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1.
Nurse Pract ; 45(3): 44-49, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32068657

RESUMO

NP educators are challenged to ensure their students have opportunities to learn how to apply skills within a telehealth context. This article presents an integration of telehealth into clinical learning, depicting the connectedness possible when a healthcare professional and patient are challenged by geographic distance.


Assuntos
Educação de Pós-Graduação em Enfermagem/organização & administração , Profissionais de Enfermagem/educação , Treinamento por Simulação/organização & administração , Telemedicina/organização & administração , Austrália , Humanos , Pesquisa em Educação de Enfermagem
2.
Presse Med ; 48(7-8 Pt 1): 780-787, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31383383

RESUMO

Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.


Assuntos
Cuidados Críticos/métodos , Educação Médica/métodos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Treinamento por Simulação , Competência Clínica , Cuidados Críticos/normas , Currículo/normas , Educação Médica/normas , Avaliação Educacional/métodos , Humanos , Ciência da Implementação , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas
3.
J Surg Res ; 244: 57-62, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279264

RESUMO

BACKGROUND: Pedestrian-related injuries are a significant contributor to preventable mortality and disability in children. We hypothesized that interactive pedestrian safety education is associated with increased knowledge, safe crosswalk behaviors, and lower incidence of pedestrian-related injuries in elementary school-aged children. METHODS: An interactive street-crossing simulation was implemented at target elementary schools in Los Angeles County beginning in 2009. Mixed-methods were used to evaluate the impact of this intervention. Multiple-choice examinations were used to test pedestrian safety knowledge, anonymous observations were used to assess street-crossing behaviors, and statewide traffic records were used to report pedestrian injuries in elementary school-aged (4-11 y) children in participating school districts. Pedestrian injury incidence was compared 1 y before and after the intervention, standardized to the incidence in the entire City of Los Angeles. RESULTS: A total of 1424 and 1522 children completed the pretest and post-test, respectively. Correct answers increased for nine of ten questions (all P < 0.01). Children more frequently looked both ways before crossing the street after the intervention (10% versus 41%, P < 0.001). There were 6 reported pedestrian-related injuries in intervention school districts in the year before the intervention and 2 injuries in the year after the intervention, resulting in a significantly lower injury incidence (standardized rate ratio 0.28; 95% CI, 0.11-0.73). CONCLUSION: Pedestrian safety education at Los Angeles elementary schools was associated with increased knowledge, safe street-crossing behavior, and lower incidence of pediatric pedestrian-related injury. Formal pedestrian safety education should be considered with injury prevention efforts in similar urban communities.


Assuntos
Acidentes de Trânsito/prevenção & controle , Educação em Saúde/métodos , Pedestres/educação , Segurança , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Educação em Saúde/organização & administração , Humanos , Incidência , Los Angeles/epidemiologia , Masculino , Pedestres/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
4.
J Clin Nurs ; 28(21-22): 3759-3775, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216367

RESUMO

AIMS AND OBJECTIVES: To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes. BACKGROUND: Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear. METHODS: A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist. RESULTS: Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Nine studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr-2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes. CONCLUSIONS: This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs. RELEVANCE TO CLINICAL PRACTICE: Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health.


Assuntos
Educação Profissionalizante/normas , Ocupações em Saúde/educação , Treinamento por Simulação/organização & administração , Currículo/normas , Humanos , Licenciamento/normas
5.
BMC Med Educ ; 19(1): 197, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185972

RESUMO

BACKGROUND: The clinical environments are more complex, diverse and rapidly changing. Patients' conditions were chronic and complexed, healthcare providers require clinical reasoning for patient safety care. One of the learning methods to foster clinical reasoning is simulation education. The aim of this study was to develop a simulation education debriefing protocol that can improve clinical reasoning. METHODS: This study was conducted following steps. For the first step, the literature review was performed to constitute a preliminary debriefing protocol. Secondly, content validity was evaluated by five simulation learning experts. Thirdly, in-depth interview was conducted to re-examine content validity with education experts. Finally, the final debriefing protocol was applied to 7 undergraduate nursing students to examine feasibility of the protocol. RESULTS: The protocol consisted of debriefing steps, learning outcome, clinical reasoning attributes, core questions and guideline for instructor. Results of applicability of debriefing protocol represented that participants mentioned their reasoning competency was improved and understood the overall flow of reasoning. CONCLUSIONS: The debriefing protocol is important to educate healthcare providers 'clinical reasoning. It would be able to contribute to develop healthcare providers' clinical competencies.


