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1.
Nurse Educ Today ; 106: 105080, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34340194

RESUMO

BACKGROUND: Patient deterioration should be detected early and responded appropriately for patient safety. It is necessary to strengthen situational awareness regarding patient deterioration. Inattentional blindness is a major factor that hinders situational awareness about patient deterioration in the clinical setting. OBJECTIVES: To analyze the impact of patient deterioration simulation using inattentional blindness (PDS-IB) on situational awareness and patient safety competency-attitude among final year nursing students. DESIGN: A randomized controlled trial. PARTICIPANTS: Final year nursing students at a university in South Korea. METHODS: Students were randomly assigned to an experimental or control group. The experimental group (n = 47) was given a PDS-IB. The control group (n = 44) received a simple patient deterioration simulation. Situational awareness and patient safety competency-attitude were measured at baseline, post intervention, and at 2 weeks follow-up. Data were analyzed using a two-way repeated measures ANOVA. RESULTS: There were statistically significant group effects, time effects, and group and time interaction effects in situational awareness and patient safety competency-attitude. CONCLUSION: PDS-IB is an effective educational strategy that increases situational awareness and patient safety competency-attitude in final year nursing students.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Conscientização , Cegueira , Competência Clínica , Humanos , Simulação de Paciente , República da Coreia
2.
Nurse Educ Today ; 106: 105057, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34311292

RESUMO

INTRODUCTION: Simulation is an innovative teaching pedagogy commonly used in nursing education. Simulation-based nursing education increases the clinical competency of nursing students. However, it is unknown if the repetitive practice of skills through simulation results in long-term retention of both low- and high-complexity skills. OBJECTIVES: The objective of the study was to evaluate the effect of repeated simulation experience post debriefing on the undergraduate nursing students' self-efficacy. METHODS: A quasi-experimental one-group repeated measures design was used. A convenience sample involving undergraduate nursing students enrolled in "Nursing Care for Childbearing Families" and "Nursing Care for Child-rearing Families" (N = 126) were chosen. A self-reported Self-efficacy Likert scale was used to measure the student's self-efficacy. RESULTS: Findings showed drop in self-efficacy following the first simulation with a significant improvement of the students' self-efficacy following a repeated simulation experience. CONCLUSION: This finding could inspire nursing faculty to adopt the repeated simulation experience that will allow the students to master the case scenario and clinical skills while enhancing self-efficacy.


Assuntos
Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Competência Clínica , Humanos , Simulação de Paciente , Autoeficácia
3.
Nurse Educ Today ; 106: 105059, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34329963

RESUMO

BACKGROUND: Simulation-based education may improve clinical decision-making skills and supplement clinical placement of nursing students to prepare them for real healthcare settings. Exposing students to several simulation sessions could maximise learning, but longitudinal randomised studies are lacking regarding the effects of simulation-based education. OBJECTIVE: In this randomised study, we followed a class of nursing students to assess the effect of multiple simulations on the students' self-reported clinical decision-making skills and self-confidence. DESIGN: A randomised controlled trial, collecting data four times throughout a 3-year nursing program; at the beginning of the second semester as baseline and at the end of each of the following academic years. Students experienced either a single (control) or a double (intervention) set of simulation scenarios in four simulation days, including several simulation scenarios for each session. SETTING: A university in Norway, 2018-2020. PARTICIPANTS: The study included 146 baccalaureate nursing students who volunteered to participate. METHODS: The participants completed two validated instruments, the 24-item Nurse Decision-Making Instrument and the Self-Confidence Scale, and demographic data were collected. Analysis of covariance and linear mixed-effect models were applied to analyse the effect of the double compared to the single scenario simulations. RESULTS: Complete data were obtained for 71 participants. The results showed no significant differences between double vs single scenario sessions on clinical decision-making scores (B = -0.2; 95% confidence interval, -2.1 to 1.7; p = 0.806) or self-confidence score (B = -0.1; 95% confidence interval, -0.4 to 0.2; p = 0.467). However, the overall self-confidence scores increased significantly over time. CONCLUSION: In this randomised study, we found no effects of double vs single scenario simulations on clinical decision-making or self-confidence scores among nursing students during their 3-year program.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Competência Clínica , Humanos , Aprendizagem , Simulação de Paciente
4.
Med Educ Online ; 26(1): 1946896, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34180780

