A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa.

Perosky J, Richter R, Rybak O, Gans-Larty F, Mensah MA, Danquah A, Debpuur D, Kolbilla D, Ofosu A, Anderson F, Marzano D, Andreatta P.

University of Michigan, Ann Arbor, MI 48109-5201, USA.

Simul Healthc. 2011 Feb;6(1):42-7.

Pubmed

Abstract

INTRODUCTION: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia. Despite an UN Millennium Development Goal to reduce maternal mortality rates, no significant effect has resulted to date, in large part because women in these areas give birth in rural communities with poor access to definitive care. Traditional birth attendants (TBAs) provide care for delivering mothers; however, they are neither trained nor equipped to recognize or manage PPH as a life-threatening emergent condition. The purpose of this study was to design and evaluate a low-cost, portable simulator for training TBAs and nurse midwives in the use of bimanual compression to manage PPH.

METHODS: Clinicians in USA and Ghana were consulted to develop the engineering specifications, including low cost, long lifetime, easy to use, portable, and high anatomic and procedural fidelity. Pugh charts were used to finalize the design from multiple concepts. The simulator was built and evaluated for validity by American and Ghanaian obstetricians, nurse midwives, midwifery students, and TBAs. The feasibility of the simulator for training illiterate learners was also assessed.

RESULTS: The simulator was evaluated to be an effective training platform with excellent fidelity and valid feedback mechanisms. It was demonstrated to be a feasible platform for training illiterate TBAs to perform bimanual compression.

CONCLUSIONS: The low cost, portable simulator developed for this project has the potential to reduce maternal mortality from PPH in the developing world. Research is ongoing in this application.

Copyright © 2011 Society for Simulation in Healthcare

PMID: 21330849 [PubMed - in process]

Simulation training in central venous catheter insertion: improved performance in clinical practice.

Evans LV, Dodge KL, Shah TD, Kaplan LJ, Siegel MD, Moore CL, Hamann CJ, Lin Z, D'Onofrio G.

Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut 06519, USA. leigh.evans@yale.edu

Pub Med Id: 20736674

Acad Med. 2010 Sep;85(9):1462-9.

Abstract

PURPOSE: To determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice.

METHOD: This prospective, randomized, controlled, single-blind study of first- and second-year residents occurred at a tertiary care teaching hospital from January 2007 to September 2008. The intervention group (n = 90) received a didactic and hands-on, competency-based simulation training course in US-guided CVC insertion, whereas the control group (n = 95) received training through a traditional, bedside apprenticeship model. Success at first cannulation and successful CVC insertion served as the primary outcomes. Secondary outcomes included reduction in technical errors and decreased mechanical complications.

RESULTS: Blinded independent raters observed 495 CVC insertions by 115 residents over a 21-month period. Successful first cannulation occurred in 51% of the intervention group versus 37% of the control group (P = .03). CVC insertion success occurred for 78% of the intervention group versus 67% of the control group (P = .02). Simulation training was independently and significantly associated with success at first cannulation (odds ratio: 1.7; 95% confidence interval: 1.1-2.8) and with successful CVC insertion (odds ratio: 1.7; 95% confidence interval: 1.1-2.8)--both independent of US use, patient comorbidities, or resident specialty. No significant differences related to technical errors or mechanical complications existed between the two groups.

CONCLUSIONS: Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.

PMID: 20736674 [PubMed - indexed for MEDLINE]

EXPRESS-Examining Pediatric Resuscitation Education Using Simulation and Scripting: The Birth of an International Pediatric Simulation Research Collab

Cheng A, Hunt EA, Donoghue A, Nelson K, Leflore J, Anderson J, Eppich W, Simon R, Rudolph J, Nadkarni V; for the EXPRESS Pediatric Simulation Research Investigators.

From the British Columbia Children's Hospital (A.C.), Vancouver, Canada; Johns Hopkins Children's Hospital (E.A.H., K.N.), Baltimore, MD; Children's Hospital of Philadelphia (A.D., V.N.), Philadelphia, PA; Children's Medical Center of Dallas (J.L.), Dallas, TX; Oregon Health Sciences University (J.A.), Portland, OR; Children's Memorial Hospital (W.E.), Chicago, IL; and Center for Medical Simulation (R.S., J.R.), Boston, MA.

Simul Healthc. 2011 Feb;6(1):34-41.

Pubmed:21330848

Abstract

Over the past decade, medical simulation has evolved into an essential component of pediatric resuscitation education and team training. Evidence to support its value as an adjunct to traditional methods of education is expanding; however, large multicenter studies are very rare. Simulation-based researchers currently face many challenges related to small sample sizes, poor generalizability, and paucity of clinically proven and relevant outcome measures. The Examining Pediatric Resuscitation Education Using Simulation and Scripting (EXPRESS) pediatric simulation research collaborative was formed in an attempt to directly address and overcome these challenges. The primary mission of the EXPRESS collaborative is to improve the delivery of medical care to critically ill children by answering important research questions pertaining to pediatric resuscitation and education and is focused on using simulation either as a key intervention of interest or as the outcome measurement tool. Going forward, the collaborative aims to expand its membership internationally and collectively identify pediatric resuscitation and simulation-based research priorities and use these to guide future projects. Ultimately, we hope that with innovative and high-quality research, the EXPRESS pediatric simulation research collaborative will help to build momentum for simulation-based research on an international level.

PMID: 21330848 [PubMed - as supplied by publisher]

Method and reporting quality in health professions education research: a systematic review

David A Cook, Anthony J Levinson, Sarah Garside

Medical Education 2011: 45: 227–238
http://www.ncbi.nlm.nih.gov/pubmed/21299598

Context  Studies evaluating reporting quality in health professions education (HPE) research have demonstrated deficiencies, but none have used comprehensive reporting standards. Additionally, the relationship between study methods and effect size (ES) in HPE research is unknown.

Objectives  This review aimed to evaluate, in a sample of experimental studies of Internet-based instruction, the quality of reporting, the relationship between reporting and methodological quality, and associations between ES and study methods.

Methods  We conducted a systematic search of databases including MEDLINE, Scopus, CINAHL, EMBASE and ERIC, for articles published during 1990–2008. Studies (in any language) quantifying the effect of Internet-based instruction in HPE compared with no intervention or other instruction were included. Working independently and in duplicate, we coded reporting quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and coded study methods using a modified Newcastle–Ottawa Scale (m-NOS), the Medical Education Research Study Quality Instrument (MERSQI), and the Best Evidence in Medical Education (BEME) global scale.

Results  For reporting quality, articles scored a mean ± standard deviation (SD) of 51 ± 25% of STROBE elements for the Introduction, 58 ± 20% for the Methods, 50 ± 18% for the Results and 41 ± 26% for the Discussion sections. We found positive associations (all p < 0.0001) between reporting quality and MERSQI (ρ = 0.64), m-NOS (ρ = 0.57) and BEME (ρ = 0.58) scores. We explored associations between study methods and knowledge ES by subtracting each study’s ES from the pooled ES for studies using that method and comparing these differences between subgroups. Effect sizes in single-group pretest/post-test studies differed from the pooled estimate more than ESs in two-group studies (p = 0.013). No difference was found between other study methods (yes/no: representative sample, comparison group from same community, randomised, allocation concealed, participants blinded, assessor blinded, objective assessment, high follow-up).

Conclusions  Information is missing from all sections of reports of HPE experiments. Single-group pre-/post-test studies may overestimate ES compared with two-group designs. Other methodological variations did not bias study results in this sample.