted of sewing biotissues to simulate PJ. The drill was repeated a total of five times by each of the participant surgical fellows. The improvement of the surgical fellows' technical proficiency was evaluated by the supervisor surgeons using the Objective Structured Assessment of Technical Skills (OSATS) scale. RESULTS: Eight HBP surgical fellows completed all the 5 drills. Both the OSATS 25 score and OSATS summary score, assessed by the two supervisor surgeons, improved steadily with repeated execution of the PJ drill. The average OSATS score, as assessed by both the supervisor surgeons, improved significantly from the first to the final drill, with a P value of 0.003 and 0.014 for the assessment by the two surgeons, respectively. On the other hand, no chronological alteration was observed in time of procedure (P = 0.788). CONCLUSION: Repeated execution of a biotissue PJ drill improved the HBP surgical fellows' technical proficiency, as evaluated by OSATS. The present study lends support to the evidence that simulation training can contribute to shortening of the time required to negotiate the learning curve for the technique of PJ in the actual operating room.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Internado y Residencia , Páncreas/cirugía , Pancreatoyeyunostomía/educación , Entrenamiento Simulado/métodos , Cirujanos/educación , Humanos
14.
Br J Anaesth ; 126(4): 854-861, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33422288

RESUMEN

BACKGROUND: Positive communication behaviour within anaesthesia teams may decrease stress response and improve clinical performance. We aimed to evaluate the effect of positive communication during medical handover on the subsequent team-based clinical performance in a simulated critical situation. We also assessed the effect of positive communication behaviour on stress response. METHODS: This single-centre RCT involved anaesthesia teams composed of a resident and a nurse in a high-fidelity scenario of anaesthesia-related paediatric laryngospasm after a standardised handover. During the handover, similar information was provided to all teams, but positive communication behaviour was adopted only for teams in the intervention group. Primary outcome was team-based clinical performance, assessed by an independent blinded observer, using video recordings and a 0-to 100-point scenario-specific scoring tool. Three categories of tasks were considered: safety checks before the incision, diagnosis/treatment of laryngospasm, and crisis resource management/non-technical skills. Individual stress response was monitored by perceived level of stress and HR variability. RESULTS: The clinical performance of 64 anaesthesia professionals (grouped into 32 teams) was analysed. The mean (standard deviation) team-based performance score in the intervention group was 44 (10) points vs 35 (12) in the control group (difference: +8.4; CI95% [0.4-16.4]; P=0.04). The effects were homogeneous over the three categories of tasks. Perceived level of stress and HR variability were not significantly different between groups. CONCLUSIONS: Positive communication behaviour between healthcare professionals during medical handover improved team-based performance in a simulation-based critical situation. CLINICAL TRIAL REGISTRATION: NCT03375073.


Asunto(s)
Competencia Clínica/normas , Comunicación , Cuidados Críticos/normas , Personal de Salud/normas , Grupo de Atención al Paciente/normas , Pase de Guardia/normas , Entrenamiento Simulado/normas , Adulto , Cuidados Críticos/métodos , Femenino , Humanos , Masculino , Estudios Prospectivos , Entrenamiento Simulado/métodos
15.
J Laryngol Otol ; 135(2): 179-181, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33500010

RESUMEN

BACKGROUND: Simulation training has become a core component in the training of ENT surgeons. It provides the opportunity for the repetitive practice of a surgical technique. Simulators are broadly categorised into low- and high-fidelity simulators. A method using a home microprocessor to enhance a low-fidelity surgical simulator is introduced. METHOD: The Yorick tonsil tie trainer was enhanced using an Arduino microcontroller attached to the simulated inferior pole of the tonsil. The Arduino was coded to give a visual stimulus when linear motion exceeded parameters. The prototype simulator was tested to gain information on whether the enhancement could identify differences between novice and expert users. CONCLUSION: An enhanced low-fidelity tonsil trainer was produced using a low-cost, simple home microprocessing board. The enhanced simulator gives objective feedback allowing for self-directed learning. Further research is required to evaluate the benefits of these enhancements above non-enhanced simulation training.


