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Background In the simulation community, colleagues who are no longer clinically practicing were often proximal to the COVID-19 response, not working in the frontlines of patient care. At the same time, their work as simulationists changed dramatically or was halted. This research explored the experiences of those simulationists who have clinical backgrounds but did not provide direct patient care during the initial pandemic response. The aim of this study was to allow those simulationists to share and have their stories heard. Methods This qualitative research used a narrative approach to answer the research question: What were the experiences of those in the simulation community who did not contribute to the frontline patient care response during the early stages of the pandemic? A semi-structured questionnaire aimed at eliciting a story was disseminated through online simulation discussion boards. Data was collected through PHONIC with options to type or speak responses. Responses were analyzed using an inductive analytical process to identify themes or patterns in the narratives. Results Thirty-six respondents completed the survey between August 1, 2020 and November 30, 2020. Narrative arcs were identified that illustrated the events, actions, thoughts and feelings representative of experiences shared by many simulationists. Two major themes emerged: Challenges and Opportunities. Challenges included feelings of guilt; frustration; overwhelmed, stressed and exhausted; being away from the action, being unused and underappreciated. Opportunities included leadership (evolution and innovation), personal development, and being a part of something. Conclusions The findings reflect a snapshot in time of how simulation was viewed and used in the world during a pandemic through the personal stories of simulationists with clinical backgrounds who did not provide direct patient care. Sharing these narratives may inform future simulation development; however, it is vitally important that the emotions are recognized and acknowledged. Managers should ensure mental health resources and support are available to all staff, including those not deployed to the frontline.

This study evaluated the psychometric properties of the modified Simulation Effectiveness Tool (SET), the SET-M. The SET, developed in 2005, was updated to be consistent with INACSL Standards of Best Practice, QSEN practices, and American Association of Colleges of Nursing baccalaureate essentials. Undergraduate nursing students from two nursing programs, one with multiple campuses, completed the SET-M following completion of a simulated clinical experience; 1,288 students took part in the study. Exploratory factor analysis was completed using unweighted least squares. Four subscales were identified with acceptable internal consistency: Prebriefing (α = .833), Learning (α = .852), Confidence (α = .913), and Debriefing (α = .908). Revisions made to modify the SET to current standards of simulation practice have resulted in the SET-M, which has been shown to be a valid and reliable method of evaluating students' perceptions of the effectiveness of learning in the simulation environment.

The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l =515) and the intervention group received lecture plus a simulation exercise (n l+s =1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

Background: Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students. Method: A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria. Results: No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes. Conclusion: No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136–142.]

2 World Health Organization Maximizing Positive Synergies Collaborative Group, An assessment of interactions between global health initiatives and country health systems. “Slices of Swiss Cheese”: A Recipe to Taste Improvement from Medication Errors Right Drug, Right Route, Wrong Patient Case Study. Applying Lean management principles to improve Safety and quality and cost reduction in Meta-Iodo-Benzyl-Guanidine (MIBG) Scans.

Many articles exist today espousing the value of debriefing following a simulation or gaming event. Although debriefing, a reflection-on-action strategy, is important, a useful reflection strategy may accentuate the reflection-in-action process that is arguably even more important than the debriefing. In this article, we explain a concept called the reflective pause and how it can be used during simulation cases to lead the learners to the objectives and enhance the learning process. We provide a review of the literature concerning reflection-in-action and ways that the reflective pause may be used during key learning events. The reflective pause is relatively absent from the simulation-based education lexicon. Used effectively, the reflective pause may become one of the most valuable learning strategies in a simulation educator's tool belt. [ J Contin Educ Nurs. 2020;51(1):32–38.]

