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1.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 98-107, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31256010

RESUMEN

BACKGROUND: Neonatal healthcare professionals require frequent simulation-based education (SBE) to improve their cognitive, psychomotor and communication skills during neonatal resuscitation. However, current SBE approaches are resource-intensive and not routinely offered in all healthcare facilities. Serious games (board and computer based) may be effective and more accessible alternatives. OBJECTIVE: To review the current literature about serious games, and how these games might improve knowledge retention and skills in neonatal healthcare professionals. METHOD: Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science and EMBASE databases were performed to identify studies examining serious games in neonatology. All games, such as board games, tabletop games, video games, screen-based simulators, tabletop simulators and virtual reality games were included. RESULTS: Twelve serious games were included in this review (four board games, five video games and three virtual reality games). Overall, knowledge improvement was reported for the RETAIN (REsuscitationTrAINing for healthcare professionals) board game (10% increase in knowledge retention) and The Neonatology Game (4.15 points higher test score compared with control). Serious games are increasingly incorporated into Nursing and Medical School Curriculums to reinforce theoretical and practical learning. CONCLUSIONS: Serious games have the potential to improve healthcare professionals' knowledge, skills and adherence to the resuscitation algorithm and could enhance access to SBE in resource-intensive and resource-limited areas. Future research should examine important clinical outcomes in newborn infants.


Asunto(s)
Juegos Recreacionales , Resucitación/educación , Entrenamiento Simulado/métodos , Juegos de Video , Realidad Virtual , Humanos , Recién Nacido
2.
West J Emerg Med ; 20(5): 731-739, 2019 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-31539330

RESUMEN

INTRODUCTION: In 2012, Botswana embarked on an organized public approach to prehospital medicine. One goal of the Ministry of Health (MOH) was to improve provider education regarding patient stabilization and resuscitation. Simulation-based instruction is an effective educational strategy particularly for high-risk, low-frequency events. In collaboration with partners in the United States, the team created a short, simulation-based course to teach and update prehospital providers on common field responses in this resource-limited setting. The objective of this study was to evaluate an educational program for Botswanan prehospital providers via written and simulation-based examinations. METHODS: We developed a two-day course based on a formal needs assessment and MOH leadership input. The subject matter of the simulation scenarios represented common calls to the prehospital system in Botswana. Didactic lectures and facilitated skills training were conducted by U.S. practitioners who also served as instructors for a rapid-cycle, deliberate practice simulation education model and simulation-based testing scenarios. Three courses, held in three cities in Botswana, were offered to off-duty MOH prehospital providers, and the participants were evaluated using written multiple-choice tests, videotaped traditional simulation scenarios, and self-efficacy surveys. RESULTS: Collectively, 31 prehospital providers participated in the three courses. The mean scores on the written pretest were 67% (standard deviation [SD], 10) and 85% (SD, 7) on the post-test (p < 0.001). The mean scores for the simulation were 42% (SD, 14.2) on the pretest and 75% (SD, 11.3) on the post-test (p < 0.001). Moreover, the intraclass correlation coefficient scores between reviewers were highly correlated at 0.64 for single measures and 0.78 for average measures (p < 0.001 for both). Twenty-one participants (68%) considered the course "extremely useful." CONCLUSION: Botswanan prehospital providers who participated in this course significantly improved in both written and simulation-based performance testing. General feedback from the participants indicated that the simulation scenarios were the most useful and enjoyable aspects of the course. These results suggest that this curriculum can be a useful educational tool for teaching and reinforcing prehospital care concepts in Botswana and may be adapted for use in other resource-limited settings.


Asunto(s)
Curriculum , Servicios Médicos de Urgencia , Personal de Salud/educación , Modelos Educacionales , Resucitación/educación , Entrenamiento Simulado/métodos , Adulto , Botswana , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
3.
Indian Pediatr ; 56(5): 369-373, 2019 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-31102378

