This study highlights the growing significance of healthcare simulation in enhancing the quality and safety of patient care across Latin America and the Caribbean, by analyzing bibliometric trends and the impact of publications on simulation-based clinical training between 2012 and 2022. Leveraging the Scopus database and VOSviewer software for thesaurus interaction analysis, the research identified 610 documents, accumulating 4681 citations, thereby indicating a burgeoning interest in this field with notable publication spikes in 2017 and 2020. Brazil and the United States emerged as leading contributors, with a primary focus on "simulation training," "clinical competence," "medical education," and "education." The study observed an uptick in international collaboration, mirroring the increase in document count and citations. This bibliometric review underscores the emphasis on evaluating technical skills and clinical practices as prevailing areas of interest, highlighting Brazil's significant academic contributions, and suggesting a promising future for the implementation of clinical simulation in the region. The study advocates for continued scholarly output to align with global advancements in medical simulation, aiming to optimize patient outcomes.

A good knowledge of the theoretical foundations of medicine helps students and physicians to better recognize and treat patients with complex medical conditions, including sepsis and septic shock. The article describes the authors' experience in implementing the analysis of sepsis and septic shock using a high-fidelity simulated clinical scenario in the course of pathological physiology for preclinical medical students. The unique aspect of our approach is the integration of core physiology concepts, such as homeostasis, causality, structure-function relationships, and fundamental pathophysiology concepts (e.g., etiology, pathogenesis, cell and tissue damage, inflammation, symptoms, and syndromes) in the analysis of the patient's condition on the high-fidelity simulator with preclinical medical students. According to the students' feedback, the use of a high-fidelity simulator to analyze the sepsis and septic shock scenario increased their interest in the class, improved their motivation to learn the material, and helped them adapt in a safe environment to making decisions based on a large amount of data about a complex patient condition in a time-sensitive situation.NEW & NOTEWORTHY The authors applied core theoretical concepts of physiology and the fundamental concepts of pathological physiology for teaching sepsis and septic shock clinical scenarios on the high-fidelity simulator in the course of pathological physiology for preclinical medical students. It elevated students' interest and motivation, enhanced the educational experience, and prepared students better for real-world clinical decision-making. We consider that this idea might be an inspiration to colleagues and invite further discussion.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

Simulation is a well-established component of central venous catheter (CVC) training. However, there is little published regarding how to train residents to supervise CVC insertion.

We describe a curriculum designed to help trainees identify potential procedural errors and improve their comfort with supervising CVC insertion.

We conducted a one-group, pre-post-posttest study. All participants completed a pre-simulation assessment (Time 1) that evaluated residents' ability to identify potential complications with CVC insertion and their procedural completion and procedural supervision comfort. Residents then participated in a simulation in which they supervised a mock proceduralist insert a CVC and commit five pre-specified errors. Participants completed the same comfort assessment immediately following the simulation (Time 2) and repeat knowledge and comfort assessments five months later (Time 3).

Forty-seven interns participated in the study. Relative to Time 1 (M = 3.00, SD = 1.02), interns were significantly more comfortable supervising CVC insertion at Time 2 (M = 3.75, SD = 0.85) and at Time 3 (M = 4.08, SD = 0.58).

We describe a simulation designed to help residents identify errors when supervising CVC insertion. Due to a poor survey response rate, no comparisons between pre- and post-simulation error identification could be determined. However, following our CVC supervisor simulation, participants reported immediate and sustained increases in their comfort supervising CVC placement.

This work describes an innovative simulator for clinical hyperbaric chambers that addresses critical training gaps in hyperbaric medicine. The system provides medical and technical personnel with a risk-free environment to develop essential operational skills without endangering patients or costly equipment. The simulator employs a dual-module architecture with web-based accessibility, intuitive controls for realistic chamber operation, and robust administrative capabilities. To evaluate the effectiveness of the simulator in the training process, we conducted a pilot study with clinical professionals. This study demonstrated significant improvements in procedural proficiency and emergency response capabilities, with participants showing measurable skill enhancement after simulator-based training sessions. The preliminary quantitative assessments revealed high educational value of proposed simulation software. This technological advancement represents a substantial contribution to hyperbaric medicine education, supporting both initial training and ongoing competency maintenance for clinical and technical operators in this specialized medical field.

Inguinal hernia is a common childhood pathology, making inguinal hernia repair (IHR) a key pediatric surgical procedure. Surgical success relies heavily on knowledge of groin anatomy, and both open and laparoscopic approaches require considerable repetition to master. As surgical simulators have been shown to improve performance for other surgical procedures, we developed a combined open and laparoscopic pediatric IHR simulator-named POLISHeR-to train residents, fellows, and practicing surgeons in both types of repair.

