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1.
Br J Nurs ; 29(1): 36-43, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917949

RESUMO

The aim of this narrative literature review was to explore the impact of interprofessional simulation-based team training on difficult airway management. The Fourth National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society identified recurrent deficits in practice that included delayed recognition of critical events, inadequate provision of appropriately trained staff and poor collaboration and communication strategies between teams. Computerised databases were assessed to enable data collection, and a narrative literature review and synthesis of eight quantitative studies were performed. Four core themes were identified: debriefing, measures of assessment and evaluation, non-technical skills and patient safety, and patient outcomes. There are many benefits to be gained from interprofessional simulation training as a method of teaching high-risk and infrequent clinical airway emergencies. The practised response to emergency algorithms is crucial and plays a vital role in the reduction of errors and adverse patient outcomes.


Assuntos
Manuseio das Vias Aéreas , Pessoal de Saúde/educação , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/métodos , Pessoal de Saúde/psicologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
World Neurosurg ; 133: e874-e892, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541754

RESUMO

OBJECTIVE: The increasing challenges facing the training of future neurosurgeons have led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and determine their educational effects. In this second part, we aim to identify the available simulators for spine, pediatric neurosurgery, interventional neuroradiology, and nontechnical skills, assess their validity, and determine their effectiveness. METHODS: Both Medline and Embase were searched for English language articles that validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework, and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness for each simulator or training course. RESULTS: Overall, 114 articles for 108 simulation-based training models or courses were identified. These articles included 24 for spine simulators, 3 for nontechnical skills, 10 for 9 pediatric neurosurgery simulators, and 12 for 11 interventional neuroradiology simulators. Achieving the highest rating for each validity domain were 3 models for content validity; 16 for response processes; 1 for internal structure; 2 for relations to other variables; and only 1 for consequences. For translational outcomes, 2 training courses achieved a level of effectiveness of >2, showing skills transfer beyond the simulator environment. CONCLUSIONS: With increasing simulators, there is a need for more validity studies and attempts to investigate translational outcomes to the operating theater when using these simulators. Nontechnical skills training is notably lacking, despite demand within the field.


Assuntos
Competência Clínica , Procedimentos Neurocirúrgicos/educação , Treinamento por Simulação/métodos , Medula Espinal/cirurgia , Coluna Vertebral/cirurgia , Criança , Humanos , Radiologia/educação
3.
World Neurosurg ; 133: e850-e873, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541755

RESUMO

OBJECTIVE: The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aim to identify the currently available simulators and training courses for neurosurgery, assess their validity, and determine their effectiveness. METHODS: Both MEDLINE and Embase were searched for English language articles which validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness (LoE) for each simulator or training course. RESULTS: On screening of 6006 articles, 114 were identified to either validate or determine an LoE for 108 simulation-based training models or courses. Achieving the highest rating for each validity domain were 6 models and training courses for content validity, 12 for response processes, 4 for internal structure, 14 for relations to other variables, and none for consequences. For translational outcomes, 6 simulators or training achieved an LoE >2 and thus showed skills transfer beyond the simulation setting. CONCLUSIONS: With the advent of increasing neurosurgery simulators and training tools, there is a need for more validity studies. Further attempts to investigate translational outcomes to the operating theater when using these simulators is particularly warranted. More training tools incorporating full-immersion simulation and nontechnical skills training are recommended.


Assuntos
Encéfalo/cirurgia , Competência Clínica , Procedimentos Neurocirúrgicos/educação , Treinamento por Simulação/métodos , Crânio/cirurgia , Humanos
4.
Br J Anaesth ; 124(2): 206-213, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839255

RESUMO

BACKGROUND: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings. METHODS: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. RESULTS: The ANTS total scores improved from pre- (11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. CONCLUSIONS: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Treinamento por Simulação/métodos , Anestesistas , Países em Desenvolvimento , Seguimentos , Humanos , Estudos Prospectivos , Ruanda
5.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 98-107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31256010

RESUMO

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


Assuntos
Jogos Recreativos , Ressuscitação/educação , Treinamento por Simulação/métodos , Jogos de Vídeo , Realidade Virtual , Humanos , Recém-Nascido
6.
Ann Otol Rhinol Laryngol ; 129(1): 46-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31466464

RESUMO

OBJECTIVES: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). METHODS: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. RESULTS: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. CONCLUSION: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. LEVEL OF EVIDENCE: 3b.


