BACKGROUND

Simulation immerses learners in guided replications of real-life experiences. Simulation-based learning in the health profession allows trainees and professionals to practice skills in a controlled environment using various modalities, enhancing patient safety and minimizing clinical errors.

To describe the profile of Philippine studies on clinical simulation in healthcare professional education and assess the methodological quality of these studies.

We conducted a scoping review of studies on clinical simulation studies in healthcare education in the Philippines. We followed the methods for scoping review and reported using the PRISMA Scoping review checklist. We searched for relevant studies from electronic databases (PubMed, Scopus, CENTRAL, Herdin, and Cochrane) as of May 17, 2024, and summarized descriptive data on the characteristics of the study, population, clinical simulation technique, and outcomes, using graphical summaries and tables. We assessed the methodological quality of included studies using the Modified Medical Education Research Study Quality Instrument (MMERSQI).

We included 13 studies mostly published in the 2020s (7), by faculty as main author (9), with hospital affiliation (10), single-center (11), setting in NCR (11), analytic (10), medical field (10), educational purpose (7), using task trainers (5), low- to medium-fidelity (11), with technical competencies (mostly skills) as desired outcome (9), median sample size of 40, and including mostly postgraduate level participants (7). There was moderate methodological quality (median MMERSQI score, 51 [range, 40, 77] with the ‘type of data’ item being highly reported and ‘validity of instrument tool’ item poorly reported.

The observed gaps in methodological rigor, study design, and fidelity of simulation techniques in healthcare education in the Philippines highlight opportunities for advancing the field. Future research should aim to address these gaps, particularly by increasing the use of RCTs, enhancing the validity of measurement tools, and incorporating comprehensive simulation components.

INTRODUCTION: A previous prospective, randomised controlled trial showed that animated videos shown to children before magnetic resonance imaging (MRI) scan reduced the proportion of children needing repeated MRI sequences and improved confidence of the children staying still for at least 30 min. Children preferred the interactive video. We hypothesised that the interactive video is non-inferior to showing two videos (regular and interactive) in improving children's cooperativeness during MRI scans. METHODS: In this Institutional Review Board-approved prospective, randomised, non-inferiority trial, 558 children aged 3-20 years scheduled for elective MRI scan from June 2017 to March 2019 were randomised into the interactive video only group and combined (regular and interactive) videos group. Children were shown the videos before their scan. Repeated MRI sequences, general anaesthesia (GA) requirement and improvement in confidence of staying still for at least 30 min were assessed. RESULTS: In the interactive video group ( n = 277), 86 (31.0%) children needed repeated MRI sequences, two (0.7%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 22.1% after the video. In the combined videos group ( n = 281), 102 (36.3%) children needed repeated MRI sequences, six (2.1%) needed GA and the proportion of children who had confidence in staying still for more than 30 min increased by 23.2% after the videos; the results were not significantly different between the two groups. CONCLUSION The interactive video group demonstrated non-inferiority to the combined videos group.
Child ; Humans ; Anesthesia, General ; Magnetic Resonance Imaging ; Prospective Studies ; Simulation Training ; Child, Preschool ; Adolescent ; Young Adult ; Video Recording

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 ;

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

Computer Simulation ; Curriculum ; Education, Medical ; organization & administration ; trends ; Electronic Health Records ; Health Services Research ; Humans ; Interdisciplinary Communication ; Leadership ; Patient Care Team ; Public Health ; Schools, Medical ; Singapore

PURPOSE: This study aimed to compare the effects of simulation integrated with problem based learning (S-PBL) according to the sequences of problem-based learning (PBL) and high fidelity simulation training (HFS) on knowledge, clinical performance, clinical judgment, self-confidence, and satisfaction in fourth-grade nursing students. METHODS: In this randomized crossover design study, four S-PBLs on medical-surgical nursing were applied alternatively to two randomly-assigned groups of 26 senior nursing students for 8 weeks. The collected data were analyzed using an independent t-test. RESULTS: The method of administering PBL prior to HFS led to significantly higher scores on knowledge (t=2.28, p=.025) as compared to the method of administering HFS prior to PBL. However, the latter method led to significantly higher scores on clinical performance (t=−6.49, p < .001) and clinical judgment (t=−4.71, p < .001) as compared to the method of administering PBL prior to HFS. There were no differences in the effect of the two methods on self-confidence (t=1.53, p=.128) and satisfaction (t=1.28, p=.202). CONCLUSION: The integration sequences of S-PBL was associated with different learning outcomes. Therefore, when implementing S-PBL, it is necessary to consider the educational goal to executes an appropriate sequence of integration.
Cross-Over Studies ; Humans ; Judgment ; Learning ; Medical-Surgical Nursing ; Methods ; Nursing Education Research ; Nursing ; Problem-Based Learning ; Simulation Training ; Students, Nursing

PURPOSE: The purpose of this review was to evaluate the effects of emergency nursing simulation program on nursing students and nurses. METHODS: This systematic review was performed as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and using the R program meta package (version 4.9-2). RISS, KISS, and DBpia Library databases were searched for studies published between June 2000 and August 2018 using the following key words: (Emerge* OR nursing) AND (nurs* OR simulation). Selected studies were assessed for methodological quality using Risk of Bias for Non randomized Studies. RESULTS: 7 studies were identified and all of them met the inclusion criteria. The outcome variables were significant clinical performance, self-efficacy except knowledge, and problem-solving ability. CONCLUSION: This review provides updated evidence of the simulation-based education program in emergency nursing. Further studies are required to increase generalizability using randomized population, research design and controlled trials with sufficient sample size. Moreover, valid measurements are needed to assess the main outcomes.
Bias (Epidemiology) ; Education ; Emergencies ; Emergency Nursing ; Humans ; Korea ; Nursing Care ; Nursing ; Research Design ; Sample Size ; Simulation Training ; Students, Nursing

OBJECTIVES: The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. METHODS: A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. RESULTS: The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. CONCLUSIONS: A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.
Cardiopulmonary Resuscitation ; Health Personnel ; Heart Massage ; Humans ; Prospective Studies ; Simulation Training ; Smartphone ; Thorax

Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.
Anesthesia, Conduction ; Anesthesiology ; Competency-Based Education ; Curriculum ; Internship and Residency ; Learning ; Nerve Block ; Simulation Training ; Ultrasonography

PURPOSE: Optimal methods for communication skills training (CST) are an active research area, but the effects of CST on communication performance in objective structured clinical examinations (OSCEs) has not been closely studied. Student roleplay (RP) for CST is common, although volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST program improved OSCE performance compared to our previous RP strategy. METHODS: We performed a retrospective, quasi-experimental study of 2 second-year medical student cohorts' OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). The t-test and analysis of variance were used to compare the total scores in 3 assessment domains: generic communication, clinical communication, and physical examination/procedural skills. RESULTS: The baseline characteristics of groups (scores on the Australian Tertiary Admission Rank, Undergraduate Medicine and Health Sciences Admission Test, and medicine program interviews) showed no significant differences between groups. For each domain, the SP-only CST group demonstrated superior OSCE outcomes, and the difference between cohorts was significant (P<0.01). The superiority of volunteer SP CST over student RP CST in terms of OSCE performance outcomes was found for generic communication, clinical communication, and physical examination/procedural skills. CONCLUSION: The better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP program as an effective and efficient way to improve CST among junior medical students.
Australia ; Clinical Competence ; Cohort Studies ; Humans ; Non-Randomized Controlled Trials as Topic ; Patient Compliance ; Patient Simulation ; Retrospective Studies ; Students, Medical ; Volunteers