A CT scan of a 7-year-old was scaled down to create a virtual 3D model of a 2-year-old using our validated protocol for anatomical modelling. Physical replicas of the pelvis, abdominal wall, aorta, and inferior vena cava were 3D-printed to create a life-size unisex base for open and laparoscopic IHR, while a small mobile unisex base was 3D-printed for open IHR. We recruited six experienced surgeons and trainees to pilot the face validity of POLISHeR.

After multiple iterations, we successfully developed a modular 3D-printed simulator for open and laparoscopic IHR. Printing the life-size base cost $331.69 USD, whereas the small base cost $17.54. An open modular cartridge cost $9.92 for females and $14.21 for males, whereas replacement parts cost under $1.30. A laparoscopic modular cartridge cost $6.16 for females and $10.91 for males, whereas replacement parts cost $0.28. Pilot study participants provided encouraging feedback with respect to POLISHER's face validity.

Our low-cost simulator holds promise for enhancing training for pediatric IHR. Our next step is to conduct validation trials for trainees and practicing surgeons in both well-resourced and resource-limited settings.

Not applicable.

Simulation training has become part of medical student education, however endoscopy simulators have mostly been reserved for speciality training. Evidence suggests that simulation training has the potential to educate future doctors about endoscopy procedures and improve their communication with patients. Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that is technically challenging and poorly understood by medical students. This study aimed to investigate whether simulating gastroscopy and ERCP using an anatomical model of the upper gastrointestinal tract improves procedural knowledge, confidence, and performance in medical students.

Students completed three attempts at gastroscopy and one attempt at ERCP using the model. Participants rated knowledge and confidence relating to endoscopic procedures before and after completing the simulation. Students also reported their attitudes towards endoscopic simulation training after their participation.

There was a significant increase in self-perceived knowledge of the purpose of and steps involved in endoscopy (P < 0.001), gastrointestinal anatomy (P = 0.003), and biliary system anatomy (P = 0.002) after using the simulator. Participants also reported significantly increased skills confidence in performing gastroscopy and duodenoscopy (P < 0.001), including in their ability to explain endoscopic procedures to a patient (P < 0.001). All participants agreed (5%) or strongly agreed (95%) that simulation training is a useful addition to their learning, and that they would like more simulation training in the medical curriculum.

Simulation training is an effective and engaging method of promoting procedural awareness and understanding of basic endoscopic procedures in medical students, with the potential to improve doctor-patient interactions in early clinical practice.

The Virtual Dental Clinics (VDCs) are designed in an interactive mode for undergraduate dental students to expose them to dental clinical cases in the form of didactic learning rather than experiential learning. VDCs simulate realistic dental practice scenarios within a virtual environment, providing students with opportunities to engage in clinical decision-making, patient interactions, and procedural simulations.

This study aims to assess students' perceptions regarding the usefulness of Virtual Dental Clinics (VDCs) in simulated clinical training using a validated questionnaire. The study seeks to assess student perceptions on usefulness, satisfaction, ease of learning and ease of use of Virtual Dental Clinics as a clinical teaching and learning tool.

The Virtual Dental Clinics were designed on themes from sub-specialities of dentistry. Themes for clinical case scenarios were selected and designed with the guidance of specialist faculty and the E-Learn department of International Medical University. "A total of 29 Year 3 dental students participated in the study after using the VDC for two weeks. Year 3 dental students were included, as they recently began clinical postings, lacking exposure to advanced clinical situations. A pre-piloted and validated questionnaire named the 'USE questionnaire' was utilized to assess student perceptions regarding the usefulness, ease of use, ease of learning, and satisfaction with VDCs."

Data analysis showed that students expressed significantly different opinions regarding the domains Usefulness & Ease of Learning (mean difference 0.48, p < 0.001) as well as Usefulness and Satisfaction (mean difference 0.43, p < 0.001). The significant results for the usefulness domains suggest that although the tool is effective in helping the user achieve their task, there is still room for improvement in making it more user-friendly and easier to learn as well as in overall user satisfaction. Our study evaluated the impact of Virtual Dental Clinics (VDCs) on student perceptions. Data analysis using Wilcoxon signed rank test with Bonferroni correction and found significant differences between 'Uselessness' and other domains, which demonstrated the perceived utility of VDCs as an educational tool in the clinical setting. Importantly, uselessness was rated significantly higher compared to 'Ease of use (p < 0.001), 'Ease of learning' p < 0.001) and satisfaction (p < 0.001). No significant differences were observed between 'Ease of use, ease of learning and satisfaction' (p > 0.05). The results demonstrate VDCs efficacy in supporting educational needs of students. These findings suggest that while users perceived the tool as effective in task completion (usefulness), further improvements may be required to improve its ease of use, learnability, and overall satisfaction. The lack of significant differences among the latter three domains may indicate a comparable user experience in those aspects.

