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 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: 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 aim of this study was to assess the efficacy of web-based simulation and high-fidelity simulation on acute heart disease patient care. METHODS: The project used a comparative study design with two simulation-based training modalities. A total of 144 nursing students participated in this study: 76 students in a web-based simulation, and 68 students in a high-fidelity simulation. Participants rated their self-efficacy, problem-solving ability, interest in learning, level of stress, satisfaction with the simulation experience, and level of difficulty of the simulation. RESULTS: The scores for self-efficacy, problem-solving ability, and interest in learning including interest in clinical training in the high-fidelity simulation group was higher than in the web-based simulation group. However, there were no significant differences in interest in learning, including interest in nursing knowledge, and in lab training, level of stress, satisfaction with the simulation experience, and level of difficulty of the simulation. CONCLUSION: A high-fidelity simulation of acute heart disease patient care might be beneficial to developing many more abilities for nursing students than would a web-based simulation. Also, since the web-based simulation improved interest in nursing knowledge, it could be a viable alternative to high-fidelity simulation. Further study is needed to verify the effects of varied levels of simulation-based care with more rigorous outcomes.
Heart Diseases* ; Heart* ; Humans ; Learning ; Nursing ; Patient Care* ; Simulation Training ; Students, Nursing

BACKGROUND: After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. METHODS: One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. RESULTS: There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P < 0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). CONCLUSION: A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.
Clinical Clerkship ; Clinical Competence ; Education, Medical, Undergraduate ; Humans ; Licensure ; Outcome Assessment (Health Care) ; Patient Simulation ; Problem-Based Learning ; Role Playing ; Schools, Medical ; Sensitivity and Specificity ; Simulation Training ; Vaginal Discharge

OBJECTIVE: To develop a ventilation tube insertion simulator for training and evaluation of otorhinolaryngology residents in myringotomy with ventilating tube insertion.

METHODS:

            DESIGN:            Cross - Sectional Study

            SETTING:           Tertiary National University Hospital

            PARTICIPANTS:   Otologists and otorhinolaryngology resident trainees

A simulation tool for myringotomy with ventilation tube insertion was fabricated using silicone sealant, aluminum tube, rubber ball, plaster of paris and plastic sheet, and pretested by our expert panel. Residents were then evaluated using an objective structured clinical examination (OSCE) checklist while performing the procedure using the same model. Three trials were given, and OSCE scores were obtained, for each resident.

RESULT: The pinna, ear canal, tympanic membrane, malleus handle were deemed realistic by the expert panel. Residents performed the procedure at an average of 87 seconds. Average OSCE score for all residents was 17.17, with senior residents having a higher average score (18.3) than junior residents (16.6). However, this was not statistically significant (2 tailed t-value, significance level 0.05 = -1.27, p = .227). The most common cause of trial failure was dropping of the tube in the middle ear, while the most common error made was using more than 2 attempts at performing the incision.

CONCLUSION:  This simulation platform may be a valuable tool to use in educating and developing skills and proper technique of myringotomy with ventilation tube insertion. It is reproducible, affordable, realistic, sturdy and versatile in its applications. Residents who show adequate dexterity and consistency during simulation may eventually be allowed to perform the procedure on patients and provide feedback regarding the usefulness of the simulation.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Otitis Media With Effusion ; Middle Ear Ventilation ; Tympanic Membrane ; Simulation Training ; Patient Simulation

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

OBJECTIVESince appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management.

METHODSA descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant.

RESULTSOur findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively).

CONCLUSIONATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Advanced Trauma Life Support Care ; Clinical Competence ; Humans ; Inservice Training ; Patient Simulation ; Students, Medical ; Wounds and Injuries ; diagnosis ; therapy

PURPOSE: This study was carried out to develop simulation scenarios for the management patient falls and to evaluate the effects of using the scenarios with student nurses. METHODS: The research design was a quasi-experimental study using a methodology study. Study participants were 30 students who were in 4th year of nursing at one College of Nursing. RESULTS: When comparing knowledge of falls before and after the simulation program, it was found that knowledge increased by 4.90 (from 24.60 pre-test to 29.50 post-test). For clinical performance of fall management, the score for assessment was 10.17 out of 16, for intervention 5.97 out of 10, and for evaluation 7.33 out of 8. The average score for reporting a fall to the doctor was 19.87 out of 30 based on SBAR. Prior to the implementation of the simulation program, the confidence of reporting to the physician was less than 5 in all four areas, but self-confidence improved by more than 6 points in all four areas after the program was implemented. CONCLUSION: Findings indicate that results of fall management simulation practice can contribute to nursing students' knowledge of falls, as well as to nursing interventions and post-treatment following a patient fall.
Accidental Falls ; Humans ; Non-Randomized Controlled Trials as Topic ; Nursing ; Patient Care Management ; Research Design ; Self Report ; Simulation Training ; Students, Nursing

PURPOSE: The purpose of this study was to examine the effects of a virtual reality simulation and a blended simulation on nursing care for children with asthma through an evaluation of critical thinking, problem-solving processes, and clinical performance in both education groups before and after the educational intervention.METHODS: The participants were 48 nursing students. The experimental group (n=22) received a blended simulation, combining a virtual reality simulation and a high-fidelity simulation, while the control group (n=26) received only a virtual reality simulation. Data were collected from February 25 to 28, 2019 and analyzed using SPSS version 25 for Windows.RESULTS: The pretest and posttest results of each group showed statistically significant improvements in critical thinking, problem-solving processes, and clinical performance. In a comparison of the results of the two education groups, the only statistically significant difference was found for critical thinking.CONCLUSION: Simulation-based education in child nursing has continued to involve high-fidelity simulations that are currently run in many programs. However, incorporating a new type of blended simulation, combining a virtual reality simulation and a high-fidelity simulation, into the nursing curriculum may contribute to the further development of nursing education.
Asthma ; Child ; Computer User Training ; Curriculum ; Education ; Education, Nursing ; Humans ; Nursing ; Nursing Care ; Patient Simulation ; Pediatric Nursing ; Students, Nursing ; Thinking