spsim 2017 Bern

Poster Presentation 2 – 17.03.2017 – 13.45 to 14.45 – A 019

After the poster presentation, posters will be exhibited in the hall in front of the seminar rooms.

Poster 2-1: Improving Non-Technical Skills of Helicopter Emergency Medical Services – a Comprehensive Simulation Program

Sabine Nabecker1, Stefan Lötscher1,2, Roland Albrecht2, Yves Balmer1, Robert Greif1, Lorenz Theiler1,2
1Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, University of Bern; 2Swiss Air-Rescue Rega, Zurich, Switzerland; sabine.nabecker@insel.ch
Background: Mandatory crew resource management trainings in flight simulator and regular use of checklists are established in aviation. Simulation trainings were introduced in the last decades in medicine especially in the care for the critically ill patient. The Swiss Air-Rescue (Rega) Helicopter Emergency Medical Services (HEMS) consist of a pilot, a paramedic/HCM (HEMS crew member) and an emergency physician. These interprofessional crews perform at highest professional standard. To improve not only technical emergency medicine competencies, a comprehensive simulation program was started in 2015, focusing specifically on non-technical skills.
Project description: Simulation based training was organized at 3 different centers for the Rega staff: at the Bern Simulation- and CPR Center (BeSiC) at the Bern University Hospital; the Swiss Institute for Emergency Medicine (SIRMED ) in Nottwil, Switzerland and the Maquet extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) training center in Rastatt, Germany.
The two Swiss simulation centers offer a 1-day critical resource management simulation on high-fidelity manikins in typical, complex emergency medical situations. Crew members (paramedics and physicians) participate once per year. The aim is to train team cooperation in life-threatening medical emergencies while applying effective leadership and communication. Special focus lies on dynamic decision-making and situation awareness under time pressure and stress. After each simulated scenario structured video-assisted debriefings allow for deeper learning and the elaboration of an action plan for further improvement of the crew performance in and out of the helicopter. The center in Germany provides a 1-day simulation of critical incidents in ECMO and IABP use during helicopter transport.
Furthermore, to maintain knowledge and skills during real-life emergencies, the entire HEMS crew (pilot, paramedic and physician) regularly trains low-fidelity simulation based advanced and basic life support at their helicopter bases 4 times per year. In these short (30 minutes) training sessions the entire crew including the pilot trains together on selected scenarios. As these trainings are implemented in the daily routine, they provide an excellent possibility to refresh knowledge and non-technical skills in the spare times between missions.
Outcome: In so far 20 training session, 160 participants trained in these inter-professional simulations in teams of 8-10 participants per training. At BeSiC, 96% (2015) and 98% (2016) of participants rated the course as “very realistic”, and 92% (2015) and 91% (2016) of participants were confident to apply the newly acquired content in their daily clinical practice. At SIRMED, 94% (2015) and 93% (2016) rated the course as “very realistic”, and 93% (2015) and 90% (2016) were confident in transferring the content to their daily practice. Likewise, the critical incident course about ECMO and IABP in Rastatt was rated as “very realistic” by 96% (2015) and 95% (2016) of the participants. Overall, 90 to 100% of participants in all simulation trainings would recommend these inter-professional simulation trainings to colleagues.
Challenges: The simulation-based education program for the Switzerland-wide operating Rega HEMS started successfully. While the current scenario trainings mainly focused on the interfaces between preclinical setting and hospital or between hospital and transfer setting, during the next 2 years simulation trainings will additionally focus on critical incident scenarios taking place within the helicopter, the jet airplane and the ambulance vehicle. In the next few months, the simulation program will also expand to include jet crews and
Rega emergency dispatchers, but not yet pilots. Additionally, simulation trainings together with cardiovascular perfusionists are planned.
Discussion: Interestingly, while simulation training is already commonly associated with aviation, it is still not ubiquitously applied to rescue staff in HEMS organizations. The described high-fidelity simulation program focusing on critical incidence simulation of emergency medical situations has the potential to improve patient care by reflecting human factors under extreme rescue situations. It needs to be investigated whether these trainings are capable to transfer those communication and leadership skills into clinical practice. If simulation-based training of HEMS emergency interventions result in better team performance and improved task management, patients’ care will improve. This also implies behavioral changes that usually need years of on-going training. A simulation program such as the one described might be one possible way to foster such changes.

