Objective: Neurosurgical boot camps allow trainees to hone practical skills in a risk-free environment, but the models and simulators used are relatively costly. In developing countries like the Philippines, low-cost alternatives have to be devised. The authors aimed to demonstrate the feasibility of using local, readily available, and inexpensive tropical fruits as surrogate models for basic neurosurgical skills training during a neurosurgical boot camp. Methods: Locally available tropical fruits were used to teach basic neurosurgical skills to trainees. Coconut, pomelo, and watermelon were used as models for head clamp application, scalp and dural suturing, and ventriculostomy, respectively. Feedback was obtained from the participants after the boot camp. Results: All eight residents thought that the boot camp was useful in learning new skills, and that the fruit models served their purpose. The trainees favored the fruit models that catered to the skill sets required according to level of training. The use of tropical fruits in the boot camp also provided an informal atmosphere that was conducive to learning. Conclusion The novel use of tropical fruits as surrogate models in basic neurosurgical skills training was a feasible and affordable alternative in resource-limited settings, although the activity was perceived to be more useful to junior than to senior residents. The informal atmosphere generated by the use of the fruits contributed to an improved learning experience for the trainee.
Teaching ; Simulation Training ;

PURPOSE: The purpose of this study was to review intervention programs for experienced nurses' job stress and mental health. METHODS: Searches of literature were conducted through four electronic databases (RISS, KISS, PubMed, and CINAHL), focusing on the recent 5-year publications in English or Korean. Thirteen studies were selected for the final analysis and Scottish Intercollegiate Guidelines Network checklist was used to assess methodological rigor and quality. RESULTS: Randomized controlled trials were used in five studies and quasi-experimental designs in eight studies. Cognitive-Behavioral Therapy (CBT) and group approach were the most frequent types of interventions in six and nine studies respectively. On average, the intervention was required for eight weeks and 60~120 minutes per session. After evaluating the effects of CBT, complementary alternative therapy, informative training, simulation training and stimuli control, most of the tested interventions reduced experienced nurses' job stress and improved mental health, but informative training did not. CONCLUSION: Despite the obvious importance of experienced nurses in quality of nursing care, it has not been well studied due to limited numbers of studies with less rigorous design. Study findings provide a basis for developing intervention programs to reduce job stress and improve mental health for experienced nurses.
Checklist ; Mental Health ; Nursing Care ; Simulation Training

Plastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training.
Curriculum ; Education ; Humans ; Inservice Training ; Microsurgery ; Patient Simulation ; Surgery, Plastic

A previous systematic review on osteoporosis knowledge published showed that only several studies investigated osteoporosis knowledge in health professionals, and it found that their knowledge was not as adequate and sufficient as it should be. Since then, studies published on osteoporosis knowledge among health professionals have also assessed and found that they still do not have adequate and sufficient osteoporosis knowledge. To increase and improve osteoporosis knowledge among health professionals, recommendations in osteoporosis education in the health professions, including the application of the cognitive load theory, online learning, problem-based learning, practical learning, simulation-based learning, interactive learning, and feedback are covered in order to ensure health professionals can have adequate and sufficient osteoporosis knowledge to best prevent and treat individuals with the disease.
Education* ; Health Occupations* ; Learning ; Osteoporosis* ; Problem-Based Learning ; Simulation Training

Although there are many commercially available training software programs for pharmacokinetics, they lack flexibility and convenience. In this study, we develop simulation software to facilitate pharmacokinetics education. General formulas for time courses of drug concentrations after single and multiple dosing were used to build source code that allows users to simulate situations tailored to their learning objectives. A mathematical relationship for a 1-compartment model was implemented in the form of differential equations. The concept of population pharmacokinetics was also taken into consideration for further applications. The source code was written using R. For the convenience of users, two types of software were developed: a web-based simulator and a standalone-type application. The application was built in the JAVA language. We used the JAVA/R Interface library and the ‘eval()’ method from JAVA for the R/JAVA interface. The final product has an input window that includes fields for parameter values, dosing regimen, and population pharmacokinetics options. When a simulation is performed, the resulting drug concentration time course is shown in the output window. The simulation results are obtained within 1 minute even if the population pharmacokinetics option is selected and many parameters are considered, and the user can therefore quickly learn a variety of situations. Such software is an excellent candidate for development as an open tool intended for wide use in Korea. Pharmacokinetics experts will be able to use this tool to teach various audiences, including undergraduates.
Education ; Indonesia ; Korea ; Learning ; Methods ; Pharmacokinetics ; Pliability ; Simulation Training

