PURPOSE: Emergency departments (EDs) are complex and dynamic working environments in which crises can easily develop. ED members must be trained to recognize and prevent impending crises or resolve active ones. Patient simulation (PS) is emerging as an effective tool in team training. We investigate the participants' responses to a simulation-based ED Crisis Management Team Training (CMTT) program we developed and applied. METHODS: We developed a pilot 2-hour simulation-based ED-CMTT program and applied to ED members who worked in three different types of EDs. The program was consisted of a lecture for principles of crisis resource management (CRM) and team dynamics, orientation to simulator and simulation environment, PS session with videoassisted debriefing and survey. After finishing the program, participants completed a survey and were solicited comments. RESULTS: Fifty-two trainee participated in more than one of total seven pilot programs. The responses for the program are as follow: enjoyable and satisfied, 4.00+/-0.74; helpful for their teamwork, 3.98+/-0.73; understanding of CRM principles, 4.00+/-0.63; attainment of learning objectives, 3.80+/-0.83; quality of faculty, 3.90+/-0.63; time allocation, 3.40+/-0.70. The responses for PS session are as follow: realism of scenario, 3.98+/-0.63; realism of simulator, 3.10+/-1.05; realism of simulation environment, 3.44+/-0.98; quality of audio-visual system, 3.81+/-0.74. Overall comments were positive and commonest request was to have more experiences in variable scenarios. However, some problems like time shortage and lack of realism were also pointed. CONCLUSION: The participants' reaction show that the simulation-based ED-CMTT program was well accepted by ED members. Creating more variable crisis scenarios and realistic simulation setting will be necessary for improving the program.
Emergencies ; Learning ; Orientation ; Patient Simulation

PURPOSE: The purpose of this study was to identify the effects of structured self-debriefing using 3S models on the clinical competency, self-efficacy, and educational satisfaction in nursing students after simulation. METHODS: For this study, 76 third-year undergraduate nursing students from S university were invited. They were divided into two groups, which consisted of a self-debriefing (SDG=41) group and an instructor-led debriefing group (ILDG=35). Collected data was analyzed using Chi-square, t-test, and an independent t-test with the PASW statistics 18.0 for Windows Program. RESULTS: Clinical competency was generally high in the SDG, and statistically significant differences between the SDG and the ILDG occurred after simulations 3, 4, and 5. There were no statistically significant differences in self-efficacy and educational satisfaction between the SDG and the ILDG. However, educational satisfaction in the SDG was slightly higher, while self-efficacy was low compared to the ILDG. CONCLUSION: The results indicate that the method of structured self-debriefing using a 3S model can be effective in improving clinical competency. Further studies need to be investigated.
Humans ; Nursing* ; Patient Simulation ; Students, Nursing*

High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.
Anesthesiology ; Humans ; Patient Simulation ; Reproducibility of Results ; Research Personnel

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

PURPOSE: The purpose of this research was to identify the effectiveness of a standardized patient (SP) instructor. The study was performed to compare the effects of two types of instruction on breast examination skills by an SP instructor and a professor. METHODS: Fifty-four medical students in the third year and 4 SPs participated in the study. In a pretest, each student was judged by the SP individually in performing a breast examination and completed a questionnaire about perception. Next, students were randomly assigned to 2 experimental groups (small-group instruction by an SP instructor or professor). A posttest of performance and perception was administered using the same procedures as in the pretest. To identify the effectiveness of the SP instructor, differences in student scores between the groups were analyzed by t-test. RESULTS: In the posttest of student performance on the breast examination, there was no significant difference between the groups (p=0.270). With regard to student perception, scores on self-confidence in the breast examination were significantly different (p=0.026) between the groups, of which students who received instruction from the professor showed a higher level. Additionally, there was a significant effect on students' perceived reliability of instruction by the SP instructor (p=0.011), and students who were instructed by the SP demonstrated higher reliability compared with professor-taught students. CONCLUSION: Instruction by an SP instructor has the same effectiveness as instruction by a professor. SP instructors have very powerful effects on student performance and perception.
Breast ; Humans ; Patient Simulation ; Physical Examination ; Students, Medical ; Surveys and Questionnaires

PURPOSE: Evaluation of clinical skills and attitude including development of dynamic patient-doctor relationship is important in board examination (BE). Korean Neurological Association (KNA) has introduced clinical performance examination (CPX) utilizing standardized patients (SP) to BE in 2007. In this study, the authors describe the 3-year experience of CPX in BE through 2009. METHODS: To implement CPX session in BE, KNA developed CPX workshop for BE attendees and members of grading committee. CPX sessions in BE consisted of two model scenarios mimicking neurological patients in clinical practice. The total score and itemized scores of CPX sessions were compared with other areas of BE, and scores from each year were also compared. RESULTS: Scores from CPX sessions were significantly correlated with BE step II. Among the itemized scores of CPX sessions, clinical items including history taking and physical examination were significantly correlated with scores from other areas of BE. However, scores from global assessment from SP were strongly associated with patient-doctor relationship, history taking, and patient education. CONCLUSION: Our experiences suggest that CPX utilizing SP is a useful tool to assess the clinical skills in BE. In order to produce clinically well qualified neurologists, more efforts should be made to develop cases and to improve assessment tools for CPX.
Clinical Competence ; Educational Measurement ; Humans ; Licensure ; Patient Simulation ; Physical Examination