Poster 2-2: Evaluation of a Mass Casualty Incident (MCI) from the Simula-tion Patients’ Perspective using a Questionnaire

Stefanie Merse1, Margarita Gestmann2, Louisa-Marie Pokriefke3, Marc Schütte4
1Universitätsklinikum Essen, Germany; 2Universität Duisburg-Essen, Germany; 3Universität Duisburg-Essen, Germany; 4HAW Hamburg, Germany; stefanie.merse@uk-essen.de
Background: In Germany real MCI simulations are conducted regularly. Routinely the process flows of rescue services were observed and evaluated alongside. Simulation patients (SP) were questioned about their assessment and experience in the context of the MCI 500 major training at the Berlin Airport in April 2016.
Question: SP have not been subjected to structured questioning about their assessment and their experience as participants in realistic MCI simulations until now.
A questionnaire (Q) for the SP survey was especially developed and utilized for the first time.
The main issue of the research was whether a Q for the SPs’ subjective assessment could contribute to a gain of knowledge for a MCI.
Methods: After concluding the MCI 500 simulation the SP were questioned simultaneously and retrospectively.
The evaluation was conducted at a central location by the means of a questionnaire. Overall 31 items were collected using the five-level Likert-type scale regarding the following topics:
1. First aid at the place of action
2. Transport to first care treatment location,
3. Care for the physically non-injured persons
4. Cooperation among the rescue forces
5. Personal impressions of SP
The Likert-type questionnaire contained five control items.
To identify dispersion parameters, frequency distribution, and central tendency (median, midpoint) a univariate descriptive data analysis was used as method.
Results: The SP group (n = 260) consisted of 70% male and 30% female attendants of police academy and police officers. The age peak for the group lay between 18 and 29 years of age. The questionnaires’ response rate was at 99,6 %, n = 259 of which could be evaluated.
The subjective contentment from the SPs’ point of view was attributable to the following factors:
1. Duration of waiting time until first care was conducted.
More than 55% of SP declared that they felt cold, and in no more than 6% of the cases a blanket was offered to keep them warm.
2. Information flow concerning the next steps and actions to be taken was estimated as good or sufficient in almost 3% of the cases.
3. In up to 65% of the cases emergency staff asked uninjured SPs about their condition, and 28% were informed about pending procedures. Emergency pastoral care workers were recognized and engaged by about 60% of SPs.
4. SP estimated team collaboration among rescue workers very realistically. This was congruent with the results of the professional observers.
5. The general care for SP was rated from sufficient to good by 31%. The individual knowledge gain for SP regarding the MCI was at 35%. About 42% of them would remain calm in case of emergency. In a real case of emergency 64% would not worry about medical emergency care.
Discussion: For the most part the SPs’ view of the MCI was congruent with the view by professional observers. This especially opened the topics of interface communication in medical emergency care up for closer analysis.
As in the present case a structured SP questionnaire can contribute to a knowledge gain regarding MCI-simulations containing the specific topics.
Conclusion: The SPs’ feedback provided a valuable supplement to strategic observations by professional observ-ers during the MCIs.
Some process flows and potential obstacles can be further optimized by insights from this perspec-tive. This especially applies to the topics of communication and medical care.
The survey tool requires further testing and validating in future MCI simulations.
Sources: Hochschule für Angewandte Wissenschaften Hamburg, Hamburg University of Applied Sciences Fakultät Life Sciences Rettungsingenieurwesen
Evaluationsbericht zur MANV-500-Übung auf dem Flughafen Berlin Brandenburg

Poster 2-3: Evaluation of virtual reality as mass casualty incident training modality