Asunto(s)
Otorrinolaringólogos/educación , Tonsila Palatina/cirugía , Entrenamiento Simulado/métodos , Refuerzo Biomédico/métodos , Competencia Clínica/normas , Simulación por Computador , Retroalimentación , Humanos , Entrenamiento Simulado/economía , Entrenamiento Simulado/estadística & datos numéricos , Cirujanos/educación
16.
J Med Internet Res ; 22(12): e22420, 2020 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-33325836

RESUMEN

Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there has been a shift to practicing skills through simulations with mannequins or patient actors. Virtual reality (VR), and in particular, the use of 360-degree video and audio (cineVR), is the next-generation advancement in medical simulation that has novel applications to augment clinical skill practice, empathy building, and team training. In this paper, we describe methods to design and develop a cineVR medical education curriculum for trauma care training using real patient care scenarios at an urban, safety-net hospital and Level 1 trauma center. The purpose of this publication is to detail the process of finding a cineVR production partner; choosing the camera perspectives; maintaining patient, provider, and staff privacy; ensuring data security; executing the cineVR production process; and building the curriculum.


Asunto(s)
Simulación por Computador/normas , Educación Médica/métodos , Entrenamiento Simulado/métodos , Realidad Virtual , Humanos , Heridas y Traumatismos
17.
Cochrane Database Syst Rev ; 12: CD011545, 2020 12 16.
Artículo en Inglés | MEDLINE | ID: mdl-33325570

RESUMEN

BACKGROUND: Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care. OBJECTIVES: To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience. SEARCH METHODS: The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes. MAIN RESULTS: We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions). AUTHORS' CONCLUSIONS: Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.


Asunto(s)
Obstetricia/educación , Grupo de Atención al Paciente/organización & administración , Entrenamiento Simulado/métodos , Puntaje de Apgar , Sesgo , Cesárea/estadística & datos numéricos , Competencia Clínica , Intervalos de Confianza , Urgencias Médicas , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Errores Médicos/prevención & control , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Distocia de Hombros/epidemiología , Resultado del Tratamiento
18.
Educ Health (Abingdon) ; 33(2): 37-45, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33318452

RESUMEN

Background: Highly infectious but rare diseases require rapid dissemination of safety critical skills to health-care workers (HCWs). Simulation is an effective method of education; however, it requires competent instructors. We evaluated the efficacy of an internet-delivered train-the-trainer course to prepare HCWs to care for patients with Ebola virus disease (EVD). Methods: Twenty-four individuals without prior EVD training were recruited and divided into two groups. Group A included nine trainees taught by three experienced trainers with previous EVD training. Group B included 15 trainees taught by five novice trainers without previous EVD training who completed the train-the-trainer course. We compared the efficacy of the train-the-trainer course by examining subject performance, measured by time to complete 13 tasks and the proportion of steps per task flagged for critical errors and risky and positive actions. Trainees' confidence in their ability to safely care for EVD patients was compared with a self-reported survey after training. Results: Overall trainees' confidence in ability to safely care for EVD patients did not differ by group. Participants trained by the novice trainers were statistically significantly faster at waste bagging (P = 0.002), lab specimen bagging (P = 0.004), spill clean-up (P = 0.01), and the body bagging (P = 0.008) scenarios compared to those trained by experienced trainers. There were no significant differences in the completion time in the remaining nine training tasks. Participants trained by novice and experienced trainers did not differ significantly with regard to the proportion of steps in a task flagged for critical errors, risky actions, or positive actions with the exception of the task "Man Down in Gown" (12.5% of steps graded by experienced trainers compared to 0 graded by novice trainers, P = 0.007). Discussion: The online train-the-trainer EVD course is effective at teaching novices to train HCWs in protective measures and can be accomplished swiftly.