This study has provided an understanding of student perception across the various aspects of usefulness, satisfaction, ease of use, and ease of learning in virtual dental clinics. The significant differences between some domains highlight variability in end-user experience, providing rationale for future improvements and optimization of end-user experience.

Emergency medicine (EM) is a dynamic field requiring continual procedural proficiency, particularly in high-acuity, low-occurrence (HALO) procedures such as cricothyrotomy and transvenous pacemaker placement. Despite the importance of these skills, many EM faculty members face challenges maintaining proficiency due to limited time and exposure.

This faculty development initiative aimed to address skill degradation in HALO procedures and other critical clinical pathways among mid- and senior-career EM faculty.

Targeting 56 faculty members across a four-year EM training program, the initiative incorporated anonymous needs assessments and feedback from residents and consulting services. Over four years (2019-2023), eleven interactive sessions were delivered during faculty meetings and retreats, blending didactic presentations with hands-on practice.

Participation rates were high, with five topics achieving attendance over 100% through voluntary session repeats and spaced repetition. One-on-one workshops provided advanced training in airway management and ultrasound-guided procedures, with 49 faculty members attending. Feedback was overwhelmingly positive, with faculty endorsing continued participation in future sessions. As a result, participation in at least one session per year is now tied to value-based incentive compensation.

While challenges remain, such as expanding access and incentivizing attendance, the initiative underscores the critical importance of targeted faculty development to ensure ongoing competency in evolving clinical skills and procedures.

Intra-operative consultation (IOC) presents an opportunity for successful collaboration around direct patient care in an unanticipated fashion. Besides technical performance and cognitive guidance, successful IOC benefits from incorporating a blend of non-technical skills (NTS) such as communication, teamwork, and decision-making during the ideally supportive episode. Failure to use such skills may lead to untoward consequences for the surgeon who requests IOC despite successful patient rescue.

This narrative review explores the role of NTS within the context of IOC, particularly focusing on the dynamics between the surgeon seeking assistance and the surgeon providing aid.

A comprehensive literature search was performed using PubMed and OVID Medline, covering publications up to January 2024. Search terms included "non-technical skills," "intra-operative consultation," "conflict management in surgery," and "surgical teamwork." Manuscript selection was based on relevance to NTS within the context of IOC. The findings were synthesized to craft a narrative review of the importance of NTS during IOCs.

IOC setting variability reflects consulting surgeon experience, case complexity, intra-operative events, resource availability, and responding surgeon specialty. Essential expectations for both the consulting and responding surgeon include embracing a collegial, non-judgmental approach that prioritizes patient safety and team cohesion. Strategies for conflict management-effective communication, active listening, and appropriate non-verbal cues-are readily leveraged to establish a supportive environment during IOC. Additionally, cultural elements - such as the reluctance to seek help due to fear of potential reputational damage - stand as barriers to viewing requesting IOC as a hallmark of maturity and professional practice.

NTS supports effective and successful IOC, positioning it as a valuable tool for ongoing professional development. By fostering a culture of consultation and collaboration, the surgical community can enhance both patient care and surgeon well-being. Incorporating NTS into surgical training is one means by which to adaptively overcome existing cultural barriers which impede IOC and may asymmetrically impact early career surgeons.

Ultrasound guidance during centesis is recommended to reduce the risk of serious complications, improve success rates, and choose appropriate sampling locations and equipment. The aim of this study was to develop an accessible and reusable ultrasound skill simulator for ultrasound guided centesis (USGC). Fifty second-year veterinary students reviewed an instructional video prior to performing two USGC skill tests on the simulator, separated by a period of practice. Following practice there was a significant improvement in scores (p < .0001), and average score and time improved by 8.6% and 163.3 seconds, respectively. The proportion of successful aspirates improved by 9%, from 66% to 75%. Most post-session survey feedback was positive, and none was negative. Thirty-eight of 49 participants (78%) indicated they would prefer learning this skill with the simulator or in combination with individual practice and/or observation. Ninety-eight percent (49/50) strongly agreed that "this training simulator should be incorporated into the veterinary curriculum," and 94% (47/50) strongly agreed with the statement, "I would use this training simulator again to practice basic ultrasound skills." Eighty-four percent (42/50) strongly agreed their skills and knowledge improved using the simulator, and 82% (41/50) strongly agreed they gained confidence with ultrasound using the simulator. The remainder of the responses for these four questions was agreement, and no student disagreed with any of the statements. The authors conclude this is an effective and well-received simulator for teaching ex vivo USGC and recommend incorporation into the veterinary curriculum for basic ultrasound skill training.

