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To define the competencies in ultrasound knowledge and skills that are essential for interventional radiology trainees to master when performing ultrasound-guided renal biopsy, and to design simulation-based training to develop these competencies. A whole-task training and competency-based assessment methodology was adopted. 42 fellowship-trained interventional radiologists were contacted to participate in the process. An anonymous three-round modified Delphi process was used to identify and assess the crucial procedural steps in performing an ultrasound-guided renal procedure. The primary survey round allowed free text submission of the procedure steps. The primary survey was analysed to identify the common key tasks and these were grouped in procedural domains. For rounds two and three consensus on key steps was evaluated. 75% agreement was required to progress to the final task list. The final task list was reviewed to identify simulation strategies. Nine interventional radiologists completed the three-round modified Delphi process. 24 competencies were determined to be important across the seven procedural domains. One competency identifying contraindications was removed due to disagreement among participants. The educational review of the final task list identified simulation strategies: three domains involving simulated participants and four domains requiring hybrid simulation involving simulated participants, simulator training and interprofessional simulation. Twenty-three competencies were identified in a blueprint for the development of a simulation curriculum to meet the training requirement of radiologists performing ultrasound-guided renal biopsy.

Background Adequate clinical skills training is a challenge for present day medical education. Simulation Based Education (SBE) is playing an increasingly important role in healthcare education worldwide to teach invasive procedures. The impact of this teaching on students along with retention of what is taught is not fully understood. The purpose of this study was to evaluate the retention levels of practical skills taught and assessed by SBE and to explore the degree of re-training required to restore decayed performance. In exploring this aim, the study further investigates how skilled performance decays over time and which dimensions of clinical skills were more likely to decay. Methods Study participants were 51 final year medical students. They were provided with online pre-course videos and procedural guides asynchronously with repeatedly access. 7 of the skills taught over 2 years using task trainers were selected. Following demonstration from faculty, students practiced in small groups with faculty facilitated supervision and peer support prior to formal testing. Score sheets with itemised procedure checklists detailing the minimum passing standard (MPS) for each skill were designed. To test retention of skills, 18 months later, there was an unannounced test to demonstrate proficiency in the skills. Students were asked to complete a questionnaire indicating how many times and where they had practiced or performed the skills. Results 55% of the students were deficient in 3 or more skills and 4% were not competent in 5 or more skills. A significant number of students had never practiced some skills following the initial teaching session. A relationship was noted with the number of times students self-declared that they had practiced and their performance. Decay is evident in both psychomotor and cognitive domains of the skills. Conclusion A curriculum with deliberate practice significantly increases the competence of students in defined clinical skills. Deliberate practice of clinical skills, under supervision of an engaged instructor, is a key component of the mastery model. Experiences and assessments in the clinical setting need to be augmented with focus on direct observation and focused feedback to reinforce the skills acquired in the simulated setting.

Robotic-assisted surgery (RAS) has been rapidly integrated into surgical practice in the past few decades. The setup in the operating theater for RAS differs from that for open or laparoscopic surgery such that the operating surgeon sits at a console separate from the rest of the surgical team and the patient. Communication and team dynamics are altered due to this physical separation and visual barriers imposed by the robotic equipment. However, the factors that might comprise effective communication among members of RAS teams and the contextual factors that facilitate or inhibit effective communication in RAS remain unknown. We aim to develop a taxonomy of communication behaviors and contextual factors that influence communication in RAS teams. We also aim to examine the patterns of communication behaviors based on gender. We will first perform a scoping review on communication in RAS to develop a preliminary taxonomy of communication based on the existing literature. We will then conduct semistructured interviews with RAS team members, including the surgeon, assisting surgeon or trainee, bedside or first assistant, nurses, and anesthetists. Participants will represent different disciplines, including urology, general surgery, and gynecology, and have a range of experiences in RAS. We will use a reflexive thematic analysis to analyze the data and further refine the taxonomy. We will also observe live robotic surgeries at Royal College of Surgeons in Ireland (RCSI)-affiliated hospitals. We will observe varying lengths and conditions of RAS procedures to a capture a wide range of communication behaviors and contextual factors to help finalize the taxonomy. Although we anticipate conducting 30 interviews and 30 observations, we will collect data until we achieve data sufficiency. We will conduct data collection in parallel with data analysis such that if we identify a new behavior in an interview, we will follow up with questions related to that behavior in additional interviews and/or observations. The taxonomy from this project will include a list of actionable communication behaviors, contextual factors, their descriptions, and examples. As of May 2024, this project has been approved by the RCSI Research and Ethics Committee. Data collection started in June 2024 and will continue throughout the year. We plan to publish the findings as meaningful results emerge in our data analysis in 2024 and 2025. The results from this project will be used to observe and train surgical teams in a simulated environment to effectively communicate with each other and prevent communication breakdowns. The developed taxonomy will also add to the knowledge base on the role of gender in communication in RAS and produce recommendations that can be incorporated into training. Overall, this project will contribute to the improvement of communication skills of surgical teams and the quality and safety of patient care. PRR1-10.2196/54910.