Assuntos
Laringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Procedimentos Cirúrgicos Reconstrutivos/educação , Treinamento por Simulação , Traqueia/cirurgia , Animais , Criança , Pré-Escolar , Humanos , Lactente , Laringoestenose/cirurgia , Modelos Animais , Pediatria/educação , Coelhos , Ovinos , Suínos , Estenose Traqueal/cirurgia
7.
Nurs Educ Perspect ; 41(1): 57-58, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860492

RESUMO

Considered the norm in multiple academic settings, simulation provided a low-risk, transformational clinical learning environment across programs at a college of nursing. Undergraduate nursing students received feedback from practicing nurses, whereas graduate nursing students honed skills in evaluative feedback and communication. This intraprofessional learning opportunity cultivated a rich learning environment. Feedback revealed that the learning milieu was permeated with opportunities needed for skills, competencies, and leadership development. Focusing on the concept of root cause analysis, this experience provided nurse administration students with hands-on exposure that would ultimately lead to developing competencies needed for roles in nursing leadership.


Assuntos
Bacharelado em Enfermagem , Análise de Causa Fundamental , Treinamento por Simulação , Humanos , Liderança , Estudantes de Enfermagem
8.
Nurs Educ Perspect ; 41(1): 59-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860493

RESUMO

Creating simulation-based learning experiences is a process. With tools such as the 2016 INACSL Standards of Best Practice: Simulation Simulation Design and theories to guide development, nurse faculty have the opportunity to create rich simulation-based learning experiences that promote student learning. The purpose of this article is to describe an innovative simulation-based experience that applies simulation design criteria in a non-manikin experience. Using a ShadowBox approach, novice nursing students were exposed to expert decision-making in a simulated environment. We describe this approach and how the simulation design criteria are applied.


Assuntos
Bacharelado em Enfermagem , Treinamento por Simulação , Estudantes de Enfermagem , Tomada de Decisões , Humanos , Aprendizagem
9.
Nurs Educ Perspect ; 41(1): 63-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31860495

RESUMO

Undergraduate didactic nursing leadership courses lack experiential opportunities to address working with culturally diverse populations. The authors used Bafa Bafa©, a cross-cultural low-fidelity simulation, to further develop critical thinking and emotional intelligence skills in prelicensure nursing students. This article describes the authors' experiences of integrating this innovative teaching strategy in the classroom to increase cultural awareness. The students' discovery of unexpected feelings, thoughts, and perceptions has the potential to extend beyond the simulated experience when coupled with faculty reinforcement of engaging in self-reflective practice as a professional nurse.


Assuntos
Bacharelado em Enfermagem , Treinamento por Simulação , Estudantes de Enfermagem , Competência Cultural , Inteligência Emocional , Humanos , Liderança , Estudantes de Enfermagem/psicologia
11.
Bone Joint J ; 101-B(12): 1585-1592, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786991