RESUMO

Virtual patients (VP) have been advocated as reliable tools for teaching and evaluating clinical skills and competence. We have developed an internet-based, OSCE-like, conversational VP system designed both for training and assessment of medical students. The system, that encompasses complete patient management from H&P to diagnostic procedures and treatment, has now been used regularly during the clerkship of internal medicine. The present article describes the system and compares assessments undertaken with the VP-system over the last five years, to traditional bed-side oral exams. All students practiced on their own exercise VP cases, while preparing for the final exam. A total of 586 students were evaluated simultaneously with both assessment modalities. The αCronbach of the VP exam averaged 0.86. No correlation was found between the grades obtained in the two exams, indicating that the VP exam evaluated different parameters than those assessed by the examiners in the oral examinations. We conclude that a VP system can be utilized as a valid and reliable examination tool. It is also most useful for independent training by students during their ward-based learning, as well as when not studying in classes, wards or clinics, when social distancing is required.


Assuntos
Avaliação Educacional/métodos , Medicina Interna/educação , Simulação de Paciente , Realidade Virtual , Competência Clínica , Comunicação , Humanos , Interface Usuário-Computador
5.
J Psychosoc Nurs Ment Health Serv ; 59(8): 15-21, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34142918

RESUMO

The purpose of the current study was to evaluate changes in attitudes toward psychiatric nursing and mental health problems in a sample of nursing students after exposure to high-fidelity standardized patient (SP) simulation scenarios. This study used a quasi-experimental, single-group pre-/post-survey approach. Immediately before and after exposure to SP simulation scenarios, undergraduate nursing students completed Attitudes to Mental Illness (AMI) and the Attitudes to Psychiatry (ATP) surveys. There were significant improvements in the following ATP domains: psychiatric career choice and psychiatric teaching (p = 0.046 and 0.007, respectively). There were no significant changes in the AMI survey, but items related to social stigma improved following the simulation. Findings of this study suggest a potential benefit of SP simulation on nursing students in developing their attitudes toward psychiatry and mental health problems. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 15-21.].


Assuntos
Bacharelado em Enfermagem , Transtornos Mentais , Enfermagem Psiquiátrica , Estudantes de Enfermagem , Atitude do Pessoal de Saúde , Humanos , Saúde Mental , Simulação de Paciente , Inquéritos e Questionários
6.
Rev Lat Am Enfermagem ; 29: e3452, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34190943

RESUMO

OBJECTIVE: to evaluate the reported performance regarding clinical judgment by undergraduate Nursing students. METHOD: a cross-sectional study with the application of the Lasater Clinical Judgment Rubric-Brazilian Version in 166 undergraduate Nursing students from a Brazilian public university. The data were analyzed descriptively and analytically (by comparing the level of clinical judgment among students from the initial, intermediate, and concluding groups). The following tests were applied: Chi-square, Fisher's Exact and Kruskal-Wallis, and a p-value of 0.05 was adopted. The reliability of the global instrument (Cronbach's alpha) was 0.786. RESULTS: of the 166 students, 65.7% evaluated themselves as proficient in relation to the reported performance on clinical judgment. Of the rubric's 11 dimensions (focused observation, recognizing deviations from expected patterns, information seeking, prioritizing data, making sense of data, calm and confident manner, clear communication, well-planned intervention/flexibility, being skillful, evaluation/self-analysis, and commitment to improvement), only four groups did not present significant differences among them (p<0.05): focused observation, information seeking, prioritizing data, and calm and confident manner. CONCLUSION: the performance on clinical judgment reported as proficient was pointed out by 65.7% of the students and a significant statistical difference was verified in seven dimensions, among beginners, intermediate, and concluding students, compatible with the evolution of learning.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Brasil , Competência Clínica , Estudos Transversais , Avaliação Educacional , Humanos , Julgamento , Simulação de Paciente , Reprodutibilidade dos Testes
7.
Nurs Educ Perspect ; 42(4): 235-237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34152102

RESUMO

ABSTRACT: The purpose of this multisite, randomized, pretest/posttest quasi-experimental study was to compare student nurse competency, learning retention, and perceived student support after exposure to a deliberate practice debriefing versus standardized debriefing. Fifty undergraduate students participated in the complex response to rescue simulation. The intervention group had significantly higher total mean and three subscale scores on the competency tool than the comparison group, although differences in learning retention and student support were not significant. This study provides preliminary support for the effectiveness of deliberate practice debriefing to enhance students' mastery of skills and behaviors in complex simulations.