RESUMEN

OBJECTIVE: To document the impact of neonatal resuscitation capacity building of birth attendants at district and sub-district level on fresh stillbirth within the public health system in India. DESIGN: An implementation research using pre-post study design. SETTING: 3 high-infant and neonatal mortality districts (Gonda, Aligarh and Raebareli) of Uttar Pradesh, India. PARTICIPANTS: Pregnant women who delivered at the health facilities and their newborns. INTERVENTIONS: An intervention package with (i) training on essential newborn care resuscitation; (ii) skill laboratories establishment for peer-interactive learning; (iii) better documentation; and (iv) supportive supervision was implemented at all health facilities in the districts. MAIN OUTCOME MEASURES: Impact on fresh stillbirth rates and resuscitation practices were documented at 42 health facilities (Gonda-17, Aligarh-8 and Raebareli-17) over 12-18 months. RESULTS: Out of the 3.3% (4431/133627) newborns requiring resuscitation, 58.5% (n=2599) were completely revived, 19% (n=842) had some features of hypoxic insult after birth and 1.4% (n=62) were stillbirths. There was 15.6% reduction in still birth rate in the three districts with the intervention package. CONCLUSIONS: The reduction in still birth rate and improvement in newborn resuscitation efforts in the three districts indicated feasibility of implementation and scalability of the intervention package. However sustenance of the impact over longer period needs documentation.


Asunto(s)
Creación de Capacidad , Educación Médica Continua/métodos , Educación Continua en Enfermería/métodos , Hospitales de Distrito , Partería/educación , Resucitación/educación , Mortinato/epidemiología , Educación Médica Continua/organización & administración , Educación Continua en Enfermería/organización & administración , Estudios de Factibilidad , Femenino , Humanos , India/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Embarazo
4.
BMC Med Educ ; 19(1): 161, 2019 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-31113417

RESUMEN

BACKGROUND: A prompt start to an appropriate neonatal and paediatric resuscitation is critical to reduce mortality and morbidity. However, residents are rarely exposed to real emergency situations. Simulation-based medical training (SBMT) offers the opportunity to improve medical and non-technical skills in a controlled setting. This survey describes the availability and current use of SBMT by paediatric residents in Italy with the purpose of understanding residents' expectations regarding neonatal and paediatric emergency training, and identifying gaps and potential areas for future implementation. METHODS: A survey was developed and distributed to Italian residents. SBMT was defined as any kind of training with a mannequin in a contextualised clinically realistic scenario. RESULTS: The response rate was 14.4%, covering the 71% of Italian paediatric residency programmes. Among them, 88% stated that Out of the 274 residents, 88% stated that they received less than 5 h of SBMT during the past training year, with 66% not participating in any kind of simulation activity. In 62% of the programmes no simulation training facility was available to residents. Among those who received SBMT, 46% used it for procedures and skills, 30% for clinical scenarios, but only 24% of them reported a regular use for debriefing. Of the overall respondents, 93% were interested in receiving SBMT to improve decision-making abilities in complex medical situations, to improve technical/procedural skills, and to improve overall competency in neonatal and paediatric emergencies, including non-technical skills. The main barriers to the implementation of SBMT programmes in Italian paediatric residencies were: the lack of experts (57%), the lack of support from the school director (56%), the lack of organisation in planning simulation centre courses (42%) and the lack of teaching materials (42%). CONCLUSIONS: This survey shows the scarce use of SBMT during paediatric training programmes in Italy and points out the main limitations to its diffusion. This is a call to action to develop organised SBMT during paediatric residency programs, to train qualified personnel, and to improve the quality of education and care in this field.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Internado y Residencia , Resucitación/educación , Entrenamiento Simulado , Niño , Curriculum , Evaluación Educacional , Urgencias Médicas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Italia , Maniquíes , Evaluación de Programas y Proyectos de Salud
5.
Mil Med ; 184(Suppl 1): 326-328, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30901409

RESUMEN

With damage control surgery and resuscitation teams, the military is bringing surgical as well as intensive care far forward to areas where mass casualty events are an ever-present threat. One procedure that the team is required to be proficient in is arterial line insertion and transducing. To our knowledge, there are no previously described field arterial line simulation models. We present an arterial line insertion and transducer simulator created using medium resistance Thera-band tubing, saline, Coban, and a SAM splint. Ten deployed members of a damage control surgical team received 30 minutes of instruction on how to properly insert an arterial line and how to set up the transducer equipment. All participants were able to show proficiency in radial artery line insertion and transducer setup despite 8 of the 10 participants having never inserted or setup an arterial line. We describe, to our knowledge, the first arterial line insertion and transducing model utilizing only items found in the deployed environment. This model can be easily made and utilized to train medical personnel of all skill levels to augment the capabilities of medical units in areas where mass casualty events are likely.