Boris Tolg1, Frank Hörmann1, Marc Schütte1, Jonas Jost1, Vanessa Martin1, Stefanie Merse2
1University of Applied Sciences Hamburg, Germany; 2University Duisburg-Essen, Faculty of Medicine, Essen, Germany; boris.tolg@haw-hamburg.de
Background: Mass casualty incidents (MCI) are fortunately rare situations. Nonetheless the threat of terrorist attacks, natural disasters or accidents are always present. Since the training of MCI handling is associated with a huge amount of human resources, material and money. The simulation of those events cannot be realized for all students on a regular basis. As an MCI is usually associated with a phase of chaos preparation of the rescue teams in form of training of the proper protocols is vital for successful management of the situation and therefore the survival of the people affected.
Virtual reality could be a possible solution for this problem, since MCIs can be simulated in a virtual environment with low costs and only a limited number of staff necessary compared to a real life scenario.
Thus different steps of MCI management training can be realized at any time and place where a personal computer is available.
This study was approved by the local ethics commission.
Research question: This work is a first study to compare results and behavior of medical and paramedical personnel in a simulated MCI using standardized patients(SP) in a prepared lab with the same lab rebuild in a virtual environment and patients realized by virtual entities.
Since user interface interactions are different to real world interactions the aim of this study was to explore outcome differences in a standardized triage exercise delivered in a scenario with SP and the same scenario in virtual reality.
The most relevant factor in MCI management is patient triage. A virtual reality training method and tool therefore must be able to deliver a patient triage environment comparable in outcome to a real life scenario based training.
Methods: The study was set as a cross-over study with the groups g1 and g2. Group g1 realized the triage scenario with SP first and the virtual scenario second . For Group g2 the order of the simulations was reversed. The participants were students of the HAW with experience in emergency rescue management.
The mSTaRT algorithm was used for classification of the patients.
Evaluation was based on questionnaires and loud thinking protocols. One questionnaire delivered data on mSTaRt skills (based on self-assessment) before and after each training session. The user-experience-questionnaire (UEQ) was used as an operational definition for modality moderated interaction. Thinking aloud protocols were intended to reveal insights into the cognitive process of task performance.
In order to get thinking-aloud protocols, participants were equipped with a microphone and received an instruction to articulate their thoughts while performing the triage tasks.
Results: The study was realized with 18 participants that had been randomly assigned to the groups.
The triage results of both groups have been compared using the t-test and the statistical tool R. For g2 a marginal increase of correct triage results could be shown (p=0.086). The effect strength was calculated using cohens d, showing a weak effect. For g1 the t-test shows no effect. A comparison of the self-evaluation of the users showed, that g1 had a higher experience level, so a cover effect is possible.
The UEQ shows good results for both types of simulation regarding the parameters attractiveness, stimulation and novelty but occasionally uncorrelated results for the parameters perspicuity, efficiency and dependability which indicate that the participants were insecure about the intention of the questionnaire.
Discussion: The collected data shows that virtual reality training is an appropriate modality to train triage algorithms in an effective and repeatable manner. It is important to have an interface, which allows the medical personnel to interact fast and smoothly within their environment. For this a tutorial for the software should be implemented prior to the training session.
Conclusion: This study shows that a virtual reality environment can be an effective tool in the training of the first essential task of mass casualty incident management. The next step will be adding further protocols like request for additional emergency support as well as a full patient treatment module. Further research is needed to assess its usefulness for the entire MCI management process.
[1] “Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management.”, Pucher Et al., J Trauma Acute Care Surg. 2014 Aug;77(2):315-21.
[2] “Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.”, Ingrassia et al., Eur J Emerg Med. 2015 Apr;22(2):121-7.
[3] “MiRTE: Mixed Reality Triage and Evacuation game for Mass Casualty information systems design, testing and training.”, Yu et al., Conf Proc IEEE Eng Med Biol Soc. 2011;2011:8199-202.

Poster 2-4: The participation of MSc nursing students in designing simulations

Patrik PucerBoštjan Žvanut
University of Primorska Faculty of Health Sciences, Slovenia; patrik.pucer@fvz.upr.sibostjan.zvanut@fvz.upr.si
Background: The importance of simulation in nursing education is increasing. In the past, several effort was spent to design new nursing simulations. Unfortunately, many of these simulations do not help nurses to achieve competencies required in the clinical environment. Previous studies report about the needs for nursing simulations in real-life clinical settings. However, nurses do not have the required expertise and time to prepare simulation specifications for simulation trainings providers.
Research question: This article presents the idea of including nursing MSc students in designing simulations. The aforementioned idea was implemented in practice in the course Simulation in nursing (MSc in Nursing), at the University of Primorska, Faculty of health sciences. Students were required to prepare simulation’s specifications according to their learning needs identified in their everyday work in nursing clinical practice. The principal outcome of this course is to prepare a practical simulation project under the technical and expert supervision of lecturers. Hence, we pose the following research question: Can nursing MSc students provide adequate specifications for simulations in nursing?
Methods: Qualitative content analysis was performed on 17 simulation projects implemented in academic years 2012/2013 – 2015/2016: 6 simulations were implemented on high fidelity human patient simulator, 8 were implemented as e-learning simulations, and 3 with simulated patients. These simulation projects were implemented in groups of 2-5 students. Different project outcomes (e.g. simulation proposals, written seminars, videos of simulations, e-learning contents) were analysed in order to answer to the research question. The projects’ outcomes were coded independently by two researchers iteratively through three phases: open coding, axial coding, and selective coding. After each phase the results were compared and consolidated between the two researchers.
Results: The following core categories emerged as a result of qualitative analysis: positive aspects of including nursing MSc students (sub-categories: identification of required simulations in nursing clinical practice, innovative simulation proposals, inclusion of process elements in simulations), and negative aspects of including nursing MSc students (sub-categories: inconsistent technical specification of simulation, unfeasible proposals).
Discussion: Our results indicate that nursing MSc students with considerable work experience can provide a valid help in designing innovative nursing simulations. The negative aspects that emerged from the analysis can be bridged by assisting these students in the preparation and pilot phase. The participation of nursing MSc students is relevant for the development of new, innovative simulations in nursing.
Conclusion: Nursing MSc students with considerable experience in clinical practice and interest in the field of nursing simulations can be a valid member of the nursing simulation development team. Their participation can provide practical examples of teaching/learning requirements, which emerge from real-life.

