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:

Increasingly adopted in healthcare education for their ability to engage learners, develop teamwork and critical thinking skills, escape rooms are defined as ‘live-action, team-based games where players discover clues, solve puzzles, and accomplish tasks in one or more rooms in order to accomplish a specific goal’ [1]. The literature suggests that escape rooms have the potential to engage learners[2,3]. Our simulation team, consisting of academic and simulation technicians, created a virtual escape room using IntuifaceTM software for our immersive learning environment. This interactive touchscreen experience allowed nursing students to practice critical thinking, communication, and teamwork as they navigated a virtual patient’s home, consisting of a linear storyline of puzzles within a 40-minute limit. These were focused on wound assessment and management.

Supporting Documents – Figure 1-A92

Introduction:

Table-top simulation is an innovative low fidelity simulation tool which has become trendy over the last few years. Despite its popularity the effectiveness of table-top exercises has not yet been examined in the literature. This narrative review aimed to examine if table-top simulation is an effective educational tool.

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:

Nursing and Midwifery Council (NMC) approved institutions can deliver up to 600 hours of Simulated Practice Learning (SPL) within the 2,300 practice hours, pre-registration nursing students are required to register [1]. Many approved Higher Education Institutions (HEIs) are using immersive technology-enhanced learning as part of a blended approach in their SPL delivery. Virtual Reality (VR) is commonly used to simulate immersive environments where learners can practise decision-making skills within different clinical contexts. Alongside this, there is a need for 3rd year nursing students to develop peer supervision and coaching skills in preparation for registration [2]. The purpose of this work is to report on an evaluation of a teaching intervention, utilising both VR and peer-to-peer learning.

Supporting Document – Table 1-A89

Table 1.

Results of scenario peer 1 vs peer 2.

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:

It is known that for approximately 70% of tertiary level burns referrals, total body surface area (TBSA) calculations are largely overestimated. Furthermore, patients at the point of arrival often are inadequately fluid resuscitated. A learning need to address these factors for multi-disciplinary emergency and surgical care teams was identified, simulation is recommended as a useful tool to prepare health care workers for such cases and address skills gaps amongst teams [1]. A study conducted in 2016 [2] emphasized the affirmative impact of employing moulage based simulation of burns injuries on the overall learning process. In answer to this we have developed an innovative methodology for creating representations of full thickness burns on simulation manikins.

Supporting Documents – Figure 1-A87

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:

Simulation-based training has been shown to significantly improve clinician performance in emergency front of neck access (eFONA), particularly among professionals in high-acuity settings [1]. However, traditional simulation options—including animal tissue models and commercially available part-task trainers—present notable limitations. Ethical concerns, unpleasant sensory experiences, high costs, and environmental impacts restrict their accessibility and scalability. In response to ongoing budget constraints within the NHS, we aimed to develop a low-cost, sustainable, and easily reproducible model for eFONA training using readily available materials.

Supporting Documents – Figure 1-A85

Introduction:

Public satisfaction with General Practice (GP) services has reached an all-time low, amid increasing demand for appointments and strain on resources. In response, the UK government launched the “Delivery Plan for Recovering Access to Primary Care,” which includes a commitment to modernise primary care and improve patient access through digital innovation. A key component of this transformation is the implementation of Total Patient Triage (TPT), a model that assesses all patient contacts to determine the most appropriate clinical pathway. Widely adopted during the COVID-19 pandemic, TPT facilitates remote consultations, reduces reliance on traditional telephone booking systems, and aims to optimise time for both patients and clinicians.

Supporting Document – Table 1-A84

Table 1.

Average scores for four statements evaluating the tabletop simulation session on total patient triage. Likert scale from 1 to 5 (with 5 being “strongly agree”).

On a scale of 1-5 (5 being ‘strongly agree’ and 1 being ‘strongly disagree’), how much do you agree with the following statements?	Average score
I felt that today was interactive and stimulating.	4.92
I felt that today was relevant to my development needs.	4.82
I found today’s tabletop simulation useful.	4.78
My awareness of the total patient triage process has increased because of today’s session.	4.68

Introduction:

Empathy and effective communication are critical to safe, patient-centered healthcare, yet these ‘softer’ skills are often underdeveloped in traditional training when compared to ‘harder’ skills [1, 2]. Simulation tools exploring immersive and XR technologies can often prioritise clinical tasks over emotional engagement. Emerging from an arts-led collaboration between disabled-led arts organisation ZU-UK and researchers at the University of Greenwich, SIMFONIK is an app-based, audio-led XR simulation platform that uses storytelling, immersive audio, and scaffolded role-play to enhance healthcare students’ empathy [3], communication resilience, and emotional awareness. Drawing from techniques in serious games, LARP, and immersive theatre, SIMFONIK places students directly into the patient’s perspective through progressive and accessible instruction-led experiences.

