Debriefing or Feedback: Exploring the Impact of Two Post-Scenario Discussion Methods in the Acquisition and Retention of Non-Technical Skills.

INTRODUCTION: There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams' acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students' opinion and preference on the post-scenario discussion. MATERIAL AND METHODS: Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management. To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback. RESULTS: Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method. CONCLUSION: Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.

Introdução: Há uma escassez de estudos quantitativos comparando objetivamente o debriefing e o feedback como métodos de discussão pós-cenário e o seu impacto na aquisição e retenção de competências não-técnicas pelas equipas de saúde. O objetivo principal deste estudo é explorar esta questão de investigação, usando uma amostra de estudantes de medicina. Adicionalmente, foi analisada a opinião e preferência dos estudantes sobre o método de discussão pós-cenário. Material e Métodos: Quarenta e cinco estudantes de medicina foram distribuídos em 15 equipas e alocados aleatoriamente a dois grupos. Cada equipa participou em três cenários de simulação diferentes, com níveis de dificuldade semelhantes e as mesmas oportunidades para aplicar as seguintes competências não-técnicas específicas: liderança, comunicação e gestão de tarefas. Para avaliar a aquisição e retenção de competências, os cenários decorreram nos dias um (linha de base), dois (aquisição) e 20 (retenção). O desempenho de cada equipa foi avaliado objetivamente por um observador, através da análise das gravações dos cenários e de uma checklist. Os estudantes foram ainda convidados a avaliar individualmente a condução do debriefing e do feedback. Resultados: Ambos os grupos (debriefing e feedback) demonstraram um incremento semelhante nas pontuações objetivas, com um aumento acentuado entre os dias um e dois (aquisição) e um aumento ligeiro entre os dias dois e 20 (retenção). Os estudantes indicaram o debriefing como método de discussão preferencial. Conclusão: O debriefing e o feedback são métodos eficazes de discussão pós-cenário, promovendo a aquisição e retenção de competências não-técnicas por estudantes pré-graduados. A aliança da prática reflexiva do debriefing com o estilo diretivo de feedback, alternando apropriadamente entre facilitação e instrução, é um compromisso aceitável para alcançar uma discussão educacionalmente significativa num tempo limitado.

A model for educational simulation of hemodynamic transitions at birth.

Birth is characterized by swift and complex transitions in hemodynamic and respiratory variables. Unrecognized pathologies or incidents may quickly become fatal or cause permanent damage. This article introduces an essential component of an acute perinatal care simulator, namely a model for educational simulation of normal hemodynamic transitions seen during and shortly after birth. We explicitly formulate educational objectives and adapt a preexisting model for the simulation of neonatal cardiovascular physiology to include essential aspects of fetal hemodynamics. From the scientific literature, we obtain model parameters that characterize these aspects quantitatively. The fetal model is controlled by a time- and event-based script of changes occurring at birth, such as onset of breathing and cord clamping, and the transitory phase up to 24 h after birth. Comparison of simulation results with published target data confirms that realistic simulated hemodynamic vital signs are achieved.

How to use telesimulation to reduce COVID-19 training challenges: A recipe with free online tools and a bit of imagination.

This article was migrated. The article was marked as recommended. In response to COVID-19 outbreak, alternatives to face-to-face classes/seminars rapidly emerged and telecommunication platforms become the new classrooms. Although with additional challenges, telesimulation based classes can benefit from online platforms and innovative strategies, to promote a meaningful and interactive distance-learning experience. A combination of several free online resources is used to recreate (at distance) emergency simulation scenarios. Practicalities involving this strategy are described in the form of a recipe, including supplemental guides and an illustrative video, allowing its rapid implementation. Feedback from students on the educational gains was surveyed, as a preliminary evaluation of this methodology. The use of free online tools makes it accessible off-site and worldwide, including in low-resources locations. This strategy has high potential to be used in the transitional post-confinement period or as a future complement to physical settings.

General Public's Knowledge Regarding Basic Life Support: A Pilot Study with a Portuguese Sample.

