Resumen: La capacitación toxicológica cursa con disparidad en relación con otras áreas del conocimiento médico, lo que favorece vacíos cognitivos en los profesionales de la salud. Este documento ...presenta una propuesta educativa para el abordaje de «toxíndromes mayores» a través de un esquema que integra su identificación y tratamiento mediante escenarios de simulación clínica con empleo de pacientes simulados/estandarizados para el pregrado médico en el Centro Universitario del Sur de la Universidad de Guadalajara, desarrollado durante el año 2023. Abstract: Toxicological training has disparities in relation to other areas of medical knowledge, which favors cognitive gaps in health professionals. This document presents an educational proposal for the approach of “major toxidromes” through a scheme that integrates their identification and treatment through clinical simulation scenarios with the use of simulated/standardized patients for the medical undergraduate degree at the Centro Universitario del Sur of the Universidad de Guadalajara, developed during the year 2023.
•Multiple-patient simulations may increase nursing student confidence and competence.•Results about multi-patient simulations are disparate with limited generalizability.•Research on multiple-patient ...simulation should focus on objective outcome measures.•More evidence is needed to support prelicensure multi-patient simulation in nursing.
Prelicensure nursing students generally provide care for only one or two patients within the clinical setting. This model does not allow students to develop the essential leadership skills of prioritization, delegation, critical thinking/clinical reasoning, and interprofessional collaboration and communication. Simulation offers an ideal opportunity for nursing students to manage multiple-patient assignments in a safe space. The purpose of this integrative review was to present the current state of the science related to prelicensure nursing student outcomes associated with multiple-patient simulation.
Database searches of CINAHL, PubMed, Emcare, and Scopus identified 298 articles for review.
Eleven articles (six quantitative, four mixed-methods, and one qualitative) were isolated for inclusion in this integrative review.
There is limited robust research exploring prelicensure nursing students’ outcomes related to multiple-patient simulation. While current evidence suggests that multiple-patient simulations may increase students’ confidence and competence in some aspects of managing multiple-patient assignments, the findings are generally disparate and not generalizable. More research is warranted to provide support for evidence-based teaching related to multiple-patient simulations in prelicensure nursing education.
IntroductionSimulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By ...replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings, such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education.MethodsThe present scoping review adheres to the guidelines outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist" and the "Joanna Briggs Institute (JBI) Reviewers' Manual". This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023.ResultsThe search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study's second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection.ConclusionSBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness and provides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiency and effectiveness.
Simulation has long been integrated in anaesthesiology training, yet a comprehensive review of its effectiveness is presently lacking. Using meta-analysis and critical narrative analysis, we ...synthesized the evidence for the effectiveness of simulation-based anaesthesiology training. We searched MEDLINE, ERIC, and SCOPUS through May 2011 and included studies using simulation to train health professional learners. Data were abstracted independently and in duplicate. We included 77 studies (6066 participants). Compared with no intervention (52 studies), simulation was associated with moderate to large pooled effect sizes (ESs) for all outcomes (ES range 0.60–1.05) except for patient effects (ES −0.39). Compared with non-simulation instruction (11 studies), simulation was associated with moderate effects for satisfaction and skills (ES 0.39 and 0.42, respectively), large effect for behaviours (1.77), and small effects for time, knowledge, and patient effects (−0.18 to 0.23). In 17 studies comparing alternative simulation interventions, training in non-technical skills (e.g. communication) and medical management compared with training in medical management alone was associated with negligible effects for knowledge and skills (four studies, ES range 0.14–0.15). Debriefing using multiple vs single information sources was associated with negligible effects for time and skills (three studies, ES range −0.07 to 0.09). Our critical analysis showed inconsistency in measurement of non-technical skills and consistency in the (ineffective) design of debriefing. Simulation in anaesthesiology appears to be more effective than no intervention (except for patient outcomes) and non-inferior to non-simulation instruction. Few studies have clarified the key instructional designs for simulation-based anaesthesiology training.
Virtual Patient Simulation Using Copula Modeling Zwep, Laura B.; Guo, Tingjie; Nagler, Thomas ...
Clinical pharmacology and therapeutics,
April 2024, 2024-04-00, 20240401, Letnik:
115, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Virtual patient simulation is increasingly performed to support model‐based optimization of clinical trial designs or individualized dosing strategies. Quantitative pharmacological models typically ...incorporate individual‐level patient characteristics, or covariates, which enable the generation of virtual patient cohorts. The individual‐level patient characteristics, or covariates, used as input for such simulations should accurately reflect the values seen in real patient populations. Current methods often make unrealistic assumptions about the correlation between patient's covariates or require direct access to actual data sets with individual‐level patient data, which may often be limited by data sharing limitations. We propose and evaluate the use of copulas to address current shortcomings in simulation of patient‐associated covariates for virtual patient simulations for model‐based dose and trial optimization in clinical pharmacology. Copulas are multivariate distribution functions that can capture joint distributions, including the correlation, of covariate sets. We compare the performance of copulas to alternative simulation strategies, and we demonstrate their utility in several case studies. Our work demonstrates that copulas can reproduce realistic patient characteristics, both in terms of individual covariates and the dependence structure between different covariates, outperforming alternative methods, in particular when aiming to reproduce high‐dimensional covariate sets. In conclusion, copulas represent a versatile and generalizable approach for virtual patient simulation which preserve relationships between covariates, and offer an open science strategy to facilitate re‐use of patient data sets.
