More than a feeling: emotional regulation strategies for simulation-based education.

Simulation-based education often involves learners or teams attempting to manage situations at the limits of their abilities. As a result, it can elicit emotional reactions in participants. These emotions are not good or bad, they simply are.

Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study.

Background: Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians.

Methods: Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios.

Emotions in simulation-based education: friends or foes of learning?

In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another.

Wrestling With the Invincibility Myth: Exploring Physicians' Resistance to Wellness and Resilience-Building Interventions.

Purpose: Physicians are expected to provide compassionate, error-free care while navigating systemic challenges and organizational demands. Many are burning out. While organizations are scrambling to address the burnout crisis, physicians often resist interventions aimed at enhancing their wellness and building their resilience.

Does the age of acute care physicians impact their (1) crisis management performance and (2) learning after simulation-based education? A protocol for a multicentre prospective cohort study in Toronto and Ottawa, Canada.

Introduction: The proportion of older acute care physicians (ACPs) has been steadily increasing. Ageing is associated with physiological changes and prospective research investigating how such age-related physiological changes affect clinical performance, including crisis resource management (CRM) skills, is lacking. There is a gap in the literature on whether physician's age influences baseline CRM performance and also learning from simulation.

PTSD, Acute Stress, Performance and Decision-Making in Emergency Service Workers.

Despite research identifying high levels of stress and traumatic stress symptoms among those in the emergency services, the impact of these symptoms on performance and hence public safety remains uncertain. This review paper discusses a program of research that has examined the effects of prior critical incident exposure, acute stress, and current post-traumatic symptoms on the performance and decision-making during an acutely stressful event among police officers, police communicators, paramedics and child protection workers. Four studies, using simulation methods involving video simulators, human-patient simulators, and/or standardized patients, examined the performance of emergency workers in typical workplace situations related to their individual profession.

E-learning optimization: the relative and combined effects of mental practice and modeling on enhanced podcast-based learning-a randomized controlled trial.

Enhanced podcasts increase learning, but evidence is lacking on how they should be designed to optimize their effectiveness. This study assessed the impact two learning instructional design methods (mental practice and modeling), either on their own or in combination, for teaching complex cognitive medical content when incorporated into enhanced podcasts. Sixty-three medical students were randomised to one of four versions of an airway management enhanced podcast: (1) control: narrated presentation; (2) modeling: narration with video demonstration of skills; (3) mental practice: narrated presentation with guided mental practice; (4) combined: modeling and mental practice.

Five Questions Critical Care Educators Should Ask About Simulation-Based Medical Education.

Simulation is now commonly used in health care education, and a growing body of evidence supports its positive impact on learning. However, simulation-based medical education (SBME) involves a range of modalities, instructional methods, and presentations associated with different advantages and limitations. This review aims at better understanding the nature of SBME, its theoretic and proven benefits, its delivery, and the challenges posed by SBME.

Balancing care and teaching during clinical activities: 2 contexts, 2 strategies.

Purpose: The goal of this study was to better understand how clinical supervisors integrate teaching interactions with medical trainees into 2 types of clinical activities in the critical care setting: multidisciplinary rounds and medical crises.

Methods: We conducted a qualitative, observational study based on an ethnographic approach. We observed the teaching interactions among clinical supervisors and medical trainees during 12 multidisciplinary rounds and 74 medical crises in 2 academic hospitals.

Model of interactive clinical supervision in acute care environments. Balancing patient care and teaching.

Rationale: Progressive trainee autonomy is considered essential for clinical learning, but potentially harmful for patients. How clinical supervisors and medical trainees establish progressive levels of autonomy in acute care environments without compromising patient safety is largely unknown.

Objectives: To explore how bedside interactions among supervisors and trainees relate to trainee involvement in patient care and to clinical oversight.

Creating learning momentum through overt teaching interactions during real acute care episodes.

Clinical supervisors fulfill a dual responsibility towards patient care and learning during clinical activities. Assuming such roles in today's clinical environments may be challenging. Acute care environments present unique learning opportunities for medical trainees, as well as specific challenges.

