The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection. (Funded by the National Institute of General Medical Sciences; ProACT ClinicalTrials.gov number, NCT02130986 .).
Introduction Our goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas. Methods We conducted a feasibility study to establish the process for successful delivery of educational content to learners overseas via telesimulation over a five-month period. Participants were registrants in an EMS course on MCI triage broadcast from University of California, Irvine Medical Simulation Center. The intervention was a Simple Triage and Rapid Treatment (START) course. The primary outcome was successful implementation of the course via telesimulation. The secondary outcome was an assessment of participant thoughts, feelings, and attitudes via a qualitative survey. We also sought to obtain quantitative data that would allow for the assessment of triage accuracy. Descriptive statistics were used to express the percentage of participants with favorable responses to survey questions. Results All 32 participants enrolled in the course provided a favorable response to all questions on the survey regarding their thoughts, feelings, and attitudes toward learning via telesimulation with wearable/mobile technology. Key barriers and challenges identified included dependability of Internet connection, choosing appropriate software platforms to deliver content, and intercontinental time difference considerations. The protocol detailed in this study demonstrated the successful implementation and feasibility of providing education and training to learners at an off-site location. Conclusion In this feasibility study, we were able to demonstrate the successful implementation of an intercontinental MCI triage course using telesimulation and wearable/mobile technology. Healthcare providers expressed a positive favorability toward learning MCI triage via telesimulation. We were also able to establish a process to obtain quantitative data that would allow for the calculation of triage accuracy for further experimental study designs.
IntroductionMost medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR.MethodsThis was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual.ResultsStudents in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30–4.82]) for SIM and 3.89 cm (95% CI [3.50–4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699–0.751]) for SIM group and 0.679 (95% CI [0.655–0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7–40.8]) for SIM group and 79.5 s (95% CI [44.8–119.6]) for STD group, p=0.007.ConclusionHigh-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.
It can be concluded that medical knowledge acquisition is improved in the video animation group compared with the current standard of care (P = .001). It can also be concluded that it is feasible to implement a novel media platform to educate patients receiving opioid analgesics in the ED (96.1%).
Objective: The objective was to evaluate the comparative effectiveness of telesimulation versus standard simulation in teaching medical students the management of critically ill patients Methods: Prospective, randomized crossover study of 32 fourth-year medical students at a university medical simulation center. Students were randomized to the standard simulation (SIM) or telesimulation (TeleSIM) group between September 2014 and February 2015. The SIM group experience included participating in a live, fully immersive simulation case followed by debriefing with their SIM cohort and a live TV Internet connection to the TeleSIM group. The TeleSIM group experience included remotely observing the live simulation case at an off-site location, followed by a shared group debriefing via live TV Internet connection. Subject assessment was performed with a written evaluation tool. During a second instructional session, the students crossed over and participated in a different simulation scenario and assessment. Mean evaluation scores were calculated along with 95% confidence intervals (CIs) and were analyzed via linear regression. Our secondary outcome was a survey evaluating the perceptions and attitudes held between the two simulation modalities.Results: Of 33 eligible students, 32 participated in the study (97.0%). We found no significant difference in the mean evaluation scores of the two groups: SIM group mean = 96.6% (95% CI = 94.5%-98.6%) and TeleSIM group mean = 96.8% (95% CI = 94.8%-98.9%). We also found no significant difference in the favorability of teaching modality (TeleSIM vs. SIM) on the survey. Conclusion:In our prospective randomized crossover study evaluating telesimulation versus standard simulation, we found no significant difference in evaluation scores among the two groups. There was also no significant difference found in the favorability of one teaching modality on a posteducational session survey. Our data support and highlight the capability of telesimulation to provide educational benefit to learners who do not have direct access to simulation resources.T elesimulation is a new and innovative concept and process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location. 1 This new delivery method of content via simulation has its origins with the past decade and has seen rapid growth, being implemented in areas such as surgery, anesthesia, pediatric resuscitation, and emergency medicine. 2-9 Although telecommunication and simulation resources have been used in the past
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