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This study evaluates the impact of high-fidelity simulation on the acquisition and retention of competencies in nursing students. High-fidelity simulation provides a realistic and risk-free environment allowing students to practice, which potentially enhances the acquisition and retention of required competencies. A blinded, randomised clinical trial with three arms was conducted with a pretest and a follow-up at 6 months (post-test 1) and 12 months (post-test 2). This study was conducted with 105 s-year nursing students, divided into three groups: control (6 low-fidelity simulations), intervention 1 (3 high-fidelity and 3 low-fidelity) and intervention 2 (6 high-fidelity simulations). Competencies were assessed using the Objective Structured Clinical Examination at baseline, 6 and 12 months. Student satisfaction was measured with the Simulated Clinical Experiences Scale. Initial competency scores were similar across groups. At 6 months, both intervention groups showed significant improvements in critical thinking (6.2 and 6.0, p < 0.05), clinical skills (6.8 and 6.6, p < 0.05), communication (8.0 and 8.3, p < 0.05) and ethics (7.6 and 7.5, p < 0.05) compared with the control group. Intervention group 1 demonstrated better competency retention at 12 months. Overall satisfaction with highfidelity simulation was high (9.13/10), with particular praise for the practical dimension (8.95/10), realism (8.02/10) and the cognitive dimension (9.43/10). High-fidelity simulation has the potential to enhance nursing competencies effectively. This approach supports long-term skill retention, highlighting the importance of a well-structured curriculum that integrates different simulation levels for optimal student preparation for clinical practice.

Background The use of an observer tool (OT) has been shown to improve learning of technical skills through observation in simulation. The objective was to assess the impact of a non-technical OT on anaesthesia residents’ learning of non-technical skills (NTS) during simulation. Methods After consent, residents were randomised into 2 groups: OT+ (with an OT based on NTS to be systematically completed during observation of others) and OT- (without OT). Both groups observed a high-fidelity simulation of crisis management (with or without OT), then were asked to perform actively another simulation. The primary outcome was NTS performance, assessed by an evaluator using the Anaesthesia Non-Technical Skills score (ANTS score out of 16) on video recording. Secondary outcomes were results of score items, satisfaction, team performance, and professional impact. Results No significant difference was found between OT + group ( n  = 33) and OT- group ( n  = 30) for the ANTS score (OT + 12 [9.5–12.5], OT- 10.5 [8.75–12]/16 ( p  = 0.13)). Among sub-items of the ANTS score, decision-making was significantly better in the OT + group (3 [2–3] versus 2 [2–3], p  = 0.01). Satisfaction, team performance and perception of professional impact were not significantly different between groups. Conclusions This study showed no significant difference in learning of observational anaesthesia resident’s NTS whether or not they were provided a non-technical OT during crisis management simulation. Decision-making was better with an OT. Further work is necessary to define the place of OT in observer-based learning.

This study aimed to evaluate the effects of the psychoacoustic learning method and high-fidelity simulation on the cardiac auscultation competence of nursing students. Cardiac auscultation is a crucial skill for nursing students, yet many struggle to develop proficiency. Simulation-based training has emerged as a potential solution, but the effectiveness of different simulation modalities remains unclear. A randomized controlled experimental study. A total of 52 s-year nursing students were randomly assigned to one of three groups: psychoacoustic learning (n = 18), high-fidelity simulation (n = 17) and control (n = 17). Cardiac auscultation competence was assessed through a success test administered at three-time points: pre-test, post-test and follow-up (four weeks later). Learning satisfaction and self-confidence in learning were measured post-intervention. The psychoacoustic learning group significantly improved cardiac auscultation scores from pre-test to post-test and follow-up (p < 0.05). The high-fidelity simulation group improved from pre- to post-test (p < 0.05) but not at follow-up. The control group showed no significant changes. No significant between-group differences in auscultation scores (p > 0.05), but high-fidelity simulation had higher learning satisfaction (p = 0.013) and total scale scores (p = 0.017) than psychoacoustic learning. Group-time interaction was not significant (p = 0.547). Psychoacoustic learning boosts short- and medium-term cardiac auscultation skills, while high-fidelity simulation enhances short-term performance and learning satisfaction. Combining psychoacoustic methods with simulation or traditional teaching may improve sustainable learning outcomes, balancing effectiveness, accessibility and cost.

To explore the quality, reliability, and practical effect of the Simodont virtual simulation training system in preclinical teaching of access and coronal cavity preparation for dental undergraduate students. Twenty dental undergraduate students from Guanghua School of Stomatology, Sun Yat-sen University, were recruited and randomly divided into two groups after theory training. The groups were allocated using the random number method and assessed for access and coronal cavity preparation skills using a standardized assessment form and the Simodont virtual simulation system operation manual. Baseline scores were recorded for each student. One group received training with the Simodont virtual simulation system, while the other used a conventional phantom simulator system. After training, skills were reassessed, and scores were recorded. The groups then switched training systems and were assessed again. All students completed a Teaching Questionnaire at the end of the training. Data was collected and analyzed. The mean score of students in the virtual simulation priority group (15.9 ± 0.56 points) and the phantom-simulator priority group (15.3 ± 0.40 points) was significantly higher than the baseline score (13.3 ± 0.63 points) and (13.1 ± 0.30 points) ( P < 0.05), respectively. Furthermore, the mean score of students in the virtual simulation priority group after training with both systems (15.9 ± 0.56 points) was significantly higher than that of the students in the virtual simulation priority group alone (14.2 ± 0.62 points) ( P < 0.05). The mean score was also significantly higher in the virtual simulation priority group of students (15.9 ± 0.56 points) trained with both systems than in the phantom-simulator priority group of students (15.3 ± 0.40 points) trained with both systems for the assessment (p < 0.05). The mean score of students in the phantom-simulator priority group (15.3 ± 0.40 points) after training with both systems was significantly higher than that of the students in the phantom-simulator priority group alone (14.3 ± 0.28 points) ( P < 0.05). The questionnaire results showed that the students fully agreed that \"the Simodont virtual simulation system has the characteristics of repeatability, multi-dimensionality, and multiple practices, and gives me more attention to details. However, they also noted that \"it needs to be improved and upgraded to be closer to the conventional phantom-simulator system. Compared with the conventional phantom-simulator system alone, the preclinical teaching effectiveness of access and coronal cavity preparation could be significantly enhanced by incorporating the Simodont virtual simulation system alongside the phantom-simulator training system. The training sequence might influence this improvement.