Asunto(s)
Cateterismo/métodos , Simulación de Paciente , Resucitación/educación , Dispositivos de Acceso Vascular/normas , Cateterismo/normas , Competencia Clínica/normas , Humanos , Medicina Militar/educación
6.
Mil Med ; 184(Suppl 1): 347-360, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30901425

RESUMEN

Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users' skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.


Asunto(s)
Evaluación Educacional/métodos , Hemorragia/terapia , Enseñanza/normas , Torniquetes , Socorristas/educación , Socorristas/estadística & datos numéricos , Diseño de Equipo/normas , Humanos , Medicina Militar/educación , Resucitación/educación , Resucitación/métodos , Entrenamiento Simulado/métodos , Enseñanza/tendencias
7.
West J Emerg Med ; 20(2): 228-231, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30881540

RESUMEN

Video review for quality and education purposes has been a valued tool for decades. However, the use of this process dropped significantly after the development of the Health Insurance Portability and Accountability Act in the 1990s. Video review was recently reestablished at our institution. By working with our institutional legal counsel and risk management team, we have been able to create a video review process that complies with legal requirements. Literature on this subject has not described the process of obtaining video recordings. We aimed to review the process of obtaining high quality recordings in a secure manner. We hope that in the future, the data collected through our multidisciplinary review process will be helpful in improving quality of care for injured patients and providing coaching and feedback to learners, as well as improving our trauma education curriculum.


Asunto(s)
Resucitación/normas , Grabación en Video , Heridas y Traumatismos/terapia , Humanos , Grupo de Atención al Paciente/normas , Mejoramiento de la Calidad , Resucitación/educación , Gestión de Riesgos , Traumatología/educación
8.
Simul Healthc ; 14(3): 146-156, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30817560

RESUMEN

INTRODUCTION: Despite standardized neonatal resuscitation program (NRP) training, retention and adherence to the NRP algorithm remain a challenge. Cognitive aids can potentially improve acquisition and application of NRP knowledge and skills. The objective of this study was to determine whether an interactive mobile application providing audiovisual prompts, NRP Prompt, can help novice NRP providers learn the NRP algorithm more effectively and therefore improve their NRP performance. METHODS: First- and second-year residents from family medicine and obstetrics and gynecology attending NRP training were randomized into intervention and control groups. Resident pairs used standard visual aids with NRP Prompt (intervention) or visual aids only (control) in two simulated neonatal resuscitation training sessions with each resident taking turns as a team leader. Pairs were then evaluated in a third simulation that was video recorded, where neither group used cognitive aids. The primary outcome was comparing resuscitation performance. Secondary outcomes included the following: times to positive-pressure ventilation, intubation, and chest compressions. RESULTS: Thirty-nine residents participated, of which 18 received the intervention. Neonatal resuscitation program performance scores did not significantly differ (P = 0.69). Wilcoxon rank-sum tests showed no significant differences in secondary outcomes of times to positive-pressure ventilation (P = 0.43), intubation (P = 0.44), or chest compressions (P = 0.35). CONCLUSIONS: Training using NRP Prompt did not improve performance scores in simulated neonatal resuscitations immediately after training. Potential reasons include voice prompts in their current format being distracting and lack of customizability to user preferences. Future development of prompting applications should apply a user-centered design approach to optimize the ability to meet end-user needs.


Asunto(s)
Recursos Audiovisuales , Competencia Clínica/normas , Protocolos Clínicos/normas , Aplicaciones Móviles , Resucitación/educación , Algoritmos , Canadá , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Internado y Residencia/métodos , Masculino , Proyectos Piloto , Entrenamiento Simulado , Método Simple Ciego
9.
BMC Med Educ ; 19(1): 40, 2019 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-30700296