The purpose of the study was to evaluate the psychometric properties of the Facilitator Competency Rubric (FCR). The FCR was developed to fill a deficit in tools available to holistically evaluate competency of simulation facilitators. The FCR has five constructs: preparation, prebriefing, facilitation, debriefing, and evaluation. Benner's novice-to-expert theory was used to categorize subcomponents. Expert panel validation was sought. Participants from four baccalaureate nursing programs completed 107 observations of facilitators using the FCR. Interrater reliability as assessed using generalizability theory was good. G coefficients ranged from good to excellent (.80 to .99). FCR items appeared to be well constructed. Term, day of the week, time of day, and simulation type were significant predictors of the FCR global score. The FCR is a valid, reliable tool that can be used for formative or summative evaluation of simulation facilitators. Scores can guide and prioritize faculty development.

BackgroundThe coronavirus disease 2019 (COVID-19) crisis created pressure on healthcare institutions to be prepared with maximum workforce and bed capacity. Clinical education during COVID-19 has high risk of disease transmission to learners due to contamination of equipment, supplies and surfaces, in addition to increased clinical-related stress and fear. Simulation-based education (SBE) has potential to help manage the pandemic by rapidly upskilling nurses’ clinical responsibilities.MethodsUpskilling of 445 non-critical care nurses was conducted using SBE between 14th March and 30 May 2020. Training consisted of completing a mandatory online critical care awareness module, followed by 3 hours of critical care simulation-based scenarios using demonstration and return-demonstration approach.ResultsAll 445 non-critical care nurses completed required modules and simulation experiences. The critical care simulation-based upskilling programme was evaluated as an effective way to learn how to manage critically ill patients. The majority of evaluation items were rated over 95% for effectiveness of the education; four items were less than 95% (88–94%). Lower rated items considered training and practice time, improved competency and commitment to apply learning.ConclusionRapidly developed and implemented upskilling of critical care nurses was effectively accomplished with SBE. However, learners noted the need for longer learning times and increased practice opportunity to improve competency. Lack of intent to apply the patient care techniques requires further study. SBE has potential as an effective educational method for rapid preparedness in future crisis.

BackgroundConversations are influenced by cultural perceptions, beliefs and values. Debriefing is a learning conversation. Without cross-cultural engagement or culturally relevant teaching, learning may be compromised and may result in an outcome opposite of that intended.ObjectiveThis systematic review explores cultural considerations in healthcare simulation debriefing. We sought to explore findings that could help debriefers create culturally responsive and inclusive debriefings.Study selectionStudies were included if they were peer-reviewed articles in any language and focused on healthcare simulation debriefing and global cultural considerations. Research study methods included qualitative, quantitative or both. The review included any health-related profession and level of learner.FindingsThree studies met the criteria. The purposes of the three studies were significantly different and did not directly study cultural considerations in debriefing.ConclusionsThe learner–educator relationship is at risk and learning may be negatively impacted without addressing cultural awareness. More studies are needed to fully describe the effect of culture on successful debriefing.

Background: Simulation-based medical education is more prevalent in undergraduate preclinical medical education and acts as a foundation for clinical learning in years three and four. Currently, there is a call to teach clinical application of basic science material in preclinical years one and two. Methods: Two groups of students participated in this investigation; a historical control of 270 students from the 2010 matriculating class and students receiving the intervention (anatomy lecture plus airway management simulation) from the 2012 matriculating class (n=337). Descriptive statistics were calculated for demographic and academic performance variables. Unadjusted and adjusted odds of passage of mid-term and final assessment were calculated. The final assessment was defined as one correct, two correct, and all three questions correct. Results: Adjusted odds of passage of mid-term exam for the control group were 3.9 (95% CI: 2.7-5.9), virtually unchanged from the unadjusted odds of passage. Control group results for final exam passage as defined as one correct increased from .7 to .9 when adjusted for variables (95% CI:.3-2.5). Odds of passage of final assessment, for the control group, for adjusted models for two or greater correct increased from 4.1 to 5.6 (95% CI:2.6-13.7) and from 34.1 to 44.0 (95% CI: 21.7-102.5) when three answers (or 100%) are needed for passage. Conclusions: When passage criteria for the final exam were defined as one correct, addition of a simulation exercise to the anatomy lecture increased the rate of passage by 11% after adjusting for covariates. However, when passage criteria for the final exam was defined as two or three correct, addition of a simulation exercise to the anatomy lecture decreased the rate of passage.