Assuntos
Competência Clínica , Treinamento por Simulação , Bacharelado em Enfermagem/métodos , Humanos , Entrevistas como Assunto , Reprodutibilidade dos Testes , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas
6.
J Allied Health ; 48(2): e65-e68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167021

RESUMO

Interprofessional education (IPE) among healthcare students of different programs provides a foundation for learning how to work effectively as a team. Combining IPE and simulation gives students the chance to interact with each other while caring for a patient in a safe setting. Adding IPE to established curriculum for healthcare disciplines poses significant challenges: synchronizing student schedules, low student and faculty buy-in, lack of administrative support, outdated equipment and technology, and inadequate space. This paper describes a process of incorporating IPE simulations into established curricula for nursing, radiologic science, and respiratory care students. Following the simulations, students (n=98) were asked to respond to their experience via survey questionnaire. The results suggested that IPE simulation activities were effective and enjoyable learning opportunities that meet the IPE core competencies of improving teamwork, communication, mutual respect of values and ethics, and learning of others' roles and responsibilities. In conclusion, when a structured framework for IPE is lacking, it still appears to be a meaningful learning activity and worth the efforts of interdisciplinary faculty.


Assuntos
Pessoal de Saúde/educação , Relações Interprofissionais , Aprendizagem Baseada em Problemas , Treinamento por Simulação/organização & administração , Atitude do Pessoal de Saúde , Educação em Enfermagem/organização & administração , Pessoal de Saúde/psicologia , Humanos , Modelos Educacionais , Equipe de Assistência ao Paciente , Pneumonia/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Radiologia/educação , Terapia Respiratória/educação , Acidente Vascular Cerebral/terapia
7.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 22(3): 137-143, mayo-jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183068

RESUMO

Introducción: Cuando con los resultados de un examen clínico objetivo estructurado (ECOE) se decide sobre la futura competencia profesional de estudiantes de medicina, la fiabilidad de dicha prueba debe adecuarse a esta finalidad. Objetivo: Calcular la fiabilidad (alfa de Cronbach) de una serie de ECOE y su relación con la duración, número de participantes, estaciones, ítems y evaluadores. Sujetos y métodos: Se analizan 14 ECOE realizados a 2.995 estudiantes de cuarto y quinto curso de la Facultad de Medicina de Granada desde 2004 a 2013. Resultados: La fiabilidad fue ≥ 0,70 en el 92,84% de los ECOE. También fue significativamente ≥ 0,70 cuando la duración total fue ≥ 60 minutos (p = 0,042), el número de estaciones ≥ 10 (p = 0019), el número de ítems ≥ 50 (p = 0,018) y el número de evaluadores ≥ 6 (p = 0,018). No se observaron diferencias con el número de estudiantes ni con las opciones al ítem utilizadas. Conclusiones: Los ECOE cuyos resultados se utilicen para aprobar asignaturas de la carrera de medicina deben tener una fiabilidad ≥ 0,70. Para alcanzar dicha fiabilidad o mayor, el formato debe constar de al menos 10 estaciones, durar ≥ 60 minutos, tener ≥ 50 ítems y ≥ 6 evaluadores


Introduction: When the future professional competence of medical students is decided based on results of an objective structured clinical examination (OSCE), the reliability of this test should be adequate to this purpose. Aim: To calculate the reliability (Cronbach's alpha) of each one of OSCEs we performed and its relationship with the duration, number of participants, stations, items and evaluators. Subjects and methods: Fourteen OSCE tests performed to 2995 medical students of 4th and 5th year of the Faculty of Medicine of Granada between 2004 to 2013 were analyzed. Results: The reliability was ≥ 0.70 in 92.84% of the OSCEs. It was also significant ≥ 0.70 with a total duration ≥ 60 minutes (p = 0.042), and a number of stations ≥ 10 (p = 0.019), a number of items ≥ 50 (p = 0.018) and a number of evaluators ≥ 6 (p = 0.018). No differences with the number of students, neither with the options to the item were observed. Conclusions: The OSCEs carried out in centers which results are used to approve subjects of the medical career, must have a reliability ≥ 0.70. To achieve this reliability or greater, the format should consist of at least: 10 stations, a duration ≥ 60 minutes, and having ≥ 50 items and ≥ 6 evaluators


Assuntos
Humanos , Competência Profissional , Estudantes de Medicina , Reprodutibilidade dos Testes , Treinamento por Simulação/organização & administração , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Treinamento por Simulação/estatística & dados numéricos
10.
Simul Healthc ; 14(4): 217-222, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116168