Simulation-based education (SBE) has become an integral part of training in health professions education, offering a safe environment for learners to acquire and refine clinical skills. As a non-ionising imaging modality, ultrasound is a domain of health professions education that is particularly supported by SBE. Central to many simulation programs is the use of animal models, tissues, or body parts to replicate human anatomy and physiology. However, along with its educational benefits, the use of animals in SBE generates a considerable amount of waste, raising important environmental and ethical concerns. Although research indicates that animal models yield comparable educational outcomes to synthetic models, animal models continue to be preferred in surgical and medical training. In response to these challenges, the principles of Replacement, Reduction, and Refinement (the 3Rs) have emerged as guiding standards to minimise the impact of animal use in research and education. Furthermore, synthetic models align with 3R principles, addressing ethical and environmental issues by reducing animal dependence and waste generation. Synthetic models offer key educational benefits over animal models by closely mimicking human anatomy and pathophysiology, providing consistent and anatomically accurate training. Unlike animal models, they eliminate variability in tissue properties, ensuring standardised and reliable experiences. Moreover, synthetic models can simulate specific pathologies, enabling targeted learning that may be difficult with animal tissue. Resistance related to clinical relevance and preference for animal-based SBE is a persisting challenge that might be overcome through the development of clinically and anatomically relevant tissue-mimicking materials, like those previously developed for other applications such as quality assurance phantoms in diagnostic imaging. The involvement of knowledge or end-user engagement, along with evidence-based design solutions, is crucial to catalyse a paradigm shift in a discipline deeply entrenched in tradition. The combined expertise, skills, and perspectives of medical professionals, educators, academic researchers, and industry specialists could collaboratively develop alternative methods to simulate live animal scenarios, replacing and reducing animal tissue dependence in SBE.

It is essential to evaluate the functionality of surgical simulation models, in order to determine whether they perform as intended. In this study, we assessed the use of a simulated laparotomy incision and closure-training model by collating validity evidence to determine its utility as well as pre and post-test interval data. This was a quantitative study design, informed by Messick's unified validity framework. In total, 93 participants (surgical trainees ​= ​80, experts ​= ​13) participated in this study. Evaluation of content validity and the models' relationships with other variables was conducted, along with a pre and post-test confidence assessment. The model was deemed realistic and useful as a teaching tool, providing strong content validity evidence. In assessment of relationships with other variables, the expert group out-performed the novice group conclusively. Pre and post-test evaluation reported a statistically significant increase in confidence levels. We present strong validity evidence of a novel laparotomy incision and closure simulation-training model. •Abdominal wall entry and closure are core skills junior surgical trainees are expected to perform early on in training.•Proficiency through simulation-based education is desirable where possible prior to real patient encounters.•Evaluating surgical simulation training models for validity is important to ensure the model performs as required.•Our research demonstrates strong validity evidence to support this training model as a reliable and effective tool in surgical simulation training.

Background Ensuring equitable access to education is a fundamental goal in health professions training, particularly in simulation-based learning, where realistic clinical scenarios prepare learners for real-world practice. Universal Design for Learning (UDL) offers a robust framework for creating instructional strategies, materials, and environments that are accessible and effective for all learners. Main body In this article, we provide practical guidance and actionable strategies for incorporating UDL principles into simulation-based activities. Engaging in simulation-based education requires a leap of faith and a willingness to embrace vulnerability, as learners must immerse themselves in authentic scenarios. By integrating UDL principles, educators can create a supportive environment that reduces barriers, fosters psychological safety, and ensures that all participants feel empowered to take these risks and fully engage in the learning process. This framework supports opportunities for every learner to partake in meaningful and challenging experiential learning, ultimately preparing them for successful clinical practice. Conclusion From scenario design to debriefing techniques, this article offers insights and recommendations grounded in evidence-based practices, thereby empowering educators to optimize the effectiveness and accessibility of their simulation programs. By embracing UDL principles, educators in health professions education can create simulation experiences that cater to the diverse needs of learners, ensuring that all participants have the opportunity to thrive and succeed in their learning journeys.

Background Simulation-enhanced education (SEE) is increasingly integral to neurosurgical training, yet the mechanisms underpinning effective skill to clinical practice remain under-explored. This study, grounded in the Four-Component Instructional Design (4 C/ID) model and principles of deliberate practice investigates key variables influencing the translational impact of SEE on neurosurgical competence. Methods A sequential explanatory mixed-methods design was employed. Quantitative data were collected via a 17-item questionnaire administered to neurosurgical residents and experts ( n  = 57), capturing domains such as instructional design, fidelity, skill transfer and assessment. Descriptive statistics, internal consistency (Cronbach’s alpha), and exploratory factor analysis were used to identify prevailing trends and subscales. These findings informed semi-structured interviews ( n  = 13), which probed underlying factors affecting skill transfer. Interview data were analysed using inductive thematic analysis, with themes mapped to quantitative constructs. Triangulation was achieved by integrating both data strands, and multiple researchers contributed to coding and analysis to enhance credibility. Results Participants reported that SEE improved procedural confidence, technical competence, and task fluency. However, concerns persist around the realism of simulation, it’s applicability to complex clinical scenarios, and engagement among senior residents. Integration of quantitative and qualitative findings highlighted the value of simulation for procedural readiness and objective assessment, particularly when training design aligned with cognitive learning theory. Triangulation confirmed the robustness of emerging themes and provided a comprehensive understanding of the factors influencing translational impact. Conclusion SEE supports the development of neurosurgical competence, particularly when grounded in robust instructional design and deliberate practice. Addressing challenges related to fidelity, transferability, and engagement will further the predictive validity and adaptive realism of neurosurgical simulation curricula.

