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1.
Nurs Educ Perspect ; 41(1): 52-53, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31860490

RESUMEN

This article summarizes a pilot simulation using standardized patients that was designed to develop skills necessary to care for the critically ill mental health patient nearing the end of life. Although the simulation was found to be a valuable teaching strategy, additional research, with a rigorous design, is recommended to further develop this teaching method. The authors suggest adopting a theoretical framework for debriefing that would elicit emotions, address the emotional needs of students, and assist them to develop coping strategies and skills necessary to care for patients at the end of life.


Asunto(s)
Enfermedad Crítica , Trastornos Mentales , Cuidado Terminal , Competencia Clínica , Emociones , Humanos , Salud Mental , Simulación de Paciente , Cuidado Terminal/normas
2.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 391-398, dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-185136

RESUMEN

Objetivos. Demostrar el efecto de simulaciones inmersivas repetidas cada 6 semanas, en comparación con su repetición cada 6 meses, sobre la evolución del rendimiento de un equipo multidisciplinar en situaciones pediátricas de riesgo vital durante un año. Método. Ensayo controlado aleatorizado unicéntrico que incluyó 12 equipos multidisciplinares (EMD) del servicio de emergencias médicas (SEM) de Francia compuesto por 4 miembros (médico/residente/enfermera/conductor de ambulancia). En el grupo experimental, 6 EMD se enfrentaron a 9 escenarios diferentes de shock pediátrico en simulaciones de alta fidelidad durante un año. En el grupo de control, 6 EMD tuvieron 3 escenarios comunes a los del grupo experimental (inicial, intermedio -después de seis meses- y final -después de un año-). Se evaluó el rendimiento técnico, mediante la Team Average Performance Assessment Scale (TAPAS) y la escala de rendimiento de acceso intraóseo (IO), y el no técnico, mediante la Clinical Teamwork Scale (CTS) y la Behavioral Assessment Tool (BAT) para los líderes. Se analizó la evolución en el tiempo y se compararon los dos grupos durante los simulacros comunes. Resultados. Las puntuaciones del rendimiento se incrementaron significativamente a lo largo del tiempo en el grupo experimental (p = 0,01 para TAPAS, p = 0,008 para IO, p = 0,03 para CTS y p = 0,02 para BAT) en comparación con el grupo control (p = 0,46 para TAPAS, p = 0,55 para IO, p = 0,62 para CTS y p = 0,58 para BAT). Todas las puntuaciones fueron más altas en el grupo experimental que en el grupo control durante la última sesión (55,8 ± 6,3 vs 31,2 ± 10,3, p = 0,01 para TAPAS; 91,7 ± 8,0 vs 62,9 ± 16,2, p = 0,01 para IO, 63,2 ± 9,3 vs 47,2 ± 13,1, p = 0,03 para CTS; y 72,8 ± 5,1 vs 51,2 ± 14,3, p = 0,01 para BAT). Se observó una diferencia significativa en las dos escalas de puntuación de rendimiento técnico (p = 0,02 para TAPAS y p = 0,03 para IO) a favor del grupo experimental durante la sesión intermedia. También hubo una estrecha relación entre los rendimientos del líder y del equipo, tanto para el rendimiento no técnico (rho > 0,9) como el técnico (rho > 0,7). Conclusiones. La formación basada en la simulación debería repetirse más de tres veces al año. Nuestros resultados favorecen la repetición de una situación poco común de alto riesgo cada seis semanas para mejorar todas las escalas de puntuación de rendimiento y garantizar puntuaciones aceptables de rendimiento técnico y no técnico durante un año