Assuntos
Bacharelado em Enfermagem , Enfermeiras e Enfermeiros , Treinamento por Simulação , Estudantes de Enfermagem , Competência Clínica , Humanos , Simulação de Paciente
8.
J Contin Educ Nurs ; 52(5): 240-247, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038681

RESUMO

BACKGROUND: There is an ever-widening academic-practice gap. Less than one third of new graduates demonstrate entry-level competencies required for practice. Hospitals expend many resources to create nurse residency programs to remediate this gap. Online interactive case simulation is effective to increase competencies and decrease the length of orientation and rate of turnover. The aims of this pilot research study were to quantify the academic-practice gap and to strengthen areas of development for competent and safe clinical practice through use of an online patient simulation program. METHOD: A pretest-posttest quasi-experimental study using an online patient simulation program was implemented in a convenience sample of nurse residents over 16 months. RESULTS: Twenty-nine residents completed more than 3,400 patient simulations. Improvement in pretest and posttest metrics included 100% of nurse residents committing a sentinel error event decreased to 20.7%, 766 medication errors decreased to 160, and failed-to-rescue an average of 81% of the time decreased to 23%. CONCLUSION: Interactive online patient simulation programs provide a powerful learning methodology in which learners improve patient safety and reduce failures to rescue. [J Contin Educ Nurs. 2021;52(5):240-247.].


Assuntos
Educação de Pós-Graduação em Enfermagem , Internato e Residência , Simulação de Paciente , Competência Clínica , Educação de Pós-Graduação em Enfermagem/métodos , Humanos , Segurança do Paciente , Lacunas da Prática Profissional
10.
J Nurs Educ ; 60(4): 235-239, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34038280

RESUMO

BACKGROUND: Providing authentic educational experiences in clinical teaching laboratories or health care simulation environments is fundamental to producing optimum learning. However, some simulated diagnostic devices are price prohibitive or yet to be developed. This article explores a collaborative effort between health academics and engineering interns to develop cost-effective, authentic devices that overcome limitations of those currently available. METHOD: Simulated patient tympanic thermometer and pulse oximetry devices were developed for use in clinical teaching laboratories and health care simulation environments. RESULTS: The tympanic thermometers and pulse oximetry probes provide programmable temperature, pulse, and oxygen saturation for use with any commercially available manikins or standardized patients. CONCLUSION: Authentic simulated diagnostic devices can enhance reality and foster immersion in clinical simulation scenarios. Sharing cost-effective innovations designed to address the simulation-specific limitations of commercially available diagnostic devices provides health care educators with solutions that can enhance the authenticity of clinical teaching experiences for participants. [J Nurs Educ. 2021;60(4):235-239.].


Assuntos
Manequins , Diagnóstico de Enfermagem , Simulação de Paciente , Simulação por Computador , Humanos , Aprendizagem , Diagnóstico de Enfermagem/métodos , Sinais Vitais
11.
BMJ ; 373: n1087, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980718

RESUMO

OBJECTIVE: To estimate population health outcomes with delayed second dose versus standard schedule of SARS-CoV-2 mRNA vaccination. DESIGN: Simulation agent based modeling study. SETTING: Simulated population based on real world US county. PARTICIPANTS: The simulation included 100 000 agents, with a representative distribution of demographics and occupations. Networks of contacts were established to simulate potentially infectious interactions though occupation, household, and random interactions. INTERVENTIONS: Simulation of standard covid-19 vaccination versus delayed second dose vaccination prioritizing the first dose. The simulation runs were replicated 10 times. Sensitivity analyses included first dose vaccine efficacy of 50%, 60%, 70%, 80%, and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread (that is, non-sterilizing vaccine); and an alternative vaccination strategy that implements delayed second dose for people under 65 years of age, but not until all those above this age have been vaccinated. MAIN OUTCOME MEASURES: Cumulative covid-19 mortality, cumulative SARS-CoV-2 infections, and cumulative hospital admissions due to covid-19 over 180 days. RESULTS: Over all simulation replications, the median cumulative mortality per 100 000 for standard dosing versus delayed second dose was 226 v 179, 233 v 207, and 235 v 236 for 90%, 80%, and 70% first dose efficacy, respectively. The delayed second dose strategy was optimal for vaccine efficacies at or above 80% and vaccination rates at or below 0.3% of the population per day, under both sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100 000. The delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested. CONCLUSIONS: A delayed second dose vaccination strategy, at least for people aged under 65, could result in reduced cumulative mortality under certain conditions.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Saúde Pública/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Vacinas contra COVID-19/imunologia , Hospitalização , Humanos , Pessoa de Meia-Idade , Ocupações , Simulação de Paciente , SARS-CoV-2/genética , SARS-CoV-2/imunologia , Sensibilidade e Especificidade , Análise de Sistemas , Resultado do Tratamento , Vacinação
12.
Educ Prim Care ; 32(5): 303-307, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33890545

