Comparison of a Modified Longitudinal Simulation-Based Advanced Cardiovascular Life Support to a Traditional Advanced Cardiovascular Life Support Curriculum in Third-Year Medical Students

Teaching and Learning in Medicine

Volume 23, Issue 4, 2011

Paul Y. Koa, Jay M. Scotta, Aurel Mihaia & William D. Granta
pages 324-330

Background: Simulation is an effective tool for teaching medical students in cardiac arrest management. Purpose: The purpose of this article is to compare the efficacy of a traditional Advanced Cardiovascular Life Support (ACLS) course versus a modified longitudinal ACLS course using high-fidelity simulation in medical students.

Methods: One group enrolled in a 2-day traditional ACLS course while another group participated in independent learning over 2 weeks and 2 simulation sessions using Laerdal Sim-Man. The modified curriculum also included environmental fidelity with simulation, access to materials electronically, smaller class sizes, and integration of real experiences in the Emergency Department into their learning. Student performance was measured with a scripted, videotaped mega code, followed by a survey.

Results: We enrolled 21 students in a traditional ACLS program and 29 students in the simulation-based program (15 and 26 videos available for analysis). There was no difference in Time to Initiate CPR or Time to Shock between the groups, but the modified curriculum group demonstrated higher performance scores. They also felt better prepared to run the code during a simulation and in a hospital setting compared to students in the traditional ACLS curriculum.

Conclusions: Students in a modified longitudinal simulation-based ACLS curriculum demonstrated better proficiency in learning ACLS compared to a traditional curriculum.

Simulation to Enhance Patient Safety Why Aren’t We There Yet?

Rajesh Aggarwal, PhD; and Ara Darzi, PC, KBE, MD

CHEST 2011; 140(4):854–858
PMID: 21972381

Abstract
The delivery of state-of-the-art medical care is complex, with large numbers of treatment strategies often available to individual patients. It is paramount to ensure that each patient receives optimal treatment in a safe, effective, and timely manner. Evidence suggests that an unacceptably high number of patients currently experience suboptimal care as the result of adverse events and medical error. Simulation-based training reduces medical error, enhances clinical outcomes, and reduces the cost of clinical care. It is surprising that medical simulation is not routinely integrated into the training curricula of all health-care professionals. Simulation enables doctors to practice and hone their technical, communication, decision making, and crisis management skills in a safe and educationally orientated environment. The process can foster the development of interprofessional working skills, leading to enhanced patient outcomes. Selection, credentialing, and revalidation of medical professionals are also possible in a simulation setting, enabling maintenance of standards of practice throughout a medical career. In order for simulation to become a part of the medical curriculum, collaborative efforts are required from academics, physicians, managers, and policy makers alike. Bringing these groups together, while a challenge, can lead to high-level outputs in medical care, which will benefit all.

PMID: 21972381

Technology-Enhanced Simulation for Health Professions Education A Systematic Review and Meta-analysis

David A. Cook, MD, MHPE; Rose Hatala, MD, MSc; Ryan Brydges, PhD; Benjamin Zendejas, MD, MSc; Jason H. Szostek, MD; Amy T. Wang, MD; Patricia J. Erwin, MLS; Stanley J. Hamstra, PhD

JAMA.http://jama.ama-assn.org/content/306/9/978.short
2011;306(9):978-988. doi: 10.1001/jama.2011.1234

ABSTRACT

Context Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education.

Objective To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention.

Data Source Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011.

Study Selection Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals.

Data Extraction Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors.

Data Synthesis From a pool of 10 903 articles, we identified 609 eligible studies enrolling 35 226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I2>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality.

Conclusion In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.

KEYWORDS: computer simulation, computer-assisted instruction, education, medical, education, professional, learning, meta-analysis.

The effectiveness of a cognitive task analysis informed curriculum to increase self-efficacy and improve performance for an open cricothyrotomy.

J Surg Educ. 2011 Sep-Oct;68(5):403-7.

Campbell J, Tirapelle L, Yates K, Clark R, Inaba K, Green D, Plurad D, Lam L, Tang A, Cestero R, Sullivan M.
Source
Center for Creative Technologies, University of Southern California, Los Angeles, California.
Abstract
OBJECTIVE:
This study explored the effects of a cognitive task analysis (CTA)-informed curriculum to increase surgical skills performance and self-efficacy beliefs for medical students and postgraduate surgical residents learning how to perform an open cricothyrotomy.

METHODS:
Third-year medical students and postgraduate year 2 and 3 surgery residents were assigned randomly to either the CTA group (n = 12) or the control group (n = 14). The CTA group learned the open cricothyrotomy procedure using the CTA curriculum. The control group received the traditional curriculum.

RESULTS:
The CTA group outperformed the control group significantly based on a 19-point checklist score (CTA mean score: 17.75, standard deviation [SD] = 2.34; control mean score: 15.14, SD = 2.48; p = 0.006). The CTA group also reported significantly higher self-efficacy scores based on a 140-point self-appraisal inventory (CTA mean score: 126.10, SD = 16.90; control: 110.67, SD = 16.8; p = 0.029).

CONCLUSIONS:
The CTA curriculum was effective in increasing the performance and self-efficacy scores for postgraduate surgical residents and medical students performing an open cricothyrotomy.

Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

PMID: 21821221 [PubMed - in process]

Simulation in medical education.

Med Teach. 2011;33(1):1-3.