Objective. To demonstrate an effect of 1 year of training using immersive simulations repeated every 6 weeks versus every 6 months to improve the performance of multidisciplinary teams (MDTs) working with children in lifethreatening situations. Methods. Randomized controlled trial in 12 MDTs of emergency responders in France. Each MDT consisted of 4 persons: a physician, a resident, a nurse, and the ambulance driver. Six MDTs participated in 9 different high-fidelity simulations of pediatric shock over the course of a year. Six control MDTs were presented with 3 of the experimental group’s simulations at 3 time points (starting point, 6 months, and 1 year). Technical performance was assessed with the Team Average Performance Assessment Scale (TAPAS) and an intraosseous (IO) access performance scale. Nontechnical performance assessment instruments were the Clinical Teamwork Scale (CTS) and, for leadership, the Behavioral Assessment Tool (BAT). Progress over time was analyzed by comparing the 2 groups during the 3 simulations they experienced in common. Results. Performance scores rose significantly over the study period in the experimental group (P=.01 for the TAPAS score, P=.008 for IO access, P=.03 for the CTS score, and P=.02 for the BAT score) but did not change in the control group (P=.46 for TAPAS, P=.55 for IO access, P=.62 for CTS, and P=.58 for BAT). All mean (SD) scores were higher in the experimental group than in the control group in the last session: TAPAS, 55.8 ± 6.3 vs 31.2 ± 10.3, P=.01; IO access, 91.7 ± 8.0 vs 62.9 ± 16.2, P=.01; CTS, 63.2 ± 9.3 vs 47.2 ± 13.1, P=.03; and BAT, 72.8 ± 5.1 vs 51.2 ± 14.3, P=.01). The 6-month assessment showed significant between-group differences on 2 technical performance measures (P=.02 for TAPAS and P=.03 for IO access); the experimental group’s scores were higher. We also observed close correlations between the performance of the leader and the group on both nontechnical (rho > 0.9) and technical (rho􀀃> 0.7) assessments. Conclusions. Simulation-based training should be repeated more than 3 times per year. Our findings suggest the advisability of repeating simulations of infrequent, high-risk scenarios every 6 weeks to improve all performance scores and guarantee acceptable technical and nontechnical performance throughout the year


Asunto(s)
Humanos , Masculino , Femenino , Niño , Entrenamiento Simulado/métodos , Liderazgo , Medicina de Urgencia Pediátrica/métodos , Investigación Interdisciplinaria , Simulación de Paciente , Choque , Análisis de Varianza
4.
Undersea Hyperb Med ; 46(4): 467-481, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31509903

RESUMEN

Introduction/Background: The incidence of complications and number of critically ill patients in hyperbaric medicine is relatively low [1]. This poses a challenge to those tasked with educating trainees as well as maintaining the skills of staff. Hyperbaric medicine fellows may not be exposed to critical patient scenarios or complications of hyperbaric medicine during a one-year fellowship. Additional staff may be unfamiliar with these situations as well. The purpose of hyperbaric simulation curriculum is to train health care providers for rare situations. To our knowledge, this hyperbaric simulation curriculum is the first published use of simulation education in the specialty of undersea and hyperbaric medicine. Materials and Methods: Two simulation cases have been developed that involve a patient with oxygen toxicity during hyperbaric treatment as well as an ICU patient with mucous plugging. Results: Medical training simulations are an effective method of teaching content and training multiple roles in Undersea and Hyperbaric Medicine. Summary/Conclusions: A hyperbaric simulation curriculum is an achievable educational initiative that is able to train multiple team members simultaneously in situations that they may not encounter on a regular basis. We believe that this could be easily exported to otherinstitutions for further education.


Asunto(s)
Curriculum , Educación Médica/métodos , Oxigenación Hiperbárica , Entrenamiento Simulado/métodos , Enfermedades del Sistema Nervioso Central/inducido químicamente , Enfermedades del Sistema Nervioso Central/terapia , Becas , Humanos , Oxigenación Hiperbárica/efectos adversos , Unidades de Cuidados Intensivos , Intubación Intratraqueal , Moco , Oxígeno/envenenamiento , Simulación de Paciente
5.
BMC Health Serv Res ; 19(1): 612, 2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31470856

RESUMEN

BACKGROUND: Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. METHODS: A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION5, the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. RESULTS: Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION5: t (26) = - 5.16; p < 0.001) (SDM-Q-Doc: t (26) = - 4.39; p < 0.001) (SDM-Q-9: t (26) = - 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. CONCLUSION: The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.


Asunto(s)
Asma/terapia , Competencia Clínica/normas , Médicos/normas , Anciano , Comunicación , Retroalimentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Participación del Paciente , Simulación de Paciente , Relaciones Médico-Paciente , Encuestas y Cuestionarios , Grabación en Cinta , Grabación en Video
6.
Med. intensiva (Madr., Ed. impr.) ; 43(6): 346-351, ago.-sept. 2019. ilus, graf, tab
Artículo en Español | IBECS | ID: ibc-183253

