The Role of Technology in Health Professions Education During the COVID-19 Pandemic.

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.

A call to action: Building evidence for use of simulation in nurse practitioner education.

Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.

Health Information Technology Scholars Program: From Implementation to Outcomes.

AIM: This article reports the development, implementation, and outcomes of the Health Information Technology Scholars (HITS) program. BACKGROUND: HITS is one of nine faculty development collaborative projects funded by the Health Resource Service Administration to integrate information and other technologies in nursing education and practice. METHOD: In addition to evaluating the content and context of the program, the evaluation includes descriptive statistics, goal attainment scaling, diffusion of innovation index, utilization of knowledge survey, and exemplars from scholars. RESULTS: The HITS program developed 265 faculty across 132 nursing programs in 43 states over 5 years. HITS scholars impacted more than 59,000 students and 9,000 other faculty. These technology leaders have numerous presentations, publications, and awards. CONCLUSION: Success of the HITS program is attributed to the strength of the faculty development collaborative partnership, the applicant selection process, and the program design.

The National League for Nursing Project to Explore the Use of Simulation for High-Stakes Assessment: Process, Outcomes, and Recommendations.

AIM: This project was designed to explore the feasibility of using simulation for high-stakes assessment in pre-licensure RN programs. METHOD: A think tank of experts recommended simulation scenarios suitable for assessing students at the end of their program. Two teams were formed: one to design the simulations, the other to develop the evaluation plan. Scenarios were piloted and refined, then sent to schools across the country. Student performances on video recordings were scored by raters. RESULTS: Essential elements of simulation design, implementation, evaluation tools, and processes were found. CONCLUSION: Well-designed and facilitated scenarios, delivered in the controlled environment of the simulation center, can be a reliable and valid tool for evaluating the clinical skills of students.

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial.

BACKGROUND: Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. DESIGN: A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. METHODS: Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. RESULTS: More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p < 0.001]; and defibrillation: [C: 157(140-254) vs. 6M: 138(107-158) vs. 3M: 115(101-119) vs. 2M: 109(98-129); p < 0.001]. A composite outcome of key priorities, compressions within 20s, defibrillation within 180 s and use of a backboard, revealed improvement with more frequent training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p < 0.001]. CONCLUSION: Results revealed short in-situ training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA.

Enhancing Empathy in Undergraduate Nursing Students: An Experiential Ostomate Simulation.

AIM: The aim of this study was to implement and evaluate an experiential learning simulation created to enhance nursing students' empathy during patient care encounters. BACKGROUND: The investigators proposed that an ostomy simulation experience would be an efficient method for providing this educational content. METHOD: Content analysis was conducted on essays using Krippendorff's technique to quantify the simulation. RESULTS: Each unit of measure, or paper, contained between 1 to 14 empathic comments. Of the total sample, 22.8 percent had three or five empathic comments; 10 percent had four, and 9 percent had six or more comments per paper. Eighty-five percent of participants felt this simulation experience was beneficial for enhancing empathy in clinical practice. CONCLUSION: The assignment was an effective, objective method that utilized simulation to teach empathy to baccalaureate nursing students.

Increasing faculty capacity: findings from an evaluation of simulation clinical teaching.

AIM: To compare how the use of different "doses" of simulation in undergraduate clinical teaching affect faculty capacity. BACKGROUND: Since 2008, the NYU College of Nursing has used a "high dose" of simulation to substitute for 50 percent of the clinical hours in core medical-surgical courses to address a shortage of faculty and clinical sites. Johns Hopkins University School of Nursing has used limited, "low-dose" simulation hours to supplement clinical hours. METHOD: The evaluation included program data and surveys and qualitative interviews with faculty and students in each program. RESULTS: Implementing "high-dose" clinical simulation resulted in a nearly 50 percent increase in faculty capacity at NYU, expanding undergraduate enrollment from 613 students in 2007 to 900 in 2012, with no negative impacts on faculty work life or student outcomes. CONCLUSION: Substituting simulation for traditional clinical hours can be a sustainable and educationally sound option to increase faculty capacity.

A clinical academic practice partnership: a clinical education redesign.

The clinical academic practice partnership (CAPP), a clinical redesign based on the dedicated education unit concept, was developed and implemented by large, private school of nursing in collaboration with 4 clinical partners to provide quality clinical education, to explore new clinical models for the future, and to test an innovative clinical education design. An executive steering committee consisting of nursing leaders and educators from the school of nursing and the clinical institutions was established as the decision-making and planning components, with several collaborative task forces initiated to conduct the work and to accomplish the goals. This article will describe methods to initiate and to organize the key elements of this dedicated education unit-type clinical model, providing examples and an overview of the steps and elements needed as the development proceeded. After 18 months of implementation in 4 different nursing programs in 4 different clinical institutions, the clinical redesign has shown to be a positive initiative, with students actively requesting CAPP units for their clinical experiences. Preliminary findings and outcomes will be discussed, along with nursing education implications for this new clinical redesign.