Background Effective communication is a fundamental skill in clinical medicine; however, traditional approaches often fail to equip learners with an ability to authentically and empathically engage with the complexities of real patients’ experiences. Narratology has been proposed as a pedagogical framework for augmenting empathy and patient-centred communication in medical students. Methods In April 2025, we undertook a mixed-methods pilot study to evaluate the impact of a one-week narratology module on second-year undergraduate medical students at the Royal College of Surgeons in Ireland (RCSI), Dublin. The module involved close reading, group viewings, facilitated small-group workshops, and whole-group discussions in response to narrative works by Irish writers and storytellers, followed by written personal reflections. At the outset and conclusion of the module, each student undertook a clinical history with a simulated patient (SP) portraying early-stage dementia. SPs assessed each student’s empathy and communication using the Consultation and Relational Empathy (CARE) Measure. Results Overall, 30 medical students (age 20 ± 1.1 yrs, 59.1% female) were included; of these, 22 completed both SP encounters. Total CARE Measure score significantly increased post-intervention: median within-subject difference = 3.00 (-0.25, 10.00) [ P  = 0.0035]. Analysis of individual CARE Measure items revealed significant improvement post-intervention in “Q2: Letting you tell your story” ( P  = 0.0131), “Q3: Really listening” ( P  = 0.0474), “Q4: Being interested in you as a whole person” ( P  = 0.0474), “Q5: Fully understanding your concerns” ( P  = 0.0369), and “Q6: Showing care and compassion” ( P  = 0.0054). Qualitative analysis of students’ written reflections ( n  = 30) identified three themes: (i) developing a safe and respectful communication environment; (ii) recognising the patient as a whole individual; and, (iii) growing in empathy and emotional connection. Conclusion Our results show that empathy and communication in early-stage medical students can improve following a short narratology module. Further prospective studies are now required to explore the longer-term effects of narratology on patient-centred healthcare. Trial registration ClinicalTrials.gov Identifier: NCT07084077 (Retrospective registration).

Background Training of the neurosurgeon today differs greatly from that of the past, with several well-documented challenges contributing to reduced operative time for current cohorts. The Joint Committee on Surgical Training (JCST) in the UK and Ireland have stated that simulation-based education (SBE) is part of the solution to tackle this training crisis. Our objective was to develop a prioritised list of technical skills through consensus with key opinion leaders (KOLs). This approach aimed to enhance understanding of the essential procedures that should shape a technical skills framework for neurosurgical simulation-based learning curricula. Methods We utilised a modified Delphi process and Copenhagen Academy for Medical Education and Simulation (CAMES) Needs Assessment Formula (NAF) to reach consensus. A total of 71 procedures were included for initial analysis, which were extracted from all phases of the JCST curriculum and subsequent brainstorming with KOLs. A five person steering group oversaw the process, to ensure a robust methodological approach was followed at all stages. Results For each of the three Delphi rounds, there were 32, 30, and 31 KOL responses, respectively. A prioritised list of 47 procedural skills was generated through consensus. The top three ranking procedures were patient positioning, pinning positions and flap design, intracranial pressure (ICP) probe insertion and external ventricular drain (EVD) insertion. Emphasis was placed on acute cranial trauma, degenerative spine, neuro-oncology and CSF diversion procedures as the categorical themes of highest priority. Conclusions We describe a multi-jurisdiction general needs assessment for technical skills in neurosurgical simulation training. This study will inform the design of future simulation-based learning curriculum in this sphere of training.

Background Healthcare simulation education often aims to promote transfer of learning: the application of knowledge, skills, and attitudes acquired during simulations to new situations in the workplace. Although achieving transfer is challenging, existing theories and models can provide guidance. Recommendations This paper provides five general recommendations to design simulations that foster transfer: (1) emphasize whole-task practice, (2) consider a cognitive task analysis, (3) embed simulations within more comprehensive programs, (4) strategically combine and align simulation formats, and (5) optimize cognitive load. We illustrate the application of these five recommendations with a blueprint for an educational program focusing on simulation activities. Conclusions More evidence-informed approaches to healthcare simulation might require a paradigm shift. We must accept that a limited number of simulations is not enough to develop complex skills. It requires comprehensive programs that combine simulation sessions with workplace learning.