Poster 2-5: How to implement simulation training in the nursing curriculum?

Stef Janssens, Leen Roes, Sarah Deschepper
KDG, Belgium; stef.janssens@kdg.be
Aims project:
• To improve interprofessional communication
• To decrease faults
• To empower nurses
The project is divided in three parts;
1. CRM study: 2015-2016: poster attached. During this study lectures are trained in CRM simulation and debriefing. They will develop their CRM and debriefing skills.
2. Implementation CRM in the curriculum: 2016-2020.
• 2016-2017: +/- 210 students(first year)
• 2017-2018: +/- 400 students(first and second year students)
• 2018-2019: +/- 600 students(first, second and third year students)
• 2019-2020: +/- 800 students(all 4 years)
3. Introducing other healthcare students in the CRM training for nursing students. Other healthcare students will join the program from 2018-2019.

 Poster 2-6: Simulation and Gaming for teaching medical approach of the neurological patient

Christina Silva Costa Klippel, Clarisse Mendes Lopes, Lúcia Helena Pezzi, Rosangela de Almeida Castro Amorim, Silvio Pessanha Neto, July Teixeira, Pedro Cruz, Jaqueline Ahlert, Brenda Emanuelle Miranda, Ana Paula Maciel Vieira, Leonardo Antunes Vilaça de Souza, Ohana Natureza, Thiago Zandonay
Estácio de Sá University, Brazil; julyt23@hotmail.com
Background: Simulation based learning consists of an appropriate methodology for the improvement of clinical and psychomotor skills of medical students in a controlled environment.
In order to provide reliability to the scenarios, the standardized patient methodology contributes to simulate real scenes of clinical cases.
This method allows students to identify and interpret signs and symptoms of a clinical condition similar to real life, according to a didactic planning.
Methodology: The purpose of the trial was to describe a game experience with the use of the standardized patient methodology in a medical learning activity. The activity took place during the Scientific Week at the Medical School of a University in Rio de Janeiro, Brazil.
The selected theme for the game was Neurological evaluation of injuries of the cranial, facial, vestibulocochlear and accessory nervs, since this analysis demands theoretical knowledge, practical skills and professional attitude towards the patient. The sample consisted of 28 students from the 1st year of medical course.
Participants attended an interactive lesson on the subject, with video presentation and simulation of patients with neurological injuries, performed by the instructors. Afterwards, participants were divided in two groups. The groups were asked to choose the right answer to ten questions on the subject, in a competition way. Then began the contest.
Two students from the Theatre Course played the standardized patients according to three contextualized cases. The actors were characterized by Moulage technique with appropriated costumes. After each case presentation, students answered questions related to neurological injuries presented in the case.
For each scenario, the instructors drew up a detailed form with the case description and the actor’s script. At the end of the game the right answers were showed and a discussion among all participants occurred.
Results: During the game students shown interest and thrill due to the realistic behavior of the actors. The hit rate of both groups were 90%
Discussion: Although the activity had involved a very easy task with simple questions, it demonstrated to be useful for student interaction and teamwork.
The teacher’s intention was to show the students that some medical themes could be discussed in a pleasant way.
Conclusion: The insertion of standardized patient methodology proved to be an effective resource to bring the student to the reality of clinical practice. The study suggests that educators employ this methodology in other educational activities.