Introduction:

Due to an everchanging healthcare environment and reduced placement availability, the NMC [1] has proposed the adoption of simulated practice learning (SPL). This has encouraged many higher education institutions (HEIs) across the country to bolster the simulation provision, preparing nursing students to face the challenges of the future in a safe environment without the risks associated with clinical practice [2].

During SPL planning for a last year undergraduate adult nursing masters programme, a learning need was identified through learners’ feedback, which highlighted their keenness to explore critical care before graduating. As the placement capacity could not be increased to accommodate large number of learners, the intensive care unit (ICU) environment was recreated digitally through projector-based interactive technology. Medical equipment, sounds, AI generated people, interactive touch-points and bed spaces were developed to increase immersion.

This paper focuses on the team’s own learning journey in adopting the technology, whilst sharing with the simulation community challenges and lessons learnt.

Supporting Documents – Table 1-A82

Table 1.

Findings and solutions after 4 iterations.

Findings		Solution
Lack of standardised practice	Unlike the tried and tested VR-based simulation, no established framework or model existed for designing and delivering an immersive room experience, leading to uncertainty and apprehension.	Produce an ad-hoc template to capture, LOs; Sequence flow (what happens at this stage); Resources needed (images, videos, sounds etc.); Interactive activity, (quizzes, drag and drop etc.)
Software inexperience	The team was unfamiliar with immersive room technology.	Regular catchups and training workshops were introduced, fostering progressive skills development.
Competing priorities	Balancing simulation development with teaching responsibilities proved challenging.	Using one version of a shared live document to identify critical steps, responsible person and obstacles, enabled asynchronous collaboration.
Educational effectiveness	Due to lack of prior experience, there were no metrics that could be used as benchmark.	A dry run, for faculty only, was conducted to test functionality and check timings. A lesson plan (LP) and a narrated video for faculty were instrumental to align LOs to delivery.The LP contained navigation of the scenes, layout of the room, duration of each scene, specific activities to run like quizzes and videos, discussion points, pre-brief, brief and debrief.
Learning and engagement	Long videos and long text caused engagement to drop.	Limit passive learning. Videos were shortened, whilst discussion points and dynamic activities were encouraged.
Future iterations	Further developments and activities stemmed from this experience.	The learning technologist adopted the template used for this experience as a starting block for a different session, resulting in a much quicker and streamlined development.

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:

Swarm debrief is one of the Patient Safety Incident Response Framework (PSIRF) learning response methods [1]. It is a group debrief aimed at fostering collective, system-based learning, used immediately after any event where there is something new to learn. During the implementation of PSIRF in our trust, a gap in Swarm debriefing skills was identified, and the simulation and human factors team was asked to provide educational support. In collaboration with the patient safety team and input from the NHS England PSIRF team, we developed a systems-based Swarm guide and an accessible, engaging audio-visual (AV) Swarm simulation to illustrate a more realistic ‘work-as-done’ example [2].

Supporting Documents – Figure 1-A80

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:

Human factors are essential to patient safety and effective clinical practice, yet traditional teaching methods often struggle to engage multidisciplinary teams in a practical and collaborative manner. Escape rooms are increasingly recognised as a didactic tool that supports active learning, problem-solving, and the development of key skills such as teamwork and communication [1]. As part of the Skills and Simulation Team’s Open Days at University Hospitals Birmingham (Heartlands, Queen Elizabeth, and Good Hope), an interprofessional escape room was developed as a novel, recreational learning activity. It aimed to bring together clinical and non-clinical staff in a high-pressure, team-based environment to reflect on human factors concepts through immersive gameplay.