RESUMEN

BACKGROUND: The 5-item non-technical skills scale for trauma (T-NOTECHS) with five response categories is developed to assess non-technical skills in trauma team resuscitations. This validated instrument assesses behavioral aspects in teamwork. Outcome instruments should undergo a robust adaptation process followed by psychometric validation to maintain their measurement properties when translated into different languages. The translatability of the T-NOTECHS into a non-Anglo-Saxon language has not been thus far unraveled. The authors aimed to assess whether the T-NOTECHS would be translatable into a non-Anglo-Saxon language and to investigate its psychometric properties for simulated multi-professional trauma team resuscitations. METHODS: The T-NOTECHS (scores: 1 = poor; 5 = excellent) was translated and cross-culturally adapted into Finnish. Data was derived from 61 real hospital trauma team resuscitation simulations with 193 multi-professional participants. Floor-ceiling effects, internal consistency, and inter-rater reliability were analyzed. An exploratory factor analysis was conducted to test construct validity. RESULTS: After pre-testing, minor changes were made to the Finnish translation of the T-NOTECHS. Mean scores of two raters were 3.76 and 4.01, respectively. The T-NOTECHS instrument showed no floor-effect either in single items or in the total score. The total score of the T-NOTECHS instrument showed a percentage of maximum scores of 1.6 and 4.9% by the Raters 1 and 2, respectively. Internal consistency (Cronbach's alpha) was 0.70 with inter-item correlation of 0.54. The intraclass correlation coefficient was 0.54 and coefficient of repeatability 1.53. The T-NOTECHS loaded on one factor. CONCLUSIONS: The T-NOTECHS translated well into a difficult non-Anglo-Saxon language. The rigorous adaptation process used here can be recommended in the translation of observational performance assessment instruments. The translated version demonstrated fair reliability and good construct validity for assessing team performance in simulated multi-professional trauma team resuscitations. The translated T-NOTECHS instrument can be used to assess the efficacy of simulated in-situ trauma team resuscitations allowing benchmarking and international collaboration.


Asunto(s)
Grupo de Atención al Paciente , Resucitación/educación , Traducción , Heridas y Traumatismos/terapia , Educación Médica Continua , Análisis Factorial , Finlandia , Humanos , Lenguaje , Psicometría , Reproducibilidad de los Resultados , Traducciones
10.
Med Educ Online ; 24(1): 1581521, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30811308

RESUMEN

Multiprofessional ward healthcare providers are generally unprepared to assemble and engage in the initial resuscitation of pediatric inpatients. This is important as the performance of these first-responders, in the several minutes prior to the arrival of acute care support, may have significant effects on overall patient outcome. Accordingly, we aimed to develop and pilot a training program intended for non-acute care inpatient providers, relevant to their working context. Using the latest theory and evidence in medical education, we created an interprofessional, entirely in-situ, simulation-based small-group activity. The activity was then piloted for four months with the goals of assessing perceived usefulness, as well as implementation factors such as participant accessibility and overall resource requirements. A total of 37 interprofessional (physician and nursing) staff were trained in 16 small group sessions over four months. Post-participation questionnaires revealed that the activity was perceived to be highly useful for their practice; especially the rapid cycle deliberate practice instructional method, and the increased focus on crisis resource management. Resource requirements were comparable to, and perhaps less than, existing acute care training programs. This project describes the preliminary steps taken in creating a curriculum intended to improve interprofessional resuscitation performance across an institution.


Asunto(s)
Educación Médica/organización & administración , Educación en Enfermería/organización & administración , Relaciones Interprofesionales , Pediatría/educación , Resucitación/educación , Niño , Competencia Clínica , Curriculum , Humanos , Grupo de Atención al Paciente/organización & administración , Proyectos Piloto , Desarrollo de Programa
11.
Arch Dis Child Fetal Neonatal Ed ; 104(6): F582-F586, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30636691

