Introduction

The ability to gain access to the peritoneal cavity and perform dependable fascial and skin closure is foundational in surgical training. We developed and evaluated a realistic, low-cost synthetic abdominal wall simulator incorporating a biomechanically similar fascial layer.

Objective

This study investigated how occupational physical activity (OPA) affects cognition and self-reported physical exertion in paramedicine students in simulation.

Background

Realism is a quality criterion for simulation. However, its impact on learning remains unclear. There is no consensus on how to assess realism in simulation except for virtual reality. A previous study of Brackney and Priode (Back to reality: the use of the presence questionnaire for measurement of fidelity in simulation, Journal of Nursing Measurement, 2017 Aug 1;25(2):66–73) looked at the evaluation of sense of presence (SoP) in high fidelity. Our study aimed to expand on these results by evaluating SoP in different simulation modalities.

Introduction

Doctors with refugee status are a heterogeneous group of learners with unknown educational needs for entering new workplaces. Better processes for integration into the healthcare workforce may improve refugee doctors’ experiences and contribute to addressing the current healthcare workforce crisis. Simulation-based education has the potential to assist with refugee doctors’ integration, but this has not yet been studied. We describe a novel approach to co-creative action research for simulation-based curriculum development. This example may inform others who are developing curricula for learners with unknown needs.

Introduction

Visually Enhanced Mental Simulation (VEMS) is a simulation technique that combines mental simulation and think-aloud with flat plastic representations of a patient(s) and relevant assessment and treatment adjuncts. It offers simple, effective and efficient education for healthcare professionals, but there is a paucity of guidance on effective VEMS design and delivery. We aimed to explore facilitator and participant perceptions of VEMS at our institution to inform guidance for facilitators and simulation program leaders.

Introduction

Simulation-based education (SBE) is widely adopted in undergraduate nurse and midwife education. The extent, format and evidence for its use in nurse and midwife advanced practitioner education is under explored. The aim of this scoping review was to establish the extent and types of available evidence on SBE for nurse and midwife advanced practitioner education.

Introduction

Simulation-based education is a well-established approach in healthcare, commonly adopted to develop and refine clinical skills, with growing use in developing communication skills. Person-centred care is pivotal in improving health outcomes, yet its adoption in health professional curricula is still developing. The current pilot study sought to (1) develop a suite of virtual simulation scenarios around person-centred care for nursing, pharmacy, physiotherapy, social work and speech pathology professionals and students, (2) explore user acceptance of the virtual simulation platform and (3) explore the perceived impact of the scenarios on their knowledge, skills and confidence in delivering person-centred care in a hospital environment.

Introduction

In the emergency departments, skin and soft tissue infections are highly common. Incision and drainage (I&D) are a critical procedural skill for emergency medicine trainees. Simulation-based training offers a practical and safe method for developing this skill. The objective was to assess the effectiveness of a newly developed, low-cost, ultrasound-compatible simulation model for abscess and cellulitis across four domains, including self-efficacy, fidelity, educational value and teaching quality, using the Michigan Standard Simulation Experience Scale (MiSSES).

Introduction

Simulation scenarios should be designed in a way that addresses the needs and expectations of learners of varied backgrounds and experience levels. Varied degrees of complexity or difficulty in simulation exercises may be an effective means to optimally align learning objectives with outcomes.

Background

Healthcare systems face increasing demands that may negatively impact staff well-being and elevate sick leave rates. Simulation-based team training enhances clinical skills through teamwork and communication training. However, further research is needed to understand its impact on healthcare professionals’ well-being. This study investigates how a simulation-based team training intervention affects sick leave among healthcare professionals.

Aim

To investigate whether regular departmental, in situ simulation in trauma resuscitation improves time to computerized tomography (CT) in real patients presenting to the Emergency Department following major trauma.

Introduction

Atypical sensory processing is a difficulty in regulating and managing sensory input in a meaningful way. Sensory processing disorder (SPD) is common in individuals with autism spectrum disorders (ASD), pervasive developmental disorders, specific learning difficulties (SpLD) and neurodiversity.

The Experiencing Sensory Overload simulation aims to champion inclusive practice and reduce health inequalities by encouraging student nurses to reconsider their working environments to create sensorily safe spaces for individuals who experience SPD. This paper explores the impact of the transformative simulation on nursing students’ confidence and knowledge of sensory overload and inclusive practice.

Introduction

Whilst virtual reality simulation (VRS) has been established in the teaching of anatomy and technical procedures, its use within acute medicine remains relatively unexplored. Furthermore, whilst VRS has been shown to have a role in improving assessment outcomes, its impact on real-life clinical practice is unknown. This pilot study investigated VRS in the teaching of acute medical topics and explored the transferability of learning from the VRS sphere into real-world clinical practice.

Introduction

This study explored the impact of incorporating a personalized moulage face mask modelled after a simulated patient, on a high-tech simulator manikin during simulation training on nursing students’ flow experience. The use of high-tech simulator manikins in medical education is common, but their generic appearance can hinder students’ engagement and learning.

Introduction

Healthcare simulation and debriefing practices are optimal tools in health professions education and rely on a well-built psychologically safe construct for effectiveness and success. However, it is not well understood how differences working in solo or group scenarios impact learner preferences on learning outcomes and maintenance of psychological safety. This study aimed to uncover the sentiment of learners towards comfort with engaging in healthcare simulation through factors that confer psychological safety. These sentiments were examined in relation to satisfaction with achievement of learning objectives. The ability to leverage solo or group participants as an intentional design feature has implications for creators of simulation curricula. With intentionality, the determination of participant number for simulation-based education may prove to enhance individualized growth while supporting a psychologically safe environment that carries through to the debriefing phase.

Background

Large language models (LLMs), such as ChatGPT, Bing and Bard, have shown promise in various applications. Their potential in healthcare simulation scenario design remains minimally explored. With the wide adoption of simulation-based education (SBE), there is an opportunity to leverage these LLMs to streamline simulation scenario creation. This study aims to compare the quality of scenarios generated by LLMs and explore their responses based on different prompting techniques.

Introduction

There is growing evidence that instruction and guidance during simulation engagement can enhance explicit and subtle procedural knowledge and skills, medical knowledge, situation awareness and organization, and observation and reflection. However, instruction and guidance to scaffold learners during simulation engagement receive limited attention in published peer-reviewed literature, simulation practice guidelines and instructional design practices. This scoping review aimed to identify specific instruction or guidance strategies used to scaffold learners during simulation engagement, who or what provided support and guidance, who received instruction or guidance, and for what reasons.

Introduction

Simulation is a mandatory component of surgical training; the challenge remains to develop ‘close-to-real’ training. Management of paediatric elbow fractures is an obligatory competence for completion of training in Trauma and Orthopaedics. Current methods use dry bone simulation to teach wire configuration, but intra-operative radiographic interpretation is not possible.

Introduction:

Cardiac arrests, though rare in District General Hospitals (DGHs), require effective team performance. Studies show that each minute of delay in delivering the first shock during out-of-hospital ventricular fibrillation cardiac arrest decreases the probability of survival to discharge by 6% [1].

During our monthly in-situ simulation program, we identified a potential delay to shock delivery with delayed connection of defibrillator pads. Using the SEIPS framework [2] we aimed to explore both equipment and workflow inefficiencies.

Supporting Documents – Figure 1-A95

Introduction:

Case-based learning (CBL) is a widely used teaching method, promoting clinical reasoning and application of knowledge through structured scenarios (1). Developing high quality CBL materials requires significant expertise and resources. Recent advances in Artificial Intelligence (AI) offer the potential to streamline this process, yet its effectiveness in producing high quality educational material is uncertain. This study aimed to evaluate whether CBL scenarios produced by AI are comparable in quality to those written by experienced educators, based on expert review across key educational domains.

Introduction:

Rectus Sheath Block (RSB) is a ‘Plan A’ regional anaesthesia technique used for perioperative pain management in abdominal surgeries [1]. Anaesthetists must perform these blocks proficiently, yet limited training opportunities reduce confidence and procedural uptake. Simulation training offers a solution, but existing models are often costly or lack anatomical realism. This study aims to develop and evaluate a cost-effective, anatomically representative, and reusable RSB training model.

Introduction:

Augmented reality (AR) provides interactive and immersive experiences that enrich medical training by enhancing learners’ spatial understanding, clinical decision-making, and engagement [1-3]. However, the uptake of AR across educational institutions remains inconsistent due to variations in infrastructure, cost, and training. This study aimed to explore medical students’ experiences with AR, measure their immersion levels, and identify perceived benefits and barriers, particularly those linked to digital inequality.

Introduction:

Medication administration is a high-risk clinical task, with errors contributing to preventable harm worldwide [1]. Competence in medicine calculation is essential to patient safety, yet nursing students often report anxiety and low confidence, increasing the risk of errors. Virtual learning environments provide valuable opportunities to develop students’ skills, build confidence, and enhance competency in medication administration.

Supporting Documents – Figure 1-A86

Introduction:

Narrative theory states that stories allow learners to contextualise education in a way that is valid to them [1,2]. Simulation-based education is an effective teaching modality, correlating with improved clinical performance. Learners benefit most from simulated environments they are engaged with and believe to be authentic [3]. Traditionally this can be limited by the number of participants. We sought to validate a combination of narrative theory and simulation-based education in Paediatric Emergency Medicine (PEM) education at international conferences.

Supporting Documents – Table 1-A81

Table 1.

Proportion of correct pre and post-education scores at 6 weeks. Statistical analysis performed using Two sample Z test of proportions. Results considered significant if p<0.05.

Question descriptor	Pre-education proportion of correct responses during the live session, mean (95% CI)	Post-education proportion of correct responses at 6 weeks, mean (95% CI)	Estimate for difference, mean (95% CI)	P-value
Timing of intubation	58.3 (48.8–67.8)	81.8 (70.4–93.2)	23.5 (8.6–38.4)	0.006
Ventilation strategies	35.6 (25.5–45.7)	72.7 (59.5–85.9)	37.1 (20.5–53.7)	<0.001
Pulmonary haemorrhage	5.2 (0.7–9.6)	68.2 (54.4–82.0)	63.0 (48.5–77.5)	<0.001
Third line inotropes	53.8 (43.6–64.0)	93.2 (85.8–100)	39.4 (26.7–52.1)	<0.001
Intravenous immunoglobulin	65.2 (55.5–74.9)	90.9 (82.4–99.4)	25.7 (12.8–38.6)	0.002

Introduction:

Tissue-mimicking materials play an integral role in clinical education through providing a controlled, risk-free environment for skill development. While commercially available phantoms enhance trainee proficiency and patient safety, their high cost and limited accessibility hinder widespread adoption. Consequently, clinical training often relies on supervised practice, constrained by logistical challenges and patient safety concerns. To address these limitations, ADAMgel was developed as a low-cost, non-toxic, and recyclable biomaterial designed to replicate human tissue properties [1]. Its successful integration into procedural training models highlights its potential as an effective simulation medium. ADAMgel offers several advantages, including versatility, affordability (<£2/kg), self-healing properties, bacterial resistance, and compatibility with diathermy and harmonic scalpels. Additionally, it closely mimics human tissue under ultrasound imaging, making it particularly valuable for sonography-based training. However, a lack of comprehensive mechanics data has restricted broader implementation in medical training. This study systematically evaluates the mechanical properties of six ADAMgel formulations to refine their suitability for simulation applications.

Introduction:

Many final-year student doctors report feeling underprepared and lacking in confidence in essential skills for on-call shifts [1]. On-call duties are a core component of foundation training. On-call simulation improves confidence in non-clinical skills such as prioritisation and stress management [2,3].

This project introduced a simulated on-call event for final-year student doctors at the University of Sheffield, aiming to boost confidence in non-clinical skills and preparedness for Foundation Year 1 (F1) on-call responsibilities.

Supporting Documents – Figure 1-A71

Introduction:

New graduate doctors often feel unprepared for decision making and communication in acute situations [1], and undergraduate medical students have limited exposure to acutely unwell children to develop these skills in a paediatric setting. Simulation-based education (SBE) offers learners a chance to practise these skills in a safe, controlled environment without risking patient safety. By replicating real-life scenarios, SBE enhances both technical and non-technical competencies, including decision-making, teamwork, and communication [2]. This project aimed to assess changes in undergraduate medical students’ self-reported confidence before and after participating in a simulation-based teaching session on paediatric emergencies.