Introduction:

Ultrasound (US) guided, or Point of Care Ultrasound (POCUS) procedures are increasingly commonplace in healthcare. These procedures improve accuracy and benefit patient safety [1]. Simulation provides a safe environment for healthcare providers to learn how to use the US probe and carry out different surgical or medical interventions such as a kidney biopsy. An innovative US compatible model for kidney biopsies was created out of mixed materials using Aqueous Dietary fibre and Antifreeze Mix (ADAM) Gel [2], a porcine kidney and porcine muscle and skin.

Introduction:

Uterine inversion is a rare but life-threatening obstetric emergency, with its precise incidence remaining unclear [1]. A Canadian case series by Baskett suggests an incidence of 1 in 3,127 deliveries [2]. Associated with considerable morbidity and mortality, prompt recognition and management are essential to improving maternal outcomes [1]. Given its rarity, exposure to this emergency may not occur until later stages of clinical training. We aimed to develop a skills-based session using low-cost simulation models to support obstetric trainees in managing acute uterine inversion and associated postpartum haemorrhage (PPH).

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.

The introduction of virtual reality within healthcare and specifically within simulation-based education, is a novel opportunity to enhance the care of our complex airway patients. ENT and anaesthetic teams frequently manage airway emergencies out-of-hours, yet our airway teaching programs have historically been delivered separately. There is a recognised need for both specialties to train together to develop team-working skills and share knowledge when managing difficult airways [1].

Methods:

We present our first regional collaborative airway teaching course delivered in February 2024 aimed at both ENT and anaesthetic trainees. This extensive high-fidelity full day program utilised a variety of teaching modalities including virtual reality (VR) oculus 3 headsets, Orsim bronchoscopy simulators, a simulated emergency cricothyroidotomy station and collaborative paediatric inhaled foreign body moulages. Our VR headsets have both adult and paediatric tracheostomy simulations and emergency ‘front of neck access’ scenarios in-built. An additional multi-player function allowed cross-specialty team working. Orsim delivered a pioneering flexible nasendoscopy technology to recreate difficult endotracheal intubation. Our emergency ‘front of neck access’ simulation utilised a bespoke mannikin to recreate the real-time tactile feedback. The paediatric inhaled foreign body moulage put our delegates through a comprehensive scenario from A&E to our own ENT theatre suite.

Results:

Regarding formal feedback, those participants that felt ‘very confident’ or ‘extremely confident’ in managing a paediatric inhaled airway foreign body improved from 0% to 83%. With regards to skills acquisition, those participants that felt ‘very confident’ or ‘extremely confident’ in performing flexible bronchoscopy improved from 50% to 92%. ENT trainees’ confidence in discussing difficult airway cases with an anaesthetic colleague improved from 20% to 80% and for anaesthetic trainees improved from 45% to 100%. All participants found the teaching day useful and 100% agreed that there should be more formal collaborative teaching between ENT and anaesthetic trainees.

With respect to the VR simulation, 50% agreed that VR simulated scenarios mimicked a real-life scenario better than conventional mannikin-based sim. 100% found it useful to perform the simulation with a trainee from a different specialty. 100% felt that VR simulation allowed a safe environment to learn, highlighting the psychologically safe learning environment that often limits conventional sim teaching.

Discussion:

This study has demonstrated that the incorporation of novel virtual reality teaching methods into our regional collaborative ENT & anaesthetics airway teaching, improved outcomes in trainees ability to manage tracheostomy and paediatric emergencies.

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. Coyle M, Martin D, McCutcheon K. Interprofessional simulation training in difficult airway management: a narrative review. The British Journal of Nursing. 2020;29(1):36–43.

Acknowledgments:

Funding was provided by our own local ENT department to purchase two VR oculus 3 headsets from ‘goggleminds’ company on a running annual basis.

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.

Simulation in medical education is a well-established tool that produces a realistic experience in a safe learning environment and is used frequently in later years of medical training. Many medical students report immense apprehension and lack of confidence prior to commencing Foundation Year 1 (FY1) [1]. To address this, we undertook a quality improvement project that incorporated game-based [2] and experiential learning [3] principles. The aim was to promote student reflection on common clinical and non-clinical challenges they may face as a Foundation Doctor.

Methods:

The escape room design encompassed a pre-existing simulation setup, incorporating key simulation equipment including a Laerdal SimMan manikin.