IntroductionA limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algorithm and expert evaluators in assessing basic laparoscopic-simulated training exercises.MethodsThe AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evaluators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise.ResultsAfter the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively.ConclusionThis first approach of AI use in basic laparoscopic skills simulated training assessment shows promising results, providing a preliminary framework to expand the use of AI to other basic laparoscopic skills exercises.

Simulators are widely used in medical education, but objective and automatic assessment is not feasible with low-fidelity simulators, which can be solved with artificial intelligence (AI) and virtual reality (VR) solutions. The effectiveness of a custom-made VR simulator and an AI-based evaluator of a laparoscopic peg transfer exercise was investigated. Sixty medical students were involved in a single-blinded randomised controlled study to compare the VR simulator with the traditional box trainer. A total of 240 peg transfer exercises from the Fundamentals of Laparoscopic Surgery programme were analysed. The experts and AI-based software used the same criteria for evaluation. The algorithm detected pitfalls and measured exercise duration. Skill improvement showed no significant difference between the VR and control groups. The AI-based evaluator exhibited 95% agreement with the manual assessment. The average difference between the exercise durations measured by the two evaluation methods was 2.61 s. The duration of the algorithmic assessment was 59.47 s faster than the manual assessment. The VR simulator was an effective alternative practice compared with the training box simulator. The AI-based evaluation produced similar results compared with the manual assessment, and it could significantly reduce the evaluation time. AI and VR could improve the effectiveness of basic laparoscopic training.

An urgent need exists to improve and maintain intrapartum skills of providers in sub-Saharan Africa. Peer-assisted learning may address this need, but few rigorous evaluations have been conducted in real-world settings. A pragmatic, cluster-randomized trial in 12 Ugandan districts provided facility-based, team training for prevention and management of postpartum hemorrhage and birth asphyxia at 125 facilities. Three approaches to facilitating simulation-based, peer assisted learning were compared. The primary outcome was the proportion of births with uterotonic given within one minute of birth. Outcomes were evaluated using observation of birth and supplemented by skills assessments and service delivery data. Individual and composite variables were compared across groups, using generalized linear models. Overall, 107, 195, and 199 providers were observed at three time points during 1,716 births across 44 facilities. Uterotonic coverage within one minute increased from: full group: 8% (CI 4%‒12%) to 50% (CI 42%‒59%); partial group: 19% (CI 9%‒30%) to 42% (CI 31%‒53%); and control group: 11% (5%‒7%) to 51% (40%‒61%). Observed care of mother and newborn improved in all groups. Simulated skills maintenance for postpartum hemorrhage prophylaxis remained high across groups 7 to 8 months after the intervention. Simulated skills for newborn bag-and-mask ventilation remained high only in the full group. For all groups combined, incidence of postpartum hemorrhage and retained placenta declined 17% and 47%, respectively, from during the intervention period compared to the 6‒9 month period after the intervention. Fresh stillbirths and newborn deaths before discharge decreased by 34% and 62%, respectively, from baseline to after completion, and remained reduced 6‒9 months post-implementation. Significant improvements in uterotonic coverage remained across groups 6 months after the intervention. Findings suggest that while short, simulation-based training at the facility improves care and is feasible, more complex clinical skills used infrequently such as newborn resuscitation may require more practice to maintain skills. Trial Registration: ClinicalTrials.gov NCT03254628.

NRC publication: Yes

Background Multiple surgical virtual reality (VR) simulators are currently available; however, there is lack of comparison between performance after practice on these simulators compared to bench top models. Utilizing the Intuitive Data recorder (IDR) and Objective performance indicators (OPI), we aim to objectively assess robotic surgical skills using a dry lab model. We hypothesize that practicing surgical skills will improve OPIs and that those who practice on the dry lab model will have a greater improvement in their OPIs compared to those who practice with Fundamentals of Robotic Surgery (FRS) SimNow VR. Methods The IDR was used to record kinematics as each participant went through five basic surgery tasks on a dry lab benchtop model to record baseline performance. Participants were then randomized to practice on the dry lab model or the corresponding SimNow Virtual reality (VR) tasks. The participants repeated the tasks again on the benchtop model. Statistical analysis was performed using paired samples t tests, independent samples t tests, and ANOVA tests. Results Twenty-seven surgeons participated in our study ranging from interns to attendings. Randomization to VR vs benchtop practice resulted in 11 and 13 participants in each group. For the rollercoaster, backhand suturing, railroad, and knot tying tasks, a significant improvement in kinematic profiles was observed. Bimanual dexterity, angular motion, and smoothness metrics improved most consistently across the tasks after practice. Kinematic profiles between those practicing on VR versus benchtop had no significant differences. Conclusions This study shows that OPIs can be used to benchmark surgical trainees. VR appears to be non-inferior to dry lab model for practice for trainees. We identified patterns in OPI improvement that can be tailored to specific skills depending on the trainees needs. Our study is the first step in developing a standardized training and assessment tool to assess competency in robotic surgery training.