Introduction:

Ireland’s clinical education capacity for health and social care faces pressure, exacerbated by a 33% vacancy rate across healthcare profession posts. With the government aiming to increase healthcare students in the education system there is a need for innovative clinical education models.

Introduction:

GPs are increasingly expected to manage acutely unwell patients presenting in the community setting1. Evidence suggests that simulation-based training (SBT) for the management of the deteriorating patient is valuable for qualified GPs 2,3. GPs in training rotate through hospital posts so are likely to have had recent exposure to acutely unwell patients, so we wanted to know would a similar approach using SBT be valuable to GPs in training?

Supporting Documents – Table 1-A52

Table 1:

The practical management of emergencies in primary care; evaluation of a brief simulation-based teaching for GPs in training.
SBT Emergency Scenario theme	% of participants with experience of managing emergencies in hospital (n=25)	% of participants with experience of managing emergencies in a GP setting (n=19)	% improvement in self-rated confidence in the theoretical management of emergencies after SBT	% improvement in self-rated confidence in the practical management of emergencies after SBT
Acute coronary syndrome	84%	47%	22%	33%
Cardiac arrest	80%	0%	21%	31%
Hypoglycaemia	80%	11%	27%	52%
Seizure	72%	0%	53%	72%
Anaphylaxis	24%	5%	29%	45%
Severe asthma	84%	32%	31%	49%
Sepsis	100%	63%	5%	40%
Meningitis	6/25	0%	29%	71%

Introduction:

Foundation doctors are expected to perform key ward-based tasks from the outset of clinical practice. However, clinical attachments alone may not provide consistent opportunities for skill development. Simulated ward rounds (SimWR) offer a standardised educational experience to supplement clinical placements. Previous literature highlights potential benefits of simulated ward activities, but call for further high-quality evidence [1]. Building on prior work [2], we developed an expanded SimWR programme, evaluating its impact on final-year medical students’ confidence with presenting cases – testing prescribing and both verbal and written documentation skills.

Supporting Documents – Figure 1-A46

Figure 1:

Confidence improvements in core ward tasks following SimWR sessions. 1(a): Confidence in scribing and prescrlibing. 1(b): Confidence with presenting to seniors over the course of SimWR sessions.

Introduction:

High-Fidelity (Hi-Fi) Simulation is essential in medical education, offering realistic clinical training in safe environments. However, the intensive resource requirements of specialised equipment, dedicated simulation suites, and trained instructors frequently limit students’ hands-on participation [1]. Many learners consequently spend most simulation sessions as passive observers. This study examines whether active participation in Hi-Fi Simulation leads to better performance in subsequent emergency scenarios compared to observation alone, while also investigating knowledge retention over time.

Introduction:

Peer Evaluated Simulation (PES), embedded in a final-year undergraduate nursing module, enables students to enact clinical scenarios and receive formative feedback from peers. In simulation-based learning, peer evaluation can be a powerful formative assessment tool. Creating a rubric for peer evaluation in simulation is a structured approach that provides students with clear guidelines and criteria to assess their peers’ performance accurately and constructively [1,2]. A well-designed rubric standardises feedback, reduces subjective bias, and encourages reflective practice. The key concepts within this PES are related to Shared Decision Making (SDM), which is a neglected component of existing simulation rubrics. Therefore, this study outlines how these components are conceptualised and developed into the rubric to enable students to critically analyse each other’s performance in a constructive, respectful manner.

Introduction:

The rapid expansion of simulation-based education (SBE) in UK nursing curricula has been driven by factors like the pandemic, updated NMC standards and placement shortages. Furthermore, financial constraints, supply chain issues and technological advances, are reshaping the way simulation is planned and delivered, hindering, at times, SBE implementation. Henceforth, it is imperative to deliver high-quality simulation for impact to ensure the current workforce is prepared to face the challenges of the future [1].

Improvement science methodologies could represent a scalable solution as they offer structured, evidence-based approaches to planning and delivering simulation programmes, ensuring sustainability, operational resilience and simulation effectiveness [2].

This abstract presents the application of improvement science tools to the planning and delivering of an SBE project, aiming to increase awareness and pave the way for a future-proof roadmap to sustainable and impactful SBE.

Supporting Documents – Table 1-A28

Table 1.

Tools for improvement in SBE.

Tool	Adoption	Benefits
Process Mapping (PM)	• Collection of data• Students’ sign in process• Day to day running of the simulation• EPAD completion• Faculty upskilling	Process controlImplemented for all the main workstreams to promote process visualisation, encouraging comprehension, facilitating discussions, elimination bottlenecks and redundant steps.
Action Effect Method (AEM)	• Kit and equipment required• Learning resources needed• Tracking and monitoring• Critical interventions to PDSA• Programme evaluation	Resources and requirementsLinked aims to required actions and resources needed, allowing the team to identify elements to implement and critical aspects warranting related testing cycles.
PDSA	• Scenario development• EPR system integration• Attendance• Evaluation completion• Proficiency tracking	Responsiveness and effectivenessCycles enabled rapid cycle testing of changes evaluating their immediate impact, and refining the simulation environment in near real-time

Introduction:

Interprofessional education (IPE) equips health profession students for collaborative practice [1]. Simulation-based IPE allows students from different professions to learn together in simulated scenarios, enhancing teamwork and patient care [2]. This study aims to conduct a comprehensive evaluation of a simulation-based IPE activity focused on disaster preparedness and management for health profession students [3].

Introduction:

Student radiographers must be proficient in appraising diagnostic images for clinical manifestations and taking appropriate action [1]. Chest X-rays (CXR’s) are the most frequently performed imaging examinations in the UK [2]. presenting complex anatomy and numerous pathologies that challenge students. Simulation-based education, particularly gamification, has shown promise in enhancing engagement and achieving learning outcomes [3]. This study evaluates the effectiveness of a co-produced, creatively designed simulation in improving CXR proficiency among third-year radiography students.

Introduction:

Simulation within physiotherapy education, is effective in developing many essential clinical and professional skills [1]. Standardised patients (SPs) help create high fidelity scenarios reflecting real-world environments, enabling students to practice person-centred care, communication skills and empathy, alongside hands-on clinical techniques [1]. The cost of hiring external actors, however, is one of the biggest barriers faced by Higher Education faculty staff [2]. While peer-peer simulation has been shown to be effective [1], our own experiences demonstrated a reluctance for many students to take on a performance role. Collaborative discussions with the university Acting programme highlighted several mutual benefits if the non-medically trained acting students were able to portray realistic patients and the physiotherapy students could ‘buy into’ character age differences. Maintaining psychological safety was also a priority.

This phenomenological study aimed to explore students’ perceptions of simulated learning, and the impact acting student SPs had on the learning experience. As qualitative methodologies are poorly represented in physiotherapy education simulation literature, a second aim was to add depth to our current knowledge.

Supporting Documents – Table 1-A21

Table 1.

Themes identified through thematic analysis.

Physiotherapy students’ perceptions of the simulated learning experience
Themes	Participant quotes
Simulation helped develop professional skills	“I had to really actively think on my feet” (P4)“It was great to collaborate with other people” (P1)“We had to problem solve” (P7)
Emotional aspects of sim	“It was amazing” (P4)“I was a bit more scared actually because it was more real” (P5)“A real confidence booster” (P7)
Environmental fidelity increased learning	“It was a fantastically safe space” (P1)“As close to a real clinical setting as it could be” (P2)“My first real experience of a hospital ward” (P3)
Simulation as an educational/ learning experience	“So many things were learnt” (P8)“The point was to learn and that was clear” (P6)“I did get valuable learning from watching” (P1)
Physiotherapy students’ perceptions of acting students portraying SPs
Skills of acting students in portraying patients	“The acting was absolutely incredible and far exceeded what I was expecting” (P2)“The acting students were taking their roles really seriously” (P9)“I found very easily that I slipped into looking at him as though he was an 82-year-old” (P11)
Enhanced learning experience	“Actors made it feel real” (P4)“It immediately put you in that professional frame of mind” (P2)“Looking at patient care, patient-centred care and how we’re actually treating the patient” (P5)
Comparisons with peer-on-peer scenarios	“If you do like mess up and you’re working with a friend, it’s like, yeah, OK we’ll give you a little bit of help” (P4)“There was a sense of realism from the acting patients that maybe we wouldn’t have got from like our peers” (P10)
Acting student opinions of the simulation experience.
Simulation as a learning experience for actors	“I found it harder to criticise them” (P12“It was certainly different to things I’ve done in the past” (P13)“I couldn’t overdo it, but I couldn’t underplay it either” (P12)“I found being that vulnerable quite difficult, even though it was fake” (P12)
Professionalism of physiotherapy students	“There was a lot of trust involved, but there wasn’t any point where I felt I wasn’t safe with it” (P12)“I didn’t feel like I needed that safety net of the lecture” (P13)“They all did brilliantly” (P12)
Actors reacting to changing situations	“Ohh, this is too easy for them. And so I made it more difficult” (P13)“I made it harder in the afternoon” (P12)

Introduction:

Virtual reality (VR) simulation is emerging as a transformative tool in medical education, offering immersive, clinical experiences on demand. In neurology, VR and augmented reality have been shown to enhance learning of complex concepts such as neuroanatomy [1]. Additionally, immersive simulation paired with structured debriefing can uncover discipline-specific knowledge gaps otherwise difficult to identify [2]. However along with addressing educational needs, limitations including logistic expertise required in deploying VR sessions at scale require further work to demonstrate pragmatic utility of this technology in educating medical students. The work presented here therefore highlights a potential role for use of VR in medical education.

Introduction:

The social care workforce must evolve to meet the changing needs of an ageing population, including increasing demand and delivery of homecare. Current training for home care workers is often theory-based, with homecare workers often feeling underconfident and lacking skills in some areas. Although simulation is widely used in healthcare for skill enhancement, it is underutilised in homecare training. This project aimed to explore the use of simulation-based education to upskill homecare workers to identify risks they may encounter in a client’s home.

Introduction:

Keeping children safe - by identifying safeguarding risks and taking prompt action - is part of all healthcare professionals’ roles [1]. However, practitioners experience numerous internal and external barriers to acting on suspected neglect - thereby delaying initial safeguarding conversations with parents [2,3].

Traditional safeguarding training is largely theoretical in nature - focusing on protocol, professional roles, and the law. Given the complexity of situations when neglect occurs, practical skills in early engagement of parents in safeguarding conversations are essential for safer outcomes for children, as is supporting practitioners to identify barriers to action. This study explored participants’ experience of, and the learning acquired from, a multi-agency simulation training on early childhood neglect.

Supporting Documents – Figure 1-A15

Figure 1:

Semi-structured interviews: themes and subthemes.

Introduction:

This study shares phase one results of a two-phase participatory research project that joins simulation faculty (educators), GP trainees (learners), simulated participants (SP’s) and persons with lived experience of chronic conditions (patients) to co-design simulations for primary care. Phase one is concerned with understanding each group’s starting perspectives on, and to surface the tensions within, the current design of simulation scenarios. The purpose is to intervene in the existing epistemic underpinnings of simulation whereby faculty are the primary source of expertise on all aspects including scenario creation and to provide a route map for others on how co-creation can be enacted in this space.

Introduction:

Simulation based education (SBE) is integral to the Internal Medical trainee (IMT) curriculum (1). As a centre, we have developed a run-through series of courses delivered annually to IMT doctors across the region in years 1-7 of their training- IMTSim. The learning objectives for these courses are curriculum mapped and incorporate spiral learning to build on key topics. Data collected through pre- and post- course questionnaires suggest that trainees find our courses enjoyable and beneficial to their professional development. As data on the longer term benefits of SBE is limited, we felt it important to evaluate the ongoing impact of our courses via a ‘one year on’ impact survey.

Introduction:

Current midwifery curricula often lack adequate training in optimal positioning techniques for pregnant women, a critical factor for ensuring safe labour outcomes. Evidence from other disciplines [1,2] strongly suggests that enhanced visualization techniques significantly improve proficiency, accelerate learning, and deepen understanding. The PROGRESSION project, funded by the Erasmus+ program, aims to develop a VR-based learning concept to visualize and train positioning maneuvers while illustrating the subtle movements of internal anatomical structures. This study aimed to assess the educational impact of PROGRESSION on midwifery students’ knowledge. Additionally, the usability of the system was also evaluated.