RESUMEN

OBJECTIVE: The International Liaison Committee on Resuscitation has found that there is a need for high-quality randomised trials of training interventions that improve the effectiveness of resuscitation skills. The objective of this study was to determine whether using a respiratory function monitor (RFM) during mask ventilation training with a manikin reduces facemask leak. DESIGN: Stratified, parallel-group, randomised controlled trial. Outcome assessors were blinded to group allocation. SETTING: Thirteen hospitals in Australia, including non-tertiary sites. PARTICIPANTS: Consecutive sample of healthcare professionals attending a structured newborn resuscitation training course. INTERVENTIONS: An RFM providing real-time, objective, leak, flow and volume information was attached to the facemask during 1.5 hours of newborn ventilation and simulation training using a manikin. Participants were randomised to have the RFM display visible (intervention) or masked (control), using a computer-generated randomisation sequence. MAIN OUTCOME MEASURES: The primary outcome was facemask leak measured after neonatal facemask ventilation training. Tidal volume was an important secondary outcome measure. RESULTS: Participants were recruited from May 2016 to November 2017. Of 402 eligible participants, two refused consent. Four hundred were randomised, 200 to each group, of whom 194 in each group underwent analysis. The median (IQR) facemask leak was 23% (8%-41%) in the RFM visible group compared with 35% (14%-67%) in the masked group, p<0.0001, difference (95% CI) in medians 12 (4 to 22). CONCLUSIONS: The display of information from an RFM improved the effectiveness of newborn facemask ventilation training. TRIAL REGISTRATION NUMBER: ACTRN12616000542493, pre-results.


Asunto(s)
Personal de Salud/educación , Máscaras , Ventilación no Invasiva/métodos , Resucitación/educación , Resucitación/métodos , Australia , Competencia Clínica , Estudios Cruzados , Humanos , Recién Nacido , Maniquíes , Método Simple Ciego , Factores de Tiempo
12.
Simul Healthc ; 14(2): 121-128, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30407960

RESUMEN

STATEMENT: The rigorous evaluation of simulation in healthcare to improve resuscitations and team functioning can be challenging. Statistical process control (SPC) charts present a unique methodology to enable statistical rigor when evaluating simulation. This article presents a brief overview of SPC charts and its advantages over traditional before and after methodologies, followed by an exemplar using SPC to evaluate an in situ team training program with embedded interprofessional education sessions.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Relaciones Interprofesionales , Control de Calidad , Resucitación/educación , Entrenamiento Simulado/organización & administración , Competencia Clínica , Servicio de Urgencia en Hospital/normas , Humanos , Grupo de Atención al Paciente/organización & administración , Evaluación de Programas y Proyectos de Salud , Entrenamiento Simulado/normas
13.
Int Health ; 11(2): 136-142, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30252052

RESUMEN

BACKGROUND: While the effectiveness of Helping Babies Breathe (HBB) training in Tanzania has been reported, no published studies of Essential Care for Every Baby (ECEB) and Essential Care for Small Babies (ECSB) in this setting have been found. This study compared knowledge before and after HBB, ECEB and ECSB training in Tanzania. METHODS: Training was provided to future facilitators (n=16) and learners (n=24) in Tanzania. Using standardized multiple-choice questions, knowledge was assessed pre- and post-HBB and ECEB courses for both learners and facilitators, while ECSB assessment was conducted with facilitators only. A >80% score was considered to be a pass. Paired t-tests were used for hypothesis testing. RESULTS: Knowledge significantly improved for both facilitators and learners on HBB and ECEB (p<0.001) and for facilitators on ECSB (p<0.001). After training, learners had difficulty identifying correct responses on one HBB item (21% incorrect) and three ECEB items (25-29% incorrect). After training, facilitators had difficulty identifying correct responses on five ECSB items (22-44% incorrect). CONCLUSIONS: Training improved knowledge in Tanzania, but not sufficiently for feeding, especially for low birthweight babies. Targeted training on feeding is warranted both within the Helping Babies Survive program and in preclinical training to improve knowledge and skill to enhance essential newborn care.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Personal de Salud/educación , Resucitación/educación , Servicios de Salud Rural , Humanos , Recién Nacido , Tanzanía
14.
Am J Surg ; 217(1): 180-185, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29934123

RESUMEN

BACKGROUND: Simulation-based training (SBT) for pediatric trauma resuscitation can improve team performance. The purpose of this study was to describe the nationwide trend in SBT use and barriers to SBT implementation. METHODS: Trauma centers that participated in ACS TQIP Pediatric in 2016 (N = 125) were surveyed about SBT use. Center characteristics and reported implementation barriers were compared between centers using and not using SBT. RESULTS: Survey response rate was 75% (94/125) with 78% (73/94) reporting SBT use. The frequency of pediatric SBT use increased from 2014 to 2016 (median 5.5 vs 6.5 annual sessions, p < 0.01). Funding barriers were negatively associated with number of annual SBT sessions (r ≤ -0.34, p < 0.05). Centers not using SBT reported lack of technical expertise (p = 0.01) and lack of data supporting SBT (p = 0.03) as significant barriers. CONCLUSIONS: Simulation use increased from 2014 to 2016, but significant barriers to implementation exist. Strategies to share resources and decrease costs may improve usage. LEVEL OF EVIDENCE: Level 3, epidemiological.