RESUMO

INTRODUCTION: Rapid response teams (RRTs) have become ubiquitous among hospitals in North America, despite lack of robust evidence supporting their effectiveness. Many RRTs do not yet use cognitive aids during these high-stakes, low-frequency scenarios, and there are no standardized cognitive aids that are widely available for RRTs on medicine patients. We sought to design an emergency manual to improve resident performance in common RRT calls. METHODS: Residents from the New York University School of Medicine Internal Medicine Residency Program were asked to volunteer for the study. The intervention group was provided with a 2-minute scripted informational session on cognitive aids as well as access to a cognitive aid booklet, which they were allowed to use during the simulation. RESULTS: Resident performance was recorded and scored by a physician who was blinded to the purpose of the study using a predefined scoring card. Residents in the intervention group performed significantly better in the simulated RRT, by overall score (mean score = 7.33/10 and 6.26/10, respectively, P = 0.02), and by performance on the two critical interventions, giving the correct dose of naloxone (89% and 39%, respectively, P < 0.001) and checking the patient's blood glucose level (93% and 52%, respectively, P = 0.001). CONCLUSIONS: In a simulated scenario of opiate overdose, internal medicine residents who used a cognitive aid performed better on critical tasks than those residents who did not have a cognitive aid. The use of an appropriately designed cognitive aid with sufficient education could improve performance in critical scenarios.


Assuntos
Equipe de Respostas Rápidas de Hospitais/organização & administração , Medicina Interna/educação , Internato e Residência/organização & administração , Treinamento por Simulação/organização & administração , Adulto , Analgésicos Opioides/toxicidade , Competência Clínica , Overdose de Drogas/terapia , Feminino , Equipe de Respostas Rápidas de Hospitais/normas , Humanos , Internato e Residência/normas , Masculino , Folhetos , Método Simples-Cego
11.
Simul Healthc ; 14(3): 175-181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31116169

RESUMO

INTRODUCTION: A key question in simulation-based education is how to maximize learning within time and resource limits, including how best to balance hands-on practice versus reflective debriefing. Several instructional design frameworks suggest setting the balance according to the type of learning objective(s); however, broad professional activities such as team-based cardiopulmonary resuscitation include several interrelated component skills. This study experimentally manipulated hands-on practice versus reflective debriefing for cardiopulmonary resuscitation skills, hypothesizing that the former best supports learning taskwork (eg, compression quality), whereas the latter best supports learning teamwork. METHODS: The study was a randomized comparison trial with a pretest and posttest. Twenty-six teams of 5 to 6 first-year residents underwent either "drill" practice of key resuscitation phases, designed to maximize deliberate practice opportunities for individual and team skills, or "scrimmage" practice, designed to maximize full-scenario rehearsals and reflective debriefs. Key taskwork and teamwork behaviors were coded, and compression quality was collected and analyzed from an accelerometer. RESULTS: Most performance parameters improved considerably from a pretest to posttest for both taskwork (eg, percent correct compression depth 62%-81%, P = 0.01) and teamwork (eg, role leadership, 47%-70%, P = 0.00). Only 2 parameters improved differently by condition, favoring "drill" training: checking "Do Not Actively Resuscitate" wristband (odds ratio = 14.75, P = 0.03) and use of compression adjuncts (estimated marginal means = 75% versus 67%, P = 0.03). CONCLUSIONS: Consistent with the notion that component skills in resuscitation do not clearly and exclusively constitute "taskwork" versus "teamwork," both instructional designs led to similar improvements despite differences in the balance between hands-on practice versus reflection.


Assuntos
Reanimação Cardiopulmonar/educação , Internato e Residência/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/organização & administração , Atitude do Pessoal de Saúde , Competência Clínica , Processos Grupais , Humanos , Liderança , Aprendizagem Baseada em Problemas/organização & administração , Papel Profissional , Fatores de Tempo
12.
Simul Healthc ; 14(4): 228-234, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116170