Supporting Documents – Figure 1-A11

Figure 1:

Box plots showing midwifery students’ knowledge levels before and after the VR-based educational experience. On the right, illustrative images of the VR training environment are presented.

Introduction:

Individuals with ASC experience poorer health outcomes globally, yet healthcare professionals often lack adequate ASC knowledge [1]. Simulation-based learning enhances recall and practice [2], though resource limitations often restrict its use. Mental health nursing simulations are less developed compared to other fields, leaving a gap in training. Our co-created 360-degree video aims to address this by providing realistic scenarios that enhance students’ empathy and confidence in working with ASC patients.

Introduction:

Emergency department thoracotomy (EDT) in children is a rare, high-stakes procedure performed primarily during traumatic cardiac arrest [1]. Training opportunities are limited, and current reliance on porcine models raises ethical concerns and lacks paediatric anatomical fidelity. This project aimed to develop and evaluate a low-cost, Aqueous Dietary fibre Antifreeze Mix gel (ADAMgel) based, synthetic model tailored to paediatric EDT, improving training accessibility, anatomical realism, and trainee confidence [2].

Supporting Documents – Figure 1-A3

Introduction:

Simulation-based interprofessional (IP) education programs at the undergraduate level remain limited both worldwide [1] and within the Portuguese educational context [2]. The LINKS workshop - Lifting INterprofessional Knowledge through Simulation - is a novel initiative designed for IP teams of healthcare students (medicine and nursing). It aims to enhance team-based behavioural competencies that are essential for effective IP teamwork. This pilot study aims to assess the impact of the LINKS workshop on communication skills within IP undergraduate teams.

Supporting Documents – Figure 1-A2

Figure 1:

Box plots illustrating team scores (n=13) for each communication strategy in Scenario 1 (S1) and Scenario 2 (S2). Scores represent the mean ratings from the four independent observers, assessing the application and consistency of the communication strategies.

Introduction:

A multi-patient simulation involving patients with acute health challenges was co-created by nursing faculty at the University of New Brunswick, Canada. The integration of this simulation occurred during the 2023 Fall term. Presented findings are focussed on data collected in the 2024 Fall term as research leads obtained ethical approval prior to this second offering. Although simulation-based experiences (SBEs) are well established as effective tools in building capacity in health care programs [1], the use of multi-patient simulations in support of skills such as clinical judgement and time management remain underexplored. The National Council State Boards of Nursing’s Clinical Judgement Measurement Model (CJMM)[2] helped frame learning objectives while INASCL standards were adhered to in the design of this simulation [3]. The purpose of this presentation is to share key findings and recommendations for a study exploring student perceptions of this multi-patient SBE.

Although educational escape rooms have become increasingly popular in recent years, the availability of tools to support their implementation has not evolved alongside. It is thought that logistical effort and lack of user-friendly, reusable tools have prevented the widespread adoption of medical escape rooms [1]. The use of widely available technologies can offer more flexibility around puzzle creation and can create an environment that closely resembles that of a clinical area, adding to the learning of medical students.

This work aims to determine whether the introduction of new technology to a low-fidelity medical escape room scenario improved the experience and benefitted the learning of medical students.

Methods:

A single-day medical escape room simulation was designed, which revolved around the management of a patient with acute coronary syndrome. A fictitious electronic patient record (EPR) system was specifically created for this scenario, containing a simple patient search function, fictitious patient information and image results with certain pages locked behind passwords.

Penultimate-year medical students, in teams of 3-4, were given 45 minutes to complete the scenario, after which a structured debrief occurred. Students were asked for feedback on their experience using free text responses and 5-point Likert scales. Students self-reported on their learning of medical concepts, non-technical skills related to simulation, and their experience of the puzzles during the scenario.

Results:

There was a 100% feedback completion rate from students who participated in the escape room (n=14). In the quantitative feedback (Figure 1-A134), all students responded strongly agree or agree that using supportive technology benefited their educational experience. 93% strongly agreed that the increasing complexity and realism of the puzzles, especially the fictitious EPR website, effectively enhanced their clinical reasoning and learning. Written feedback praised the usefulness of the fictitious EPR system and the realism of the clinical scenario.

Figure 1-A134.

Discussion:

Using digital technology in low-fidelity educational escape rooms can enhance the complexity of puzzles and orient learners towards their community of practice by simulating a clinical environment [2]. The fictitious EPR system allowed for flexible puzzle creation and familiarised learners with the use of clinical systems. All students were able to escape the room successfully, therefore creating a positive learning experience for the participants [3]. Feedback showed that the technology enhanced students’ clinical learning and skills. If designed to be reusable and user-friendly, digital technology could make simulated low-fidelity escape rooms a more accessible teaching modality for delivery across large interprofessional cohorts.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Lopez-Pernas S, Gordillo A, Barra E. Technology-enhanced educational escape rooms: a road map. IT Professional. 2021;23(2):26–32. Available from: doi: 10.1109/MITP.2021.3062749.

2. Lave J, Wenger E.In: Situated Learning: Legitimate Peripheral Participation. Cambridge University Press; 1991. Available from: doi: 10.1017/CBO9780511815355.

3. Veldkamp A. Escape education: A systematic review on escape rooms in education. Educational Research Review [Internet]. 2020;31:100364. Available from: https://www.sciencedirect.com/science/article/pii/S1747938X20300531.

Simulated teaching is common in undergraduate medical education, but the cost of high-fidelity manikin simulation can be prohibitive. Although manikin and virtual reality (VR) simulation have been evaluated in final-year medical students [1], a similar comparison has not been undertaken for early clinical years students. We aimed to compare manikin and VR simulation in this cohort.

Methods:

This single-centre, prospective, observational study recruited third- and fourth-year Hull York Medical School medical students undertaking clinical rotations at York Hospital. Ethical approval was gained. All potentially eligible students were approached. Sessions followed a structured lesson plan facilitated by a Clinical Teaching Fellow. In separate sessions, students completed an Airway, Breathing, Circulation, Disability and Exposure assessment of a simulated unwell patient using a head-mounted virtual reality device or high-fidelity manikin. All students completed a session using each modality.

The primary outcome was effectiveness of teaching, measured using the Simulation Effectiveness Tool-Modified (SET-M) [2]. SET-M was completed after each session and item scores were compared using Wilcoxson’s signed-rank test. P values <0.05 were considered significant. Demographic and safety data were collected.

Results:

Ninety-eight students of 118 eligible completed both questionnaires. Median age was 22, 67% were female, 50% were third-year. 38% had previously used VR educationally. For all SET-M items, >70% of students agreed or strongly agreed with the statement after using either modality.

After VR simulation, students were significantly more likely to feel empowered to make clinical decisions and felt they had developed a better understanding of medications; they felt more confident in their ability to prioritise care and interventions, provide interventions that foster patient safety, and use evidence-based practice to provide care.

After manikin simulation, students were more likely to feel confident in communicating with their patient and colleagues.

There were no statistically significant differences in other items of SET-M. No safety issues were reported.

Discussion:

VR allows students to respond to changing clinical conditions and see the effect of their interventions in real time, making it more suitable for developing confidence in providing and understanding interventions.

Manikin simulation requires real-time communication with the patient and clinical team, allowing better development of communication skills.

VR is flexible, easily portable and has a lower cost to set-up and maintain, making it well suited to dynamic, modern teaching environments [3].

VR and manikin simulation have comparable effectiveness overall; educators should choose the method best suited to their educational context and chosen learning outcomes.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Macnamara AF, Bird K, Rigby A, Sathyapalan T, Hepburn D. High-fidelity simulation and virtual reality: An evaluation of medical students’ experiences. BMJ Simulation and Technology Enhanced Learning. 2021;7(6):528–535.

2. Leighton K, Ravert P, Mudra V, Macintosh C. Updating the simulation effectiveness tool: Item modifications and reevaluation of Psychometric Properties. Nursing Education Perspectives. 2015;36(5):317–323.

3. Pottle J. Virtual reality and the transformation of medical education. Future Healthcare Journal. 2019;6(3):181–185.

Debriefing is a vital aspect of simulation-based learning, enabling participants to reflect on their experiences, discuss challenges, and identify areas for improvement. In medical escape rooms (MERs), gamification and debriefing enhance participant engagement and motivation. This increases cognisance and curates discussions around non-technical skill acquisition and human factors that encourage healthcare professionals to practice safely and contribute to quality improvement [1].

Methods:

Four simulation-based MERs were designed and implemented for randomly allocated penultimate medical students on clinical placement – incorporating two high-fidelity and two low-fidelity sessions delivered over four months. While these sessions encapsulated clinical assessment alongside linear puzzle solving, emphasis was placed on care escalation and the enhancement of non-technical skills.

Pre-defined learning objectives were adapted from the General Medical Council’s ‘Outcomes for Graduates’, enabling the application of theoretical knowledge and communication skills to experiential learning approaches. Students were rewarded for good clinical and interprofessional practice, which were further explored during the debrief.

Results:

Standardised feedback was obtained from all 54 students who participated using 5-point self-assessment Likert scales and free text questions. 95% responded strongly agree or agree to observed improvement in their non-technical abilities such as critical thinking, communication, decision-making and situational awareness, while 91% rated increased confidence in working in simulated team dynamics. Moreover, 97% of students found the debrief beneficial to overall clinical understanding and practice.

Qualitative feedback consistently highlighted positive enhancement of communication skills appropriate to their level. Furthermore, the debrief was praised for providing awareness of human factors and consolidating key learning points that influence patient health outcomes.

Discussion:

By constructing clinically replicable simulations underpinning the key concepts of human factors, the gamified MERs provided an engaging and immersive learning experience that promoted the development of essential non-technical skills, reinforcing their importance in quality healthcare provision. This notion is consistently underscored by the critical role of debriefing as the central and indispensable component of the simulation experience [2].

Moreover, positive learning outcomes could be attributed to the structured debriefing approach, with focused pre-defined learning objectives. This approach utilises enhanced learning depth allowing for deeper understanding and reflective practice around key relevant outcomes, likely contributing to the success of the MERs [3].

Therefore, effective debrief facilitation that proactively addresses the significance of human factors in simulation and their impact on healthcare outcomes provides valuable pedagogical insights that could be applied to future real-world clinical practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Backhouse A, Malik M. Escape into patient safety: bringing human factors to life for medical students. BMJ Open Quality [Internet]. 2019;8(1):e000548. Available from: https://bmjopenquality.bmj.com/content/8/1/e000548.

2. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2021;2(2):115–125.

3. Jørgensen T, Rosenkrantz O, Kristine EE, Theo WJ, Dieckmann P. Perceptions of medical students on narrow learning objectives and structured debriefing in medical escape rooms: a qualitative study. BMC medical education. 2024;24(1).

Simulation is a fundamental aspect of healthcare education. Developing effective simulation strategies. Virtual Reality (VR) is crucial for providing a transitional stage between theoretical knowledge and practical patient treatment. Despite the fact that improving the quality of a simulated scenario is beneficial in educational terms, the presence of cybersickness remains one of the main challenges. The susceptibility of some students to cybersickness during VR sessions presents a challenge as we explore the potential integration of VR programs. The aim of this study was to evaluate the capacity of Motion Sickness Susceptibility Questionnaire (MSSQ) to predict cybersickness.

Methods:

This Cross-sectional exploratory prospective study evaluated seventy-nine medical students in their first and second year of studies. Susceptibility to motion sickness was assessed using the MSSQ. Participants underwent two virtual reality sessions, each lasting 30 minutes. Additionally, the Simulator Sickness Questionnaire (SSQ) was applied immediately after each session to assess participants’ symptoms of motion sickness.

Results:

A total of 79 students participated in the study, with an average age of 25 years. The majority of participants were female (59.49%) and had no prior experience with virtual reality (97.46%). Additionally, 50.63% of participants regularly wore prescription glasses. Self-reported motion sickness susceptibility varied among participants: 43.04% reported no susceptibility, 40.51% reported slight susceptibility, 12.66% reported moderate susceptibility, and 3.80% reported high susceptibility. The average MSSQ score was 10.57. Following the first VR session, post-session SSQ scores for nausea were as follows: negligible (56.96%), minimal (13.92%), concerning (20.25%), and severe (8.86%). Scores for oculomotor were as follows: negligible (48.10%) minimal (16.46%), concerning (18.99%), bad (16.46%). Scores for disorientation were as follows: negligible (55.70%), significant (20.26%), bad (24.05%). In the second virtual reality session, nausea scores remained predominantly negligible (59.49%), with lower percentages in other categories. Oculomotor and disorientation scores exhibited similar results across sessions.