RESUMEN

Objetivo: Comparar en un maniquí de lactante la calidad de las compresiones torácicas según el método tradicional (MT) o según la nueva técnica de 2pulgares con puños cerrados (NM). Diseño: Estudio controlado, aleatorizado y cruzado en profesionales. Ámbito: Hospital Universitario con UCI Pediátrica del norte de España. Participantes: Residentes y enfermeros de Pediatría, habiendo superado un curso de RCP básica y avanzada pediátrica. Intervenciones: Análisis cuantitativo de calidad de compresiones torácicas en escenario de RCP en lactante durante 2 min, mediante el sistema SimPad(R) con SkillReporter(TM) de Laerdal. Variables de interés principales: Frecuencia media y porcentaje de compresiones en rango recomendada, profundidad media y porcentaje de compresiones en rango recomendado, porcentaje de compresiones con descompresión adecuada y porcentaje de compresiones realizadas con los dedos en el centro del tórax. Resultados: La calidad global de las compresiones (NM: 84,2±23,7% vs. MT: 80,1±25,4% [p=0,25; no sig.]), el porcentaje de compresiones con profundidad correcta (NM: 59,9±35,8% vs. MT: 59,5±35,7% [p=0,76; no sig.]), la profundidad media alcanzada (NM: 37,3±3,8mm vs. MT: 36±5,3mm [p=0,06; no sig.]), el porcentaje de reexpansión completa de la caja torácica (NM: 94,4±9,3% vs. MT: 92,4±18,3% [p=0,58; no sig.]) y el porcentaje de compresiones con la frecuencia recomendada (NM: 62,2±34,6% vs. MT: 51±37,2% [p=0,13; no sig.]) fueron similares con los 2métodos. Conclusiones: La calidad de compresiones torácicas con el nuevo método (pulgares con los puños cerrados) es similar a la obtenida con el método tradicional


Objective: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2thumbs with closed fists) in an infant manikin. Design: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. Setting: A University Hospital with a Pediatric ICU in the north of Spain. Participants: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. Interventions: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad(R) with SkillReporter(TM) system was used. Main variables of interest: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. Results: Global quality of the compressions (NM: 84.2±23.7% vs. MT: 80.1±25.4% [p=0.25; p=ns]), percentage of compressions with correct depth (NM: 59.9±35.8% vs. MT: 59.5±35.7% [p=0.76; p=ns]), mean depth reached (NM: 37.3±3.8mm vs. MT: 36±5.3mm [p=0.06; p=ns]), percentage of complete re-expansion of the chest (NM: 94.4±9.3% vs. MT: 92.4±18.3% [p=0.58; p=ns]), and percentage of compressions with the recommended rate (NM: 62.2±34.6% vs. MT: 51±37.2% [p=0.13; p=ns]) proved similar with both methods. Conclusions: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/métodos , Simulación de Paciente , Maniquíes , Masaje Cardíaco/métodos , Reanimación Cardiopulmonar/instrumentación , Personal de Salud/educación , Educación en Enfermería/métodos , Internado y Residencia , Análisis Cuantitativo , Masaje Cardíaco/instrumentación , Masaje Cardíaco/enfermería , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos
7.
J Grad Med Educ ; 11(4 Suppl): 146-151, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31428272

RESUMEN

Background: Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice. Objective: We developed and evaluated a SDM training program in internal medicine. Methods: Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents. Results: Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031). Conclusions: The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.


Asunto(s)
Medicina Interna/educación , Internado y Residencia , Simulación de Paciente , Adulto , Evaluación Educacional/estadística & datos numéricos , Femenino , Humanos , Masculino , Participación del Paciente , Médicos , Autoinforme , Encuestas y Cuestionarios
8.
Am J Disaster Med ; 14(1): 5-8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31441023

RESUMEN

The Center for Domestic Preparedness (CDP) in partnership with the US Department of Health and Human Services Assistant Secretary for Preparedness and Response is using a multiagency/organization, targeted, collaborative approach to adjust existing courses and develop responsive new courses to provide best practices education and experiential learning techniques in healthcare facility emergency resilience, preparedness, response, and recovery applicable to all first receivers. The CDP in Anniston, AL, is a Federal Emergency Management Agency training facility for the Nation's state, local, tribal, and territorial first responders and healthcare professionals. The Center's role has rapidly evolved to provide healthcare emergency preparedness, response, and management training. Through the integration of its Noble Training Facility, a former military hospital, the training courses replicate disaster and mass casualty emergency situations. Patient simulators enable triage and assessment of treatment for mass casualty surge skills application while an isolation ward serves as a training laboratory for the care of patients with infectious diseases of specific concern. Ambulance simulators and an eight-bay treatment area add authenticity to an integrated capstone event accompanying select classes.