Asunto(s)
Pediatría/educación , Resucitación/educación , Entrenamiento Simulado/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Traumatología/educación , Estudios Transversales , Utilización de Instalaciones y Servicios , Humanos , Estados Unidos
15.
J Matern Fetal Neonatal Med ; 32(8): 1230-1237, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29117772

RESUMEN

BACKGROUND: Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique - the HybridLab® learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later - by a remote instructor. Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014-2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab® technique at 6 and 12 months after the completion of the cycle. SUMMARY OF RESULTS: After 6 and 12 months, mean changes in the subjects' evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p = .2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller -12.7% (SD: 13.8) (p < .001). Changes in the evaluation scores of individual skills (first steps, mouth-to-mouth ventilation, and chest compressions) between the first and the second evaluation also differed statistically significantly and were smaller in the group of students who were given a possibility to remember their skills (p < .001). DISCUSSION: The HybridLab® learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab® technique for long-time retention of practical skills. CONCLUSION: As a result of the application of the HybridLab® training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Educación Médica/métodos , Neonatología/educación , Resucitación/educación , Enseñanza/estadística & datos numéricos , Competencia Clínica/normas , Educación Médica/normas , Evaluación Educacional , Humanos , Recién Nacido , Lituania , Recuerdo Mental , Neonatología/métodos , Neonatología/normas , Resucitación/estadística & datos numéricos , Estudiantes de Medicina , Enseñanza/normas
16.
Adv Neonatal Care ; 19(1): 56-64, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30148727

RESUMEN

BACKGROUND: Globally, stillbirths account for 2.7 million infant deaths each year, with the vast majority occurring in sub-Saharan Africa and South Asia. Approximately 900,000 infants die due to birth asphyxia. The focus of the Helping Babies Breathe (HBB) program is to help the nonbreathing infant to breathe within the first minute of life, termed the "Golden Minute." PURPOSE: To present a multinational interprofessional development program utilizing the train-the-trainer methodology for HBB to address neonatal morbidity and mortality. Involving nursing students in collaboration with established global partners provided an innovative method of professional development. Lessons learned and challenges will be shared to enhance success of future efforts. PROJECT IMPLEMENTATION: HBB train-the-trainer workshops were held to provide professional development for nurses and nursing students in 5 locations in 4 countries including Ethiopia, India, Vietnam, and Zambia. Workshop participants and the trainers participated in discussions and informal conversation to assess impact on professional development. RESULTS: HBB training and train-the-trainer workshops were implemented in 4 counties. Equipment and supplies were provided in these countries through several internal university grants. All 145 participants demonstrated increased knowledge and skills at the end of the workshops through the HBB check off. Collaborative teaching and cross-cultural professional skills were enhanced in student and faculty trainers. IMPLICATIONS FOR PRACTICE: Nurses, midwives, and advance practice nurses can engage globally and contribute to closing this gap in knowledge and skills by providing train-the-trainer workshops. IMPLICATIONS FOR RESEARCH: Developing systems to integrate the HBB program within each country's existing healthcare infrastructure promotes in-country ownership. Joining the global effort to save the lives of neonates can be a meaningful opportunity for innovative professional development projects. While HBB education has been shown to save lives, a 1-time training is insufficient. Determining how often HBB updates or refreshers are required to maintain skills is an important next step. Another direction for research is to implement this project within prelicensure nursing programs.


Asunto(s)
Asfixia Neonatal/terapia , Personal de Salud/educación , Capacitación en Servicio/métodos , Resucitación/educación , Asfixia Neonatal/prevención & control , Países en Desarrollo , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Masculino , Partería/educación , Evaluación de Programas y Proyectos de Salud , Resucitación/métodos
17.
Pediatr Emerg Care ; 35(7): 480-486, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27741071

RESUMEN

INTRODUCTION: Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods. OBJECTIVE: The aim of the study was to compare traditional and RCDP SBME. METHODS: Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected. RESULTS: Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, -11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue. CONCLUSIONS: This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.


