BMJ Simulation and Technology Enhanced Learning, 2021
This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive sa... more This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: ‘essential’ and ‘autonomy’ in relation to safety for standardized/simulated patients (SPs). In this time of crisis, simulationists must move the boundary of skills training previously accepted as safe for human beings, and leverage technology to ensure the highest level of safety achievable for our SPs.
BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered... more BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered annually to graduating HPB fellows, using entrustment assessments for open (IOUS) and laparoscopic (LAPUS) US. It is hypothesized that validity evidence will support the use of these assessments to determine if graduating fellows are well prepared to perform HPB US independently. METHODS Expert faculty were surveyed to set Mastery Entrustment standards for fellow performance. Standards were applied to fellow performances during two annual US skills practicums. RESULTS 11 faculty questionnaires were included. Mean Entrustment cut scores across all items were 4.9/5.0 and 4.8/5.0 and Global Entrustment cut scores were 5.0/5.0 and 4.8/5.0 for IOUS and LAPUS, respectively. 78.5% (29/37) fellows agreed to have their de-identified data evaluated. Mean fellow Entrustments (across all skills) were 4.1 (SD 0.6; 2.6-4.9) and 3.9 (SD 0.7; 2.7-5), while the Global Entrustments were 3.6 (SD 0.8; 2-5) and 3.5 (SD 1.0; 2-5) for IOUS and LAPUS, respectively. CONCLUSIONS Two cohorts of graduating HPB fellows are not meeting Mastery Standards for HPB US performance determined by a panel of expert faculty.
BMJ Simulation and Technology Enhanced Learning, 2020
A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousand... more A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to ...
Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared ... more Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.Results: The behavioural score was not more re...
We sought to determine whether mannequin-based simulation can reliably characterize how board-cer... more We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to ni...
Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2014
Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway... more Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making. Twenty-three novice anesthesiology residents were randomized into 2 groups. The primary outcome measure was the initiation of supraglottic airway and cricothyroidotomy techniques in a simulated cannot-ventilate, cannot-intubate scenario during 3 evaluation sessions. Secondary outcomes were response times for device initiation. After a baseline evaluation and didactic lecture, residents received an initial practical training in either surgical cricothyroidotomy (CRIC group) or supraglottic airway (SGA group). After the midtest, the groups switched to receive the alternate training. From baseline to midtest, the SGA group increased initiation of supraglottic airway but not cricothyroidotomy. The CRIC group increased initiation of cricothyroidotomy but not supraglottic airway. After co...
Multiphoton Microscopy in the Biomedical Sciences, 2001
ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatom... more ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatomic detail of tissues. Two Photon Confocal Microscopy (TPCM) is a new technology useful in non-destructive analysis of tissue. Laser light excites the natural florophores, NAD(P)H and NADP+ and the scattering patterns of the emitted light are analyzed to reconstruct microanatomic features. Guinea pig skin was studied using TPCM and skin preparation methods including chemical depilation and tape striping. Results of TPCM were compared with conventional hematoxylin and eosin microscopy. Two-dimensional images were rendered from the three dimensional reconstructions. Images of deeper layers including basal cells and the dermo-epidermal junction improved after removing the stratum corneum with chemical depilation or tape stripping. TCPM allows good resolution of corneocytes, basal cells and collagen fibers and shows promise as a non-destructive method to study wound healing.
BMJ Simulation and Technology Enhanced Learning, 2021
This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive sa... more This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: ‘essential’ and ‘autonomy’ in relation to safety for standardized/simulated patients (SPs). In this time of crisis, simulationists must move the boundary of skills training previously accepted as safe for human beings, and leverage technology to ensure the highest level of safety achievable for our SPs.
BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered... more BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered annually to graduating HPB fellows, using entrustment assessments for open (IOUS) and laparoscopic (LAPUS) US. It is hypothesized that validity evidence will support the use of these assessments to determine if graduating fellows are well prepared to perform HPB US independently. METHODS Expert faculty were surveyed to set Mastery Entrustment standards for fellow performance. Standards were applied to fellow performances during two annual US skills practicums. RESULTS 11 faculty questionnaires were included. Mean Entrustment cut scores across all items were 4.9/5.0 and 4.8/5.0 and Global Entrustment cut scores were 5.0/5.0 and 4.8/5.0 for IOUS and LAPUS, respectively. 78.5% (29/37) fellows agreed to have their de-identified data evaluated. Mean fellow Entrustments (across all skills) were 4.1 (SD 0.6; 2.6-4.9) and 3.9 (SD 0.7; 2.7-5), while the Global Entrustments were 3.6 (SD 0.8; 2-5) and 3.5 (SD 1.0; 2-5) for IOUS and LAPUS, respectively. CONCLUSIONS Two cohorts of graduating HPB fellows are not meeting Mastery Standards for HPB US performance determined by a panel of expert faculty.
BMJ Simulation and Technology Enhanced Learning, 2020
A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousand... more A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to ...
Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared ... more Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.Results: The behavioural score was not more re...
We sought to determine whether mannequin-based simulation can reliably characterize how board-cer... more We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to ni...
Simulation in healthcare : journal of the Society for Simulation in Healthcare, 2014
Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway... more Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making. Twenty-three novice anesthesiology residents were randomized into 2 groups. The primary outcome measure was the initiation of supraglottic airway and cricothyroidotomy techniques in a simulated cannot-ventilate, cannot-intubate scenario during 3 evaluation sessions. Secondary outcomes were response times for device initiation. After a baseline evaluation and didactic lecture, residents received an initial practical training in either surgical cricothyroidotomy (CRIC group) or supraglottic airway (SGA group). After the midtest, the groups switched to receive the alternate training. From baseline to midtest, the SGA group increased initiation of supraglottic airway but not cricothyroidotomy. The CRIC group increased initiation of cricothyroidotomy but not supraglottic airway. After co...
Multiphoton Microscopy in the Biomedical Sciences, 2001
ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatom... more ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatomic detail of tissues. Two Photon Confocal Microscopy (TPCM) is a new technology useful in non-destructive analysis of tissue. Laser light excites the natural florophores, NAD(P)H and NADP+ and the scattering patterns of the emitted light are analyzed to reconstruct microanatomic features. Guinea pig skin was studied using TPCM and skin preparation methods including chemical depilation and tape striping. Results of TPCM were compared with conventional hematoxylin and eosin microscopy. Two-dimensional images were rendered from the three dimensional reconstructions. Images of deeper layers including basal cells and the dermo-epidermal junction improved after removing the stratum corneum with chemical depilation or tape stripping. TCPM allows good resolution of corneocytes, basal cells and collagen fibers and shows promise as a non-destructive method to study wound healing.
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