Twenty final-year medical students from the University of Birmingham Medical School participated in the escape room activity, working in groups of three or four. Before and after the escape room, students rated their confidence levels on a Likert scale (1-5) regarding various clinical tasks and non-technical skills relevant to FY1: conducting an A-E assessment; formulating differential diagnoses; initiating management plans; making referrals; teamwork; leadership; task delegation and dealing with uncertainty. Mean confidence ratings were calculated for each statement pre- and post-escape room. The data was analysed using the paired-sample Student t-test with statistical significance determined by a p-value of <0.01.

Qualitative data was obtained through student self-evaluation on the skills demonstrated in the escape room and how these assisted, or hindered, their escape. Students participated in an in-person reflective debrief after the escape room.

Results:

Nine students succeeded in escaping the challenge. Analysis revealed a statistically significant increase in mean confidence ratings across six of the nine statements for all students.

Seventeen students reported identification of areas of practice to improve prior to commencement of FY1. Of these, common themes included conducting a thorough patient examination, management of sepsis, clear task delegation within a team, and medication prescribing. Common reflective discussions from the debriefs included working efficiently in a time-pressured environment and focusing amidst distraction.

Discussion:

The escape room has showcased an innovative and effective tool to help students identify their learning needs prior to FY1 and improve their confidence in common tasks in anticipation of their future clinical work. We recognise the limitations of qualitative data gathering and feedback bias from the students that successfully escaped. Overall, we believe that the gamified experience facilitated a greater student appreciation for the impact of non-technical skills in comparison to other simulation learning they have previously received.

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. Monrouxe LV, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, et al. How prepared are UK Medical Graduates for practice? A Rapid Review of the literature 2009–2014. BMJ Open. 2017;7(1).

2. Xu M, Luo Y, Xia R, Qian H, Zou X. Game-base learning in medical education. Front Public Health. 2023;11:1113682.

3. Kolb D. Experiential Learning: Experience As The Source Of Learning And Development. Englewood Cliffs, NJ: Prentice-Hall. 1984.

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).

There is increasing demand to demonstrate cost-effectiveness in simulation-based education (SBE) [1]. This challenging truth is one our department has been forced to reckon with. Consequently, this initiative aimed to provide SBE to core trainees (CTs) and operating department practitioners (ODPs) to ASPIH standards [2] without additional funding, a simulation suite, protected teaching time, or more than one faculty member.

Figure 1-A129.

These objectives suggested use of in-situ simulation. However, challenges of this format are well described. Examples include prolonged set-up, risk to expensive equipment, high facilitator candidate ratio, high facilitator workload, vulnerability to service requirements and low stakeholder buy-in [3].

Methods:

To address these challenges, an unused airway trainer head was selected. It was modified using regularly discarded anaesthetic equipment to simulate chest rise, mechanically mimic physiological and pathological positive pressure ventilation both on monitors and bagging. This was combined with a similarly assembled mechanism to simulate regurgitation and arms with cannulae connected to reservoirs. It was covered with padding, a gown and bedsheet, and secured to a canvas creating an en-bloc unit foldable into a case (Figure 1-A129).

These modifications enable one facilitator to transport all their equipment on a single airway trolley and set up in-situ simulation alone in 20 minutes. This allows exploitation of the otherwise unavailable “downtime” of CTs who have exhausted all learning opportunities on their lists and ODPs on Merit or obstetric duties. Sessions have consisted of a standardised 10-minute pre-brief, 20-minute simulation of an anaesthetic critical incident and a 20-minute debrief.

Simulated patient monitor outputs were pre-programmed in stages to anticipate the progression of the incident and the candidate’s responses. Simple controls alter the manikin’s respiratory mechanics or cause regurgitation. This permits a single facilitator to lead, conduct, monitor and debrief simulations.

Results:

Written candidate feedback has demonstrated high reported immersion, psychological safety, applicability, specific personal learning outcomes, and elicited systems issues on a local and national level. Theatre co-ordinators have accepted the minimally intrusive nature of this design. The total value of equipment and software is estimated to be less than £5000.

Discussion:

This initiative may be useful in departments with few resources for SBE or to demonstrate SBE’s merits when there is low buy-in from stakeholders. Sadly, this mannikin cannot be fully exposed, undergo CPR or defibrillation. It cannot spontaneously breathe and collapses on circuit disconnection. The vulnerabilities of in-situ simulation to service requirements and facilitator workload remain only partially addressed by this work.

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. Hippe DS, Umoren RA, McGee A, Bucher SL, Bresnahan BW. 2020. A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare. SAGE Open Medicine [online]. 8:205031212091345.