Asunto(s)
Defensa Civil , Planificación en Desastres/métodos , Socorristas/educación , Incidentes con Víctimas en Masa , Prestación de Atención de Salud , Humanos , Simulación de Paciente
9.
Br J Anaesth ; 123(5): 696-703, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31451190

RESUMEN

BACKGROUND: The 'cannot intubate cannot oxygenate' (CICO) emergency requires urgent front of neck airway (FONA) access to prevent death. In cases reported to the 4th National Audit Project, the most successful FONA was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA. Consultant anaesthetists, head and neck surgeons, and general surgeons were compared in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons. METHODS: We recruited 15 consultants from each specialty (total of 45) at a single tertiary care hospital in the UK. All agreed to participate in an in situ high-fidelity simulation of an 'anaesthetic emergency'. Participants were not told in advance that this would be a CICO scenario. RESULTS: There were no significant differences in total time to successful ventilation between anaesthetists, head and neck surgeons and general surgeons (median 86 vs 98 vs 126 s, respectively, P=0.078). Anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs 86 s, P=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed 'surgeons' best placed to perform emergency surgical FONA in a genuine CICO situation. CONCLUSION: Anaesthetists regularly trained in emergency surgical FONA function at levels comparable with head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.


Asunto(s)
Manejo de la Vía Aérea/normas , Competencia Clínica , Cartílago Cricoides/cirugía , Traqueotomía/normas , Manejo de la Vía Aérea/métodos , Anestesiología/normas , Contraindicaciones de los Procedimientos , Urgencias Médicas , Inglaterra , Cirugía General/normas , Humanos , Intubación Intratraqueal/efectos adversos , Simulación de Paciente , Distribución Aleatoria , Cartílago Tiroides/cirugía , Traqueotomía/métodos
10.
Rev Col Bras Cir ; 46(3): e20192163, 2019 Aug 05.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31389523

RESUMEN

OBJECTIVE: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. METHODS: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. RESULTS: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. CONCLUSION: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.


Asunto(s)
Competencia Clínica , Servicios Médicos de Urgencia/métodos , Simulación de Paciente , Entrenamiento Simulado/métodos , Triaje/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Estudiantes de Medicina , Estudiantes de Enfermería , Universidades
11.
Cient. dent. (Ed. impr.) ; 16(2): 149-154, mayo-ago. 2019.
Artículo en Español | IBECS | ID: ibc-183727

RESUMEN

El objetivo de este trabajo es realizar una revisión del concepto, y elementos del prebriefing como herramienta de aprendizaje basado en simulación, mediante criterios descritos en la literatura propuestos por expertos en simulación y con experiencia en la planificación de actividades y estrategias necesarias en el ámbito educativo. La simulación es una herramienta fundamental en la educación de los profesionales de la salud. En odontología se justifica su desarrollo ya que permite que los estudiantes experimenten una situación real con el propósito de aprender y obtener conocimientos que les posibilita desenvolverse en un ambiente seguro. Las experiencias de aprendizaje mediante simulación involucran tres etapas de aprendizaje: prebriefing (briefing/presimulación), participación (experiencia simulada/escenario) y debriefing (reflexión). La investigación proporciona evidencia de que el proceso de prebriefing es uno de los más importantes dentro de una experiencia de aprendizaje basado en la simulación (ABS) y se identifica como parte de una planificación que suele ser estimulada por un objetivo o conjunto de fines que se desea que los estudiantes logren. Sin embargo, en odontología existe falta de discusión basada en la evidencia respecto a su uso. Según la literatura revisada podemos concluir que el concepto de prebriefing como fase de planificación ha evolucionado a lo largo de su aplicación, utilizando diferentes términos y elementos. Entre ellos los más usados, el briefing descrito como la orientación inmediatamente antes de la actividad y la presimulación las actividades planificadas que deben ser completadas por los alumnos antes de dar inicio a un ABS