Discussion:

The MSSQ estimates an individual’s susceptibility to motion sickness and allows individuals to be classified as having low, moderate, or high susceptibility [1]. However, in other studies, the MSSQ did not predict cybersickness’s intensity [2]. The other questionnaire we used in this study was the SSQ, and this one includes evaluation items that consider various circumstances leading to cybersickness [3].

In our study we compared the results obtained between MSSQR and SSQ, and the results showed us that the 3 participants with the highest scores obtained in the MSSQR questionnaire scored 0 on both occasions they answered the SSQ questionnaire.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Kourtesis P, Papadopoulou A, Roussos P. Cybersickness in virtual reality: the role of individual differences, its effects on cognitive functions and motor skills, and intensity differences during and after immersion. Virtual Worlds. 2024;3(1):62–93.

2. Kyoung-Mi J, Moonyoung K, Sun GN, DaMee K, Hyun KL. Estimating objective (EEG) and subjective (SSQ) cybersickness in people with susceptibility to motion sickness. Applied Ergonomics. 102:2022.

3. Choi M-H, Kang K-Y, Lee T-H, Choi J-S. Correlations between SSQ Scores and ECG Data during Virtual Reality Walking by Display Type. Applied Sciences. 2024;14(5):2123.

Focused assessment sonography in trauma (FAST) is an important adjunct to doctors in emergency medicine and surgical settings for patients with blunt trauma by identifying intraperitoneal and pericardial free fluid through 4 basic views [1]. The practical training in FAST currently uses either clinical patients or simulation models (phantoms) [2]. However, these phantoms are often expensive, low fidelity, and/or have fixed anatomy [2]. This project aims to manufacture and evaluate a low-cost, high-fidelity, reusable, and dynamic FAST phantom focusing on abdominal views.

Methods:

To construct the phantom, food storage containers were placed into a plastic torso. Aqueous dietary fibre antifreeze mix (ADAMgel) was used to make the Liver and Spleen [3]. Kidneys were made using ADAMgel as a proxy medulla and gelatine for the cortex. The dynamic elements of the model were assembled using a balloon and medical tubing system, attached to a 3-way tap, syringe, and saline. The elements were placed in the respective containers in the torso.

The FAST phantom was evaluated by acute speciality doctors, who completed a pre-and post-intervention questionnaire collecting data via a 5-point Likert scale. The questions were based on the acquisition of knowledge and skills. Additional questions in the post-intervention questionnaire tested the phantom’s realism. The Likert data from the questionnaire was analysed using descriptive statistics, as shown in Table 1-A126.

Table 1-A126.

Data analysis of Likert data from participant questionnaires. Left upper quadrant (LUQ), Right upper quadrant (RUQ)

Question	Before median	IQR	% Agree/ Strongly Agree	After median	IQR	% Agree/ Strongly Agree
I understand the elements of FAST	4	2-4	60	4	4-5	80
I understand the relevant anatomy of FAST	3	2-4	50	4	3-5	70
I am comfortable carrying out a FAST exam on a patient	3.5	2-5	50	4	3-5	70
I am confident in identifying a negative FAST in RUQ	2.5	2-4	40	3.5	2-5	50
I am confident in identifying a Positive FAST in the RUQ	3	2-5	40	4	3-5	60
I am confident in identifying a negative FAST in the LUQ	2.5	2-4	40	4	4-5	50
I am confident in identifying a positive FAST in the LUQ	2.5	2-5	40	4	3-5	60
The liver reasonably resembles the real thing				4.5	4-5	80
The spleen reasonably resembles the real thing				4	4-5	80
The kidneys reasonably resemble the real thing				4	3-5	70
The positive RUQ view reasonably resembles the real thing				4	3-4	70
The positive LUQ view reasonably resembles the real thing				4	4-5	80

Results:

The FAST phantom was tested by 10 acute-specialty doctors. Its sonographic realism was rated highly with at least 70% of responses agree or strongly agree.

In the questions assessed pre-and post-intervention, at least one quartile increased post-intervention and 100% of the upper quartiles were Likert 5 (strongly agree), suggesting it was a valuable educational tool.

Discussion:

The FAST phantom improved doctors’ knowledge, skills and confidence regarding FAST, with good sonographic anatomical realism and dynamic images.

This was a small-scale, proof-of-concept project, requiring further development, testing and validation. The promising results suggest this low-cost, high-fidelity, reusable, and dynamic FAST phantom could allow greater access to simulated FAST training through more economically and environmentally sustainable routes.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology. 2017;283(1):30–48.

2. Al-Zogbi L, Bock B, Schaffer S, Fleiter T, Krieger A. A 3-D-Printed Patient-Specific Ultrasound Phantom for FAST Scan. Ultrasound Medical Biologoy. 2021;47(3):820–832.

3. Willers J, Colucci G, Roberts A, Barnes L. 0031 Adamgel: An economical, easily prepared, versatile, selfrepairing and recyclable tissue analogue for procedural simulation training. BMJ Simulation & Technology Enhanced Learning. 2015;1(suppl 2):A27.

Acknowledgments:

All funding for this project originates from Brighton and Sussex Medical School.

Growing adoption of in-office laryngology procedures emphasises the need for cost-effective and anatomically accurate training models. Blue laser growth removal is one such procedure, requiring precise laser control to remove polyps, papillomas, and cancerous growths <1mm in size [1]. Currently, training methods are limited, using cadavers (high-cost) or the ‘see one, do one, teach one’ method. The aim of this study was to demonstrate the effectiveness of a thermochromic coating for laryngological growth removal training. Through quantitative material testing and practical evaluation on a cost-effective, anatomically accurate, reproducible model, this research aimed to establish a sustainable, patient-safe alternative for training.

Methods:

Silicone samples with silicone-based thermochromic coating (Figure 1-A125.C) were prepared for blue laser material testing. Colour pixel values were sampled (Figure 1-A125.D) from a high-resolution photograph (13mm, ƒ2.2, ISO 100, 0ev, 12MP), converted into the International Commission on Illumination (CIE) 1976 L*, u*, v* colourspace (CIELUV) and colour difference, delta E (DE) CIEDE2000(1:1:1) was compared to a visual 50:50% acceptability threshold.

The laryngological simulator (Figure 1-A125.A) was constructed using 3-dimensional (3D) printing and moulding. Image segmentation was performed on the computed tomography scans of an adult male to create a 3D model. The model included hyoid bone, thyrohyoid membrane, thyroid cartilage, cricoid cartilage, trachea, oesophagus, epiglottis and vocal folds (Figure 1-A125.B). The bones were 3D printed in a photopolymer and the cartilages in thermoplastic polyurethane. The soft tissues were moulded using silicone rubbers. Following confirmation of sample effectiveness, the thermochromic coating was applied to the vocal folds, epiglottis and surrounding anatomy. Two participants utilised blue laser to test the model and completed a Likert scale questionnaire to evaluate the model’s realism and efficacy for training.

Figure 1-A125.

Results:

The CIEDE2000 differences (x̄=54.2, σ=9.06) for the silicone samples with thermochromic coating were significantly different from the 50:50% threshold value (p<=0.001) [2].

For the anatomical model, participants rated its usefulness for training highly (x̄=4.0) and its fidelity to human anatomical structures very highly (x̄=5.0).

Discussion:

Significant colour differences from 50:50% threshold value strongly suggest the change in colour from the thermochromic coating is clearly perceptible. The questionnaire responses revealed high satisfaction with the model’s efficacy in blue laser training; this suggests that the simulator, including thermochromic coating can effectively provide immediate feedback on the requisite skills for precise blue laser control in the larynx. The positive responses concerning the model’s accuracy to anatomical structures suggest the realism and robustness of the model.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Akbari E, Seifpanahi S, Ghorbani A, Izadi F, Torabinezhad F. The effects of size and type of vocal fold polyp on some acoustic voice parameters. IJMS [online]. 2018;43(2):158–163. [Accessed 26 April 2024]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936847/.

2. Perez Mdel M, Ghinea R, Herrera LJ, Ionescu AM, Pomares H, Pulgar R, et al. Dental ceramics: a CIEDE2000 acceptability thresholds for lightness, chroma and hue differences. Journal of Dentistry [online]. 2011;39(suppl 3):e37–e44. Available from: <doi: 10.1016/j.jdent.2011.09.007>. [Accessed 26 April 2024].

Medical escape rooms (MERs) are an increasingly popular game-based learning modality where participants solve puzzles to manage patients. They are delivered in a simulation-based format, amalgamating the principles of applying A-E assessments and human factors to clinically inspired puzzles to allow safe management of a simulated patient [1]. In comparing self-designed high-fidelity and low-fidelity formats, the aim is to assess the learning impact of these activities and understand the range of values gained in the different formats in correlation to their impact on goal orientation and learning outcomes.

Methods:

Four MERs were designed and delivered over 4 months. Two involved high-fidelity manikins, with participants performing A-E assessments of patients parallel to puzzle-solving. Two were delivered as low-fidelity MERs, with no manikin, but a series of puzzles which participants solved linearly, devising a diagnosis, management plan and handover to seniors. Participants were penultimate-year medical students in small groups facilitated by four faculty. The same cohort participated in both low and high-fidelity sessions.

Feedback was collected on a 5-point Likert scale, rating self-assessed change in confidence and non-technical skills and the relevance and utility of MERs in both formats.

Results:

All MERs were well-reviewed, with all participants (n= 54) responding strongly agree or agree that they would do another MER. 82% of high-fidelity participants and 100% of low-fidelity participants felt MERs should be integrated into the curriculum. While all aspects of feedback were overwhelmingly positive, the low-fidelity MER showed more consistent positive feedback, with over 90% of participants strongly agreeing or agreeing with all positive statements, whereas this fell to over 81% in the high-fidelity cohort (Figure 1-A122).

Figure 1-A122.

Discussion:

Although both are highly rated, low-fidelity MERs may provide a more consistently positive learning experience for students. This may be due to the reduced pressure on students in the low-fidelity setting, in a room with only puzzles and few other distractions, as opposed to a degree of cognitive overload in managing a patient in real-time alongside puzzles in high-fidelity settings [2].

Moreover, faculty who delivered both formats of MER noticed that in high-fidelity formats, participants’ focus remained on the patient rather than the puzzles, and the reverse was true in the low-fidelity sessions, where participants became focused on individual puzzles without applying clinical thinking to the overall scenario.

The two formats are likely to prioritise the training of different skill sets [3], and thus, they may be most beneficial when used in combination.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Guckian J, Eveson L, May H. The great escape? The rise of the escape room in medical education. Future Healthcare Journal. 2020;7(2):112–115.

2. Nicolaides M, Theodorou E, Emin EI, Theodoulou I, Andersen N, Lymperopoulos N, et al. Team performance training for medical students: Low vs high fidelity simulation. Annals of Medicine and Surgery. 2020;55:308–315.

3. Munshi F, Lababidi H, Alyousef S. Low- versus high-fidelity simulations in teaching and assessing clinical skills. Journal of Taibah University Medical Sciences [Internet]. 2015;10(1):12–5. Available from: https://www.sciencedirect.com/science/article/pii/S1658361215000141.

Frailty is a complex, multifactorial syndrome leading to loss of function and independence [1]. The benefits of exercise in frailty prevention are well established, however, strategies to enable older adults to undertake sufficient exercise safely are challenging [2]. The use of virtual reality (VR) alongside an exercise, might be a safe and engaging solution [3]. This study investigated whether there was a difference in muscular activity and heart rate intensity when comparing overground to seated VR-walking, in a young (TDY) and elderly typically developed (TDE) population.