2. Purva M, Baxendale B, Scales E. et al. Simulation-Based Education in Healthcare. [online] 2016. Available from: https://aspih.org.uk/wp-content/uploads/2017/07/standards-framework.pdf.

3. Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. In: Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools) [Internet]. US: Agency for Healthcare Research and Quality; 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43682/.

Extended reality (XR) is being increasingly used to support the delivery of healthcare education and training, offering affordable, accessible, replicable and flexible learning at scale without risk [1, 2]. XR is an overarching term for virtual reality (VR), augmented reality (AR) and mixed reality (MR) [1, 2]. A key strategic objective of the All Wales Simulation-Based Education and Training Strategy is to create the vision for how extended reality should be embedded in healthcare education and training ensuring equitable access for the workforce in Wales [3]. A literature review was undertaken to inform this and address the following questions:

● What are the application areas of XR in healthcare education and training?

● What is the effectiveness of XR upon learner/educational outcomes compared to other education and training modalities?

● What are learners’/facilitators’ perceptions of XR?

● Is XR cost-effective?

Methods:

A literature search was conducted of six databases (CINAHL, Medline, Cochrane, Scopus, ERIC, Embase) from 2020 onwards. Inclusion criteria- any empirical research, XR (VR, AR, MR), medical/nursing/health/healthcare and education/training.

Results:

A total of n=2,963 papers were identified after duplicates were removed. Following eligibility screening a decision was made to limit to systematic reviews (SRs) (Figure 1-A128). Fifty SRs met the inclusion criteria; VR (n=29), AR (n=10), VR & AR (n=4) and all three types of XR (n=7). Forty-four SRs featured doctors and healthcare students; medical (n=32) nursing (n=12), paramedic (n=2) and dental (n=2), physiotherapist (n=1) and speech therapy (n=1). The most common application area was surgery (n=19), followed by nurse education (n=8), minimally invasive surgery (n=7) ophthalmology (n=5), anatomy (n=5) Eleven SRs included a meta-analysis. XR was widely accepted by participants, but some differences were noted depending on type. Non-significant improvements in knowledge, technical skills and task performance were reported, with increased operative and surgical procedural duration. Participants reported increased learner satisfaction, higher levels of self-efficacy and reduced anxiety levels, as well as barriers and adverse effects with VR and AR. Repeated use of immersive technology was shown to help improve confidence and engagement levels. No cost effectiveness or patient outcomes were reported.

Figure 1-A128.

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources*Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers).**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

Discussion:

XR is equivocal to traditional methods of learning and can complement existing education and training approaches. Further research is needed into the cost effectiveness of XR and the transfer of learning in clinical practice and impact on patient outcomes. Greater understanding of how to support learning through XR and mitigate barriers is required.

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. NHSX, Health Education England Technology Enhanced Learning Team, UKRI Audience of the Future Challenge, NIHR Mental Health Medtech Cooperative (MindTech) and Rescape. The Growing Value of XR in Healthcare Report. 2020. Available from: https://www.xrhealthuk.org/the-growing-value-of-xr-in-healthcare. [Accessed 22 April 2024].

2. Topol E. Topol review: Preparing the healthcare workforce to deliver the digital future Health Education England The Topol Review — NHS Health Education England. 2019. Available from: hee.nhs.uk. [Accessed 22 April 2024].

3. Health Education and Improvement Wales (HEIW). All Wales Simulation-Based Education and Training Strategy for the Healthcare Workforce The vision for the next five years: 2022 – 2027. 2022. Available from: heiw.nhs.wales/files/all-wales-simulation-strategy-mg-draft-6pdf/. [Accessed 22 April 24].

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].

Addressing the challenge of providing authentic simulated practice learning (SPL) experiences for 750 first-year student nurses across multiple campuses, this presentation explores the implementation of Ruskin Row, a community simulated practice learning initiative. The aim of the SPL was for student nurses to develop competence in proficiencies identified in the UK Nursing and Midwifery Council (NMC) Future Nurse Standards of Proficiency (2018) [1], the case study seeks to investigate the effectiveness of integrating AI software to create immersive learning scenarios.