We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS Promoting Excellence And Reflective Learning in Simulation. We provide a rationale for scripted ...debriefing and introduce a PEARLS debriefing tool designed to facilitate implementation of the new framework. The PEARLS framework integrates 3 common educational strategies used during debriefing, namely, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing information in the form of directive feedback and/or teaching. The PEARLS debriefing tool incorporates scripted language to guide the debriefing, depending on the strategy chosen. The PEARLS framework and debriefing script fill a need for many health care educators learning to facilitate debriefings in simulation-based education. The PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.
Summary statement: In the absence of theoretical or empirical agreement on how to establish and maintain engagement in instructor-led health care simulation debriefings, we organize a set of ...promising practices we have identified in closely related fields and our own work. We argue that certain practices create a psychologically safe context for learning, a so-called safe container. Establishing a safe container, in turn, allows learners to engage actively in simulation plus debriefings despite possible disruptions to that engagement such as unrealistic aspects of the simulation, potential threats to their professional identity, or frank discussion of mistakes. Establishing a psychologically safe context includes the practices of (1) clarifying expectations, (2) establishing a "fiction contract" with participants, (3) attending to logistic details, and (4) declaring and enacting a commitment to respecting learners and concern for their psychological safety. As instructors collaborate with learners to perform these practices, consistency between what instructors say and do may also impact learners' engagement.
The coronavirus disease 2019 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use during tracheal intubation. ...We evaluated the impact of two aerosol boxes (an early‐generation box and a latest‐generation box) on intubations in patients with severe coronavirus disease 2019 with an in‐situ simulation crossover study. The simulated process complied with the Safe Airway Society coronavirus disease 2019 airway management guidelines. The primary outcome was intubation time; secondary outcomes included first‐pass success and breaches to personal protective equipment. All intubations were performed by specialist (consultant) anaesthetists and video recorded. Twelve anaesthetists performed 36 intubations. Intubation time with no aerosol box was significantly shorter than with the early‐generation box (median (IQR range) 42.9 (32.9–46.9 30.9–57.6)s vs. 82.1 (45.1–98.3 30.8–180.0)s p = 0.002) and the latest‐generation box (52.4 (43.1–70.3 35.7–169.2)s, p = 0.008). No intubations without a box took more than 1 min, whereas 14 (58%) intubations with a box took over 1 min and 4 (17%) took over 2 min (including one failure). Without an aerosol box, all anaesthetists obtained first‐pass success. With the early‐generation and latest‐generation boxes, 9 (75%) and 10 (83%) participants obtained first‐pass success, respectively. One breach of personal protective equipment occurred using the early‐generation box and seven breaches occurred using the latest‐generation box. Aerosol boxes may increase intubation times and therefore expose patients to the risk of hypoxia. They may cause damage to conventional personal protective equipment and therefore place clinicians at risk of infection. Further research is required before these devices can be considered safe for clinical use.
The author of the article, based on an analytical review of literature data, attempted to summarize and systematize the methods of osteoarthrosis formation through experimental modeling of cartilage ...tissue pathology. Osteoarthrosis is a degenerative-dystrophic disease of the synovial joints in humans and animals. In humans, osteoarthritis is a common and disabling pathology of the musculoskeletal system, which leads to a serious violation of the quality of life and social maladjustment. The modern concept of this pathology development characterizes this disease as a polyetiological, the appearance and development of which is influenced by both environmental factors and characteristics of an organism. The prevalence and consequences of osteoarthrosis have raised a widespread interest in this disease among a wide range of specialists in various fields, whose studies in their entirety are aimed at resolving issues related to optimizing treatment tactics and improving efficiency and safety, including medical treatment. To study the efficacy and safety of medicinal substances, agents and drugs used to treat osteoarthrosis, animal experimental models are widely used. The development of an experimental model is intended to reproduce the pathological process, which is identical to the disease in humans by its etiological and/or pathogenetic features. The article discusses the main types of experimental models of cartilage tissue pathology, describes various types of experimental animals and some experimental models, attempts to systematize and classify experimental models, characterises the reasons for choosing a rational model. Based on an analytical study of the literature data, the author of the article found that when choosing an experimental model, it is necessary to consider which type of osteoarthrosis is to be obtained: primary (osteoarthrosis, having endogenous – metabolic disturbance) or secondary (post-traumatic). In addition, the choice of the experimental model of the cartilage tissue pathology is influenced by the type, age and physiological condition of the animal used in the experiment, which affects the depth and quality of osteoarthritis reproducibility. In general, the content of the article does not claim to be complete and aims to systematize the existing experimental models of cartilage pathology, as well as to help in choosing the most optimal model and type of experimental animal to recreate the pathological process in osteoarthrosis purely.
Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation ...using standardized patients and mobile applications among nursing students.
A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction.
There were statistically significant differences in clinical surgical nursing competence (F = 8.68,
< 0.001), self-efficacy in clinical performance (F = 13.56,
< 0.001), and cultural competence (F = 10.35,
< 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion.
Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.
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