Healthcare Simulation Training Guidelines and Literature Reviews From the Third Society for Simulation in Healthcare Research Summit.

The Society for Simulation in Healthcare held its third research summit in January 2023 with the aim of establishing evidence-based guidelines for healthcare simulation training. A panel of researchers, clinicians, and subject-matter experts conducted reviews of the literature addressing 12 key topics and followed a formal process to generate 16 guidelines for simulation-based training in healthcare. Eleven peer-reviewed literature reviews accompany these guidelines.

Preparing and Presenting Validation Studies: A Guide for the Perplexed.

Simulated environments are frequently used for learner assessment, and a wide array of assessment instruments have been created to assist with this process. It is important, therefore, that clear, compelling evidence for the validity of these assessments be established. Contemporary theory recognizes instrument validity as a unified construct that links a construct to be assessed with a population, an environment of assessment, and a decision to be made using the scores.

Examining the Effect of Interruptions at Different Breakpoints and Frequencies Within a Task.

Objective: The purpose was to explore how event segmentation theory (EST) can be used to determine optimal moments for an interruption relying on hierarchical task analysis (HTA) to identify coarse and fine event boundaries.

Background: Research on the effects of interruptions shows that they can be either disruptive or beneficial, depending on which aspects of an interruption are manipulated. Two important aspects that contribute to these conflicting results concern when and how often interruptions occur.

Medical Students' Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study.

Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)-based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial.

Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication.

The Second Society for Simulation in Healthcare Research Summit: Beyond our Boundaries.

In this article, we report on the Second Society for Simulation in Healthcare Research Summit held in 2017. This meeting succeeded the First Research Summit from 2011 with the goal of advancing the scope of healthcare simulation research. During the one and a half day summit, some of the world's leading experts in simulation, healthcare, and simulation in healthcare convened to discuss ideas about what research goals would be most beneficial to the healthcare simulation community, and what could be done to achieve them.

Human Factors and Simulation in Emergency Medicine.

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change.

Initial construct validity evidence of a virtual human application for competency assessment in breaking bad news to a cancer patient.

Background: Despite interest in using virtual humans (VHs) for assessing health care communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN) to a VH patient.

Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN.

Learner Improvement From a Simulation-Enhanced Ultrasonography Curriculum for First-Year Medical Students.

Objectives: We describe a simulation-enhanced ultrasonography (US) curriculum for first-year medical students as part of a comprehensive curricular integration of US skills. Our goal was to assess student knowledge and performance of US and determine their satisfaction with the integrated curriculum.

Methods: A committee of basic science, clinical, and interinstitutional faculty developed 7 educational US modules integrated into existing anatomy and physiology courses.

Effects of a retention interval and refresher session on intracorporeal suturing and knot tying skill and mental workload.

Background: The effects of refraining from practice for different intervals on laparoscopic suturing and mental workload was assessed with a secondary task developed by the authors. We expected the inability to practice to produce a decrease in performance on the suturing, knot tying, and secondary task and skills to rebound after a single refresher session.

Methods: In total, 22 surgical assistant and premedical students trained to Fundamentals of Laparoscopic Surgery proficiency in intracorporeal suturing and knot tying were assessed on that task using a secondary task.

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial.

Objectives: To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group's experiences and learning preferences.

Methods: A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR's intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE).

Running Memory for Clinical Handoffs: A Look at Active and Passive Processing.

Objective: The goal of the present study was to examine the effects of domain-relevant expertise on running memory and the ability to process handoffs of information. In addition, the role of active or passive processing was examined.

Background: Currently, there is little research that addresses how individuals with different levels of expertise process information in running memory when the information is needed to perform a real-world task.

Differences in mental workload between traditional and single-incision laparoscopic procedures measured with a secondary task.

Intro: The mental workload associated with laparoscopic suturing can be assessed with a secondary task that requires the same visual-spatial attentional resources. The purpose of this study was to use a secondary task to measure the incremental workload demands of single-incision laparoscopic surgery (SILS) procedures versus traditional laparoscopic procedures.

Method: 12 surgery residents and surgical assistants who had met FLS criteria on an FLS and SILS simulator performed one trial each of peg transfer, cutting, and intracorporeal suturing tasks simultaneously with the secondary task and provided subjective workload ratings using the NASA-TLX.

Categorizing Fetal Heart Rate Variability with and without Visual Aids.

 This study examined the ability of clinicians to correctly categorize images of fetal heart rate (FHR) variability with and without the use of exemplars.  A sample of 33 labor and delivery clinicians inspected static FHR images and categorized them into one of four categories defined by the National Institute of Child Health and Human Development (NICHD) based on the amount of variability within absent, minimal, moderate, or marked ranges. Participants took part in three conditions: two in which they used exemplars representing FHR variability near the center or near the boundaries of each range, and a third control condition with no exemplars.

Standardized Patient Encounters: Periodic Versus Postencounter Evaluation of Nontechnical Clinical Performance.

Introduction: Standardized patients are a beneficial component of modern healthcare education and training, but few studies have explored cognitive factors potentially impacting clinical skills assessment during standardized patient encounters. This study examined the impact of a periodic (vs. traditional postencounter) evaluation approach and the appearance of critical verbal and nonverbal behaviors throughout a standardized patient encounter on scoring accuracy in a video-based scenario.

The Influence of a Crosshair Visual Aid on Observer Detection of Simulated Fetal Heart Rate Signals.

Objective To determine whether a visual aid overlaid on fetal heart rate (FHR) tracings increases detection of critical signals relative to images with no visual aid. Study Design In an experimental study, 21 undergraduate students viewed 240 images of simulated FHR tracings twice, once with the visual aids and once without aids. Performance was examined for images containing three different types of FHR signals (early deceleration, late deceleration, and acceleration) and four different FHR signal-to-noise ratios corresponding to FHR variability types (absent, minimal, moderate, and marked) identified by the National Institute of Child Health and Human Development (2008).

Resident handoff training: initial evaluation of a novel method.

Introduction: Residencies are required to have a standardized process for transitioning patient care. This study was designed to assess a novel method of training and evaluating handoffs using both a lecture format and standardized patient (SP) interactions.

Methods: Matched group design was used to randomly assign interns to trained versus control groups, with the trained group receiving formal handoff training before SP encounters.

Intracorporeal suturing: Transfer from Fundamentals of Laparoscopic Surgery to cadavers results in substantial increase in mental workload.

Introduction: A spatial secondary task developed by the authors was used to measure the mental workload of the participant when transferring suturing skills from a box simulator to more realistic surgical conditions using a fresh cadaver. We hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores.

Methods: We trained 14 surgical assistant students to FLS proficiency in intracorporeal suturing.

The cognitive demands of standardized patients: understanding limitations in attention and working memory with the decoding of nonverbal behavior during improvisations.

Introduction: This study was designed to look at the challenges of standardized patients while in role and to use the findings to enhance training methods. The study investigated the effect of improvisations and multiple-task performance on the ability of standardized patients to observe and evaluate another's communication behaviors and its associated mental workload.

Method: Twenty standardized patients participated in a 2 types of interview (with and without improvisations)-by-2 types of observation (passive and active) within-groups design.