Objective Measurement of Learners' Cognitive Load During Simulation-Based Trauma Team Training: A Pilot Study.

Introduction: Literature has shown cognitive overload which can negatively impact learning and clinical performance in surgery. We investigated learners' cognitive load during simulation-based trauma team training using an objective digital biomarker.

Methods: A cross-sectional study was carried out in a simulation center where a 3-h simulation-based interprofessional trauma team training program was conducted.

Crew Autonomy During Simulated Medical Event Management on Long Duration Space Exploration Missions.

Objective: Our primary aim was to investigate crew performance during medical emergencies with and without ground-support from a flight surgeon located at mission control.

Background: There are gaps in knowledge regarding the potential for unanticipated in-flight medical events to affect crew health and capacity, and potentially compromise mission success. Additionally, ground support may be impaired or periodically absent during long duration missions.

Developing Consensus on Simulation Fellowship Requirements on the Path to Accreditation Council of Graduate Medical Education Accreditation.

Introduction: Nonaccredited simulation fellowships have multiplied resulting in fellowship differences. Standardization of fellowship content and requirements is needed, especially if accreditation is to be achieved. Simulation fellowship criteria were developed using expert consensus and the Accreditation Council for Graduate Medical Education requirements to frame the supporting pillars for accreditation.

Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool.

Introduction: Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice.

Methods: This was a mixed methods study conducted in 2 phases, following Kane's validity framework.

Ultrasound-guided regional anesthesia in the emergency department: an argument for multidisciplinary collaboration to increase access while maintaining quality and standards.

The practice of ultrasound-guided regional anesthesia (UGRA) by emergency medicine physicians in the emergency department (ED) is increasing. The need for effective alternatives to opioid analgesia in the acute care setting likely exceeds the current capacity of UGRA-trained anesthesia teams. In this daring discourse, we outline several matters of relevance to be considered as protocols are put into place to facilitate the practice of UGRA by emergency medicine physicians in the ED.

Brain Death Determination: An Interprofessional Simulation to Determine Brain Death and Communicate with Families Focused on Neurology Residents.

Introduction: Significant variation exists in determining brain death despite an expectation of competence for all neurology residents. In addition, family discussions regarding brain death are challenging and may influence organ donation.

Methods: We developed two simulations of increasing complexity for PGY 2 and PGY 3 neurology residents.

Medical Event Management for Future Deep Space Exploration Missions to Mars.

Background: Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs).

Robotic Assistance Confers Ambidexterity to Laparoscopic Surgeons.

Study Objective: To examine whether a robotic surgical platform can complement the fine motor skills of the nondominant hand, compensating for the innate difference in dexterity between surgeon's hands, thereby conferring virtual ambidexterity.

Design: Crossover intervention study (Canadian Task Force classification II-1).

Setting: Centers for medical simulation in 2 tertiary care hospitals of Harvard Medical School.

Attending Surgeons' Leadership Style in the Operating Room: Comparing Junior Residents' Experiences and Preferences.

Purpose: Recent studies have focused on surgeons' nontechnical skills in the operating room (OR), especially leadership. In an attempt to identify trainee preferences, we explored junior residents' opinions about the OR leadership style of teaching faculty.

Methods: Overall, 20 interns and 20 mid-level residents completed a previously validated survey on the style of leadership they encountered, the style they preferred to receive, and the style they personally employed in the OR.

Expanding simulation-based education through institution-wide initiatives: A blueprint for success.

Background: The Consortium of American College of Surgeons Accredited Education Institutes (ACS-AEIs) was created to promote patient safety through the use of simulation, develop innovative education and training, advance technologies, identify best practices, and encourage research and collaboration.

Methods: During the seventh annual meeting of the consortium, leaders from across the consortium who have developed institution-wide simulation centers were invited to participate in a panel to discuss their experiences and the lessons learned.

Conclusion: These discussions resulted in definition of 5 key areas that need to be addressed effectively to support efforts of the ACS-AEIs.

Interprofessional simulation to improve safety in the epilepsy monitoring unit.