Methods:

Participants were recruited (EthicsRef: HLS/2023/PH/155), and asked to walk for six minutes overground and six minutes within an interactive VR environment. Heart rate and lower limb muscle activity were assessed via a torso-worn heart rate strap and wireless surface electromyography (EMG) respectively. A Split-Plot ANOVA, Mixed-Design Two-Way Repeated Measures ANOVA, was used to assess for differences between walking conditions and age groups in mean heart rate differences. The EMG data was compared via statistical parametric mapping, with a paired-samples t-test.

Results:

Twenty-two participants were recruited (TDY n=12; TDE n=10). EMG analysis showed a higher degree of variability in muscle activity patterns. The rectus and biceps femoris crossed the critical-t value significantly more in the elderly than in the younger population, for example, t(20) = 1.354, p<.001. The activity of the anterior tibialis and gastrocnemius crossed the critical-t value during the heel strike and toe-off, with a significant difference of t(11) = 4.254, p<.001 and t(11) = 2.976, p<.001. A decrease in heart rate was observed in both age groups, between walking conditions for the VR condition, equivalent to 12 beats per minute. The Split-Plot ANOVA, of the heart rate, resulted in an F(1)=0.907, p=0.001 for the main effect between overground and VR-walking and an F(1) = 0.001, p = 0.913 for the interaction effect, between the age categories.

Discussion:

Results show that seated walking, with VR, does activate muscles in the lower limbs and increases heart rate to a similar range as overground walking. The difference in variability of muscle activity could be caused by unfamiliarity with VR-based interaction(s). The significant differences, between the upper leg muscles, between populations, could be caused by weaker muscles in elderly people. Decreased heart rate in the VR-based environment was expected, yet less than originally expected. More research exploring strength, endurance and patient engagement is needed to evaluate the use of VR in frail patient populations.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable

References

1. Xue QL. The frailty syndrome: definition and natural history. Clinics in Geriatric Medicine. 2011;27(1):1–15.

2. Elmagd MA. Benefits, need and importance of daily exercise. International Journal of Physical Education, Sports and Health 2016;3(5):22–27.

3. MotusVR. Available from: https://motusvr.com/. [Accessed 11 March 2024].

The use of simulation-based education (SBE) fosters the development of clinical knowledge, skills, and competencies while also aiding in the management of clinical placement capacity [1]. However, the common underutilisation of expensive simulators is attributed to a lack of organisational readiness. The aim of this work is: To explore challenges, opportunities, and organisational readiness for simulation-based education in pre-registration nurse education in the UK.

Methods:

This study used a descriptive, cross-sectional research design. Sixty UK universities offering pre-registration nursing programmes participated in a survey conducted November 2022 - January 2023, with a 69% response rate. The questionnaire covered programme cohorts, student numbers, staff confidence, and the use of different simulation modalities. The survey also included the Simulation Culture Organisational Readiness Survey [2] and gathered insights through open-ended questions about challenges and opportunities in pre-registration nursing courses.

Results:

The study revealed varying levels of confidence in using different simulation modalities, with a strong preference for low-fidelity simulations. There is a consistent pattern of higher usage of low-fidelity simulations compared to high-fidelity and virtual reality. The higher the level of technology required in the simulation modality, the lower the staff confidence and use of that modality. Organisational readiness for simulation-based education (SBE) is moderately established, with room for improvement in trained staff availability. While challenges like developing staff digital literacy and expertise in SBE, infrastructure, and leadership commitment exist, SBE offers numerous opportunities, including creating safe learning environments, boosting student confidence and self-awareness, and expanding clinical placement capacity.

Discussion:

To effectively use and integrate simulation-based education into nursing programmes [3], it is essential to focus on staff development, understand the challenges, develop solutions, and engage in strategic planning involving leadership and stakeholders to ensure effective application and utilisation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable. (approval number ETH2223-2620)

References

1. Harrison N, Edmonds M, Meads C, Abdulmohdi N, Prothero L, Shaw S. Simulation in Nursing Education: an evidence base for the future. 2023. CoDH-ARU-Simulation-in-Nursing-Education-Report-Jan-2024.pdf (councilofdeans.org.uk).

2. Foisy-Doll C, Leighton K. SCORS: Simulation culture organizational readiness survey©. An adaptation with permission of the Organizational Culture & Readiness for System-Wide Integration of Evidence-Based Practice Survey©. 2017.

3. Nursing and Midwifery Council. Current Recovery Programme Standards. 2022. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/current-recovery-programme-standards.pdf.

Acknowledgments:

This study was part of a research project funded by the Council of Deans for Health.

In response to the COVID-19 pandemic, the Nursing and Midwifery Council introduced an Emergency Standard for Nursing Education in 2021, allowing for simulated practice learning to replace up to 300 hours of clinical placement. Simulated practice learning is simulation-based education that adheres with NMC standards for practice learning and assessment.

The aim of this paper is to investigate the experiences of nursing students undertaking simulated practice learning and the experiences of academic staff in acting as a practice supervisor. This abstract represents the third phase of a four-phase research study funded by the Council of Deans of Health [1].

Methods:

A case study approach combining quantitative and qualitative methods. Data collection occurred between February and March 2023 and consisted of a student nurse self-reporting survey and a focus group of academic staff. A convenience sample of student nurses was used from one University Campus. The participants included second year mental health nursing students (n=22) and child nursing students (n=26) from a sampling frame of 151 students. The first part of the student survey consisted of self-assessment of competence against NMC [2] Standards of Proficiency for Registered Nurses. The second part of the survey was a student evaluation of their experience of the simulated practice learning including supervision, assessment, skills development, support, engagement and satisfaction and transferability to other settings. A convenience sampling technique was also used to recruit mental health academic staff (n=4) who acted as practice supervisors on the simulated practice learning experience.

Ethical Approval from the University Committee was granted.

Results:

The majority of students reported that simulated practice learning was engaging, contributing to increased confidence and the development of valuable skills essential for their prospective roles as registered nurses. Notably, mental health student nurses outperformed their child nursing counterparts in attaining specified proficiencies in simulated practice learning. More than 86% of mental health students achieved six out of the nine targeted proficiencies, while for child nursing students, only two out of the ten targeted proficiencies were accomplished by over 80% of the cohort.

The academic focus group revealed 4 themes, responsibility of getting it right, addressing gaps in knowledge and experience and the challenges of being a practice supervisor.

Discussion:

Simulated practice learning can contribute to the achievement of nursing proficiency but requires careful consideration for sustainability and resource management. The modality of simulated practice learning needs to align closely with proficiency targets. Academic staff must be adequately prepared for their educational role in designing and delivering SPL.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Harrison N, Edmonds M, Meads C, Abdulmohdi N, Shaw S. Simulation in nursing education: An evidence base for the future. 2024. Available from: https://www.councilofdeans.org.uk/wp-content/uploads/2024/01/CoDH-ARU-Simulation-in-Nursing-Education-Report-Jan-2024.pdf.

2. NMC. Standards of proficiency for registered nurses. 2018. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-of-proficiency-for-nurses.pdf.

Acknowledgments:

Funding provided by Council of Deans of Schools of Health.

Introduction:

There is an increasing need to increase simulation-based learning opportunities for vascular surgery residents in endovascular skills training [1]. This study aims to explore the effectiveness of remote expert instructional feedback of endovascular simulation-based education (Figure 1-A99), as a means of increasing training opportunities in this area for vascular surgery trainees.

Figure 1-A99.

Virtual Reality (VR) offers a promising avenue for medical education, providing immersive and realistic training environments. Existing literature [1-2] suggests VR can improve aspects such as learning efficiency, knowledge retention, skill development, trainee’s confidence levels, and overall patient outcomes. As VR continues to be implemented, its utilization within medical curriculums will become mainstream. However, the factors influencing the integration of VR within medical school curriculums remain unclear. This case study investigates the successful integration of VR-based skill training at a specific medical institution, aiming to identify key factors for such integration and inform broader VR adoption within medical education.

Methods:

The successful integration of VR-based skill training within the medical curriculum at the Karpaga Vinayaga Institute of Medical Sciences (KIMS), India was explored. Semi-structured interviews were conducted with key stakeholders (N = 10), including medical faculty, and the university management personnel, and thematic analysis elicited key barriers and facilitators to the curriculum integration process.

Results:

The analysis revealed seven key themes surrounding VR integration in the medical curriculum. Four themes emerged as challenges: aligning VR modules with the existing curriculum, logistical constraints (over two-thirds of responses), lack of faculty training and support, and selecting suitable student cohorts. Three themes emerged as facilitators: alignment of VR content with national regulatory standards, student engagement with the technology, and the perceived benefits of VR (100% of responses).

Discussion:

This first-of-its-kind case study sheds light on the challenges and opportunities of integrating VR-based skill training into medical education. Notably, logistical constraints such as time limitations within a students’ existing schedule was a major concern, and all participants highlighted the potential benefits of VR, which included the opportunity for separate teaching and assessment modes within VR training modules. By analysing the KIMS’ success, the study informed the development of a comprehensive framework for VR integration within medical institutions, encompassing aspects such as curriculum design guidelines and faculty development programs.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Pottle J. Virtual reality and the transformation of medical education. Future Healthcare Journal. 2019;6(3):181.

2. Mistry D, Brock CA, Lindsey T, Lindsey II T. The present and future of virtual reality in medical education: a narrative review. Cureus. 2023;15(12).

Simulation is crucial in healthcare education as it offers a secure environment for learners to consolidate knowledge, skill acquisition and understand human factors to translate this knowledge and skill to improve patient care [1]. Simulation is now a mandatory component of training [2], courses and examinations.

Our study aimed to explore the simulation scape in hospitals in the East of England with a view to ensuring the standardisation of equipment, faculty, and debriefing techniques to enable consistent learning experiences.

Methods:

Hospitals in East of England were identified, and a questionnaire was sent to simulation leads to gather information. Non-responding hospitals were contacted via switchboard, and virtual meetings were scheduled with them to obtain information. Data was subsequently analysed and compared.

Results:

Eighty-nine percent of the trusts responded to the survey (16/18), and these hospitals were evenly spread across the region. The simulation facility varied (Figure 1-A87), with an average of three rooms being used for simulation and number of participants ranging from 8 to 90. 75% of hospitals had a debriefing room, 75% had a control room, 62% had adequate storage facilities, and 69% had custom-built simulation suites. Approximately 80% had a simulation manager, and 60% had a simulation technician and dedicated consultant. There was variability in mannikins; one trust had 15 low-fidelity mannequins, another had 7 high-fidelity mannequins, whilst some had zero. All trusts had VR simulation, no AR simulation and 62% had I-simulation. There was a variety of debriefing models used.

Figure 1-A87.

Discussion:

It can be inferred that the simulation-based learning experiences for participants in the East of England are inconsistent. This is due to variations in the debriefing models, equipment, fidelity, resources, and processes. Simplifying and standardising these processes is necessary, particularly ensuring consistency in debriefing, a crucial aspect of simulation-based education. Participant surveys would be useful to establish perceived qualitative differences in the learning experience.

Our study identified high costs, capacity constraints, and faculty-related issues. We recommended sharing our findings, exchanging ideas through a “Hub and Spoke” model, and holding an “Achievements in Sim” conference. We also suggested comparing data with other regions.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al. Training and simulation for patient safety. Quality and Safety in Health Care [Internet]. 2010;19(suppl 2):i34–i43. Available from: https://qualitysafety.bmj.com/content/19/Suppl_2/i34.

2. Taught Programme Guidance for Foundation Doctors [Internet]. Available from: https://heeoe.hee.nhs.uk/sites/default/files/taught_programme_for_foundation_doctors_20-21-_eoe_0.pdf.

Acknowledgments:

We thank Mohammed Batcha for his valuable assistance in initiating this project.

The patient safety agenda suggests that simulation can aid professional capability development, particularly leadership and communication skills [1]. Complex non-technical skills required by effective leaders may be improved by using trained simulated participants (SP) within leadership scenarios. However, evidence in this area is lacking. This study explored the student perspectives of simulation as an educational tool for leadership development in a postgraduate module.

Methods:

Ethical approval was granted by Oxford Brookes University.

A half-day pilot study was co-created by simulation and leadership experts and delivered to 15 international students from diverse backgrounds enrolled on a leadership module. The scenario utilised a trained SP portraying the role of an employee who was part of an organisational change management intervention. The participants were leading the change process. Additional pre-brief time was needed to build psychological safety within the group. The scenario was paused when learning moments were identified, to allow students and observers to participate in the discussions of leadership concepts [2]. There was an overall group debrief at the end. A focus group exploring the student perspectives of their learning experience was conducted following this debrief. The data was audio recorded, anonymously transcribed and analysed.