RESUMO

Within normal surgery hours telephone consultations have been previously shown to make up between 10-20% of patient contacts with General Practitioners (GPs) and to comprise a large proportion of a GP's daily workload. Although obviously very useful, such doctor-patient interactions can be fraught with risk. The General Medical Council (GMC) requires that newly graduated doctors should be adaptable to the challenge of delivering treatment advice and management remotely. Yet, currently, there is limited specific training in telephone consultation skills in both undergraduate and postgraduate curricula.Authentic and properly supervised exposure of medical students to GP telephone consultations can be difficult to achieve in clinical placements. Therefore, we have developed emergency telephone consultations within our primary care Safe and Effective Clinical Outcomes (SECO) clinics which are simulated GP surgeries organised for our final year students. We have expanded the range of patients presenting in these clinics by including trained, simulated patients requesting an urgent telephone consultation with a GP. In doing so we aim to enhance our student's skills and confidence in conducting telephone consultations.This teaching exchange paper aims to describe the ideas behind the construction of simulated patient telephone scripts together with the difficulties and successes encountered in introducing telephone consultations into our GP SECO clinic. We hope these ideas and processes will stimulate and enable others to help students prepare for this challenging area of clinical medicine made increasingly significant by the Covid-19 pandemic.


Assuntos
Educação de Graduação em Medicina/métodos , Clínicos Gerais/educação , Simulação de Paciente , Telefone , COVID-19 , Anticoncepcionais Orais/uso terapêutico , Feminino , Humanos , Comportamento Autodestrutivo , Estudantes de Medicina , Reino Unido
13.
Acad Med ; 96(9): 1353-1365, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33883396

RESUMO

PURPOSE: Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. METHOD: The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. RESULTS: The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. CONCLUSIONS: The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.


Assuntos
Competência Clínica , Exame Ginecológico/psicologia , Ginecologia/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Relações Médico-Paciente
15.
Educ Prim Care ; 32(4): 245-246, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33843480

RESUMO

The transition of medical education from a face-to-face to virtual setting due to the ongoing COVID-19 restrictions has been challenging. While both students and educators have now somewhat settled into new teaching methods, from Zoom™ lectures to online tutorials, the adaption of clinical skills teaching to the virtual setting has lagged behind. As a result, many students have been left feeling anxious and concerned about practicing practical and communication skills that are central to being a competent and safe doctor. In light of this, medical students at the Queen's University Belfast General Practice (GP) Society organised a series of virtual, mock Objective Structured Clinical Examinations (OSCEs) for students in Years 2-5 conducted via Zoom™. Medical students and doctors acted as examiners and simulated patients (SPs) with 'breakout rooms' being used to simulate distinct OSCE stations. This collaborative project was well received by participants and doctors alike, who found the virtual OSCEs improved their confidence in performing key clinical skills and virtual consultations. As medical students ourselves, we gained early career exposure to designing and delivering assessments and developed transferable skills, relevant both to medicine and teaching. Lastly, the peer-led approach disrupted the traditional hierarchy in medical education. Students are a key, and often overlooked, resource to overcoming challenges in medical education and educators should encourage students to become involved in medical education at an early stage in their careers.


Assuntos
COVID-19/epidemiologia , Educação Médica/métodos , Avaliação Educacional/métodos , Realidade Virtual , Competência Clínica , Humanos , Pandemias , Simulação de Paciente , Exame Físico/métodos , SARS-CoV-2
16.
J Sports Sci ; 39(sup1): 167-187, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33882779

RESUMO

The International Paralympic Committee Classification Code requires sports to develop evidence-based, sports-specific classification systems. This project aimed to determine the minimum eligibility criteria for Para nordic and Para alpine skiing by simulating vision impairments and measuring the impact of the impairments on performance in twenty-two nordic (28.09 ± 9.68 years; 16 male) and eleven alpine (37.91 ± 18.9 years, 11 male) able-sighted skiers. Eight visual acuity (VA)/contrast sensitivity (CS) (Cambridge Simulation Glasses, University of Cambridge) and six visual field (VF) impairments (bespoke goggles; University of Waterloo) were simulated. VA, CS and VF were measured in each participant before they completed an on-snow session, skiing short competition-style courses with each of the 14 simulated impairments in a randomized order. Clear goggle (no impairment) trials were used as controls. Receiver Operating Characteristic (ROC) and decision tree analyses were conducted to determine the optimum VA, CS and VF cut-offs for classifying performance based on differences from baseline in real time. Moderate impairments in VA, CS and VF negatively affect skiing performance. The recommended cut-off criteria based on both analyses were VA ≥0.90 logMAR and ≤48% VF extent for nordic and VA of ≥0.60 logMAR and VF extent of ≤59.0% for alpine.