Methods:

Ruskin Row was created through collaborative efforts involving the nursing simulation team, service users, and practice partners to develop tailored scenarios. AI-generated content, facilitated by Veed.io and Chat GPT, was integrated to enhance scenario realism. Diverse AI avatars, reflective of inclusivity. Additionally, the incorporation of diverse media elements, including videos captured using an iPhone and Gimbal, and immersive 360-degree videos filmed with an Insta X3 camera further enhance the learning experience.

The AI scenarios, developed in VEED.io, are stored in ARU’s media repository, Yuja and linked into Canvas learning management system. Students received support throughout the Simulated Placement learning from a team of academic practice supervisors, led by the placement Charge Nurse.

Results:

Student engagement was high, with positive feedback on content quality and relevance. Notably, students exhibited growth in professionalism, particularly in areas such as avoiding stereotypes and embracing empathy in patient care, aligning well with the principles of patient-centred care. However, staffing shortages posed challenges, highlighting the importance of consistent support for optimal learning experiences.

Discussion:

The experience of the development team underscores the value of collaborative input in integrating AI-generated scenarios into nursing education. By prioritising inclusivity, cultural diversity, and ethical considerations, Ruskin Row fosters innovation in educational practices. Addressing staffing concerns is pivotal for maximising the impact of simulated learning experiences, emphasising the need for sustained support mechanisms.

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. Nursing and Midwifery Council. Future Nurse: Standards of Proficiency for Registered Nurses. 2018. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf.

Management of cardiac arrests are a vital part of a doctor’s job. Although there is no data on the percentage of UK medical students who will witness an arrest, a study of Norwegian students found that 72% had witnessed defibrillation, and 47% had participated in CPR [1]. Anecdotally, UK medical students may never witness a cardiac arrest and subsequently the first arrest they attend is as a qualified doctor. It has been shown that simulation can improve the quality of care during a cardiac arrest [2]. This lesson aimed to utilise the immersive technology of the Gener8 room (interactive, immersive room designed to enhance medical education and simulation) to create a high-fidelity experience of a cardiac arrest situation, The outcome was to improve confidence and competence in management of cardiac arrest.

Methods:

Final year medical students were informed that they would be undertaking a simple lesson. It appeared to them that the lesson was going badly, with the interactive technology failing. They were sent out of the room temporarily so the tutor could ‘fix the technology’. However, after 30 seconds, an emergency buzzer was activated, the students re-entered the room and were faced with a cardiac arrest situation. The tutor played the role of arrest leader. Following the simulation, students underwent Hot Debrief’ discussing the cardiac arrest simulation and then the entire simulation.

Students were asked to rate their confidence around the management of cardiac arrests before and after the simulation and share free text comments including their enjoyment of the session. This was done on a voluntary basis.

Results:

There were 49 responses. The mean confidence rating before the session was 3.59 with a standard deviation of 2 and a variance of 4. This rose to a mean confidence score of 7.71 with a standard deviation of 1.47 and a variance of 2.16 after the session. 100% of the participants stated that they enjoyed the session. The feedback was overwhelmingly positive with the students particularly enjoying the realism and surprise element of the simulation.

Discussion:

The results strongly suggest that immersive technology is an effective tool in improving education and experience of cardiac arrests. An effective debrief to re-enforce learning outcomes and support students is essential, especially simulation featuring a surprise, as it could prove traumatic without it. Future simulations re planned for the fourth-year medical students.

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. Freund Y, Duchateau FX, Baker EC, et al. Self-perception of knowledge and confidence in performing basic life support among medical students. European Journal of Emergency Medicine 2013;20:193–196.

2. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest. 2008;133(1):56–61.

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].

Maternal cardiac arrest is rare, with an incidence of 2.78 per 100 000 maternities in the UK [1]. RCOG guidelines state that if there is no response to CPR after 4 minutes, a perimortem caesarean section (PMCS) should be performed [2]. As part of University Hospitals Sussex NHS Foundation Trust’s (UHSx) new approach to patient safety, local instances of PMCS have prompted the development of a new, simulation-based, multi-disciplinary, transformative learning package [3]. “The ADAMgel Group” in collaboration with the local, pan-UHSx simulation, emergency medicine and obstetrics departments are developing a low-cost, procedurally accurate, and sustainable PMCS simulation model.