Asunto(s)
Personal de Salud/educación , Fiebre Hemorrágica Ebola/prevención & control , Entrenamiento Simulado/métodos , Femenino , Humanos , Control de Infecciones/métodos , Intervención basada en la Internet , Masculino , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud
19.
PLoS One ; 15(12): e0244816, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33382848

RESUMEN

Debriefing is essential for effective learning during simulation-based medical education. To assess the quality of debriefings, reliable and validated tools are necessary. One widely used validated tool is the Objective Structured Assessment of Debriefing (OSAD), which was originally developed in English. The aim of this study was to translate the OSAD into German, and to evaluate the reliability and validity of this German version (G-OSAD) according the 'Standards of Educational and Psychological Measurement'. In Phase 1, the validity evidence based on content was established by a multistage cross-cultural adaptation translation of the original English OSAD. Additionally, we collected expert input on the adequacy of the content of the G-OSAD to measure debriefing quality. In Phase 2, three trained raters assessed 57 video recorded debriefings to gather validity evidence based on internal structure. Interrater reliability, test-retest reliability, internal consistency, and composite reliability were examined. Finally, we assessed the internal structure by applying confirmatory factorial analysis. The expert input supported the adequacy of the content of the G-OSAD to measure debriefing quality. Interrater reliability (intraclass correlation coefficient) was excellent for the average ratings (three raters: ICC = 0.848; two raters: ICC = 0.790), and good for the single rater (ICC = 0.650). Test-retest reliability was excellent (ICC = 0.976), internal consistency was acceptable (Cronbach's α = 0.865), and composite reliability was excellent (ω = 0.93). Factor analyses supported the unidimensionality of the G-OSAD, which indicates that these G-OSAD ratings measure debriefing quality as intended. The G-OSAD shows good psychometric qualities to assess debriefing quality, which are comparable to the original OSAD. Thus, this G-OSAD is a tool that has the potential to optimise the quality of debriefings in German-speaking countries.


Asunto(s)
Educación Médica/métodos , Entrenamiento Simulado/métodos , Traducciones , Alemania , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
20.
Educ. med. (Ed. impr.) ; 21(6): 357-363, nov.-dic. 2020.
Artículo en Español | IBECS | ID: ibc-198372

RESUMEN

Los escenarios de simulación clínica han sido explorados en medicina y enfermería como estrategia de aprendizaje y han demostrado ser efectivos para la adquisición de competencias acercando a los estudiantes a su práctica clínica real. En fisioterapia, su utilización ha sido recientemente incluida y aún no se ha documentado su potencial como estrategia de fortalecimiento curricular. Este trabajo buscó revisar en la literatura el empleo de la simulación clínica como estrategia pedagógica para la fisioterapia. Para ello, se desarrolló un proceso integrativo con base en el análisis de competencias transversales o específicas. Sus resultados señalan que la simulación mejora la calidad y competencia del fisioterapeuta en formación; el dominio donde más se usa la simulación es el cardiovascular pulmonar, seguido del musculoesquelético. Sin embargo, en fisioterapia se requiere incrementar el uso de simulación en todos los dominios para poder cualificar aún más la formación


Clinical simulation scenarios have been explored in medicine and nursing as a learning strategy. They have shown to be effective for the acquisition of skills, bringing students closer to their actual clinical practice. Its use has recently been included in physiotherapy, but its potential as a curriculum strengthening strategy has not yet been documented. This work aims to carry out a review of the literature on the use of clinical simulation as a pedagogical strategy for physiotherapy. To do this, an integrated process was developed, based on the analysis of cross-sectional or specific skills. The results indicate that simulation improves the quality and skills of the physiotherapist in training. The domain where the simulation is most used is pulmonary cardiovascular, followed by the musculoskeletal system. However, in physiotherapy it is necessary to increase the use of simulation in all domains in order to qualify the training even more


Asunto(s)
Humanos , Entrenamiento Simulado/métodos , Medicina Física y Rehabilitación/educación , Enseñanza Mediante Simulación de Alta Fidelidad/métodos , Enseñanza Mediante Simulación de Alta Fidelidad/tendencias , Competencia Clínica
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