New and Updated Cochrane Systematic Reviews

PURPOSE OF REVIEW: Nowadays, accessibility to the operative room is becoming more limited for medical students and residents, principally due to decreasing operative time, increasing waiting list, ethical consideration and legal issue in case of any complications. Simulation models have gained in popularity and are now considered a major component in the training and skill development of medical students and residents before coming to the operative room. In this review, we summarized and discussed the relevant aspect of ureteroscopy training models and gave an overview of the advantage in skill acquisition while training with a high-fidelity model.RECENT FINDINGS: Currently, there is an increase in surgical programs trying to implement endourology training models into the curriculum. The training simulators that would allow the medical students and residents to rapidly reach an autonomous level are yet to be developed. Several ureteroscopy models have been described and validated; however, the transposition of skill acquisition into real-life surgery is not properly demonstrated.SUMMARY: Training reduces the learning curve for novice medical students or residents. However, further studies are still needed to better define the impact of skill acquisition in real life and its sustainability. Publication type: Journal Article Source: MEDLINE 7.Title: Does interprofessional simulation increase self-efficacy: a comparative study. Citation: BMJ Open, 2015, vol./is. 5/1(e005472), 2044-6055 (2015) Author(s): Watters C, Reedy G, Ross A, Morgan NJ, Handslip R, Jaye P Language: English Abstract: OBJECTIVES: In this work, we have compared uniprofessional and interprofessional versions of a simulation education intervention, in an attempt to understand more about whether it improves trainees' selfefficacy.BACKGROUND: Interprofessionalism has been climbing the healthcare agenda for over 50 years. Simulation education attempts to create an environment for healthcare professionals to learn, without potential safety risks for patients. Integrating simulation and interprofessional education can provide benefits to individual learners.SETTING: The intervention took place in a high-fidelity simulation facility located on the campus of a large urban hospital. The centre provides educational activities for an Academic Health Sciences Centre. Approximately 2500 staff are trained at the centre each year.PARTICIPANTS: One hundred and fifteen nurses and midwives along with 156 doctors, all within the early years of their postgraduate experience participated. All were included on the basis of their ongoing postgraduate education.METHODS: Each course was a one-day simulation course incorporating five clinical and one communication scenarios. After each a facilitated debriefing took place. A mixed methods approach utilised precourse and postcourse questionnaires measuring self-efficacy in managing emergency situations, communication, teamwork and leadership.RESULTS: Thematic analysis of qualitative data showed improvements in communication/teamwork and leadership, for doctors and nurses undergoing simulation training. These findings were confirmed by statistical analysis showing that confidence ratings improved in nurses and doctors overall (p<0.001). Improved outcomes from baseline were observed for interprofessional versus uniprofessional trained nurses (n=115; p<0.001). Postcourse ratings for doctors showed that interprofessional training was significantly associated with better final outcomes for a communication/teamwork dimension (n=156; p<0.05).CONCLUSIONS: This study provides evidence that simulation training enhances participants' self-efficacy in clinical situations. It also leads to increases in their perceived abilities relating to communication/teamwork and leadership/management of clinical scenarios. Interprofessional training showed increased positive effects on self-efficacy for nurses and doctors.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Publication type: Journal Article Source: MEDLINE Full text: Available Highwire Press at BMJ Open 8.Title: Effects of Simulation-Based Training in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis Citation: Clinical Gastroenterology and Hepatology, October 2014, vol./is. 12/10(1611-1623), 1542-3565;1542-7714 (01 Oct 2014) Author(s): Singh S., Sedlack R.E., Cook D.A. Language: English Abstract: Background & Aims: Simulation-based training (SBT) in gastrointestinal endoscopy has been increasingly adopted by gastroenterology fellowship programs. However, the effectiveness of SBT in enhancing trainee skills remains unclear. We performed a systematic review with a meta-analysis of published literature on SBT in gastrointestinal endoscopy. Methods: We performed a systematic search of multiple electronic databases for all original studies that evaluated SBT in gastrointestinal endoscopy in comparison with no intervention or alternative instructional approaches. Outcomes included skills (in a test setting), behaviors (in clinical practice), and effects on patients. We pooled effect size (ES) using random-effects meta-analysis. Results: From 10,903 articles, we identified 39 articles, including 21 randomized trials of SBT, enrolling 1181 participants. Compared with no intervention (n= 32 studies), SBT significantly improved endoscopic process skills in a test setting (ES, 0.79; n= 22), process behaviors in clinical practice (ES, 0.49; n= 8), time to procedure completion in both a test setting (ES, 0.79; n= 16) and clinical practice (ES, 0.75; n= 5), and patient outcomes (procedural completion and risk of major complications; ES, 0.45; n= 10). Only 5 studies evaluated the comparative effectiveness of different SBT approaches; which provided inconclusive evidence regarding feedback and simulation modalities. Conclusions: Simulation-based education in gastrointestinal endoscopy is associated with improved performance in a test setting and in clinical practice, and improved patient outcomes compared with no intervention. Comparative effectiveness studies of different simulation modalities are limited. Publication type: Journal: Review Source: EMBASE 9.Title: Efficacy of simulation-based trauma team training of non-technical skills. A systematic review Citation: Acta Anaesthesiologica Scandinavica, August 2014, vol./is. 58/7(775-787), 0001-5172;1399-6576 (August 2014) Author(s): Gjeraa K., MOller T.P., Ostergaard D. Language: English Abstract: Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulationbased trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome. 