Objective: Patient safety is critical for epilepsy monitoring units (EMUs). Effective training is important for educating all personnel, including residents and nurses who frequently cover these units. We performed a needs assessment and developed a simulation-based team training curriculum employing actual EMU sentinel events to train neurology resident-nurse interprofessional teams to maximize effective responses to high-acuity events.

Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study.

Study Objective: To evaluate risk of leakage and tissue dissemination associated with various contained tissue extraction (CTE) techniques.

Design: In vitro study (Canadian Task Force classification: II-1).

Setting: Academic hospital simulation laboratory.

Comparison of video, optical, and direct laryngoscopy by experienced tactical paramedics.

Objectives: While optical and video laryngoscopy have been studied in the emergency department, the operating room, and the routine prehospital setting, their efficacy in the tactical environment--in which operator safety is as important as intubation success--has not been evaluated. This study compared direct laryngoscopes to optical (AirTraq) and video (King Vision) laryngoscopes in a simulated tactical setting.

Methods: This prospective institutional review board-approved simulation study evaluated each of the laryngoscopes in the hands of seven experienced tactical paramedics.

Using a medical simulation center as an electronic health record usability laboratory.

Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR.

Simulation-based trial of surgical-crisis checklists.

Background: Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians.

Using an Objective Structured Clinical Examination to test adherence to Joint Commission National Patient Safety Goal--associated behaviors.

Background: A study was conducted at a tertiary care academic medical center to assess a simulation-based, single-station Objective Structured Clinical Examination (OSCE) designed to evaluate intern trainees' familiarity with and adherence to behaviors associated with Joint Commission National Patient Safety Goals and The Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.

Method: Subjects were interns, from all disciplines, completing basic skills training during intern orientation. The OSCE scenario was designed to assess 13 behaviors associated with four National Patient Safety Goals (1, 2, 3, and 7) from 2009 and 2010 and the Universal Protocol.

Assessing physician leadership styles: application of the situational leadership model to transitions in patient acuity.

Background: The situational leadership model suggests that an effective leader adapts leadership style depending on the followers' level of competency.

Purpose: We assessed the applicability and reliability of the situational leadership model when observing residents in simulated hospital floor-based scenarios.

Methods: Resident teams engaged in clinical simulated scenarios.

Technique for chest compressions in adult CPR.

Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical.

Cardiopulmonary resuscitation feedback improves the quality of chest compression provided by hospital health care professionals.

Study Objective: High-quality chest compressions (CCs) are an important component of successful resuscitation. Suboptimal in-hospital CC are commonly reported. Skill degradation and fatigue have been implicated.

Simulation in graduate medical education 2008: a review for emergency medicine.

Health care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment.

Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil.

Background: Overdoses of calcium channel blocker agents result in hyperglycemia, primarily due to the blockade of pancreatic L-type calcium channels and insulin resistance on the cellular level. The clinical significance of the hyperglycemia in this setting has not previously been described.

Methods: This study is a retrospective review of all adult (age, >or=15 yrs) patients with a discharge diagnosis of acute verapamil or diltiazem overdose at five university-affiliated teaching hospitals.

Initial test of emergency procedure performance in temporary negative pressure isolation by using simulation technologies.

Study Objective: The potential of infectious disease spread in diseases such as tuberculosis, infectious disease epidemic such as avian flu and the threat of terrorism with agents capable of airborne transmission have focused attention on the need for increased surge capacity for patient isolation. Total negative pressure isolation using portable bioisolation tents may provide a solution. The study assesses the ability of health care workers to perform emergency procedures in this environment.

A comprehensive medical simulation education curriculum for emergency medicine residents.

Medical simulation allows trainees to experience realistic patient situations without exposing patients to the risks inherent in trainee learning and is adaptable to situations involving widely varying clinical content. Although medical simulation is becoming more widely used in medical education, it is typically used as a complement to existing educational strategies. Our approach, which involved a complete curriculum redesign to create a fully integrated medical simulation model with an "all at once" implementation, represents a significant departure from conventional graduate medical education models.