Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile.

Background: Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods: To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings: By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion: The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.

Percepción de la simulación en obstetricia y ginecología en el pregrado y posgrado de una universidad privada chilena / Perception of simulation in obstetrics and gynecology at the undergraduate and postgraduate levels of a private Chilean university

INTRODUCCIÓN: La simulación es una herramienta que promueve la confianza y desarrollo de habilidades en los participantes. En la evaluación de programas formativos la percepción de utilidad se vincula a la confianza y aprendizaje, y corresponde al primer nivel de evaluación según Kirkpatrick. OBJETIVO: Evaluar la percepción de internos y residentes de obstetricia y ginecología en escenarios de simulación. MATERIAL Y MÉTODOS: Investigación descriptiva cuantitativa, en una muestra a conveniencia de internos y residentes, quienes contestaron una escala de valoración global y de preferencias sobre sus simulaciones. RESULTADOS: Se obtuvieron 63 respuestas de internos (63%) y 7 de residentes (78%). La valoración promedio de las simulaciones fue de 6,42 en los internos y de 6,64 de los residentes. El 67% de los internos y el 86% de los residentes no eliminaría ninguna simulación. Los internos repetirían todas las simulaciones, en tanto que los residentes repetirían tres simulaciones de un total de 11. CONCLUSIONES: La valoración de las simulaciones fue alta en ambos grupos, difiriendo en las actividades que prefieren repetir, lo cual puede relacionarse con las competencias inherentes al rol de especialista en comparación al rol del médico general o a las diferencias en autoconfianza de internos y residentes.

INTRODUCTION: Clinical simulation is a training tool that promotes confidence and the development of procedural skills in participants, from initial training to the training of professional teams. In the evaluation of training programs, the measurement of perceived usefulness is linked to confidence and learning and corresponds to a first level of evaluation of the quality of training according to Kirkpatricks model. OBJECTIVE: To evaluate the perception of medical interns and Obstetrics and Gynecology fellows regarding simulation scenarios. MATERIAL AND METHODS: Quantitative descriptive research, in a convenience sample of interns and fellows, who answered a scale of global assessment and preferences about simulations. RESULTS: The average score was 6.42 for the interns and 6.64 for the scholarship recipients. With odd answers about the repetition of scenarios. 67% of the interns and 86% of the fellows responded that they would not eliminate any simulation. Conclusions: The evaluation of the scenarios was excellent and satisfactory by the participants.

Impacto de un entrenamiento de simulación virtual remota sincrónica para el tratamiento inicial del accidente cerebrovascular isquémico en estudiantes de medicina / Impact of synchronous remote virtual simulation training, for the initial management of ischemic stroke in medical students

Introducción: El accidente cerebrovascular (ACV) es una patología prevalente y dependiente del tiempo. Su tratamiento completo inicial es competencia obligatoria del médico general en Chile. En el contexto de la enseñanza clínica tradicional, hay pocas oportunidades de práctica en ese momento de la evolución de los casos. El objetivo fue evaluar el efecto de un programa de simulación virtual remota sincrónica para el tratamiento inicial del ACV en estudiantes de quinto año de medicina.Sujetos y métodos.Estudio cuantitativo, cuasi experimental. Se realizaron cinco sesiones, en días separados, en grupos de tres estudiantes. Cada sesión consistió en tres escenarios de simulación virtual de complejidad creciente, administrada de manera remota, con registro de desempeño individual y debriefing grupal. Se calculó la confiabilidad y se utilizó la prueba de Wilcoxon para muestras relacionadas con p < 0,05 como estadísticamente significativa para comparar los cuestionarios pre- y poscurso.Resultados.Se observó una mejoría del diagnóstico y el tratamiento farmacológico inicial del ACV entre el primer y el tercer casos. Los participantes declararon que la experiencia con el simulador creó oportunidades para la práctica clínica simulada y promovió el desarrollo de la formación en comunicación (p < 0,005). La satisfacción con el programa medida después del término del curso mostró un alto grado de acuerdo promedio.Conclusiones.La simulación virtual aplicada en un programa de práctica deliberada, con debriefing guiado por un instructor, mejoró las competencias para el tratamiento inicial del ACV en estudiantes de grado de medicina y fue muy bien valorada por los estudiantes. (AU)

Introduction: Stroke is a prevalent and time-dependent pathology. Its complete initial management is a mandatory competence of the general practitioner in Chile. In the context of traditional clinical teaching, there are few opportunities for practice at that moment of the evolution of cases. The objective was to evaluate the effect of a remote virtual simulation program, synchronous with debriefing, for the initial management of stroke in fifth year medical students.Subjects and methods.Quantitative, quasi-experimental study. Five sessions were conducted on separate days in groups of three students. Each session consisted of three virtual simulation scenarios of increasing complexity, administered remotely, with individual performance recording and group debriefing. Reliability was calculated and the Wilcoxon test for related samples with p < 0.05 was used as statistically significant to compare pre and post course questionnaires.Results.Improvement in the diagnosis and initial pharmacological management of stroke was observed between the first and third cases. Participants stated that the simulator experience created opportunities for simulated clinical practice and promoted the development of communication training (p < 0.005). Satisfaction with the program measured after completion of the course showed a high degree of average agreement.Conclusions.Virtual simulation applied in a deliberate practice program, with instructor-guided debriefing has improved competencies for the initial management of stroke in undergraduate medical students and was highly valued by the students. (AU)

Characterization of simulation centers and programs in Latin America according to the ASPIRE and SSH quality criteria.

