Review of Low and High Fidelity Simulation and Its Impact on Perfusion Education

Transcription

1 Review of Low and High Fidelity Simulation and Its Impact on Perfusion Education Chelsey E. Waller BS, Olivia M. Sydow BS, Stephen G. Melonas BS, Joseph J. Sistino PhD CCP Division of Cardiovascular Perfusion College of Health Professions Medical University of South Carolina Charleston, South Carolina

2 I have no disclosures Disclosures

3 Overview Background Significance Theory Methods Results Application to Perfusion Education

4 What is Simulation? Simulation is an educational technique that allows interactive, and at times immersive activity by recreating all or part of a clinical experience without exposing patients to the associated risks. McGaghie, William C., Viva J. Siddall, Paul E. Mazmanian, and Janet Meyers. "Lessons for Continuing Medical Education from Simulation Research in Undergraduate and Graduate Medical Education: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines." Chest Journal 135 (2009): n. pag. Web.

5 Growth of Simulation According to a survey by Qayumi et al. it can be noted that the use of realistic simulation in medical education is expanding based on their respondents of forty two centers, representing 16 countries, and over six continents. Qayumi, Karim, George Pachev, Bin Zheng, Amitai Ziv, and Valentyna Koval. "Status of Simulation in Health Care Education: An International Survey." Adv Med Educ Pract. 5 (2014): Web. Ziv, Amitai, and Stephen Small. "Patient Safety and Simulation-based Medical Education." Medical Teacher 2.5 (2000): Web.

6 What is Fidelity? Fidelity is the extent to which the appearance and behavior of the simulator/simulation match the appearance and behavior of the simulated system. Maran NJ, Glavin RJ. Low- to high-fidelity simulation- a continuum of medical education? Med Educ. 2003;37 Suppl 1:22-8 J M Beaubien, D P Baker. The use of simulation for training teamwork skills in health care: how low can you go? Qual Saf Health Care 2004;13:suppl 1 i51-i56 doi: /qshc Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Academic medicine : journal of the Association of American Medical Colleges. 2010;85(5):

7 limited to ONLY high fidelity simulation.

8 This study in 2012 was NOT a systematic review. METHODS: compared various low and high fidelity simulators while ONLY examining the performance outcomes. Findings: there was no significant difference between low and high fidelity simulation in medical education.

9 Perfusion Simulators

10 Purpose Is low or high fidelity simulation more effective in developing psychomotor, patient management, and crisis management skills in cardiovascular perfusion?

11 Significance New students: determine the best way to develop a strong foundation in the necessary clinical skills before working on patients Practicing perfusionists: continuing education

12 Null Hypothesis No difference in low vs. high fidelity simulation in the development of psychomotor, patient management, and crisis management skills

13 Conceptual Design Figure 1. Conceptual Model of Research

14 Literature Search Searched PubMed, Google Scholar, and CinAHL using the following search terms: low versus high fidelity simulation low and high fidelity simulation

15 Review of Literature Examined all levels of research design Pursued studies comparing high and low fidelity simulators across different fields -Specifically simulator advancements of psychomotor, patient management, and crisis management skills

16 Full manuscript Blinded Randomized Peer-reviewed English Inclusion Criteria Included both HFS & LFS Quantitative data for improvement of psychomotor, patient management, or crisis management skills

17 Exclusion Criteria Studies on other skills gained from simulation Simulation versus no intervention Simulation versus didactic were removed

18 Meta-Analysis All Quantitative Data Converted to Percentages Only the studies with adequate data were used in Meta-Analysis

19 Figure 2. Diagram- Search Strategy, Inclusion, and Exclusion of Studies

20 Patient Management Parameters Assessed -Satisfaction -Active learning, Collaboration, Diverse Ways, High Expectation -Objectives and Information, Support, Problem Solving, Feedback, Fidelity (Realism) -Comprehension & Preparedness Physiology -Procedural Knowledge (Confidence) -Motivation -Interest -Obstetric Skills -CTG Tracing -Decision-making -Design Features -Educational Practices -Confidence/Satisfaction -Identification -Diagnosis -Communication Skills -Examination Skills

21 Number of Parameters Number of Favorable Parameters vs. Type of Simulation Patient Managment Parameters HFS LFS No difference HFS LFS No difference Favored Model

22 Meta-Analysis of High-fidelity vs. Low-Fidelity Simulation For Patient Management

23 Psychomotor Skills Parameters Assessed -Confidence -Additional Maneuver -Performance -Fundal Pressure -Mean Scores -Total Applied Force -Task Passed -Peak Applied Force -Reduction in Inhibition -Knowledge -Current Inhibition -Clinical Performance -Technical Skills -Communication -Documentation -Procedure: baseline, days, >90 days -All Basic Actions -Episiotomy Evaluation -Delivered Posterior Arm -Achieved Delivery

24 Number of Parameters Number of Favorable Parameters vs. Type of Simulation Psychomotor Parameters HFS LFS No Difference 5 0 HFS LFS No Difference Favored Model

25 Meta-Analysis Of Studies Comparing High-fidelity Simulation For Psychomotor Skills

26 Crisis Management Parameters Assessed -Integrated Skills -Self -Efficacy -Satisfaction -Information -Confidence -Support -Teamwork Behavior Observability -Problem Solving -Teamwork Behavior Frequency -Feedback -Mental Strain -Fidelity -Flow Experience -Oxygen Prescription Time -Confidence Shoulder Dystocia -Confidence Postpartum Hemorrhage -Performance -Non-technical Skills -Salivary Cortisol -Knowledge -Skills Competency -Called Doctor or Midwife -Number of Interventions -Called Pediatrician -Oxygen Delivery Time -Stated Problem

27 Number of Parameters Number of Favorable Parameters vs. Type of Simulation Crisis Management Parameters HFS LFS No Difference HFS LFS No Difference Favored Model

28 Meta-Analysis of High-Fidelity and Low-Fidelity Simulation for Crisis Management Skills

29 Discussion Meta-Analysis Summary -Patient Management -No significant differences in HFS vs. LFS -Psychomotor Skills -No significant difference in HFS vs. LFS -Crisis Management -HFS is significantly better than LFS

30 Discussion Although most studies showed that HFS led to a positive outcome in the parameters assessed, few studies yielded a statistically significant result. A combination of both types of simulation may be beneficial depending on the skills being learned Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Academic medicine : journal of the Association of American Medical Colleges. 2010;85(5):

31 Conclusions Low fidelity = High Fidelity in learning basic skills High Fidelity Simulation favored for complex situations Progressive Simulation which is a combination of low and high fidelity may be the best option for perfusion education Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Academic medicine : journal of the Association of American Medical Colleges. 2010;85(5):

32 Limitations All of the articles were specific to medical fields outside of perfusion and, thus, only predictions could be made for the field of perfusion

33 Thank you! Chelsey E. Waller, Stephen G. Melonas Joseph J. Sistino and Carla Bistrick