INTRODUCTION: Basic life support is a key manoeuvre in a cardiac arrest situation that can often save a victim's life. This study investigates the general public's knowledge about the fundamentals of basic life support, and its association with previous training/education on basic life support and self-perception of knowledge. A secondary goal is to assess the opinion on training needs. MATERIAL AND METHODS: This is a cross-sectional, exploratory, and descriptive study, using a convenience sample of 655 individuals. A survey containing 21 questions was applied. A descriptive and inferential statistical analysis explored potential associations between variables. RESULTS: The mean score for general knowledge (75.9% ± 14.2%) was statistically significantly higher (p < 0.001) than for technical knowledge (31.2% ± 29.7). Considering the overall knowledge, the mean score was 49.0% ± 20.3%, with 100 (15.3%) respondents scoring equal or higher than 70%, and only 12 (1.8%) answering all questions correctly. Less than 30% of the sample had previous training in basic life support. DISCUSSION: The source of knowledge and time elapsed from previous training have relevant and statistically significant associations with the knowledge scores. Association of the self-perception of knowledge and the actual scores showed, in general, that participants have a correct perception of their knowledge. The knowledge scores indicate clear lack of training and knowledge among the general population. CONCLUSION: The results of this study reinforce the need for practical and regular basic life support training, ideally early in life and in the workplace. Participants recognize that they have residual or low basic life support knowledge and are motivated to attend training and refresher courses.

Introdução: O suporte básico de vida é uma manobra fundamental em situação de paragem cardíaca com grande impacto na sobrevida da vítima. Este estudo investiga o conhecimento do público geral sobre os fundamentos do suporte básico de vida e a sua associação com o treino/educação prévia e a autoperceção do conhecimento. Um segundo objetivo é avaliar a opinião sobre as necessidades de treino. Material e Métodos: Trata-se de um estudo transversal, exploratório e descritivo, utilizando uma amostra de conveniência de 655 indivíduos. A ferramenta de recolha de dados consistiu num questionário contendo 21 questões. Uma análise estatística descritiva e inferencial explorou as possíveis associações entre variáveis. Resultados: O conhecimento geral teve uma pontuação (75,9% ± 14,2%) estatisticamente significativa (p < 0,001) superior ao conhecimento técnico (31,2% ± 29,7). Considerando o conhecimento total, a pontuação média foi de 49,0% ± 20,3%, com 100 (15,3%) inquiridos com pontuação igual ou superior a 70% e apenas 12 (1,8%) respondendo corretamente a todas as questões. Menos de 30% da amostra teve treino prévio em suporte básico de vida. Discussão: O conhecimento em suporte básico de vida tem associações importantes e estatisticamente significativas com a proveniência do conhecimento e o tempo decorrido do treino anterior. A associação da autoperceção do conhecimento e as pontuações reais mostraram, em geral, que os participantes têm uma perceção correta do seu conhecimento. As pontuações de conhecimento indicam uma falta de treino e conhecimento na população em geral. Conclusão: Os resultados deste estudo reforçam a necessidade de treino prático e regular de suporte básico de vida, idealmente no local de trabalho e no início da vida. Os participantes reconhecem que o seu conhecimento em suporte básico de vida é residual ou baixo e estão motivados a participar em cursos de treino e/ou revalidação.

Evaluation of skills acquisition using a new low-cost tool for CPR self-training.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) remains essential to improve the outcome of patients in sudden cardiorespiratory arrest. Feedback on performance is a crucial component of the learning processes associated with simulation and has been shown to improve CPR quality during simulated cardiac arrest on mannequins. This study aims to evaluate skills acquisition using a new low-cost feedback device for CPR self-training when compared to standard training methods. METHODS: Thirty-nine pregraduated medical and biomedical engineering students were recruited for a longitudinal double-blinded randomized control study. For training Basic Life Support skills, the control group used a standard task-trainer and received feedback from an instructor. The intervention group used the same standard task-trainer, instrumented with the CPR Personal Trainer that provided automated performance feedback (with no instructor) on compression-related parameters. Students' knowledge and skills were assessed before and after training, through a theoretical knowledge test and 2 minutes of CPR practical performance. RESULTS: The theoretical tests showed an improvement both in the intervention and in the control group. For each compression-related parameters (hands position, recoil, rate, and depth), significant increase in scores is observed, between the pre- and the post-test, in both groups. The intervention and control groups presented identical mean differences for the total score (0.72 vs 0.72), with no statistical difference (P = 0.754). CONCLUSIONS: The proposed tool proved to be effective in the acquisition of compression-related skills, with similar outcomes as the traditional instructor-based method, corroborating the hypothesis that a low-cost tool with feedback for CPR self-training can provide an alternative or a complementary extension to traditional training methods. The system can also be considered cost-efficient as it reduces the permanent presence of an instructor for the chest compressions training, promoting regular training outside formal training courses.

