Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap. ⋯ Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.
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Human factors and teamwork are major contributors to sentinel events. A major limitation to improving human factors and teamwork is the paucity of objective validated measurement tools. Our goal was to develop a brief tool that could be used to objectively evaluate teamwork in the field during short clinical team simulations and in everyday clinical care. ⋯ The CTS was developed to efficiently measure key clinical teamwork skills during simulation exercises and in everyday clinical care. It contains 15 questions in 5 clinical teamwork domains (communication, situational awareness, decision-making, role responsibility, and patient friendliness). It is easy to use and has construct validity with median ratings consistently corresponding with the intended teamwork level. The CTS is a brief, straightforward, valid, reliable, and easy-to-use tool to measure key factors in teamwork in simulated and clinical settings.
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Management of pediatric cardiopulmonary arrest (CPA) is challenging because of the low volume of experience of most pediatric health care providers. Use of cognitive aids may assist in making rapid decisions in these crises; however, there are no known published reports on whether these aids are actually used during arrest management and whether they impact quality of care. ⋯ Eighty-five percent of residents voluntarily used a cognitive aid to assist in managing simulated pediatric CPAs. The most commonly used aids were an American Heart Association Pediatric Advanced Life Support aid and an institutionally created aid. Forty-three of 51 (84.3%) and 23 of 46 (60.5%) residents used these aids for assistance with the pulseless ventricular tachycardia and pulseless electrical activity algorithm, respectively. Unfortunately, 13 of 51 (25.5%) residents chose the incorrect treatment algorithm, resulting in inappropriate management. CONCLUSION AND APPLICATION: Although the majority of residents chose to use cognitive aids for assistance, errors in management were common. Further study is required to determine whether these errors are associated with cognitive aid design flaws and whether improving their design through human factors research can help minimize errors in Basic and Advanced Life Support, ultimately improving patient outcomes.
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In medicine, standard setting methodologies have been developed for both selected-response and performance-based assessments. For simulation-based tasks, research efforts have been directed primarily at assessments that incorporate standardized patients. Mannequin-based evaluations often demand complex, time-sensitive, hierarchically ordered, sequential actions that are difficult to evaluate and score. Moreover, collecting reliable proficiency judgments, necessary to estimate meaningful cut points, can be challenging. The purpose of this investigation was to explore whether expert judgments obtained using an examinee-centered standard setting method that was previously validated for standardized patient-based assessments could be used to set defensible standards for acute-care, mannequin-based scenarios. ⋯ An examinee-centered approach, using aggregate expert judgments of audio-video performances, was suitable for setting standards on most acute-care, mannequin-based scenarios. It is necessary, however, to have valid scores for the chosen scenarios and to sample performances across the ability spectrum.