Asunto(s)
Grupo de Atención al Paciente , Resucitación/educación , Entrenamiento Simulado , Competencia Clínica , Curriculum , Humanos , Proyectos Piloto
18.
J Spec Oper Med ; 18(4): 70-74, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30566726

RESUMEN

BACKGROUND: Vascular access is a necessary prerequisite for REBOA placement in patients with severe hemorrhagic shock. METHODS: During an EVTM workshop, 10 Special Forces (SOF) medics, five combat nurses, four military nonsurgeon physicians, and four military surgeons participated in our training program. The military surgeons functioned as the control group. A formalized curriculum was constructed including basic anatomy and training in access materials for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. Key skills were (1) preparation of endovascular toolkit, (2) achieving vascular access in the model, and (3) bleeding control with REBOA. RESULTS: The baseline knowledge of anatomy for SOF medics was significantly less than that for nurses and physicians. Medics had a median time of 3:59 minutes to sheath insertion; nurses, 2:47; physicians, 2:34; and surgeons, 1:39. Military surgeons were significantly faster than medics and military nurses (ρ = .037 resp. 0.034). Medics had a median total time from start to REBOA inflation of 5:05 minutes; nurses, 4:06; military physicians, 3:36; and surgeons, 2:36. CONCLUSION: This study showed that a comprehensive theoretical and practical training program using a task training model can be used for percutaneous femoral access and REBOA placement training of military medical personnel without prior ultrasound or endovascular experience. Higher levels of training reduce procedure times.


Asunto(s)
Aorta , Oclusión con Balón , Procedimientos Endovasculares/educación , Medicina Militar/educación , Personal Militar/educación , Resucitación/educación , Choque Hemorrágico/terapia , Estudios de Factibilidad , Humanos , Personal Militar/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Resucitación/métodos , Análisis y Desempeño de Tareas
19.
F1000Res ; 72018.
Artículo en Inglés | MEDLINE | ID: mdl-30416707

RESUMEN

Effective mask ventilation is an essential skill for any practitioner engaged in airway management. Recent methods to objectively describe mask ventilation using waveform capnography help practitioners to monitor and communicate the effectiveness of mask ventilation. Gentle mask ventilation is now considered acceptable during rapid sequence induction/intubation after loss of consciousness, hence reducing the incidence of hypoxia prior to tracheal intubation. Mask ventilation can be enhanced with muscle relaxation, a double C-E grip, and jaw thrust. This is particularly relevant for patients with reduced apnoea time. An awareness of the complications associated with mask ventilation may help reduce the morbidity associated with this technique. Effective ventilation technique and optimum device selection are important aspects for resuscitation of the newborn. Teaching correct establishment and maintenance of mask ventilation is essential for safe patient care. This review will examine some of the latest developments concerning mask ventilation for adult and paediatric patients.


Asunto(s)
Manejo de la Vía Aérea/métodos , Máscaras , Ventilación/métodos , Adulto , Manejo de la Vía Aérea/tendencias , Niño , Humanos , Máscaras/efectos adversos , Máscaras/tendencias , Guías de Práctica Clínica como Asunto , Resucitación/educación , Resucitación/métodos , Resucitación/tendencias , Ventilación/normas
20.
Pediatr Surg Int ; 34(12): 1353-1362, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30324569

RESUMEN

PURPOSE: Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients. METHODS: An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children's hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation. RESULTS: Survey response rate was 49% (n = 93/190) pre-simulation, 22% (n = 42/190) post-simulation, and 79% (n = 150/190) at 2-year follow-up. These providers reported more anxiety (p = 0.01) and less confidence (p = 0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p = 0.02) and greater confidence (p = 0.01), compared to untrained providers. CONCLUSIONS: Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence. LEVEL OF EVIDENCE: II, Prospective cohort.


Asunto(s)
Competencia Clínica , Evaluación Educacional/métodos , Grupo de Atención al Paciente/normas , Resucitación/educación , Entrenamiento Simulado/métodos , Heridas y Traumatismos/terapia , Niño , Femenino , Humanos , Los Angeles , Masculino , Estudios Prospectivos
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