BACKGROUND: Latin American clinical simulation has had an important development; there are no studies that characterize simulation centers and programs in the entire region. The aims of this work are to characterize the current state of simulation-based education in the health sciences, to determine the structure of Latin American simulation centers in terms of teaching, research, and continuing medical education (CME), as well as to determine the perception of quality based on international standards of simulation practices for the directors of Latin American centers. METHODS: A quantitative, descriptive, cross-sectional study with a demographic questionnaire and a Likert-type survey was conducted to the directors of the simulation centers found in Latin America. RESULTS: Four hundred eight simulation centers were documented, the survey was answered by 240 directors, and the data from 149 were complete responses on the 42 quality self-perception scale and considered valid on further analyses related to the quality of the programs. Most of the centers that responded correspond to Chile, Brazil, and Mexico (37.5%, 18.1%, 12.7%). 84% of the centers are university-based, and 71% of the centers are medium-sized, with less than 10 instructors (54%). The directors are mostly women (61.7%), medical doctors (50%), and nurses (40%), with clinical specialization (37%), master's degree (53%), and doctorate (13%). 75% have completed a simulation instructor course, and 6% have developed a fellowship. Most consider the maintenance of international quality standards to be relevant in their centers, mainly in reflective training techniques, ethical aspects, and adequate learning environments. CONCLUSIONS: Simulation-based education in health sciences has had an increasing development in Latin America, within a university environment, in an important academic specialization process that seeks to adhere to high-quality standards to improve training and development of clinical skills, human factors, and critical thinking. We recommend starting accreditation processes in Latin America and studies that measure the quality of simulation-based education in our region, based on objective observations more than in self-reporting.

Comparación de dos estrategias educacionales para la enseñanza del procedimiento de manejo de vía aérea en programas de práctica deliberada aplicados a estudiantes de medicina: ensayo randomizado

Background: Clinical simulation allows the acquisition of procedural skills among medical students. The anticipatory study of these skills may improve the efficiency of simulation sessions. Aim: To Compare two anticipatory study guides in the simulation of airway management, in a cohort of medical students from Chile. Material and Methods: Fifth year medical students were randomly assigned to prepare the simulation of tracheal intubation with a theoretical guide, an audiovisual guide, and a control group without study. The skills acquired were evaluated in a simulated scenario. Results: All groups increased their successful orotracheal intubation (OTI) rate and decreased the time to achieve a successful OTI after each attempt. The study group with a theoretical guide had the higher rate of success in the 1st OTI attempt without feedback. In contrast, the group without any anticipatory study had more failed attempts (1st and 2nd attempt), achieving their first successful OTI in the 3rd attempt after feedback. Conclusions: Study guides improve practice effectiveness. Our results indicate that the best results are obtained by simulation accompanied with immediate directed feedback and opportunities to repeat the procedures, independent of the type of anticipatory study.

[Simulation of tracheal intubation for medical students. The effects of anticipatory study]. / Comparación de dos estrategias educacionales para la enseñanza del procedimiento de manejo de vía aérea en programas de práctica deliberada aplicados a estudiantes de medicina: ensayo randomizado.

BACKGROUND: Clinical simulation allows the acquisition of procedural skills among medical students. The anticipatory study of these skills may improve the efficiency of simulation sessions. AIM: To Compare two anticipatory study guides in the simulation of airway management, in a cohort of medical students from Chile. MATERIAL AND METHODS: Fifth year medical students were randomly assigned to prepare the simulation of tracheal intubation with a theoretical guide, an audiovisual guide, and a control group without study. The skills acquired were evaluated in a simulated scenario. RESULTS: All groups increased their successful orotracheal intubation (OTI) rate and decreased the time to achieve a successful OTI after each attempt. The study group with a theoretical guide had the higher rate of success in the 1st OTI attempt without feedback. In contrast, the group without any anticipatory study had more failed attempts (1st and 2nd attempt), achieving their first successful OTI in the 3rd attempt after feedback. CONCLUSIONS: Study guides improve practice effectiveness. Our results indicate that the best results are obtained by simulation accompanied with immediate directed feedback and opportunities to repeat the procedures, independent of the type of anticipatory study.