RESUMO

INTRODUCTION: Healthcare simulation supports educational opportunities while maintaining patient safety. To reduce costs and increase the availability of training, a randomized controlled study evaluated central venous catheter (CVC) insertion training in the simulation laboratory with nonphysician competent facilitators (NPCFs) as instructors. METHOD: A group of learners naive to central line placement participated in a blended curriculum consisting of interactive online materials and simulation-based training. Learners were randomized to training with NPCFs or attending physician faculty. The primary outcome was simulated CVC insertion task performance, graded with a validated checklist by blinded physician reviewers. Learner knowledge and satisfaction were also evaluated. Analysis was conducted using noninferiority testing. RESULTS: Eighty-five students, 11 attending physicians, and 7 NPCFs voluntarily participated. Noninferiority testing of the difference in CVC insertion performance between NPCF-trained learners versus physician-trained learners found no significant difference [rejecting the null hypothesis of inferiority using an 8% noninferiority margin (P < 0.01)]. In addition, there was no difference found between the 2 groups on pre/post knowledge scores, self-reported learner comfort, course satisfaction, or instructor satisfaction. CONCLUSIONS: An introductory CVC curriculum can be taught to novice learners by carefully trained and supported NPCFs and achieve skill and knowledge outcomes similar to learners taught by physicians.


Assuntos
Cateterismo Venoso Central , Educação de Pós-Graduação em Medicina/organização & administração , Treinamento por Simulação/organização & administração , Ensino/organização & administração , Adulto , Competência Clínica , Currículo , Avaliação Educacional , Feminino , Humanos , Masculino , Enfermeiras Anestesistas/educação
13.
Simul Healthc ; 14(4): 235-240, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116173

RESUMO

INTRODUCTION: Prior evidence has supported the use of high-fidelity simulation in initial emergency medical services (EMS) education, but there is a dearth of research on whether EMS professionals can also benefit from it. We sought to examine simulation use and years of practice as predictors of insimulation team performance among EMS professionals. The hypothesis is that both the prior participation in simulation events and the accumulated years of practice will predict insimulation performance. METHODS: This cross-sectional study was conducted as part of a simulation-based EMS competition. Paramedic and physician teams were tested. Participants' years of EMS and healthcare practice and their prior participation in simulation events were assessed with a survey and correlated with performance in the competition. RESULTS: Participants were 120 EMS professionals from 51 teams, which was 75% of all competitors. They had in average 8.03 years of healthcare practice and 5.71 years of EMS practice and had previously participated in 4.34 simulation events. The prior participation in simulation events correlated significantly with EMS insimulation performance at the team level (r = 0.40-0.59). In contrast, neither the years of healthcare practice nor the years of EMS practice significantly predicted insimulation team performance. Furthermore, there was no interaction of simulation use and years of practice. CONCLUSIONS: The benefits of simulation use are not limited to initial EMS education but spread also to experienced professionals. Even individuals who have been working in the field for many years may benefit from high-fidelity simulation. Future research should examine whether this also translates into better clinical performance.


Assuntos
Auxiliares de Emergência/educação , Equipe de Assistência ao Paciente/organização & administração , Médicos/organização & administração , Treinamento por Simulação/organização & administração , Adulto , Competência Clínica , Estudos Transversais , Feminino , Processos Grupais , Humanos , Masculino
14.
Simul Healthc ; 14(4): 264-270, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116174

RESUMO

STATEMENT: This study is a scoping review that reviews the existing literature on educational strategies in training of cesarean section. A systematic search was carried out in relevant databases, identifying 28 studies for inclusion. Thematic analysis revealed the following training strategies: simulation-based training (team training, in situ training, technical training), simulators (low-fidelity simulators, high-fidelity simulators), clinical training, e-learning or videos, classroom-based learning (lectures, small groups), and assessment (assessment programs/interventions, assessment of learners). Simulation-based training provides a unique milieu for training in a safe and controlled environment. Simulation-based team training is widely accepted and used in obstetrics and improves nontechnical skills, which are important in emergency cesarean section. High-fidelity simulators are advanced and realistic, but because of the expense, low-fidelity simulators may provide a reasonable method for training surgical skills. The literature in training and assessment of surgical skills in relation to cesarean section is sparse, and more studies are warranted.


Assuntos
Cesárea/educação , Competência Clínica , Instrução por Computador/métodos , Humanos , Manequins , Treinamento por Simulação/organização & administração
15.
Simul Healthc ; 14(4): 209-216, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31135682