Results:

Thematic analysis of the focus group data revealed parallels with current literature such as providing safety to participate; representing real life; enabling application of theory to practice and building leadership skills [3]. Analysis also highlighted the recognition and impact of cultural differences on the awareness and use of leadership styles.

“So I think that it’s good to know that at any point we can take something from this toolbox and choose, maybe this didn’t work in the past, so maybe I can try this other style.”

“For me the strengths were that we are all culturally diverse from our discussions, so what we believe or feel about competence as a leader is different for everyone. This made the discussion quite valuable and to understand everyone’s perspective on the problems of leadership.” The study findings were mapped into a conceptual model (Figure 1-A82).

Figure 1-A82.

The perceived value of simulation for teaching leadership development using trained simulated participants

Discussion:

Simulation with a trained SP in a psychologically safe and realistic environment was an effective and culturally competent way to apply relevant leadership theory and skills, within health and social care postgraduate training. This simulation pilot facilitated critical discussions that recognised cultural differences as well as the benefits and challenges of implementing western styles of leadership in other countries.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Health Education England. Technology Enhanced Learning (TEL) [Internet]. 2020 [cited 2024 Mar 11]. Available from: https://www.hee.nhs.uk/sites/default/files/documents/National%20Strategic%20Vision%20of%20Sim%20in%20Health%20and%20Care.pdf.

2. Butler C, McDonald R, Merriman C. Origami debriefing model: unfolding the learning moments in simulation. BMJ Simulation and Technology Enhanced Learning. 2017;4(3):150–151 [cited 2024 Mar 18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936804/.

3. Botma Y. Nursing student’s perceptions on how immersive simulation promotes theory–practice integration. International Journal of Africa Nursing Sciences [Internet]. 2014;1:1–5. Available from: https://reader.elsevier.com/reader/sd/pii/S221413911400002X?token=BAFD12156F062B27BBF46DF3961F1C5D801028B37EB9DD3B3B4F9843119ABF0F1156AD77018EEE34FF679505883A85B7.

Between 2022-2023, Internationally Educated Nurses (IEN) comprised over 40% of new registrants to the Nursing and Midwifery Council [1]. IENs report a ‘culture shock’ and feel like ‘strangers’ when arriving in the NHS [1,2]. Moreover, human factors (such as communication) are a known cultural barrier faced by IENs. There is therefore a need for investment in training that facilitates cultural and linguistic competence [1].

Within our centre, a preceptorship programme exists for IENs. This includes the opportunity to attend an inter-professional simulation course, with a focus on human factors acquisition and development.

Aim: To evaluate the self-reported confidence of IENs in human factors themes, and the impact of an interprofessional human factors-based simulation course.

Methods:

All IENs were invited to attend a multi-professional simulation course as part of their preceptorship programme. 54 nurses attended 18 sessions between October 2023 and April 2024. An initial workshop on human factors was undertaken, before completing four simulated scenarios. A thorough human factors orientated debrief for each scenario was undertaken utilising the centre’s preferred model.

Self-reported confidence values across human factors themes were assessed using the Human Factors Skills for Healthcare Instrument (HuFSHI) [3]. Anonymous baseline and immediate post-course scores were collected.

Results:

Thirty-seven IENs completed the baseline HuFSHI questionnaire, 18 of which completed the post-course questionnaire. Those who only completed the post-course questionnaire were excluded due to incomplete demographic details.

The most common ethnicity of attendees was Asian/Asian British followed by Black/Black British, Caribbean or African. 81% did not speak English as a first language and 73% had no previous human factors training.

All HuFSHI parameters demonstrated notable improvements following the course (Table 1-A77). Initially, 33% felt neutral/underconfident in asking team members for information in a busy ward whereas, following the course, 100% felt confident or very confident. Overall, all participants viewed the session as useful to understanding the impact of human factors on patient care.

Table 1-A77.

Human Factors Skills for Healthcare Instrument (HuFSHI) self-reported confidence values

Discussion:

The need for human factors training for new IENs has been demonstrated alongside the positive impact that a simulation course has on IEN confidence values across human factors themes. To further assess the longevity of this intervention, a three-month follow up questionnaire will be circulated. Future research should consider whether this positive impact translates into improved patient safety and staff integration.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Lanada JA, Culligan K. The experiences of internationally educated nurses who joined the nursing workforce in England. The British Journal of Nursing. 2024;33(2):78–84.

2. Winkelmann-Gleed A, Seeley J. Strangers in a British world? Integration of international nurses. The British Journal of Nursing. 2005;14(18):954–961.

3. Reedy GB, Lavelle M, Simpson T, Anderson JE. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning. 2017;3(4):135–141.

Endoscopic ultrasound (EUS) is an advanced endoscopic modality requiring a high level of technical skill that allows the operator to view extraluminal structures (e.g. the pancreas). There is a growing unmet need for EUS services and interventions to accelerate trainees toward competency are required [1]. The Simbionix EUS Mentor simulator offers this potential but has not been validated. We devised and validated a curriculum for novice endosonographers utilising the EUS Mentor.

Methods:

The intervention’s validity was assessed utilising Messick’s unified validity framework [2], covering the content, response process, internal structure, relationship to other variables and consequences of the curriculum.

Eight novices and 5 experts were recruited. Each participant had standardised instructions. All novices completed a web based interactive EUS module to orientate them. Performance was rated using a validated DOPS tool (TEESAT) [3] by one expert assessor comprising a 1 - 4 Likert for each anatomical landmark and a 1 - 10 “global” assessment. Differences in expert and novice performance were assessed by Mann Whitney-U. A pass-fail score was derived using the contrasting groups method.

Results:

Content: Thirteen anatomical landmarks for identification by trainees performing simulated EUS were derived from the national training curriculum in EUS and thus corresponded with real world practise [1].

Response Process: The simulation task was standardised using written instructions and strict inclusion/exclusion criteria minimised potential bias.

Internal Structure: Internal consistency of the TEESAT assessment was assessed by comparing participants’ global rating with their cumulative TEESAT. This demonstrated a statistically significant correlation for novice echoendosonographers (R2 = -0.815, p<0.05).

Relationship to other variables: TEESAT scores for all of the 13 anatomical landmarks were significantly different between the novice and expert groups (p <0.05)

Consequences: The mean cumulative TEESAT scores for experts was 13.4 (SD = 1.52) and 40.5 (SD = 6.48) for novices. The contrasting groups method derived a pass/fail score of 19; i.e. a trainee could receive a “2” (“achieves with minimal verbal cues”) for 6/13 landmarks and a “1” (“achieves without instruction”) for the remaining 7 to achieve a “pass”.

Discussion:

The Messick framework is the gold standard for validating medical educational interventions. To date, no studies of any endoscopic simulator have utilised this framework. Here, we have demonstrated strong validity evidence for the utilisation for the Simbionix EUS mentor as a tool for novice trainees. This lays the groundwork for further studies to assess whether the EUS learning curve could be shortened.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. El Menabawey T, McCrudden R, Shetty D, et al. UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS). Gut 2024;73:118–130.

2. Cook DA, Hatala R. Validation of educational assessments: a primer for simulation and beyond. Advances in Simulation. 2016;1.

3. Wani S, Keswani R, Hall M, et al. A prospective multicenter study evaluating learning curves and competence in endoscopic ultrasound and endoscopic retrograde cholangiopancreatography among advanced endoscopy trainees: the rapid assessment of trainee endoscopy skills study. Clinical Gastroenterology and Hepatology. 2017;15:1758–1767.e11.

Obstetric training requires a multifaceted skill set, encompassing both technical skills (TS) and non-technical skills (NTS) [1]. TS refers to procedures (e.g., performing a caesarean section) and obstetric knowledge, while NTS are socio-cognitive skills (e.g., communication, situational awareness). Effective integration is vital for patient safety in high pressure environments like the labour ward [2]. This study aimed to develop a simulation that combined both TS and NTS learning.

Methods:

This was a rapid ethnographic study that explored the training experience of trainees who participated in a simulated labour ward on call that required the demonstration of TS and NTS skills. Specialist trainees’ years 1-2 were assigned the roles of consultant, senior house officers, patient, and observer. A simulated labour ward board, operating theatre, maternity assessment unit and antenatal ward were set up (Figure 1-A59). The participants led the ward round, prioritised patients, performed a forceps delivery in theatre, etc. (40 minutes), followed by a focus group discussion (30 minutes). Data consisted of faculty observations, focus group interviews, ethnographic researcher’s field diary, and audio recordings.

Figure 1-A59.

Layout for the simulation

Results:

This simulation was run twice with 14 trainees in total. Thematic analysis was performed on the qualitative data and analysed in context of Kopta’s three phases of skill learning: cognitive phase, the associative or integrative phase, and the autonomous phase [3]. The decisions trainees made in the simulation were compared to expected best practice. Cognitive skill learning was evidenced by trainees’ expressions of hesitancy and anxiety for new tasks (e.g., performing the antenatal ward round and consenting the patient for a rotational forceps delivery). The simulation was dominated by integrative skill learning where trainees were more familiar with TS (e.g., performing the rotational forceps delivery) and could practice NTS simultaneously (e.g., managing patients on the labour ward). Transition to the autonomous phase was seen in the episiotomy repair, where trainees exhibited confidence and competence in this task. They appeared relaxed, carried out casual conversation, and thought of case complexity beyond the routine.

Discussion:

Combining TS and NTS in one simulation maximises the learning opportunities of a single simulation session. It does not hugely increase the resource burden and can be used at any stage of training.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Johannsson H, Ayida G, Sadler C. Faking it? Simulation in the training of obstetricians and gynaecologists. Current Opinion in Obstetrics and Gynecology. 2005;17(6):557–561.

2. Ahmed F-U-A, Ijaz Haider S, Ashar A, Muzamil A. Non-technical skills training to enhance performance of obstetrics and gynaecology residents in the operating room. Journal of Obstetrics and Gynaecology. 2019;39(8):1123–1129.

3. Kopta JA. The development of motor skills in orthopaedic education. Clinical Orthopaedics and Related Research (1976-2007). 1971;75:80–85.

A rapid growth in student nurse recruitment and a chronic shortage of suitable placement opportunities motivated some universities to use simulation to ensure student progression and completion. In response to this, in 2022 the Nursing & Midwifery Council (NMC) [1] increased the number of practice hours through simulation from 300 up to 600 hours for approved universities. The purpose of this research [2] was to learn from the experiences of the approved universities, to understand their drivers for seeking NMC approval, issues relating to infrastructure and design, and challenges and opportunities in delivering simulated practice learning (SPL).

Methods:

A convenience sampling technique was used to recruit Council of Deans of Health members who deliver pre-registration nursing courses in the UK and had received NMC approval to include SPL. The sample consisted of 12 simulation leads, located across England and Scotland. Five focus groups were conducted, lasting approximately 60 mins each, via online Microsoft Team meetings between April-May 2023. The transcripts of the focus groups were thematically analysed.

Results:

Five major themes were identified: motivation for NMC approval with SPL; universities’ experience of the approval process; integrating and advancing through innovation and collaboration; sustainability; and challenges in measuring impact of SPL.

The NMC approval process was generally viewed as supportive, offering universities an opportunity to showcase their innovative practices and engage in positive dialogue. However, challenges arose from uncertainty around the regulatory requirements and evolving terminology surrounding SPL. This resulted in anxiety among university staff regarding what would be considered acceptable and how many hours would be permitted. Nevertheless, the NMC approach was viewed as evolving and as demonstrating a willingness to learn through the experience of trailblazer universities.

Participants discussed the integration of SPL into nursing programmes, emphasising creativity and collaboration with practice partners and students. The universities incorporated SPL across all years of the nursing curriculum, particularly focusing on the first year to aid the transition from theory to practice.

Discussion:

SPL is considered as a valuable learning experience for pre-registration nursing students, providing opportunities to acquire knowledge and skills. This research identified critical challenges such as funding and availability of facilities, staff expertise, student engagement, and lack of expert leadership. To enable the sustainability, there should be commitment from faculty leadership and professional development for staff. This will ensure the effective and standardised approach for simulated practice learning.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted (approval number ET2223-6347).