Assuntos
Desempenho Atlético , Esqui/classificação , Esportes para Pessoas com Deficiência/classificação , Transtornos da Visão/classificação , Acuidade Visual , Campos Visuais , Adolescente , Adulto , Sensibilidades de Contraste , Árvores de Decisões , Dispositivos de Proteção dos Olhos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Curva ROC , Valores de Referência , Fatores de Tempo , Transtornos da Visão/fisiopatologia , Pessoas com Deficiência Visual/classificação , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-33803034

RESUMO

Simulation-based communication education has improved nursing students' communication knowledge and skills. However, communication patterns that students commonly exhibit in simulated situations and students' responses to specific clinical situations have not been systematically examined. The specific aims of the present study were (1) to identify non-therapeutic communication patterns that nursing students exhibit in simulated situations in the computer simulation-based education (ComEd) program, and (2) explore students' responses to challenging clinical situations. This study used a mixed-method research design and a convenience sampling method to recruit participants. Frequency analysis and a conventional content analysis method were used to analyze answers provided by participants. A total of 66 students from four Korean nursing schools participated in the study. "False reassurance" was found to be the most common non-therapeutic communication pattern used by nursing students. Nursing students had difficulty in clinical situations such as reporting a patient's condition to a doctor, communicating with a patient and perform basic nursing skills at the same time, and managing conflicts between patients. Technology-based communication simulation programs, which reflect various clinical situations, are considered a new alternative that can supplement the limitations of clinical practicum and improve the quality of nursing education.


Assuntos
Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Competência Clínica , Comunicação , Simulação por Computador , Humanos , Simulação de Paciente
19.
GMS J Med Educ ; 38(3): Doc63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33824899

RESUMO

Objectives: Advising patients seeking medical guidance while communicating with them via telephone is a highly relevant skill in clinical daily life. However, telephone consultations differ from face-to-face interactions: clinical examination is nearly impossible and visual signals cannot be observed. Thus, telephone consultations require specific skills training. This article describes the development, implementation and evaluation of a course, "Telephone Consultation for Medical Emergencies", for 5th year medical students at the University of Bern, Switzerland. Methods: Following the evidence in the literature for telephone consultations, we developed guidelines for effective communication via telephone. After self-study of preparatory material, learners engaged in telephone consultations with simulated patients (SP) at the simulation center. They received multi-dimensional feedback regarding the encounter. Results: The course was successfully implemented in 2012. Evaluations showed the course to be well-received by students. In a survey, students agreed that they had learned many new skills and that they considered this learning as being important in their future employment. They felt that the SP feedback was helpful and that being observed by peer-students during the encounter or filling in a checklist while observing peer-students in other encounters added to their learning. During the debriefing of the simulation with a clinical expert, students judged the scenarios as realistic and relevant, praised the SP performances and identified that the most instructive aspect of the training was the opportunity to practice and to get feedback. Conclusion: Telephone consultations require specific skills that should be trained. The current Covid-19 pandemic and the recommendations of government institutions for patients to contact healthcare professionals primarily via telephone stress the importance of adequately training these skills. In this publication we describe a feasible and viable format for implementing this process.


Assuntos
Comunicação , Educação de Graduação em Medicina , Emergências , Relações Médico-Paciente , Estudantes de Medicina , Telefone , Adulto , COVID-19/epidemiologia , Competência Clínica , Avaliação Educacional , Feminino , Humanos , Masculino , Pandemias , Simulação de Paciente , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , SARS-CoV-2 , Suíça/epidemiologia
20.
Reg Anesth Pain Med ; 46(6): 540-548, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33906953

RESUMO

INTRODUCTION: Although administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way-for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients. METHODS: We systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers. RESULTS: Mean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons). DISCUSSION: We conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.


Assuntos
COVID-19 , Embalsamamento/normas , Simulação de Paciente , Animais , Cadáver , Humanos , Pandemias , Reprodutibilidade dos Testes , SARS-CoV-2
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