PURPOSE: The purposes of study was to evaluate the effect of debriefing using reflection questions and writing on the critical thinking disposition, self-efficacy, and clinical judgement ability in simulation of post-operative care of abdominal surgery. METHODS: The research method was a nonequivalent control group no-synchronized design. The study period was from August 22 to 30, 2016. The subjects were comprised of 34 people in the experimental group and 36 in the control group. In a simulation session for post-operative care of abdominal surgery, the treatment of the experimental group was to debrief for 30 minutes using Lasater's reflection questions and writing. For the control group, a typical debriefing was conducted in the same environment. RESULTS: Critical thinking disposition, self-efficacy, and clinical judgement were significantly higher in the experimental group than the control group. CONCLUSION: To enhance the critical thinking disposition, self-efficacy, and clinical judgement of nursing students in simulation, it is recommended to debrief using reflection questions and writing.
Humans ; Methods ; Patient Simulation ; Self Efficacy ; Simulation Training* ; Students, Nursing ; Thinking ; Writing*

OBJECTIVE: To develop a software based on "UniDental" system which is a virtual reality dental simulation system and applied to undergraduate majoring in stomatology to improve the ability of identifying caries. METHODS: A software was developed applying to identify virtual dental caries based on UniDental system. In the software, a virtual dental caries model was designed and carious tissue was separated to 3 layers by the depth. The stiffness was the same within each layer which was increasing gradually layer by layer. The roughness was also the same within each layer which was decreasing gradually layer by layer. Sixty-four participants in pre-clinical stage of the class of 2014 majoring in stomatology from Peking University School of Stomatology were trained with the software. During the training, the students should probe on the virtual dental carious tissue layer by layer and feel the difference of vertical stiffness and horizontal roughness of each layer by using a handpiece with realistic force feedback. After training, a questionnaire survey was conducted to evaluate the software including a score of 1-5 for haptic fidelity of stiffness and roughness and their relevant gradient and benefit of improving the ability of identifying caries, choosing the preferred training method. The data were statistically analyzed using Kruskal-Wallis test. RESULTS: The median of subjective evaluation scores of the proposed metrics were all "4", demonstrating that the software operated above medium fidelity. The stiffness scores of all 3 layers were statistically significant (P < 0.05) on the stiffness gradient score. The roughness scores of the 1st and 2nd layers were statistically significant (P < 0.05) on the roughness gradient score. The training was helpful to improve the ability of identifying caries (median was 4). The scores of all 3 layers stiffness and relevant gradient were statistically significant (P < 0.05) on the score of benefit of improving the ability of identifying caries. 90.4% of the participants preferred the traditional extracted teeth training method. CONCLUSION The virtual reality dental simulation system was helpful to improve students' ability of identifying caries. It couldn't replace the traditional extracted teeth training method by now, it should be used as a supplement to the traditional training method.
Clinical Competence ; Computer Simulation ; Dental Caries/diagnosis* ; Dental Caries Susceptibility ; Humans ; Simulation Training ; User-Computer Interface ; Virtual Reality

PURPOSE: This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education. METHODS: Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students' skill training, and evaluators' training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing. RESULTS: ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p < .001), clinical judgment (F=18.33, p < .001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=−0.38, p=.704) between the experimental and control groups. CONCLUSION: This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.
Education ; Formative Feedback ; Hospice Care ; Humans ; Judgment* ; Learning* ; Nursing* ; Simulation Training ; Students, Nursing*

PURPOSE: High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS: This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. RESULTS: Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. CONCLUSION: With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
Anesthesiology ; Canada* ; Cost-Benefit Analysis* ; Curriculum ; Education ; Learning ; Resource Allocation ; Simulation Training ; Uncertainty

PURPOSE: This purpose of this study was to investigate the effectiveness of educational design according to Goal-based Scenario constituent elements such as educational goals, mission, cover story, role, scenario operation, resources, and feedback in simulation training. METHODS: The subjects of this study were 130 nursing students in their senior year who enrolled in the simulation exercise Ⅰ course. They were divided into a total of 10 groups in which less than 20 students were assigned. In order to verify the effectiveness of the simulation training through Goal-based Scenario instructional design, a design of non-equality control group was carried out. RESULTS: The results of this study were as follows: Critical thinking (t=1.81, p=.073) and problem solving ability (t=1.79, p=.076), course satisfaction (t=8.61, p<.001) and academic performance (t=5.48, p=.001) were supported. CONCLUSION: This study applied a Goal-based Scenario simulation program to present clear objectives for simulating training and to advance learning methods that are appropriate to the current education environment. In addition, this study has significance in presenting an instructional model for various simulated practice education and can be used as useful basic data related to simulated training education.
Education ; Education, Nursing ; Humans ; Learning ; Models, Educational ; Nursing* ; Problem Solving ; Simulation Training ; Students, Nursing* ; Thinking