The objective of this work is to review the concept and elements of prebriefing as a learning tool based on simulation, using criteria described in scientific literature and proposed by experts in simulation and with experience in planning activities and strategies required in the educational field. Simulation is a fundamental tool for the education of professionals in the field of health. In dentistry, its development is justified since it allows students to experience a real situation with the purpose of learning and obtaining knowledge that allows them to gain skills in a safe environment. The learning experience through simulation involve three stages of learning: prebriefing (briefing / presimulación), participation (simulated experience / scenario) and debriefing (reflection). The research provides evidence that the preparation process is one of the most important in a simulation-based learning experience (ABS) and is identified as part of a planning that is often stimulated by a goal or set of goals the students have to achieve. However, in dentistry there is a lack of discussion based on the evidence regarding its use. According to the literature reviewed, we can conclude that the concept of prebriefing as a planning phase has evolved throughout its application using different terms and elements. Among them the most used, the briefing described as the orientation immediately before the activity and the presimulation of the planned activities that must be completed by the students before starting an ABS


Asunto(s)
Humanos , Competencia Clínica , Entrenamiento Simulado/métodos , Educación en Odontología , Maniquíes , Simulación de Paciente
12.
BMC Med Educ ; 19(1): 275, 2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337361

RESUMEN

BACKGROUND: The use of simulation technology for skill training and assessment in medical education has progressively increased over the last decade. Nevertheless, the teaching efficacy of most technologies remains to be fully determined. The aim of this prospective study was to evaluate if a short individual training on a patient simulator could improve heart and lung auscultation skills in undergraduate students. METHODS: A group of fifth-year medical school students, who had trained on a patient simulator in their third year (EXP, n = 55), was compared to a group of fifth-year medical school students who had not previously trained on it (CNT, n = 49). Students were recruited on a voluntary basis. Students were evaluated in terms of their ability to correctly identify three heart (II sound wide split, mitral regurgitation, aortic stenosis) and five lung sounds (coarse crackles, fine crackles, pleural rubs, rhonchi, wheezes), which were reproduced in a random order on the Kyoto-Kagaku patient simulator. RESULTS: Exposure to patient simulator significantly improved heart auscultation skills, as mitral regurgitation was correctly recognized by 89.7% of EXP students as compared to 71.4% of CNT students (p = 0.02). In addition, a significantly greater percentage of EXP students correctly graphed all the heart diagnoses as compared to CNT students. There were no differences between the groups in lung auscultation. CONCLUSIONS: This study demonstrates that training medical students with a patient simulator, individually for one hour, significantly ameliorated their heart auscultation skills. Our data suggests that patient simulation might be useful for learning auscultation skills, especially when it is combined with graphic sound display.


Asunto(s)
Competencia Clínica , Auscultación Cardíaca , Simulación de Paciente , Ruidos Respiratorios , Educación Médica , Evaluación Educacional , Humanos , Estudios Prospectivos , Estudiantes de Medicina
13.
Nurse Educ Today ; 81: 1-6, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31295661

RESUMEN

BACKGROUND: In the medical context, previous studies found that female care providers present more empathy with patients than their male counterparts. Yet, the explanatory mechanisms for such a difference are not fully explored. PURPOSE: Guided by the message design logics, this study looked to assess the differences in the expression of empathy by male and female nursing students. METHODS: The data included transcripts of conversations between 343 undergraduate nursing students and a virtual patient. RESULTS: Study hypothesis, which was supported, predicted that when presented with opportunities to express empathy female students will use such opportunities more frequently than male students. RQ1 assessed the level of empathic responses and showed no differences between male and female students. RQ2 focused on the cognitive models of empathy and showed that female students had more complex maps that included a larger number and levels of empathy-related concepts. CLINICAL RELEVANCE: While both male and female students could benefit from education and support in effective expression of empathy, tailored education could promote the recognition of opportunities to be empathic among male students. Clinical communication skill training programs should consider gender-sensitive interventions to support and promote male nurse empathy skills.


Asunto(s)
Cognición , Evaluación Educacional , Empatía , Estudiantes de Enfermería/psicología , Adulto , Comunicación , Bachillerato en Enfermería , Femenino , Humanos , Masculino , Simulación de Paciente , Estudios Retrospectivos , Factores Sexuales
14.
Matern Child Health J ; 23(9): 1159-1166, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31267340

