Abstract:Purpose: Competency to perform cardiopulmonary resuscitation is essential to improve the outcome during an event of cardiac arrest. Medical internship is a "transition phase" beyond which physicians are exposed to the unpreparedness and anxiety while dealing with lifethreatening conditions which need rapid actions. Experiential learning, deliberate practice and immediate feedback are the primary advantages of simulation-based medical education. In-situ simulation occurs in a real patient care environment utili… Show more
“…The simulations were conducted by the ED faculties who had past trainings and experience in conducting simulations. 20 , 29 , 30 Figure 1 Various zones in the Emergency Department before COVID-19 outbreak. Figure 2 Re-designated triage and ARI areas in the Emergency Department.…”
Section: Methodsmentioning
confidence: 99%
“…The simulations were conducted by the ED faculties who had past trainings and experience in conducting simulations. 20,29,30 For triage ISS, we designed case scenarios of the patients arriving in the ED falling under different triage categories (Supplement 3a). The triage personnel interviewed the simulated patients (SiP) portraying various case scenarios and the participants had to allocate the SiP to the appropriate zones ( Figure 3).…”
Section: Study Procedures and Data Collection Toolsmentioning
Purpose: During the outbreak of Coronavirus disease of 2019 (COVID-19), the preparedness of emergency departments (EDs) for triaging of the patients and safety of staff is of utmost importance. The aim of our study was to develop and implement COVID-19 ED triage and protected intubation protocols for COVID-19 patients with in-situ simulation (ISS) training. The latent safety threats (LST) detection also served as a platform to test new system amendments and refine the protocols and workflows with infection control issues. We also explored the effectiveness of this approach based on Kirkpatrick's model of evaluating training outcomes. Participants and Methods: The protocols and simulation scenarios were developed and validated. A total of 22 triage and 13 intubation simulation sessions were conducted in the ED with multidisciplinary staff (physicians=18, nurses=20) during a period of four months. Each simulation was followed by a debriefing session to discuss the team performance. Preand post-simulation performances were compared. LSTs were identified and remediated. An online voluntary feedback was collected from the participants to explore the opinion about the ISS sessions and confidence level using a 5-point Likert scale. Results: There was a significant improvement in triage knowledge score after ISS [5.5/10 (IQR 4-6) versus 8.5/10 (IQR 8-9), p<0.001]. There was a desirable proportion of correct responses (>75%) following the ISS for triage case scenarios. A pre-designed checklist was used during protective intubation simulations. Some important LSTs were missing medications, lack of mechanism to deliver patient samples to lab and faulty airway maneuvers. The participants' feedback on ISS showed increased skills and confidence level on triaging and protected intubation (p<0.001). They found the protocols easy to follow and they recommended for more such modules in future. Conclusion: ISS is a quick and efficient tool to implement the ED protocols for preparation of outbreaks like COVID-19. It helps the ED staff to triage and manage the airway safely. We recommend such an approach to train the multidisciplinary staff and continue to improve ourselves through ISS addressing the changing nature of the pandemic.