 Poster 2-7: Realistic simulation in the training of health professionals as volunteers for the 2016 Olympics

Christina Silva Costa Klippel, Lúcia Helena Pezzi, Silvio Pessanha Neto, Rosangela de Almeida Castro Amorim, Pedro Cruz, July Teixeira, Rafael Augusto Dantas Prinz, André Luiz Santos Saud, Marcus Vigna, Monique Vital, Eduardo Scarlatelli Pimenta, Cesar Figueiredo, Tadeu Sá, Edward Theodore Dresch, Artur Shioji Ferradosa, Luis Antonio Moliterno
Estácio de Sá University, Brazil; drpedrocruz@gmail.com
Background: For the first time in Olympics history there has been provided a special training for health professionals. It occurred in Rio de Janeiro, Brazil.
Simulation based learning is currently the most effective method for improving clinical skills, teamwork, crisis management and implementation of international clinical protocols.
Metodology: The aim of the study was to evaluate the theoretical knowledge of volunteers trained to work at the Olympic Games Rio 2016. The training programm included health care on cardiac emergencies. The methodology applies was realistic simulation.
Descriptive, retrospective and quantitative study. A total of 94 health professionals registered as volunteers for the Rio 2016 received an 8 hours training, ministered by teachers and instructors of Medical Emergencies subject at an University in Rio de Janeiro, Brazil.
Pre and post tests were used as data collection tools. The tests included 15 questions, demanding clinical judgment and not just memorization of protocols.
All participants took part in an interactive lecture on health care for cardiac arrest, automatic external defibrilator management, airway management and cardiac arrest rythms identification.
Then the practical demonstration with the mannequin began. Participants trained in pairs, being assisted and evaluated by the instructor who made corrections until the proper execution of the technique was performed. PCR rhythms were trained in the high-fidelity mannequin cardiac monitor.
Afterwards, participants received an interactive lecture on cardiac emergencies protocols. For practical activity, participants were divided in five groups. Each group took part in a simulation scenarios with subsequent debriefing session.
In addition to the study protocol, communication skills, leadership, teamwork and decision making process have been enhanced. Finally, participants answered the post-test and a presentation of correct answers was shown.
Results: The data analysis demonstrated that 89.3%% of the participants showed an increase in the hit rate at the post-test; 7.5% kept the same hit rate and only 3.2% presented a lower hit rate (p <0.05).
Realistic simulation is an established method for health professionals training. However, in order to get good outcomes, the participation of qualified teachers and instructors trained in the use on the methodology is required. It’s also necessary an adequated environment with efficients resources.
Conclusion: Realistic simulation proved to be an effective method for health professionals training in the care of cardiac emergencies.

 Poster 2-8: Realistic Simulation or Standardized Patient? The perception of medical students on learning methodologies

Christina Silva Costa Klippel, Clarisse Mendes Lopes, Marcus Vigna, Eduardo Scarlatelli Pimenta, Igor Lima, Lúcia Helena Pezzi, Monique Soriano, Jordana Barros, Wagner Patrício, Elmo Pereira Jr., Rosangela de Almeida Castro Amorim, Ohana Natureza, Thiago Zandonay, Hugo Mandarino, Marina Pessôa Galvão, Patrick Ferreira da Rocha
Estácio de Sá University, Brazil; marcusvigna@hotmail.com
Background: Currently, Simulation based learning is considered the most appropriate methodology to improve clinical skills, teamwork, crisis management and memorization of international clinical protocols.
In other to achieve an experiential learning, it is necessary that a complete interaction between students and environment can occur so that fiction can come closer to a very realistic scenario.
Metodology: The purpose of the trial was to evaluate the perception of medical students concerning two learning methodologies: Simulation versus Standardized Patient.
The sample consisted of 30 students from the 6th grade of the Medical School at an University in Rio de Janeiro.
A questionnaire created through Google Forms application was submitted. This included seven closed questions on student’s perception about the interaction difficulty when dealing with the high-fidelity simulator and with the standardized patient, the stress degree experienced with the two methodologies and the influence of these teaching methods on their performance in clinical practice.
For each question the answer was given according to a Likert scale, containing five items related to the difficulty degree: very high, high, moderate, low and very low. The “high” item was considered as standard for the answers comparison
Results: Concerning the difficulty degree of interaction, data collected showed a similar profile for the two methods, both with 25% score.
Regarding the stress degree, it was observed a 2.8% lower rate with the high fidelity simulator method.
Regarding the contribution of these teaching methods to clinical practice, the methodology with the simulator presented a 5.6% higher score (p <0.05).
Discussion: The increasing technology in healthcare education has encouraged the development of innovative methods in healthcare education.
The potential risks to patients associated with learning at the bedside are becoming increasingly unacceptable. The need of innovative education and training methods that protect the patient from preventable errors goes on.
In recent years, high-fidelity simulation has played a growing role in medical education. The standardized Patient affords the student an opportunity to learn and to be evaluated on learned skills in a simulated clinical environment.
Conclusion: Both methods have shown to be effective for the learning of medical students and demonstrated to offer great contribution to the performance of future doctors in clinical practice.

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