RESUMEN

Background Learning to identify and address social determinants of health (SDH) is a crucial component of pediatric residency training. A virtual tour of an impoverished neighborhood previously demonstrated efficacy in increasing residents' self-assessed knowledge and competence, but its impact on performance has not yet been reported. Online simulated cases are emerging as feasible assessment tools to measure trainees' skills across various healthcare settings. We developed online simulated cases to evaluate residents' retention of the virtual tour's key SDH-related learning objectives 1 month after completing this curriculum. Methods Three online simulated cases with interpolated open-ended questions were created to assess residents' ability to identify SDH, recommend appropriate resources, and display empathy. Scoring rubrics to objectively evaluate responses were developed and borderline scores were decided by a team of educators. Results 19 residents participated. Mean scores for all cases exceeded pre-established borderline scores (statistically significant in two of the three cases). More than 90% of residents identified relevant SDH in the primary care and emergency department cases. Ninety-five percent of residents recommended appropriate resources in all cases, and 89% displayed empathy. Discussion Residents' performance in online simulated cases demonstrated retention and application of the virtual tour's learning objectives, including recognizing SDH, offering appropriate resources, and displaying empathy, which supports the long-term effectiveness of the virtual tour curriculum to train pediatricians about SDH. Online simulated cases provided a standardized and cost-effective way to measure residents' skills related to curricular uptake, suggesting that this assessment approach may be adapted to evaluate other educational interventions.


Asunto(s)
Curriculum/normas , Simulación de Paciente , Pediatría/educación , Determinantes Sociales de la Salud , Adulto , Curriculum/estadística & datos numéricos , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Internado y Residencia/métodos , Internado y Residencia/normas , Internado y Residencia/estadística & datos numéricos , Aprendizaje , Masculino , Pediatría/métodos , Pediatría/normas , Características de la Residencia/estadística & datos numéricos
15.
BMC Med Educ ; 19(1): 243, 2019 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-31269937

RESUMEN

BACKGROUND: Sociodemographic subgroup differences in multiple mini-interview (MMI) performance have been extensively studied within the MMI research literature, but heterogeneous findings demand a closer look at how specific aspects of MMI design (such as station type) affect these differences. So far, it has not been investigated whether sociodemographic subgroup differences imply that an MMI is biased, particularly in terms of its predictive validity. METHODS: Between 2010 and 2017, the University Medical Centre Hamburg-Eppendorf (UKE) tested 1438 candidates in an MMI who also provided sociodemographic data and agreed to participate in this study. Out of these, 400 candidates were admitted and underwent a first objective structured clinical examination (OSCE) after one and a half years, including one station assessing communication skills. First, we analyzed the relationship between gender, age, native language and medical family background and MMI station performance including interaction terms with MMI station type (simulation, interview, and group) in a hierarchical linear model. Second, we tested whether the prediction of OSCE overall and communication station performance in particular differed depending on sociodemographic background by adding interaction terms between MMI performance and gender, age and medical family background in a linear regression model. RESULTS: Young female candidates performed better than young male candidates both at interview and simulation stations. The gender difference was smaller (simulation) or non-significant (interview) in older candidates. There were no gender or age effects in MMI group station performance. All effects were very small, with the overall model explaining only 0.6% of the variance. MMI performance was not related to OSCE overall performance but significantly predicted OSCE communication station performance with no differences in the prediction for sociodemographic subgroups. CONCLUSIONS: The Hamburg MMI is fair in its prediction of OSCE communication scores. Differences in MMI station performance for gender and age and their interaction with MMI station type can be related to the dimensions assessed at different station types and thus support the validity of the MMI. Rather than being threats to fairness, these differences could be useful for decisions relating to the design and use of an MMI.


Asunto(s)
Entrevistas como Asunto , Criterios de Admisión Escolar , Facultades de Medicina , Factores Socioeconómicos , Factores de Edad , Evaluación Educacional , Femenino , Alemania , Humanos , Masculino , Simulación de Paciente , Factores Sexuales , Adulto Joven
16.
Br J Anaesth ; 123(3): 368-377, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31255289