RESUMO

AIMS: Arthroplasty skills need to be acquired safely during training, yet operative experience is increasingly hard to acquire by trainees. Virtual reality (VR) training using headsets and motion-tracked controllers can simulate complex open procedures in a fully immersive operating theatre. The present study aimed to determine if trainees trained using VR perform better than those using conventional preparation for performing total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 24 surgical trainees (seven female, 17 male; mean age 29 years (28 to 31)) volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience of anterior approach THA. Of these 24 trainees, 12 completed a six-week VR training programme in a simulation laboratory, while the other 12 received only conventional preparatory materials for learning THA. All trainees then performed a cadaveric THA, assessed independently by two hip surgeons. The primary outcome was technical and non-technical surgical performance measured by a THA-specific procedure-based assessment (PBA). Secondary outcomes were step completion measured by a task-specific checklist, error in acetabular component orientation, and procedure duration. RESULTS: VR-trained surgeons performed at a higher level than controls, with a median PBA of Level 3a (procedure performed with minimal guidance or intervention) versus Level 2a (guidance required for most/all of the procedure or part performed). VR-trained surgeons completed 33% more key steps than controls (mean 22 (sd 3) vs 12 (sd 3)), were 12° more accurate in component orientation (mean error 4° (sd 6°) vs 16° (sd 17°)), and were 18% faster (mean 42 minutes (sd 7) vs 51 minutes (sd 9)). CONCLUSION: Procedural knowledge and psychomotor skills for THA learned in VR were transferred to cadaveric performance. Basic preparatory materials had limited value for trainees learning a new technique. VR training advanced trainees further up the learning curve, enabling highly precise component orientation and more efficient surgery. VR could augment traditional surgical training to improve how surgeons learn complex open procedures. Cite this article: Bone Joint J 2019;101-B:1585-1592.


Assuntos
Artroplastia de Quadril/educação , Educação de Pós-Graduação em Medicina/métodos , Ortopedia/educação , Treinamento por Simulação/métodos , Realidade Virtual , Adulto , Competência Clínica , Feminino , Seguimentos , Humanos , Curva de Aprendizado , Londres , Masculino , Desempenho Psicomotor , Método Simples-Cego
12.
Medicine (Baltimore) ; 98(49): e18201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804343

RESUMO

BACKGROUND: Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation. METHODS: A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance. RESULTS: Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ±â€Š0.96) at HEP and 3.54 (SD ±â€Š0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ±â€Š1.24) at HEP and 2.21 (SD ±â€Š1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ±â€Š0.98) at HEP and 4.47 (SD ±â€Š0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ±â€Š1.82) versus 10.22 (SD ±â€Š1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Liderança , Equipe de Assistência ao Paciente/normas , Postura , Melhoria de Qualidade , Adulto , Lista de Checagem , Estudos Transversais , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Malásia , Masculino , Projetos Piloto , Treinamento por Simulação , Inquéritos e Questionários , Gravação em Vídeo
13.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 451-454, Out.-Dez. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1024494

RESUMO

Introduction: The anatomy of the temporal bone is complex due to the large number of structures and functions grouped in this small bone space, which do not exist in any other region in the human body. With the difficulty of obtaining anatomical parts and the increasing number of ear, nose and throat (ENT) doctors, there was a need to create alternatives as real as possible for training otologic surgeons. Objective: Developing a technique to produce temporal bone models that allow them to maintain the external and internal anatomical features faithful to the natural bone. Methods: For this study, we used a computed tomography (CT) scan of the temporal bones of a 30-year-old male patient, with no structural morphological changes or any other pathology detected in the examination, which was later sent to a 3D printer in order to produce a temporal bone biomodel. Results: After dissection, the lead author evaluated the plasticity of the part and its similarity in drilling a natural bone as grade "4" on a scale of 0 to 5, in which 5 is the closest to the natural bone and 0 the farthest from the natural bone. All structures proposed in the method were found with the proposed color. Conclusion: It is concluded that it is feasible to use biomodels in surgical training of specialist doctors. After dissection of the bone biomodel, it was possible to find the anatomical structures proposed, and to reproduce the surgical approaches most used in surgical practice and training implants (AU)


Assuntos
Humanos , Masculino , Adulto , Osso Temporal/cirurgia , Simulação por Computador , Impressão Tridimensional , Modelos Anatômicos , Procedimentos Cirúrgicos Otológicos/métodos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Educação Médica , Treinamento por Simulação
14.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 391-398, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185136