Methods:

ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) was infused in a large stockinette and layered with chamois leather and velcro tape to reproduce the anatomical layers encountered when performing PMCS. This was fastened to a simple clothes mannikin frame in which we excised a fluid retaining cavity for our uterus model. A plastic doll in a watertight bag was used to simulate the foetus and amniotic sac. Foam pads were attached to the chest to allow simultaneous CPR, and a rocker bottom to enable a lateral decubitus position. This aims to add situational realism, and replicate known ergonomic issues and human factors.

Results:

Initial feedback from senior clinicians, experienced in the techniques, has been excellent. The procedural accuracy, fidelity to biological tissue and the capacity to simulate CPR were highlighted as particular successes (Figure 1-A120).

The ADAMgel layers can be recycled and re-used, in line with the UHSx “Planet First” sustainability policy. The fabric layers were either stitched back together for reuse or new Velcro tape was applied to reset the manikin. All the materials were low cost and readily available, and assembly was straightforward.

Discussion:

ADAMgel in combination with other readily available materials can produce an effective, low-cost, sustainable, and procedurally accurate PMCS model. This model, paired with appropriate speciality-specific learning resources and more generalised multi-disciplinary team centred learning outcomes, will enable high-acuity-low-occurrence (HALO) training in this procedure. Collaboration between different departments to share mental models, decision-restricting barriers and how an MDT can support decision-makers in this high-stress situation will be incorporated into the regular UHSx patient-safety based simulation program, ensuring our trust is prepared for these events. Further work to limit usage of non-recyclable materials will be needed to bring the model fully in-line with the ethical principles of the ADAMgel group.

Figure 1-A120.

Model in use

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. Beckett V, Knight M, Sharpe P. The <scp>CAPS</scp> Study: incidence, management and outcomes of cardiac arrest in pregnancy in the <scp>UK</scp>: a prospective, descriptive study. BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(9):1374–1381.

2. Chu J, Johnston T, Geoghegan J. Maternal collapse in pregnancy and the puerperium. BJOG: An International Journal of Obstetrics & Gynaecology. 2020;127(5).

3. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

Simulation has become a ISCP mandated component of surgical training, and the challenge remains to develop ‘close-to-real’ training [1]. Management of paediatric elbow fractures is an obligatory competence for completion of training in Trauma and Orthopaedics. Current methods using saw bones teach the concepts of wire configuration, but the limitations include an absence of soft tissues, and intra-operative X-ray interpretation is not possible. Research question was if suitable models could be designed to maximise the realism of training and allow radiographic assessment during the simulated scenario.

Methods:

In conjunction with Axial 3D Printing (Belfast, N. Ireland) a child’s elbow model was produced with radiopaque ‘bone’ and flexible radiolucent ‘soft tissues’ technology to produce a high-fidelity paediatric elbow, suitable to be used under radiological guidance, as an adjunct to teaching Kirschner wiring of a supracondylar fracture. Simulation training of 19 Orthopaedic Trainees (ST3-8) was undertaken.

Results:

Participant feedback was collected with positive responses regarding the model’s usefulness for simulation training within a theatre environment, particularly for trainees with less experience. There was a trend towards decreased screening time and duration of the procedure between junior and senior trainees. Junior trainees had a greater increase in self-reported confidence in performing the procedure. This was measured using a 5-point Likert score with improvement of 1.8 in the ST3-4 cohort compared to 0.44 in the trainees ST5+ (p = 0.003).

Each trainee was dual marked for their performance of the simulated K-wiring procedure using the Objective Structured Assessment of Technical Skills (OSATS) Global Rating Scale [2]. Senior trainees had an average OSATS score of 31.8 compared to the junior trainees who averaged 27.9 (p = 0.015) which mirrors real-life expectations. This proficiency in utilising the simulation model among more experienced surgeons reflects its realism and usefulness as an educational tool.

Discussion:

This new 3D printing technique demonstrates development in modern surgical training. Saw-bones have numerous limitations, while the costs and practicalities of cadaveric training remains prohibitive. By combining realism and low risk these 3D printed models may offer a solution to these challenges and contribute to enhanced patient care.

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. So HY, Chen PP, Wong GKC, Chan TTN. Simulation in medical education. J R Coll Physicians Edinb. 2019;49(1):52–57.

2. van Hove PD, Tuijthof GJM, Verdaasdonk EGG, Stassen LPS, Dankelman J. Objective assessment of technical surgical skills. British Journal of Surgery. 2010;97(7):972–987.