PURPOSE: This study was conducted to compare the effects of simulation-based training on knowledge, self-efficacy and clinical performance, underwent before or after the clinical practice for the nursing students. METHOD: A comparison group design was established with pre-clinical practice group (n=34) and post-clinical practice group (n=34). Both groups participated in simulation-based training before or after the clinical practice at the recovery room. Chi-square test, t-test and paired t-test were performed to analyze the data. RESULTS: Both groups showed significantly higher post-test scores in knowledge and self-efficacy than pre-test scores (p<.001). The group with simulation training performed before their clinical practice (pre-clinical practice group) showed significantly higher self-efficacy (p=.044) than the group with simulation training done after their clinical practice (post-clinical practice group). However, there was no significant difference in the knowledge (p=.922) and clinical performance (p=.887). CONCLUSION: These findings of the study suggest that simulation based training in pre-clinical practice is effective to enhance the self-efficacy and to improve knowledge and clinical performance of the nursing students.
Education ; Humans ; Patient Simulation ; Recovery Room ; Students, Nursing*

A wide range of e-learning modalities are widely integrated in medical education. However, some of the key questions related to the role of e-learning remain unanswered, such as (1) what is an effective approach to integrating technology into pre-clinical vs. clinical training?; (2) what evidence exists regarding the type and format of e-learning technology suitable for medical specialties and clinical settings?; (3) which design features are known to be effective in designing on-line patient simulation cases, tutorials, or clinical exams?; and (4) what guidelines exist for determining an appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and performance-based skill practices? Based on the existing literature and a variety of e-learning examples of synchronous learning tools and simulation technology, this paper addresses the following three questions: (1) what is the current trend of e-learning in medical education?; (2) what do we know about the effective use of e-learning?; and (3) what is the role of e-learning in facilitating newly emerging competency-based training? As e-learning continues to be widely integrated in training future physicians, it is critical that our efforts in conducting evaluative studies should target specific e-learning features that can best mediate intended learning goals and objectives. Without an evolving knowledge base on how best to design e-learning applications, the gap between what we know about technology use and how we deploy e-learning in training settings will continue to widen.
Computer-Assisted Instruction ; Education, Medical* ; Knowledge Bases ; Learning ; Patient Simulation

Problem-based learning (PBL), a relatively new approach to teaching, has been introduced in several of the medical schools in the Southeast Pacific region. This approach emphasises active, self-directed learning and puts the emphasis on the individual student and his/her role in the educational process. It is well known that assessment plays a large role in influencing student learning behaviour. Therefore, it is important that the assessment process not hamper learning or adversely affect attainment of the goals of the curriculum. If student behaviours are directed toward achieving success on the assessments, instructors' efforts to create a climate of self-directed learning and individual responsibility will be frustrated. This article provides information on the different classes of assessment vehicles available to assess the various domains of medical competence. We pay special attention to the critical relationship between the educational goals of problem-based learning and the different assessment instruments used. We briefly describe some assessment instruments and how it can relate to these goals in a positive manner. We conclude that no assessment instrument is ideal and that each has unique inherent deficiencies. As a consequence, a successful student assessment process requires use of several complementary instruments.
Clinical Competence ; Education, Medical ; Humans ; Patient Simulation ; Problem-Based Learning

PURPOSE: This study was done to evaluate the persistency of effects of an integrated nursing simulation program on interest in learning, recognition of importance of communication, communication skills, and problem-solving abilities. METHOD: Forty-seven nursing students were recruited for this quasi-experimental design research. The experimental group (n=23) performed the simulation program for two weeks, and the control group (n=24) performed traditional clinical nursing practice for two weeks. Data were collected at baseline, immediately after the intervention, at 4 weeks, and finally at 8 weeks. RESULTS: With respect to all variables, no significant differences were found between the experimental group and the control group. Interest in learning showed a significant increase in the control group (F=3.59, p=.018) at 4 weeks, and there was a significant increase in problem-solving abilities in the experimental group (F=4.98, p=.004) immediately after the intervention. CONCLUSION: Findings from this study suggest that the integrated nursing simulation program is as effective as the traditional clinical nursing practice, and the integrated nursing simulation program could be used as an alternative.
Humans ; Learning ; Methods ; Nursing* ; Patient Simulation ; Program Evaluation* ; Students, Nursing