RESUMO

INTRODUCTION: An adverse event (AE) is a negative consequence of health care that results in unintended injury or illness. The study investigates whether simulation-based event analysis is different from traditional event analysis in uncovering root causes and generating recommendations when analyzing AEs in hospitalized children. METHODS: Two simulation scenarios were created based on real-life AEs identified through the hospital's Safety Reporting System. Scenario A involved an error of commission (inpatient drug error) and scenario B involved detecting an error that already occurred (drug infusion error). Each scenario was repeated 5 times with different, voluntary clinicians. Content analysis, using deductive and inductive approaches to coding, was used to analyze debriefing data. Causes and recommendations were compiled and compared with the traditional event analysis. RESULTS: Errors were reproduced in 60% (3/5) of scenario A. In scenario B, participants identified the error in 100% (5/5) of simulations (average time to error detection = 15 minutes). Debriefings identified reasons for errors including product labeling, memory aid interpretation, and lack of standard work for patient handover. To prevent error, participants suggested improved drug labeling, specialized drug kits, alert signs, and handoff checklists. Compared with traditional event analysis, simulation-based event analysis revealed unique causes for error and new recommendations. CONCLUSIONS: Using simulation to analyze AEs increased unique error discovery and generated new recommendations. This method is different from traditional event analysis because of the immediate clinician debriefings in the clinical environment. Hospitals should consider simulation-based event analysis as an important addition to the traditional process.


Assuntos
Erros de Medicação/prevenção & controle , Recursos Humanos em Hospital/educação , Treinamento por Simulação/organização & administração , Lista de Checagem , Rotulagem de Medicamentos/normas , Humanos , Transferência da Responsabilidade pelo Paciente/normas
16.
Rev Epidemiol Sante Publique ; 67(3): 201-204, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31006583

RESUMO

INTRODUCTION: The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48hours. A specific medical cover was organized in a particular "post-attacks" context and with harsh constraints due to delimitation of an inner zone under the sole UN authority ("blue zone"). OBJECTIVE: To evaluate medical means involved and medical activity. METHODS: Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the "blue zone". End-points: engaged workforce, number of visits, including transfers and medicalized transfers. RESULTS: In "France zone" (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In "blue zone": 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43±1 years. Trauma patients were most numerous (20%). CONCLUSION: Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required.


Assuntos
Mudança Climática , Medicina de Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Nações Unidas/organização & administração , Adulto , Aeroportos/organização & administração , Congressos como Assunto/organização & administração , Feminino , França , Humanos , Masculino , Corpo Clínico/organização & administração , Pessoa de Meia-Idade , Encaminhamento e Consulta/organização & administração , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Transporte de Pacientes/organização & administração
17.
Am J Hosp Palliat Care ; 36(9): 820-830, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30974949

RESUMO

BACKGROUND: Pediatric palliative care (PPC) education is lacking in pediatric critical care medicine (PCCM) fellowships, despite the desire of many program directors and fellows to expand difficult conversation training. Simulation-based training is an experiential method for practicing challenging communication skills such as breaking bad news, disclosing medical errors, navigating goals of care, and supporting medical decision-making. METHODS: We describe a simulation-based PPC communication series for PCCM fellows, including presimulation session, simulation session, debriefing, and evaluation methods. From 2011 to 2017, 28 PCCM fellows participated in a biannual half-day simulation session. Each session included 3 scenarios (allowing for participation in up to 18 scenarios over 3 years). Standardized patients portrayed the child's mother. PCCM and interprofessional PPC faculty cofacilitated, evaluated, and debriefed the fellows after each scenario. Fellows were evaluated in 4 communication categories (general skills, breaking bad news, goals of care, and resuscitation) using a 3-point scale. A retrospective descriptive analysis was conducted. RESULTS: One hundred sixteen evaluations were completed for 18 PCCM fellows. Median scores for general communication items, breaking bad news, and goals of care ranged from 2.0 to 3.0 (interquartile range [IQR]: 0-1) with scores for resuscitation lower at 1.0 (IQR: 1.5-2). DISCUSSION: This experiential simulation-based PPC communication curriculum taught PCCM fellows valuable palliative communication techniques although revealed growth opportunities within more complex communication tasks. The preparation, methods, and lessons learned for an effective palliative simulation curriculum can be expanded upon by other pediatric training programs, and a more rigorous research program should be added to educational series.