Biomedical Simulation: Evolution, Concepts, Challenges and Future Trends.

Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.

A simulação biomédica é uma ferramenta educativa para a formação nas ciências da saúde, com aplicação nos vários níveis de ensino. Proporciona experiências ativas e sistemáticas de aprendizagem com o treino de conhecimentos, habilidades e atitudes, de forma segura, pedagogicamente orientada e eficiente. Neste contexto, a simulação biomédica proporciona habilidades e experiência que facilitam a transferência de competências cognitivas, psicomotoras e de comunicação, mudando assim o comportamento e atitudes, aumentando, em última instância, a segurança do doente. Para além do impacto sobre o desempenho individual e de equipa, a simulação proporciona o ambiente ideal para o estudo de falhas organizacionais e teste de melhorias nos desempenhos dos sistemas. Nas últimas décadas, a simulação na área da saúde cresceu lentamente, mas de forma constante, com um amadurecimento significativo nos últimos 10 anos. A comunidade de simulação deve continuar a liderar o estabelecimento de standards nesta área, assim como o desenvolvimento de estratégicas e políticas para assegurar a sua implementação coordenada e custo-efetiva, no aumento da segurança do doente. Este artigo apresenta os movimentos evolutivos da simulação biomédica, incluindo uma revisão das iniciativas portuguesas e programas nacionais. Para nivelar o conhecimento e padronizar a terminologia, são apresentados conceitos básicos, mas essenciais, da simulação clínica, juntamente com algumas considerações sobre avaliação, validação e fiabilidade. As seções finais discutem os desafios atuais e as iniciativas e estratégias futuras, cruciais para a integração de programas de simulação no movimento global de promoção da segurança do paciente.

Corrected and improved model for educational simulation of neonatal cardiovascular pathophysiology.

We identified errors in the software implementation of the mathematical model presented in: Sá Couto CD, van Meurs WL, Goodwin JA, Andriessen P. A model for educational simulation of neonatal cardiovascular pathophysiology. Simul Healthcare 2006;1:4-12. Simulation results obtained with corrected code are presented for future reference. All but one of the simulation results do not differ by more than 9% from the previously published results. The heart rate response to acute loss of 30% of blood volume, simulated with corrected code is stronger than published target data. This modeling error was masked by errors in code implementation. We improved this response and the model by adjusting the gains and adding thresholds and saturations in the baroreflex model. General considerations on identification of model and code errors and model validity are presented.

A model for educational simulation of neonatal cardiovascular pathophysiology.

Full-body patient simulators provide a technological basis for clinical education without risk to real patients. In a previous study, we described a model for educational simulation of infant cardiovascular physiology. Using essentially the same methodology, we derive a mathematical model for the cardiovascular system of a healthy 1-week-old neonate. Computer simulations of this model result in vital signs that are close to target hemodynamic variables. Simulated systemic arterial pressure waveform and left ventricular pressure-volume loop are realistic, and the system reacts appropriately to blood loss. We also adapt the model structure and change its parameters to reflect the congenital heart defects: patent ductus arteriosus, tetralogy of Fallot, complex coarctation of the aorta with patent foramen ovale, and transposition of the great arteries. Simulated vital signs are again close to target hemodynamic variables. The resulting model for neonatal cardiovascular pathophysiology is an essential step in attaining a full-body, model-driven neonatal acute care simulator.

A model for educational simulation of infant cardiovascular physiology.

Full-body patient simulators provide the technology and the environment necessary for excellent clinical education while eliminating risk to the patient. The extension of simulator-based training into management of basic and critical situations in complex patient populations is natural. We describe the derivation of an infant cardiovascular model through the redefinition of a complete set of parameters for an existing adult model. Specifically, we document a stepwise parameter estimation process, explicit simplifying assumptions, and sources for these parameters. The simulated vital signs are within the target hemodynamic variables, and the simulated systemic arterial pressure wave form and left ventricular pressure volume loop are realistic. The system reacts appropriately to blood loss, and incorporation of aortic stenosis is straightforward. This infant cardiovascular model can form the basis for screen-based educational simulations. The model is also an essential step in attaining a full-body, model-driven infant simulator.