References

1. Nursing and Midwifery Council. Current Recovery Programme Standards. 2022. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/current-recovery-programme-standards.pdf.

2. Harrison N, Edmonds M, Meads C, Abdulmohdi N, Prothero L, Shaw S. Simulation in Nursing Education: an evidence base for the future. 2023. CoDH-ARU-Simulation-in-Nursing-Education-Report-Jan-2024.pdf (councilofdeans.org.uk)

Acknowledgments:

This study was part of a research project funded by the Council of Deans of Health.

The skill of placing, checking and troubleshooting double lumen tubes (DLTs) is an important aspect of training in anaesthesia. However, this can be a source of anxiety, misconception and unsafe practice due to a lack of exposure.

The ability to conduct an anaesthetic on one lung forms part of the Royal College of Anaesthetists 2021 Stage 2 Curriculum, stating that anaesthetists should be able to “Demonstrate safe anaesthetic care for adults requiring non-complex thoracic procedures under direct supervision, including one lung ventilation” [1].

The lack of exposure to this skill may continue to the level of consultant, for example those who have occasional exposure to DLTs in certain lists such as CEPOD, oesophagectomies or spinal surgery.

The aim of the One Lung Course is to increase confidence and exposure to the skill of placing DLTs and troubleshoot common problems of one lung ventilation (OLV). This is achieved with skill-stations and simulation-based scenarios with common problems experienced during OLV cases, such as hypoxia on one lung, dependent lung tension pneumothorax and desaturation during rigid bronchoscopy.

The mannequin we use is dynamic in its ability to develop clinical changes such as a pneumothorax during a simulation, enabling the real-time and tactile feedback as one would experience with a real patient.

Methods:

A pre-course questionnaire asked the candidates to detail the number of DLTs recorded in their logbooks and their self-reported confidence of this skill, alongside troubleshooting OLV and intra-operative hypoxaemia during a OLV case on a scale of 1-10. The same questions were posed after the course to compare pre- and post-course scores.

Results:

The results were collated from all candidates, 33 in total, who were from a range of training grades, (at least ST4) and included some non-thoracic consultant anaesthetists. The range of logbook entries were from 0 to 60.

Results were highly conclusive that the teaching and revision of these skills increased the candidates’ confidence of siting, checking and managing a DLT and troubleshooting intra-operative hypoxaemia. Confidence increased by 70% from pre- to post-course for both measures (Figure 1-A47).

Figure 1-A47.

Discussion:

The use of simulation for these skills in a low-stress and non-clinical setting significantly increased the candidates’ knowledge and confidence in the skill of placing a DLT.

The aim going forward is to incorporate this simulation as part of anaesthetic trainees’ Cardiothoracic Anaesthesia Block. This will help increase knowledge and confidence for managing DLT anaesthesia.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. General Anaesthesia | The Royal College of Anaesthetists [Internet]. www.rcoa.ac.uk. [cited 2024 Apr 30]. Available from: https://www.rcoa.ac.uk/documents/2021-curriculum-learning-syllabus-stage-2/general-anaesthesia.

Most foundation doctors within the UK provide patient care out-of-hours, working with greater independence and a more intense workload than during in-hours. Despite this, there is a lack of on-call experience for medical students, with new Foundation Year 1 (FY1) doctors reporting significant anxiety, particularly when forced to work beyond their competencies [1]. Increased anxiety is linked to higher rates of medical errors [1]. Concerning rises in death rates during junior doctor changeover in August has further compounded these worries, prompting action to resolve this issue [2]. We created a simulated out-of-hours on-call shift to better prepare final-year medical students for the transition to FY1.

Methods:

Eight simulated ward-based tasks were created involving data interpretation, documentation and prescribing. These simulated patient materials were placed in clinical environments around the hospital. The session began with students being handed over a job from the day team, with regular bleeps to direct them to further stations. The session concluded with a simulated cardiac arrest and a discussion on resuscitation. Senior doctors were available through a simulated switchboard, which students could call anytime. The following day, a debrief took place with accompanying teaching and feedback on overall student performance. Students were asked to complete a pre- and post-session questionnaire to provide feedback and guide the future development of the simulation.

Results:

Fourteen final-year medical students from two universities completed the same simulation over two evenings. Students reported a mean increase in self-rated confidence across all eight scenarios (Figure 1-A46). Students also reported self-rated improvements across seven skills domains, including working within their competencies, high-risk prescribing and knowing when to escalate to seniors using a structured handover. Only four students had prior on-call experience, but all 14 reported that the session increased their insight into what is expected of an FY1 on-call.

Figure 1-A46.

Student self-rated confidence on a 5-point Likert scale (1= not confident, 5=extremely confident), pre- and post-simulation. The bar graph demonstrates the mean rating from all students, with the standard deviation represented by error bars. Individual ratings are plotted.

Discussion:

Although participant numbers were small, students reported significant improvements in their readiness to start FY1. This highlights the importance of on-call experiences in the medical education curriculum to ease the transition from student to doctor. Arranging equivocal experiences shadowing junior doctors is challenging; however, simulation offers a safe space to mimic independent patient care, an infrequent experience for medical students. The nuances of patient care at our site may differ from that of the students’ first FY1 rotation, e.g. electronic vs paper prescribing. This may limit the simulation’s impact however further work in the area can help to maximise its benefits.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. McCullough JH, van Hamel C. Anxiety among newly-qualified doctors: An eight-year analysis. Medical Teacher. 2019;42(1):52–57.

2. Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS ONE. 2009;4(9).

While much is known about students’ experiences and outcomes with virtual simulation (VS), little is known about the skills required to conduct the complex activity of facilitating simulation in the virtual environment [1], nor the needs and experiences of facilitators.1A successful experience goes far beyond simply offering learners’ access to a VS; it requires a facilitator who understands the learners’ needs and course objectives, can create a welcoming virtual space that promotes learning, and can evaluate the experience. Currently, there is a gap in our understanding of the best ways to facilitate the different modalities used in VS and what skills, professional development, experience, and supports facilitators need.

Research Questions:

1) How well prepared were facilitators in the Virtu-WIL project, i.e., what were the facilitators’ perceptions of their training needs and what recommendations did they have for training?

2) From a student and a facilitator perspective, what was the impact of the VS on` student learning?

3) What impact did the VS have on students’ readiness for the clinical setting/workplace and what factors contributed to that impact?

Methods:

An exploratory qualitative research process was conducted to explore simulation facilitators’ experiences with the virtual simulations using individual interviews. In addition, we used focus groups to assess the impact on students. A facilitator or student interview guide was used by the researchers. Data were analysed by the authors using a thematic content analysis [2].

Results:

Ten facilitators from six educational institutions participated in the study: three from nursing, three from medical laboratory technology and four from paramedicine. Twenty-one students from five institutions participated: 8 from paramedicine and 13 from nursing. Some facilitators had previous simulation training and experience while others had no prior simulation experience. Two major themes were identified: The Facilitator Experience and VS: Impact on Learning. Facilitators and students were clear: to be effective, VSs need to align with course learning objectives, meet learner needs, and be skilfully facilitated. Effective facilitation had a positive impact on student outcomes.

Discussion:

We learned the importance of a skilled facilitator in all stages of simulation pedagogy. The facilitator plays a vital role and it is not sufficient to be trained in in-person simulation, facilitators need training in the nuances of VS. Our study highlights the complexity of the facilitator role in which they have to use their knowledge and skills to create a safe, stimulating learning environment to enhance the learning environment.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Hodges B, Albert M, Arweiler D, et al. The future of medical education: A Canadian environmental scan. Medical Education. 2011;45:95–106.

2. Leigh E, Likhacheva E, Tipton E, de Wijse-van Heeswijk M, Zürn B. Why facilitation? Simulation & Gaming. 2021;52(3):247–254.

Acknowledgments:

This project was funded by Colleges and Institutes of Canada, Government of Canada.

Simulation-based education is becoming integral to healthcare professional education due to its effectiveness in improving clinical skills and knowledge in a safe and controlled environment. Full-scale simulation (FSS) is commonly used, however, Visually Enhanced Mental Simulation (VEMS) is still a developing modality. It includes visuals of a patient and equipment, and think-aloud to identify students’ thinking and interactions during a clinical scenario as in FSS [1,2]. We aim to explore the perspectives of nursing students and lecturers concerning FSS and VEMS.

Methods:

This mixed methods study (IRB approval aHSK/PGR/UH/03692) involved 150 adult nursing students exposed at least once to either or both FSS and VEMS. Some also volunteered to be interviewed. Healthcare lecturers from the same higher education institution received a VEMS guide to understand what it is, think about its application in their programme, and were invited to be interviewed.

Results:

Interview participants included 11 students and 10 lecturers with no or limited simulation experience. Students reported that VEMS provided a different learning experience to FSS. They felt both approaches had the same conceptual fidelity. Observers prompted scenario participants during classroom-based VEMS whereas observers in FSS were in an observation room with noise issues from peers and difficulties hearing VEMS participants. Students also reported feeling intimidated when being watched remotely during FSS, while VEMS provided a more reassuring environment. They appreciated the VEMS visuals prompting their thinking but missed the opportunity to use real equipment.

Lecturers noted that VEMS could be an alternative for non-technical skills training sessions and provide learning outcomes similar to FSS. They recognised that FSS could be more intimidating than VEMS due to its often high reliance on technology. They reported that VEMS should be a supplementary training modality but not standalone as it is not appropriate for technical skills training. They suggested that FSS was not needed in undergraduate education due to being complex, and VEMS could suffice in most of the training. Additionally, VEMS, being a classroom-based activity, it enabled the engagement of a greater number of students.

Discussion:

The overall study showed that VEMS and FSS provided similar learning outcomes [3], but VEMS offered a more comfortable learning environment. While FSS remains an essential tool for developing clinical skills, VEMS could be a valuable alternative for some non-technical skills training sessions. The findings of this study could inform educators’ decision-making when selecting simulation methods for healthcare students and professionals’ education.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Doğan B, Pattison N, Alinier G. An untested approach to facilitating visually enhanced mental simulation online with multiple learners: A mini guide. In: Journal of Emergency Medicine, Trauma & Acute Care, Qatar Health 2020 Conference. Qatar: HBKU Press. 2021;2021(2):39.

2. Demir S, Tunçbilek Z, Alinier G. The effectiveness of online Visually Enhanced Mental Simulation in developing casualty triage and management skills of paramedic program students: A quasi-experimental research study. International Emergency Nursing. 2023;67:101262.

3. Dogan B, Pattison N, Alinier G. A form of mental simulation with significant enhancements enabling teamwork training. International Journal of Healthcare Simulation. 2021;1(1):56–60.

Telehealth is a remote or virtual care delivery using telecommunication technologies. To deliver effective telehealth as part of a digitally enabled NHS [1], Allied Health Professionals (AHP’s) need developed digital capabilities [2], adaptable communication skills and a professional “webside manner”. Simulation-based education is proposed as an authentic and engaging way to facilitate such learning. This Higher Education Institution (HEI) consulted with multiple stakeholders and developed an evidence-based [3] telehealth learning package including simulated telehealth activities. This evaluation explores the effectiveness of the education package on transforming AHP students’ telehealth knowledge, confidence and attitudes.

Methods:

Learning included online resources with information, quizzes, lived experience video scenarios, facilitated seminars and simulated telehealth activities where drama students acted as simulated patients. Small group simulated telehealth activities included pre-brief and de-brief.

Approximately 90 AHP pre-registration students undertook the learning and were invited to complete pre- and post-learning questionnaires (via MSForms) including self-rated knowledge, confidence and attitudes to telehealth. Quantitative responses were analysed using descriptive statistics and paired comparisons made using Wilcoxon signed-rank tests. Qualitative responses were thematically analysed by large language model (ChatGPT). HEI research ethics was adhered to with self-declaration of evaluation.

Results:

50 AHP (occupational therapy and physiotherapy) students completed pre- and post-course questionnaires.

Telehealth confidence (max. score 25) significantly increased post-course (Mdn 21, IQR 3) compared to pre-course (Mdn 15, IQR 6) with large effect size, T=1233.5, p=<.001, r=0.58. Telehealth knowledge (max. score 25) significantly increased post-course (Mdn 22.5, IQR 4) compared to pre-course (Mdn 15, IQR 6.25) with large effect size, T=1186, p=<.001, r=0.57

Qualitative ‘key learning-point’ themes included: adapting to telehealth, providing patient-centred care, creating the right environment, access and equity, professionalism and safety, technical and practical considerations, and training and education.