“…The simulations were conducted by the ED faculties who had past trainings and experience in conducting simulations. 20 , 29 , 30 Figure 1 Various zones in the Emergency Department before COVID-19 outbreak. Figure 2 Re-designated triage and ARI areas in the Emergency Department.…”
Section: Methodsmentioning
confidence: 99%
“…The simulations were conducted by the ED faculties who had past trainings and experience in conducting simulations. 20,29,30 For triage ISS, we designed case scenarios of the patients arriving in the ED falling under different triage categories (Supplement 3a). The triage personnel interviewed the simulated patients (SiP) portraying various case scenarios and the participants had to allocate the SiP to the appropriate zones ( Figure 3).…”
Section: Study Procedures and Data Collection Toolsmentioning
Purpose: During the outbreak of Coronavirus disease of 2019 (COVID-19), the preparedness of emergency departments (EDs) for triaging of the patients and safety of staff is of utmost importance. The aim of our study was to develop and implement COVID-19 ED triage and protected intubation protocols for COVID-19 patients with in-situ simulation (ISS) training. The latent safety threats (LST) detection also served as a platform to test new system amendments and refine the protocols and workflows with infection control issues. We also explored the effectiveness of this approach based on Kirkpatrick's model of evaluating training outcomes. Participants and Methods: The protocols and simulation scenarios were developed and validated. A total of 22 triage and 13 intubation simulation sessions were conducted in the ED with multidisciplinary staff (physicians=18, nurses=20) during a period of four months. Each simulation was followed by a debriefing session to discuss the team performance. Preand post-simulation performances were compared. LSTs were identified and remediated. An online voluntary feedback was collected from the participants to explore the opinion about the ISS sessions and confidence level using a 5-point Likert scale. Results: There was a significant improvement in triage knowledge score after ISS [5.5/10 (IQR 4-6) versus 8.5/10 (IQR 8-9), p<0.001]. There was a desirable proportion of correct responses (>75%) following the ISS for triage case scenarios. A pre-designed checklist was used during protective intubation simulations. Some important LSTs were missing medications, lack of mechanism to deliver patient samples to lab and faulty airway maneuvers. The participants' feedback on ISS showed increased skills and confidence level on triaging and protected intubation (p<0.001). They found the protocols easy to follow and they recommended for more such modules in future. Conclusion: ISS is a quick and efficient tool to implement the ED protocols for preparation of outbreaks like COVID-19. It helps the ED staff to triage and manage the airway safely. We recommend such an approach to train the multidisciplinary staff and continue to improve ourselves through ISS addressing the changing nature of the pandemic.
“…9 Simulation has been proven to improve the competency of interns. 8,10 Adding simulation to training is a growing trend nowadays in the field of medical education. The current study was planned to evaluate the perception of interns about their experience during one-month EM rotation, and to assess the impact of adding simulation-based training (SBT).…”
Objective: To evaluate the perception of interns about their experience during one-month rotation in the emergency department, and the impact of adding simulation-based training.
Method: The retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised feedback surveys filled by interns at the end of their rotation in the emergency department between December 2017 and July 2020. The feedback questionnaire in use is aimed at evaluating interns’ experience with the emergency department rotation and the common academic activities during the rotation period. A comparison was done between those who had received simulation-based training and those who had not. Data was analysed using SPSS 24.
Results: Of the 971 interns having done rotation in the emergency department, 718(74%) had completed the survey. Simulation-based training had been received by 208(29%) interns, while 510(71%) had not received it. Mean points given on a scale of 1-10 by the interns was 8.2+/-1.8. Overall, 684(95%) interns believed the rotation had met or exceeded their expectations (p>0.001). There was no significant difference between those who had received simulation-based training and those who had not (p>0.05).
Conclusion: Interns had a positive perception towards the learning experience during their emergency department rotation, but there was no difference between those who had received simulation-based training and those who had not.
Key Words: Simulation, Internship, Emergency medicine, Curriculum, Education.
“…We read with great interest the article by Shrestha et al, 1 implementing and evaluating in-situ simulation (ISS) to train interns with regards to cardiopulmonary resuscitation (CPR). As 5th-year medical students in the UK, we have also experienced simulation-based medical education (SBME) and have found it to be a valuable tool in learning to apply theoretical knowledge in practical situations.…”
Section: Dear Editormentioning
confidence: 99%
“…As shown by Zendejas et al, cost is often overlooked in SBME and its underreporting presents a potential barrier to adoption. 3 Whilst we appreciate Shrestha et al's statement that ISS decreased required resources in comparison to private external Basic Life Support and Advanced Cardiac Life Support courses, 1 we recommend comprehensive costing according to a costreporting framework such as Levin's three-step model. 4 ISS costs involving material and equipment, personnel, facility and opportunity cost should not be overlooked, and a subsequent objective cost-effective analysis would help waiver concerns.…”
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