RESUMEN

BACKGROUND: Our goal is to develop metrics that quantify the translation of performance from cadavers to patients. Our primary objective was to develop steps and error checklists from a Delphi questionnaire. Our second objective was to show that our test scores were valid and reliable. METHODS: Sixteen UK experts identified 15 steps conducive to good performance and 15 errors to be avoided during interscalene block on the soft-embalmed cadaver and patients. Thereafter, six experts and six novices were trained, and then tested. Training consisted of psychometric assessment, an anatomy tutorial, volunteer scanning, and ultrasound-guided needle insertion on a pork phantom and on a soft-embalmed cadaver. For testing, participants conducted a single interscalene block on a dedicated soft-embalmed cadaver whilst wearing eye tracking glasses. RESULTS: We developed a 15-step checklist and a 15-error checklist. The internal consistency of our steps measures were 0.83 (95% confidence interval [CI]: 0.78-0.89) and 0.90 (95% CI: 0.87-0.93) for our error measures. The experts completed more steps (mean difference: 3.2 [95% CI: 1.5-4.8]; P<0.001), had less errors (mean difference: 4.9 [95% CI: 3.5-6.3]; P<0.001), had better global rating scores (mean difference: 6.8 [95% CI: 3.6-10.0]; P<0.001), and more eye-gaze fixations (median of differences: 128 [95% CI: 0-288]; P=0.048). Fixation count correlated negatively with steps (r=-0.60; P=0.04) and with errors (r=0.64; P=0.03). CONCLUSIONS: Our tests to quantify ultrasound-guided interscalene nerve block training and performance were valid and reliable.


Asunto(s)
Anestesiología/educación , Educación de Postgrado en Medicina/métodos , Bloqueo Nervioso/normas , Investigación en Medicina Traslacional/normas , Cadáver , Lista de Verificación , Técnica Delfos , Educación de Postgrado en Medicina/normas , Humanos , Simulación de Paciente , Psicometría , Reproducibilidad de los Resultados , Escocia , Investigación en Medicina Traslacional/métodos , Ultrasonografía Intervencional/métodos
17.
J Wound Ostomy Continence Nurs ; 46(4): 315-320, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274862

RESUMEN

PURPOSE: The purpose of this study was to evaluate the impact of incontinence on epithelial-moisture barrier function and the subsequent risk for incontinence-associated dermatitis by exposing healthy volunteers to a premium incontinence pad wet with synthetic urine. DESIGN: Prospective, single-group study. PARTICIPANTS AND SETTING: Thirty women 65 years or older participated in the study. Participants had healthy skin of the buttocks, perineal, and perigenital areas and were not incontinent of urine or stool. The study was conducted at a contracted clinical research facility in Southeastern United States. METHODS: Four hundred milliliters of synthetic urine was distributed across the width of a premium incontinence pad with wicking technology containing a superabsorbent polymer core. Participants laid supine for a total of 4 hours, with the wet pad under the buttocks. Skin assessments were conducted at baseline prior to contact with the wet pad, at 15 minutes, 30 minutes, and 1, 2, and 4 hours after exposure to the synthetic urine. Outcome measures were skin moisture content, cutaneous pH, transepidermal water loss (TEWL), mean coefficient of friction values (static and dynamic), and tolerability evaluations (expert clinical grader-assessed erythema and participant-assessed discomfort). RESULTS: Mean moisture content of the skin increased from 46.19 ± 22.1 to 1845.28 ± 542.7 micro-Siemens (µS) after just 15 minutes of exposure and was significantly increased at all time points compared to baseline (P < .001). Cutaneous pH increased from 5.67 ± 0.5 to 6.25 ± 0.1 after 15 minutes; pH was higher at all time points compared to baseline (P < .001). Passive transfer of water through the stratum corneum (TEWL) showed an increase from 9.02 ± 2.2 g/m/h at baseline to 16.83 ± 5.2 g/m/h at 4 hours (P < .001). There was a significant increase from baseline to 4 hours in mean coefficient of static friction (0.32 ± 0.01 vs 0.47 ± 0.03; P < .00001) as well as mean coefficient of dynamic friction (0.29 ± 0.01 vs 0.42 ± 0.02; P < .00001). There was a significant increase in erythema and an increase in participant-assessed discomfort at all time points (P < .005). CONCLUSIONS: Our findings suggest that impairment of the skin's epithelial-moisture barrier function associated with inflammation and development of incontinence-associated dermatitis begins rapidly after an incontinence event, even with the use of a premium pad with wicking technology. Study findings also suggest that prompt attention to incontinence events is needed to prevent moisture-associated skin damage (incontinence-associated dermatitis) even when absorbent pads are used.