Attitudes included 74% agreement/strong agreement that students were likely encourage telehealth in their future practice. 76% rated the simulation element of training as ‘very helpful’, 74% felt simulation was the most helpful element of the training and 98% were likely recommend the course to others.

Discussion:

A 12-hour education package was shown to be effective in increasing AHP student telehealth knowledge and confidence. Simulation was highly valued as a method to transform skills. This work has implications of benefit to HEI’s delivering AHP courses and provides encouraging evidence to support incorporation of telehealth simulation in pre-registration, inter-professional education and training. Further work is being undertaken to understand how simulation knowledge and confidence relates to AHP student performance in practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. NHS. The NHS Long-Term Plan. 2019. Available from: https://www.longtermplan.nhs.uk/.

2. Health Education England. 2018. A Health and Care Digital Capabilities Framework.

3. Davies L, Hinman RS, Russell T, et al. An international core capability framework for physiotherapists to deliver quality care via videoconferencing: a Delphi study. Journal of Physiotherapy 2021;67:291–297.

Acknowledgments:

HEE Funding was obtained in 2020 for original creation of a telehealth learning package for qualified healthcare staff.

Performing chest compressions (CC) during cardiorespiratory resuscitation (CPR) can lead to rescuer fatigue, potentially diminishing the quality of CPR. Previous studies [1-3] showed that the physical fitness of the rescuer might affect fatigue levels and CPR effectiveness. This study aims to examine how physical activity levels influence muscle activity and its correlation with the quality of CC.

Methods:

This study is part of an ongoing multicentric pseudo-randomized manikin study, that is being conducted in Portugal, Finland and Germany. Data was collected between May and October 2023. Healthcare professionals (doctors, nurses and paramedics), experienced in CPR, aged between 18 and 65 years-old, were recruited by convenience sample to perform 3 minutes of uninterrupted CC in a Resusci Anne QCPR (Laerdal) simulator, placed on a bed, without mattress. The bed height was adjusted to the rescuer’s knees level.

Socio-demographic data and physical activity levels were collected using a questionnaire, which included the Stanford Brief Activity Survey (SBAS). Electromyogram (EMG) surface electrodes were placed in both triceps brachii to assess the muscle activation levels through the calculation of the root mean square (RMS) value. Participants reported their fatigue timing during the exercise, and perceived exertion was evaluated using the Borg Scale immediately post-trial. CC quality was measured by the depth of compressions recorded by the simulator. EMG and CC depth were sampled every 15-sec and calculated from the mean of 4 consecutive contractions. Approval from the ethical committee was obtained prior the study.

Results:

Twenty-five participants were included, with mean age was 38.6 ± 11.4; 60% were female (n=15) and 52% physically active (n=13). During CPR, sedentary individuals reported fatigue earlier than the active participants (96s vs 180s), although not statistically significant. They also experienced a higher perceived exertion after the trial on the Borg Scale (14 vs 12, p = 0,03). EMG showed a slightly greater recruitment of muscle fibres for sedentary individuals, although not significantly different from active participants. (Figure 1-A30, left). Compression depth in sedentary participants decreased over time, with the mean value dropping to sub-optimal level (< 5cm) after 75 s (Figure 1-A30, right).

Figure 1-A30.

Muscle activity (Left) and chest compressions depth (right) for sedentary and active individuals, during the 3-min uninterrupted chest compression exercise. Boxes present the median self-reported fatigue time.

Discussion:

Physical fitness appears to influence the efficacy of CPR. Active individuals maintained adequate compression depth longer with less muscle activation, suggesting better endurance and technique efficiency. Conversely, sedentary participants experienced quicker fatigue and reduced compression quality, underscoring the importance of physical fitness in performing effective CPR.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of physical activity of the rescuer on chest compression duration and its effects on hemodynamics and fatigue levels of the rescuer: a simulation-based study. Indian Journal of Critical Care Medicine. 2020.

2. López-González A, Sánchez-López M, Garcia-Hermoso A, López-Tendero J, Rabanales-Sotos J, Martínez-Vizcaíno V. Muscular fitness as a mediator of quality cardiopulmonary resuscitation. American Journal of Emergency Medicine. 2016;34:1845–1849.

3. Ock SM, Kim YM, Chung JH, Kim SH. Influence of physical fitness on the performance of 5-minute continuous chest compression. European Journal of Emergency Medicine. 2011;18(5):251–256.

Acknowledgments:

This work was supported by national funds of the FCT – Fundação para a Ciência e a Tecnologia, I.P., under the project “QualityCPR, ref. 2022.03731.PTDC”, and by a grant from the Laerdal Foundation (ref. 2022-0083).

Reflective Learning Conversations (RLC) can be used during debriefing to develop competence and clinical reasoning of healthcare practitioners [1, 2]. The current available RLC debriefing models were established to develop general clinical reasoning skills without consideration of the influencing factors concerning different learners’ experiences and competence levels in a multicultural simulation learning environment.2 Ignoring these factors can put learners at risk of cognitive overload, inappropriate engagement in the learning process, and underdeveloped clinical reasoning [2, 3]. To mitigate that risk, a learner-centered RLC debriefing model was co-designed by a working group of simulation experts, educators, and clinical stakeholders. We aim to describe the evaluation of the co-designed RLC debriefing model’s reliability and validity for use in multicultural simulation learning environments in the presence of different learners with different levels of competence and experience.

Methods:

A mixed methods quasi-experimental, pre-test/post-test research design was used to evaluate the RLC debriefing model’s reliability and validity. The study sample consisted of a cohort of critical care nurses and advanced nurse practitioners who attended critical care simulation courses (n=110) between 3 March 2022 and 2 February 2023, and were recruited from nine large tertiary public hospitals in Qatar. Participants (n=110) were pre-assigned to simulation activities as experimental (n=55) and control (n=55) groups. The data were collected from both groups using self-reported questionnaires, three direct observations and video reviews of the participants’ clinical reasoning using CREST and LCJR tools, and focus group interviews. The quantitative data analyses were conducted using Mann-Whitney and Wilcoxon tests, and a thematic analysis for the qualitative data analysis.

Results:

The newly co-designed RLC model was deemed to be valid and reliable to enhance learners’ clinical reasoning skills while attending adult critical care simulation-based courses. The post-test group had a significantly higher level of clinical reasoning compared to the pre-test group, p= [.608, <.001, <.001] z= [-.513, -3.729, -5.850] respectively for three different observations (Table 1-A26). The model demonstrated a Cronbach alpha and ICC of (α=0.968, and ICC=0.972) respectively.

Discussion:

Attending simulation in the presence of different learners’ experiences and competence levels in a multicultural simulation learning environment are important factors in avoiding clinical reasoning under-development and cognitive overload. A learner-centered RLC debriefing model was co-designed and evaluated in consideration of these factors toward clinical reasoning optimisation. The model is deemed valid and reliable to enhance participants’ clinical reasoning for a single discipline (nursing), and future validations are recommended for interprofessional simulation-based education.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare simulation standards of best practiceTM The debriefing process. Clinical Simulation in Nursing. 2021;58:27–32.

2. Almomani E, Sullivan J, Samuel J, Maabreh A, Pattison N, Alinier G. Assessment of clinical reasoning while attending critical care Postsimulation reflective learning conversation: a scoping review. Dimensions of Critical Care Nursing. 2023;42(2):63–82.

3. Almomani E, Sullivan J, Saadeh O, Mustafa E, Pattison N, Alinier G. Reflective learning conversations model for simulation debriefing: a co-design process and development innovation. BMC Medical Education. 2023;23(1):837.

Table 1-A26.

Descriptive and inferential tests for direct observation and video review using CREST and LCJR

Assessment method	Group	N	Mean Rank	Mann-Whitney U	Wilcoxon W	Z	P-Value
1st direct observation using CREST	Control	55	54.50	1457.500	2997.500	-.513	.608
	Experimental	55	56.50
2nd direct observation using CREST	Control	55	46.00	990.000	2530.000	-3.729	<.001
	Experimental	55	65.00
3rd direct observation using CREST	Control	55	39.69	643.000	2183.000	-5.850	<.001
	Experimental	55	71.31
1st direct observation using LCJR	Control	55	52.63	1354.500	2894.500	-1.242	.214
	Experimental	55	58.37
2nd direct observation using LCJR	Control	55	56.00	1485.000	3025.000	-.201	.841
	Experimental	55	55.00
3rd direct observation using LCJR	Control	55	43.50	852.500	2392.500	-4.735	<.001
	Experimental	55	67.50
1st video review usingCREST	Control	55	54.50	1457.500	2997.500	-.513	.608
	Experimental	55	56.50
2nd video review using CREST	Control	55	41.41	737.500	2277.500	-5.268	<.001
	Experimental	55	69.59
3rd video review usingCREST	Control	55	35.81	429.500	1969.500	-7.223	<.001
	Experimental	55	75.19
1st video review usingLCJR	Control	55	47.40	1067.000	2607.000	-3.038	.002
	Experimental	55	63.60
2nd video review usingLCJR	Control	55	52.08	1324.500	2864.500	-1.296	.195
	Experimental	55	58.92
3rd video review usingLCJR	Control	55	37.27	510.000	2050.000	-6.767	<.001
	Experimental	55	73.73
Total		110

Interprofessional Education (IPE) helps improve collaboration between different professionals working in Intensive Care Units (ICU) improving clinical outcomes and staff well-being. In-situ simulation (ISS) has been increasingly used in ICU settings to reproduce real-life clinical issues. In Whiston ICU, ISS is undertaken as an IPE intervention, allowing doctors and nurses to train together in the clinical environment. This evaluation explores how the ISS programme produces interprofessional outcomes for different staff groups, whether undertaking simulation in the clinical environment impacts this, and what features of the programme help make inter-professional simulation effective.

Methods:

A qualitative realist evaluation approach was adopted to create and then test hypotheses about how the ISS programme might work to produce interprofessional learning [1]. These Initial Programme Theories (IPTs) were constructed using documentary analysis and from discussions with the designers and facilitators of the ISS programme. Ten IPTs were tested and refined by two methods. PubMed was searched to identify potential mechanisms which might facilitate or impede interprofessional learning [2]. At the same time, qualitative data collection, consisting of non-participant observation of ISS, semi-structured interviews and an interprofessional workshop was undertaken in Whiston Hospital ICU staff. Triangulation of qualitative data and the literature was used to test and refine IPTs.

Results:

One Non-Participant Observation was undertaken. Two doctors, three nurses and one medical student were interviewed, and four doctors and six nurses attended an interprofessional workshop. Iterative refining of IPTs using computer-assisted qualitative data analysis software (NVivo) [3]; allowed the identification of three relevant contexts (a busy ICU with high clinical acuity, the clinical environment of the ICU, and new/junior vs. experienced/senior participants) and four mechanisms which facilitate successful interprofessional ISS. These were ‘Planning and Logistics’, ‘Interdependence’, ‘Embodiment’ and ‘Psychological Safety’; this allowed the generation of two middle-range theories:

1. In a busy ICU with high clinical acuity, a well-planned ISS allow staff from different healthcare professions to participate without distractions from clinical work.

2. Well-designed ISS encourages interdependence among healthcare professionals, clarifies different professional roles, and promotes the transfer of interprofessional skills to practice.

Discussion:

ISS is a valuable tool in IPE. To be successful it requires careful planning and organisational support. Emphasis should be placed on ensuring a diverse but equitable mix of professions, with interprofessional instructional design of scenarios to create simulations which cause interdependence between different professions to solve clinical problems and engender embodiment in participants to improve role clarity and transfer to practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Pawson R, Tilley N. Realistic Evaluation. 1997. Sage.

2. Hewitt G, Sims S, Harris R. Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care. J Interprof Care. 2014;28(6):501–506.

3. Dalkin S, Forster N, Hodgson P, Lhussier M, Carr SM. Using computer assisted qualitative data analysis software (CAQDAS; NVivo) to assist in the complex process of realist theory generation, refinement and testing. International Journal of Social Research Methodology. 2021;24(1):123–134.