Assuntos
Comunicação , Cuidados Críticos/organização & administração , Cuidados Paliativos/organização & administração , Pediatria/educação , Treinamento por Simulação/organização & administração , Tomada de Decisão Clínica , Docentes de Medicina , Bolsas de Estudo , Humanos , Estudos Retrospectivos , Revelação da Verdade
18.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 22(2): 57-64, mar.-abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183015

RESUMO

Los talleres de habilidades son modalidades de simulación clínica con gran impacto en la seguridad del paciente porque desarrollan la memoria visual, manual y sensorial de los novatos, integrándola a flujos de trabajo psicomotrices en maniobras clínicas de difícil aprendizaje. Con el desarrollo tecnológico de los últimos años, ha aumentado su presencia, nivel de fidelidad y potencial didáctico. Con el objetivo de contar con estrategias docentes que tuvieran en cuenta estas complejidades y actualizar y mejorar la calidad del aprendizaje, se realizó una búsqueda bibliográfica sobre modelos históricos y tendencias modernas en diseño y gestión de estas actividades y se construyó un modelo de entrenamiento y un protocolo ad hoc que sirvieron de guía a instructores de simulación definiendo estrategias para cada una de las fases de la actividad simulada. Ambas herramientas se han aplicado en talleres de habilidades complejos de odontología en la Universidad Europea de Madrid durante más de tres años


Skills workshops are clinical simulation modalities with great impact on patient safety because they develop the visual, manual and sensory memory, integrating them into psychomotor workflows in clinical maneuvers that are difficult to learn. With the technological development of the last years, their presence, fidelity level and didactic potential have increased. In order to have teaching strategies that take into account these complexities and update and improve the quality of learning, a bibliographic search was carried out on historical models and modern trends in the design and management of these activities, and a training model and an ad hoc protocol were built to guide simulation instructors by defining strategies for each of the phases of the simulated activity. Both tools have been applied in complex dentistry skills workshops at the Universidad Europea de Madrid for a period of more than three years


Assuntos
Humanos , Treinamento por Simulação/organização & administração , Educação/métodos , Aprendizagem , Competência Clínica , Materiais de Ensino , Segurança do Paciente , Pesquisa Qualitativa
19.
Curr Opin Anaesthesiol ; 32(2): 136-143, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817385

RESUMO

PURPOSE OF REVIEW: Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. RECENT FINDINGS: Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU. The role of simulation training for technical and nontechnical skills acquisition is growing. Feedback is difficult to provide, but critical to facilitate learner success; frameworks, and approaches are becoming more standardized. SUMMARY: Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools.


Assuntos
Anestesiologia/educação , Medicina Baseada em Evidências/educação , Unidades de Terapia Intensiva/organização & administração , Internato e Residência/organização & administração , Ensino , Anestesiologistas/organização & administração , Anestesiologistas/psicologia , Competência Clínica , Currículo , Eficiência Organizacional , Metas , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Resiliência Psicológica , Treinamento por Simulação/organização & administração , Treinamento por Simulação/tendências
20.
Simul Healthc ; 14(2): 129-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30730469

RESUMO

INTRODUCTION: With the growth of telehealth, simulation personnel will be called upon to support training that integrates these new technologies and processes. We sought to integrate remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams. We describe how we overcame technical challenges of creating shared awareness of the patient's condition and the care team's progress among those executing the simulation, the care team, and the eICU. METHODS: The objective of the simulations was to introduce telehealth technology and new processes of engaging the eICU via telehealth during sepsis care in 2 rural EDs. Scenario development included experts in sepsis, telehealth, and emergency medicine. We describe the operational systems challenges, alternatives considered, and solutions used. Participants completed surveys on self-confidence presimulation/postsimulation in using telehealth and in managing patients with sepsis (1-10 Likert scale, with 10 "completely confident"). Pre-post responses were compared by two-tailed paired t test. RESULTS: We successfully engaged the staff of two EDs: 42 nurses, 9 physicians or advanced practice providers, and 9 technicians (N = 60). We used a shared in situ simulation clinical actions observational checklist, created within an off-the-shelf survey software program, completed during the simulations by an on-site observer, and shared with the eICU team via teleconferencing software, to message and cue eICU nurse engagement. The eICU nurse also participated in debriefing via the telehealth video system with successful simulation engagement. These solutions avoided interfering with real ED or eICU operations. The postsimulation mean ± SD ratings of confidence using telehealth increased from 5.3 ± 2.9 to 8.9 ± 1.1 (Δ3.5, P < 0.05) and in managing patients with sepsis increased from 7.1 ± 2.5 to 8.9 ± 1.1 (Δ1.8, P < 0.05). CONCLUSIONS: We created shared awareness between remote eICU personnel and in situ simulations in rural EDs via a low-cost method using survey software combined with teleconferencing methods.


Assuntos
Medicina de Emergência/educação , Serviço Hospitalar de Emergência/organização & administração , Hospitais Rurais/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/organização & administração , Telemedicina/organização & administração , Competência Clínica , Pessoal de Saúde/educação , Humanos , Sepse/terapia , Treinamento por Simulação/economia
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