RESUMO

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


Assuntos
Humanos , Masculino , Feminino , Criança , Treinamento por Simulação/métodos , Liderança , Medicina de Emergência Pediátrica/métodos , Pesquisa Interdisciplinar , Simulação de Paciente , Choque , Análise de Variância
15.
Arch Esp Urol ; 72(9): 904-914, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697250

RESUMO

OBJECTIVES: To describe a roadmap of the most representative milestones and considerations in the validation of surgical simulators, especially those of laparoscopic surgery. And additionally, help determine when in this process a simulator can be considered as validated. METHODS: A non-systematic review was carried out searching terms like simulation, validation, training, assessment, skills and learning curve, as well as providing the experience accumulated by our center. RESULTS: An ideal classical validation process should consist of the following steps: fidelity, verification/calibration/ reliability, subjective and objective strategies. Baseline tests of fidelity and verification/calibration/ technological reliability are not always detailed in the simulation literature. A simulator can be considered validated if, at least, satisfactorily completed any of the two main objective strategies, that is, constructive and/or criterion validity. CONCLUSIONS: The methodologies to validate simulators as useful and reliable for the improvement of psychomotor/ technical skills are widely analyzed, although there is a variety of approaches depending on the scientific reference consulted, not being implemented equally in all works. This apparent arbitrariness should be considered in advance because it can lead the researcher to misunderstandings, especially when the simulator will be regarded as valid.


Assuntos
Laparoscopia , Treinamento por Simulação , Competência Clínica , Simulação por Computador , Humanos , Laparoscopia/métodos , Curva de Aprendizado , Reprodutibilidade dos Testes
16.
J Laparoendosc Adv Surg Tech A ; 29(11): 1419-1426, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31613679

RESUMO

Background: The eoSim® laparoscopic augmented reality (AR) simulator has instrument tracking capabilities that may be suitable for implementation in laparoscopic training. The objective is to assess face, content, and construct validity of this simulator for basic laparoscopic skills training. Methods: Participants were divided into three groups: novices (no training), intermediates (<50 laparoscopic procedures), and experts (>50 laparoscopic procedures). Three basic tasks were completed on the simulator: thread transfer (1), cyst dissection (2), and tube ligation (3). A questionnaire was completed on realism, didactic value, and usability of the simulator. Measured outcome parameters were as follows: time, distance, time off screen, average speed, acceleration, and smoothness. Results: Mean ± standard deviation scores on realism were positive (Task 1 or T1; 3.9 ± 0.7, P = .13, T2; 3.7 ± 0.7, P = .07, T3; 3.7 ± 0.07), as well as didactic value (T1; 3.9 ± 0.8, P = .71, T2; 3.9 ± 0.8, P = .31, T3; 4.0 ± 0.8, P = .40). Usability was valued the highest, with mean scores between 3.9 and 4.3 (T1; P = .71, T2; P = .80, T3; P = .85). Scores did not differ significantly between groups. Experts were significantly faster (Task 1; P < .001, Task 2; P = .042, Task 3: P < .001) with higher handling speed for tasks 2 and 3 (Task 1; P = .20, task 2; P = .034, task 3; P = .049). Results for other outcome parameters also indicated experts had better instrument control and efficiency than novices, although these differences did not reach statistical significance. Conclusions: The eoSim laparoscopic AR simulator is regarded as a realistic, accessible, and useful tool for the training of basic laparoscopic skills, with good face validity. Construct validity of the eoSim AR simulator was demonstrated on several core variables, but not all.