Asunto(s)
Dermatitis/prevención & control , Piel/fisiopatología , Factores de Tiempo , Incontinencia Urinaria/complicaciones , Orina/química , Almohadillas Absorbentes , Dermatitis/fisiopatología , Humanos , Simulación de Paciente , Estudios Prospectivos , Incontinencia Urinaria/enfermería , Orina/fisiología
18.
Rev Bras Enferm ; 72(3): 624-631, 2019 Jun 27.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31269125

RESUMEN

OBJECTIVE: To construct and validate a clinical simulation setting for postpartum haemorrhage. METHOD: Quantitative research of methodological development, carried out from May to July of 2016 with 22 expert judges and 30 students. Analysis was performed from descriptive statistics, Binomial Test and Content Validity Index (CVI), considering CVI ≥ 80%. RESULTS: Setting construction was based on learning objectives, fidelity, evaluation tool, pre-setting activities and debriefing. Agreement, regarding its validity, was satisfactory in the 23 items analyzed. Items evaluated by judges had CVI> 0.90; in the evaluation by students, CVI was > 0.95. CONCLUSION: It was considered validated and suitable for training and use by nursing students. Other studies should be carried out in order to test its effectiveness in the construction of theoretical and practical knowledge of both nursing students and nurses during Permanent Education.


Asunto(s)
Hemorragia Posparto/terapia , Entrenamiento Simulado/normas , Adulto , Competencia Clínica/normas , Femenino , Humanos , Persona de Mediana Edad , Simulación de Paciente , Embarazo , Entrenamiento Simulado/métodos , Entrenamiento Simulado/estadística & datos numéricos , Estudiantes de Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios
19.
Nurse Educ Pract ; 38: 14-20, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31174134

RESUMEN

A number of studies attest to the effectiveness of virtual patients in fostering and assessing students' development of clinical reasoning. An objective assessment of students' clinical reasoning is, however, challenging. This study focused on determining the psychometric properties of the virtual patient version of the Lasater Clinical Judgment Rubric, a rubric that is aimed at assessing nursing students' clinical reasoning processes when encountering virtual patients. A nonexperimental design was used in which data from 125 students' reflections on solving two different virtual patient scenarios were included in the analysis. First, a deductive content analysis was conducted using the categories of the rubric as a lens. After that, each student's performance was quantified according to the different levels of the rubric. Exploratory factor analysis and test of normality and reliability, including the Kaiser-Meyer-Olkin test, Bartlett's test, the Shapiro-Wilk test, and Cronbach's alpha were used in the analysis. The result suggested three factors: "Understanding the patient", "Care planning" and "Reflecting" that explained 81.8% of the variance. Cronbach's alpha was 0.931. The result showed the rubric to be a valid assessment instrument for assessing nursing students' clinical reasoning when encountering virtual patients.


Asunto(s)
Competencia Clínica/normas , Simulación de Paciente , Psicometría/métodos , Adulto , Evaluación Educacional/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría/instrumentación , Psicometría/normas , Reproducibilidad de los Resultados , Estudiantes de Enfermería/psicología , Estudiantes de Enfermería/estadística & datos numéricos , Realidad Virtual
20.
J Allied Health ; 48(2): 81-87, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31167008

RESUMEN

PURPOSE: This study examined the impact of video-based and live standardized patient scenarios on attitudes toward and readiness for interprofessional education (IPE) in occupational therapy (OT) and physical therapy (PT) students. In academic health programs, IPE is used to teach the knowledge and skills to develop interprofessional teamwork abilities; however, research is limited on the impact of standardized patient scenario experiences (SPSE) on the effectiveness of IPE in OT and PT students. PARTICIPANTS: The study involved 49 participants: 23 OT and 26 PT students. METHODS: A descriptive quantitative pilot study measured attitudes and readiness for IPE using a repeated-measures design and the Readiness for Inter-Professional Learning Scale (RIPLS), a 19-item Likert scale. Students completed the RIPLS prior to an interprofessional team assignment, following an interprofessional team meeting to plan the standardized patient evaluation, and after a live SPSE. A 3 x 2 repeated-measures MANOVA analyses was used to determine differences between groups and change over time. RESULTS: Statistically significant changes occurred in Teamwork and Professional Identify subscales of the RIPLS for both groups after the live SPSE. IMPACT: Findings support the use of team-based, live SPSE to improve OT and PT students' readiness for and attitudes toward IPE.


Asunto(s)
Actitud del Personal de Salud , Terapia Ocupacional/educación , Simulación de Paciente , Fisioterapia/educación , Estudiantes del Área de la Salud/psicología , Competencia Clínica , Procesos de Grupo , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Interprofesionales , Grupo de Atención al Paciente/organización & administración , Proyectos Piloto
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