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd. Publication type: Journal: Review Source: EMBASE 10.Title: Error management training and simulation education. Citation: The clinical teacher, December 2014, vol./is. 11/7(537-40), 1743-4971;1743-498X (2014 Dec) Author(s): Gardner A, Rich M Language: English Abstract: BACKGROUND: The integration of simulation into the training of health care professionals provides context for decision making and procedural skills in a high-fidelity environment, without risk to actual patients. It was hypothesised that a novel approach to simulation-based education error management training would produce higher performance ratings compared with traditional step-by-step instruction.METHOD: Radiology technology students were randomly assigned to participate in traditional procedural-based instruction (n = 11) or vicarious error management training (n = 11). All watched an instructional video and discussed how well each incident was handled (traditional instruction group) or identified where the errors were made (vicarious error management training). Students then participated in a 30-minute case-based simulation. Simulations were videotaped for performance analysis. Blinded experts evaluated performance using a predefined evaluation tool created specifically for the scenario. Blinded experts evaluated performance using a predefined evaluation tool created specifically for the scenarioRESULTS: The vicarious error management group scored higher on observer-rated performance (Mean = 9.49) than students in the traditional instruction group (Mean = 9.02; p < 0.01).CONCLUSIONS: These findings suggest that incorporating the discussion of errors and how to handle errors during the learning session will better equip students when performing hands-on procedures and skills. This pilot study provides preliminary evidence for integrating error management skills into medical curricula and for the design of learning goals in simulation-based education.Copyright 2014 John Wiley & Sons Ltd. Publication type: Journal Article Source: MEDLINE Full text: Available Salisbury District Hospital Healthcare Library at CLINICAL TEACHER 11.Title: Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model Citation: Radiation Oncology, August 2014, vol./is. 9/1, 1748-717X (August 28, 2014) Author(s): Giuliani M., Gillan C., Wong O., Harnett N., Milne E., Moseley D., Thompson R., Catton P., Bissonnette J.-P. Language: English Abstract: Purpose: To evaluate the feasibility and educational value of high-fidelity, interprofessional team-based simulation in radiation oncology. Methods: The simulation event was conducted in a radiation oncology department during a non-clinical day. It involved 5 simulation scenarios that were run over three 105 minute timeslots in a single day. High-acuity, low-frequency clinical situations were selected and included HDR brachytherapy emergency, 4D CT artifact management, pediatric emergency clinical mark-up, electron scalp trial set-up and a cone beam CT misregistration incident. A purposive sample of a minimum of 20 trainees was required to assess recruitment feasibility. A faculty radiation oncologist (RO), medical physicist (MP) or radiation therapist (RTT), facilitated each case. Participants completed a pre event survey of demographic data and motivation for participation. A post event survey collected perceptions of familiarity with the clinical content, comfort with interprofessional practice, and event satisfaction, scored on a 1-10 scale in terms of clinical knowledge, clinical decision making, clinical skills, exposure to other trainees and interprofessional communication. Means and standard deviations were calculated. Results: Twenty-one trainees participated including 6 ROs (29%), 6 MPs (29%), and 9 RTTs (43%). All 12 cases (100%) were completed within the allocated 105 minutes. Nine faculty facilitators, (3MP, 2 RO, 4 RTTs) were required for 405 minutes each. Additional costs associated with this event were 154 hours to build the high fidelity scenarios, 2 standardized patients (SPs) for a total of 15.5 hours, and consumables. The mean (+/-SD) educational value score reported by participants with respect to clinical knowledge was 8.9 (1.1), clinical decision making 8.9 (1.3), clinical skills 8.9 (1.1), exposure to other trainees 9.1 (2.3) and interprofessional communication 9.1 (1.0). Fifteen (71%) participants reported the cases were of an appropriate complexity. The importance of further simulation events was rated highly at 9.1/10. Conclusions: High-fidelity simulation training is feasible and effective in a radiation oncology context. However, such educational activities require significant resources, including personnel and equipment. Publication type: Journal: Article Source: EMBASE Full text: Available ProQuest at Radiation Oncology Full text: Available ProQuest at Radiation Oncology 12.Title: Expertise in medicine: using the expert performance approach to improve simulation training Citation: Medical education, February 2014, vol./is. 48/2(115-123), 1365-2923 (Feb 2014) Author(s): Causer J., Barach P., Williams A.M. Language: English Abstract: We critically review how medical education can benefit from systematic use of the expert performance approach as a framework for measuring and enhancing clinical practice. We discuss how the expert performance approach can be used to better understand the mechanisms underpinning superior performance among health care providers and how the framework can be applied to create simulated learning environments that present increased opportunities to engage in deliberate practice. The expert performance approach is a systematic, evidence-based framework for measuring and analysing superior performance. It has been applied in a variety of domains, but has so far been relatively neglected in medicine and health care. Here we outline the framework and demonstrate how it can be effectively applied to medical education. Deliberate practice is defined as a structured and reflective activity, which is designed to develop a critical aspect of performance. Deliberate practice provides an opportunity for error detection and correction, repetition, access to feedback and requires maximal effort, complete concentration and full attention. We provide guidance on how to structure simulated learning environments to encourage the accumulation of deliberate practice. We highlight the role of simulation-based training in conjunction with deliberate practice activities such as reflection, rehearsal, trial-and-error learning and feedback in improving the quality of patient care. We argue that the development of expertise in health care is directly related to the systematic identification and improvement of quantifiable performance metrics. In order to optimise the training of expert health care providers, advances in simulation technology need to be coupled with effective instructional systems design, with the latter being strongly guided by empirical research from the learning and cognitive sciences. 2014 John Wiley & Sons Ltd. Publication type: Journal: Review