Assuntos
Realidade Aumentada , Competência Clínica , Laparoscopia/educação , Treinamento por Simulação/métodos , Adulto , Cistos/cirurgia , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Software , Esterilização Tubária , Inquéritos e Questionários , Adulto Jovem
17.
Rev Lat Am Enfermagem ; 27: e3174, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596409

RESUMO

OBJECTIVE: to analyze the contributions of the in situ simulation in the self-confidence of early childhood and elementary education teachers regarding the initial management of health complications in school. METHOD: this is a pre-post testing quasi-experimental study. Two pre and post in situ simulation instruments were applied to 76 teachers, namely: visual analogue scale of teachers' self-confidence in the management of health complications at school, and a questionnaire to assess their knowledge on the subject. The educational activity was composed of four scenarios of in situ simulation. The data were analyzed by descriptive and analytical statistics using univariate and multivariate linear regression. RESULTS: the comparison of results of pre and post in situ simulation self-confidence identified promotion of self-confidence (p<0.001), especially for those teachers with less professional experience (p=0.008), without previous similar experience (p=0.003) and who actively participated in the simulation (p=0.009). CONCLUSION: the teachers feel uncomfortable to handle health complications. The in situ simulation elevated the perception of self-confidence among teachers.


Assuntos
Serviços de Saúde Escolar , Professores Escolares , Autoimagem , Treinamento por Simulação , Adulto , Brasil , Educação Profissionalizante/métodos , Feminino , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo
18.
BMC Surg ; 19(1): 146, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619236

RESUMO

BACKGROUND: Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. METHODS: Thirty-three residents in obstetrics and gynecology at University of Pisa, Italy were recruited, and they received a simulation program consisting of 5 tasks. They had to perform basic laparoscopic surgery maneuvers as creating pneumoperitoneum, positioning trocars under vision, demonstrating the appropriate use of dominant and non-dominant hand and making single stitch and knot. They were evaluated with a modified OSATs scale. RESULTS: Senior trainees had better score than junior trainees (p value< 0,005) and after different sessions of simulation scores of both groups significantly improved (p < 0,001), especially for the junior group. All the trainees reported self-assessments that matched with the evaluation of external observers demonstrating the importance of simulation also as auto-evaluation test. CONCLUSIONS: In this study, we demonstrated the role of simulation as powerful tool to evaluate and to self-assess surgical technical skills and to improve own capacities, with the use of a modified OSATs scale adapted to specific exercises.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Internato e Residência , Laparoscopia/educação , Treinamento por Simulação , Competência Clínica , Ginecologia/educação , Humanos , Itália , Cirurgiões/educação
19.
Plast Reconstr Surg ; 144(4): 597e-605e, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568292

RESUMO

BACKGROUND: Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and objectively demonstrates a need for more hands-on rhinoplasty exposure for residents. METHODS: A systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Concurrently, an online survey was developed, assessing resident comfort and training in rhinoplasty, and e-mailed to Canadian and U.S. plastic surgery training programs. RESULTS: ONE HUNDRED THIRTY-EIGHT: residents completed the survey, 62 junior (first- to third-year residents) and 76 senior residents (fourth- to sixth-year residents). Seventy-two percent of senior residents (95 percent of sixth-year residents) reported adequate rhinoplasty exposure, as opposed to 13 percent of junior residents. Seventy-five percent of senior residents most often participated as observers or first assistants, 25 percent participated as co-surgeons, and 73.9 percent did not perform a key rhinoplasty step more than five times. Residents felt the three most difficult steps of rhinoplasty were nasal osteotomy (76.1 percent), caudal septum/anterior nasal spine manipulation (65.2 percent), and nasal tip sutures (55.8 percent), and 73.9 percent felt that simulator training would substantially improve confidence. CONCLUSIONS: Despite sufficient exposure to rhinoplasties, residents were least confident in performing rhinoplasties relative to other aesthetic procedures, likely because of the high proportion of rhinoplasty exposure that is observational as opposed to hands-on acquisition of surgical maneuvers in the operating room. The survey established the maneuvers residents find the most difficult, and as programs adopt competency-based training, developing rhinoplasty simulators targeting specific identified steps may help improve competence for rhinoplasty skills.


Assuntos
Internato e Residência/métodos , Modelos Educacionais , Rinoplastia/educação , Treinamento por Simulação , Previsões , Humanos , Internato e Residência/tendências , Autorrelato
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