Interdisciplinary collisions: bringing healthcare professionals together.

Since the publication of its reports, Health professions education: A bridge to quality (2003) and To err is human: Building a safer health system (2000), the Institute of Medicine has continued to emphasize interprofessional education (IPE), founded on quality improvement and informatics, as a better way to prepare healthcare professionals for practice. As this trend continues, healthcare education will need to implement administrative and educational processes that encourage different professions to collaborate and share resources. With greater numbers of students enrolled in health professional programs, combined with ethical imperatives for learning and reduced access to quality clinical experiences, medical and nursing education increasingly rely on simulation education to implement interdisciplinary patient safety initiatives. In this article, the authors describe one approach, based on the Core Competencies for Interprofessional Collaborative Practice released by the Interprofessional Education Collaborative (2011), toward providing IPE to an audience of diverse healthcare professionals in academia and clinical practice. This approach combines professional standards with the authors' practical experience serving on a key operations committee, comprising members from a school of medicine, a school of nursing, and a large healthcare system, to design and implement a new state-of-the-art simulation center and its IPE-centered curriculum.

Development and psychometric testing of the colonoscopy embarrassment scale.

Colorectal cancer, the third leading cause of cancer-related death in the United States, could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment is one important barrier to colonoscopy, but little is known about embarrassment in this context, and there were no reliable and valid measures of this construct. The purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. Transtheoretical Model of Behavior Change and Health Belief Model provided the theoretical basis for this study. Participants were health maintenance organization members aged 50 to 65 years (N=234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. Internal consistency (Cronbach's α=.96) and construct validity of the 13-item instrument were demonstrated. This unidimensional scale shows promise as a valid and reliable instrument to measure colonoscopy-related embarrassment and to inform development of interventions to reduce embarrassment, leading to higher colonoscopy completion rates and lower mortality.

Multi-center development and testing of a simulation-based cardiovascular assessment curriculum for advanced practice nurses.

Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one-group pre-to-post-intervention design. Educational interventions included faculty-led, simulation-based case presentations using the Harvey cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer-based CD-ROM program. Outcome measures included a 31-item cognitive written exam, a 13-item skills checklist used in each of a three-station objective structured clinical exam, learner self-efficacy and satisfaction survey, instructor satisfaction and self-efficacy survey, and a participant logbook to record practice time using the self-learning materials. Thirty-six students who received the simulation-based training showed statistically significant pre-to-post-test improvement in cognitive knowledge and cardiovascular assessment skills.

Research regarding methods of assessing learning outcomes.

As the use of simulation-based assessment expands for healthcare workers, there is a growing need for research to quantify the psychometric properties of the associated process and outcome measures.

Advanced cardiac life support instruction: do we know tomorrow what we know today?

This study compared two instructional and evaluation methods for teaching advanced cardiac life support (ACLS) to health care professionals who were taking the ACLS course for the first time. Outcomes of the instruction were measured on completion of the course and at 3 months and 6 months postinstruction to identify differences in participants' knowledge retention, skills competency, and self-efficacy in performing ACLS. In addition, satisfaction with the teaching method was evaluated. The two methods of teaching and evaluating competencies for ACLS were (1) traditional classroom instruction plus practice and evaluation with monitors (low-fidelity simulation); and (2) classroom instruction plus practice with high-fidelity patient simulators. Participants in the study were 148 health care professionals or health care students who were novices in ACLS preparation. Participants were recruited from a large Midwest school of nursing and school of medicine, a Midwest physicians' assistant program, and a not-for-profit hospital. The findings showed no significant differences in ACLS knowledge, skills, self-efficacy, or learner satisfaction immediately after instruction or at 3 to 9 months posttraining. Retention of ACLS knowledge and skills competency over time was low in both groups; recommendations and interventions are discussed based on the study results.

Learning together: Using simulations to develop nursing and medical student collaboration.

Collaborative interdisciplinary learning is a core educational requirement cited by the Institute of Medicine Health Professions Education Report (2003). This descriptive study supports the Nursing Education Simulation Framework for designing simulations used as an interdisciplinary teaching strategy in health professions curricula. The purpose of this study was to investigate the use of the framework for the collaborative medical and nursing management of a surgical patient with complications. Simulation design features, student satisfaction, and self-confidence were measured. Results indicate both medical and nursing student groups'perceptions of the design features of the collaborative simulation were positive. Feedback and guided reflection were identified by both student groups as important simulation design features. Data analyzed from the Collaboration Scale suggest that designing simulations that place medical and nursing students together is beneficial for both the medical students and the nursing students.

Constructing maternal-child learning experiences using clinical simulations.

Clinical simulations are gaining more attention in the field of maternal-child health and allow nursing programs and service organizations to assess competency of students and staff in key patient safety situations. Nursing and midwifery programs, orientations, and yearly reaccreditation modules commonly include simulation on postpartum hemorrhage, placenta abruption, shoulder distocia, and other high-risk, low-incidence emergency events. This article describes the use of simulations by educators and managers as teaching or professional development strategies.