Khan K, Pattison T, Sherwood M.
Source

Manchester Medical School, University of Manchester, Faculty of Medical and Human Sciences, UK. kamran.khan@manchester.ac.uk

Abstract
Studies in cognitive psychology inform us that the recall of information and its application are best when it is taught and rehearsed in environments similar to workplace. The healthcare professions are heavily task- and performance-based where non-technical skills, decision making and clinical reasoning are important alongside integrity, empathy and compassion. Most of these attributes are difficult to teach and assess in the traditional classrooms. Enhanced patient safety on one hand has to be the ultimate outcome of any medical curriculum while on the other hand, it itself can be potentially compromised in an apprenticeship-based model of medical education. A range of simulation techniques are very well placed to be used alongside clinical placements. These can be employed to enhance learning of healthcare professionals in safe environments, without compromising the patient safety, while maintaining a high degree of realism. This article builds an argument for the use of simulation techniques to enhance patient safety and points the readers to the AMEE Guide No. 50 on simulation, which is written as a practical manual on building a simulation programme in healthcare education.

PMID: 21182376 [PubMed - indexed for MEDLINE]

Advances in simulation for pediatric critical care and emergency medicine.

PMID: 21494148

Curr Opin Pediatr. 2011 Apr 13. [Epub ahead of print]

Yager PH, Lok J, Klig JE.

aDivision of Pediatric Critical Care Medicine, Massachusetts General Hospital for Children, Massachusetts, USA bHarvard Medical School, Boston, Massachusetts, USA cDivision of Pediatric Emergency Medicine, Massachusetts General Hospital for Children, Massachusetts, USA.

Abstract

PURPOSE OF REVIEW: Routine integration of simulation into healthcare education and practice has gained momentum. Simulation is particularly important to acute and critical care pediatrics, as it offers alternative methods of training for high-risk and/or lower-frequency events in children. This review will discuss the recent advances in simulation education for pediatric critical care and emergency medicine and assess its potential for future growth through these subspecialties.

RECENT FINDINGS: Research indicates that simulation with a high-fidelity manikin is more realistic than with a simple manikin. Multievent simulation centers, on-site suites and mobile units for in-situ training offer a variety of venues for training. High-fidelity simulation is now used to identify performance gaps, enhance educational curricula and assess core competencies. A landmark study demonstrated improvement in outcomes from in-hospital pediatric cardiopulmonary arrest following the introduction of a pediatric simulation-based mock code program.

SUMMARY: High-fidelity simulation is emerging as a powerful tool for pediatric emergency medicine and critical care education through both individual and team-based training exercises. Programs can be tailored to meet specific institutional needs and budget limitations. As pediatric simulation-based programs evolve, further progress is anticipated in acute and critical care outcomes.

PMID: 21494148

Effect of a Simulation Educational Intervention on Knowledge, Attitude, and Patient Transfer Skills: From the Simulation Laboratory to the Clinical

Effect of a Simulation Educational Intervention on Knowledge, Attitude, and Patient Transfer Skills: From the Simulation Laboratory to the Clinical Setting

PubMed Id: 21487345

.

Oʼdonnell JM, Goode JS Jr, Henker R, Kelsey S, Bircher NG, Peele P, Bradle J, Close J, Engberg R, Sutton-Tyrrell K.

From the Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing (J.M.O., R.E., J.S.G., R.H.); Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (S.K., K.S.-T., P.P., N.G.B.); University of Pittsburgh School of Medicine (N.G.B.); University of Pittsburgh School of Dental Medicine (J.C.); The Winter Institute for Simulation, Education and Research (WISER) (J.M.O.); Department of Anesthesiology, University of Pittsburgh Medical Center (N.G.B., J.S.G., J.B.); and

Abstract

INTRODUCTION: Musculoskeletal injury in the workplace is the primary work-related factor in loss of nursing personnel from the workforce. Moving or transferring patients is the dominant contributing event. A simulation educational approach has not been closely studied in this area but may have advantages over traditional approaches. Specific aims were to (1) evaluate the effect of a simulation intervention on success of patient transfers in a clinical setting and (2) measure change in participants' knowledge and attitude as a result of the intervention.

METHODS: A prospective, observational, longitudinal design was used. Baseline patient transfer observations were conducted on control and intervention units. An optimum task set was developed using hierarchical task analysis methods. Subjects (N = 71) completed pre- and postintervention knowledge and attitude assessments. The intervention consisted of simulated patient transfers using a mannequin, education, and training, followed by repeated simulated transfers using a mannequin with debriefing. Observations of patient transfers in patient care areas were repeated at 4 and 12 weeks.

RESULTS: Patient transfer success improved from 66% at baseline to 88% at the 4-week measurement point (t = 7.447, P ≤ 0.0004). At 12 weeks, transfer success had decreased to 71%, with addition of new employees between weeks 4 and 12 confounding the 12-week measurement. Knowledge improved from a baseline of 65% to 95% postsimulation intervention (z = -6.634, P ≤ 0.0004). Attitude change was also evaluated with significance seen with 12 of 15 items (P ≤ 0.05).

CONCLUSIONS: A simulation intervention was successful in significantly improving knowledge and changing subject perceptions with regard to this task. Skills acquired through simulation successfully transferred to the clinical setting. Improvement in success for patient moves not trained in the simulation laboratory suggests that acquired skills were generalizable and supports application to different settings.

PMID: 21487345 [PubMed - as supplied by publisher]