Clinical supervision and learning opportunities during simulated acute care scenarios.

Context: Closer clinical supervision has been increasingly promoted to improve patient care. However, the continuous bedside presence of supervisors may threaten the model of progressive independence traditionally associated with effective clinical training. Studies have shown favourable effects of closer supervision on trainees' learning, but have not paid specific attention to the learning processes involved.

Predictable chaos: a review of the effects of emotions on attention, memory and decision making.

Healthcare practice and education are highly emotional endeavors. While this is recognized by educators and researchers seeking to develop interventions aimed at improving wellness in health professionals and at providing them with skills to deal with emotional interpersonal situations, the field of health professions education has largely ignored the role that emotions play on cognitive processes. The purpose of this review is to provide an introduction to the broader field of emotions, with the goal of better understanding the integral relationship between emotions and cognitive processes.

Interventions to reduce the consequences of stress in physicians: a review and meta-analysis.

A significant proportion of physicians and medical trainees experience stress-related anxiety and burnout resulting in increased absenteeism and disability, decreased patient satisfaction, and increased rates of medical errors. A review and meta-analysis was conducted to examine the effectiveness of interventions aimed at addressing stress, anxiety, and burnout in physicians and medical trainees. Twelve studies involving 1034 participants were included in three meta-analyses.

Impact of acute stress on resident performance during simulated resuscitation episodes: a prospective randomized cross-over study.

Background: Medical trainees have identified stress as an important contributor to their medical errors in acute care environments.

Purposes: The objective of this study was to determine if the addition of acute stressors to simulated resuscitation scenarios would impact on residents' simulated clinical performance.

Methods: Fifty-four residents completed a control and a high-stress simulated scenario on separate visits.

Effects of clinical supervision on resident learning and patient care during simulated ICU scenarios.

Objectives: Closer supervision of residents' clinical activities has been promoted to improve patient safety, but may additionally affect resident participation in patient care and learning. The objective of this study was to determine the effects of closer supervision on patient care, resident participation, and the development of resident ability to care independently for critically ill patients during simulated scenarios.

Design: This quantitative study represents a component of a larger mixed-methods study.

Simulation-based assessment of paramedics and performance in real clinical contexts.

Objective: The objective of this study was to seek validity evidence for simulation-based assessments (SBA) of paramedics by asking to what extent the measurements obtained in SBA of clinical competence are associated with measurements obtained in actual paramedic contexts, with real patients.

Methods: This prospective observational study involved analyzing the assessment of paramedic trainees at the entry-to-practice level in both simulation- and workplace-based settings. The SBA followed an OSCE structure involving full clinical cases from initial patient contact to transport or transfer of care.

The impact of stress on paramedic performance during simulated critical events.

Objectives: Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics' ability to care for patients during stressful events. In this study, we examined paramedics' acute stress responses and performance during simulated high-stress scenarios.

Stress responses and decision making in child protection workers faced with high conflict situations.

Introduction: The assessment of children at risk of abuse and neglect is a critical societal function performed by child protection workers in situations of acute stress and conflict. Despite efforts to improve the reliability of risk assessments through standardized measures, available tools continue to rely on subjective judgment. The goal of this study was to assess the stress responses of child protection workers and their assessments of risk in high conflict situations.

Impact of stress on resident performance in simulated trauma scenarios.

Background: Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations.

Review article: simulation in anesthesia: state of the science and looking forward.

Purpose: Within the field of anesthesia, simulation has been used as a tool for training and assessment for over 30 years. The purpose of this review is to evaluate the state of the science in terms of its effectiveness as an approach to both training and assessment in anesthesia. Articles in the area of simulation and anesthesia published up to and including 2011 were reviewed for inclusion in this narrative review.

The study of factors affecting human and systems performance in healthcare using simulation.

A large body of research using simulation in healthcare has focused on simulation itself as an object of research. However, simulation can also be used in research on human or system performance. It can be used to investigate the effects of performance shaping factors that would otherwise be difficult to study in the actual clinical setting due to practical constraints or ethical concerns.