Background: The coronavirus disease (COVID-19) pandemic highlighted the importance of physicians managing patients with noninvasive respiratory support (NIRS), including noninvasive ventilation (NIV) and high-flow nasal cannulas (HFNCs), emphasizing the need for thorough education on these modalities. Objective: To determine the effect of a novel simulation-based curriculum on improving the equipment familiarity and understanding of the physiology and application of NIRS among internal medicine residents. Methods: The curriculum consisted of a didactic session on the clinical application of NIRS, a case-based scenario on NIV using high-fidelity simulation, and a debrief session. Learners filled out surveys before and after the session to evaluate changes in objective knowledge of and subjective comfort with NIRS. P values were calculated using independent two-sample t tests. Results: Most residents (85.6%; n = 101) confirmed never having received a formal training in NIRS. At baseline, 34.7% (n = 41) and 24.6% (n = 29) felt "comfortable" or "very comfortable," respectively, using NIRS, which improved to 91.5% (n = 108) and 89% (n = 105) after the session (P = 0.001). A statistically significant improvement in clinical knowledge was demonstrated after the session (P < 0.05), with residents correctly recognizing all three indications for bilevel positive airway pressure (BiPAP) (87.2% to 98.3%, 56% to 67.8%, and 21.2% to 55.1%), contraindications to BiPAP (81.4% to 90.7%), appropriate adjustment of BiPAP (30.5% to 73.7%), and HFNC settings (68.6% to 79.7%). Following the curriculum, postgraduate year (PGY)-1 (PGY-1)s' knowledge was increased beyond the baseline of the PGY-2/3s who trained in New York during the pandemic (mean score change 50.6% to 72.1% for PGY-1s, 61.5% to 75.7% for PGY-2/3s). Three-month retention surveys revealed consistent learner satisfaction and learner retention in all aspects. Conclusion: Our 1-hour high-fidelity simulation-based curriculum significantly enhanced medical residents' knowledge, skills, and confidence in using NIRS for acute respiratory failure, with particularly notable benefits for those in the early years of training. Such a simulation-based curriculum could potentially lead to better hospital resource allocation and improved patient outcomes.

Complications from cast removal are infrequent but can cause permanent skin sequelae. Formal training in cast removal is limited during residency. This study aimed to develop a plaster cast removal simulation model for resident training.

Quasiexperimental study. A pediatric forearm phantom with temperature sensors was designed to simulate forearm cast removal. Six first-year orthopedic residents with no prior cast removal experience and two experts were evaluated. The residents underwent an initial evaluation, followed by an instruction session, and a final evaluation. Performance was assessed using a specific ratings scale (SRS), the Objective Structured Assessment of Technical Skills (OSATS) guideline, procedure time, and temperature measurement. Median scores with ranges were reported, and pre- and posttraining performances were compared using the Wilcoxon test. Experts scores were compared with resident scores using the Mann-Whitney test. The statistical significance was set at p<0.05.

Significant improvements in OSATS [(pre 22 points (range: 20-24); posttraining 25 (range: 25-28) (p=0.03)] and SRS [pre 8.5 points (range: 7-9); post 10 points (range: 8-10) (p=0.02)] were observed. No differences were found in temperature (p=0.50) and procedure time (p=0.09). When comparing residents' post-training scores with those of experts, no significant differences were found in OSATS (p=0.16), SRS (p=0.11), temperature measurement (p=0.50), or procedure time (p=0.09).

The plaster cast removal simulation model proved to be an effective training tool for residents, enabling them to achieve expert-level competency. Significant improvements were observed in OSATS and SRS scores post-training, highlighting the positive impact of the intervention on this skill.

The US population is aging. With this demographic shift, more older adults will be living with chronic conditions and geriatric syndromes. To prepare the next generation of health care professionals for this aging population, we need to provide training that captures the complexity of geriatric care.

This pilot study aimed to assess the feasibility of the cinematic-virtual reality (cine-VR) training in the complexity of geriatric care. We measured changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy before and after participating in the training program.

We conducted a single-arm, pretest-posttest pilot study to assess the feasibility of a cine-VR training and measure changes in attitudes to disability, self-efficacy to identify and manage elder abuse and neglect, and empathy. Health professional students from a large university in the Midwest were invited to participate in 1 of 4 cine-VR trainings. Participants completed 3 surveys before and after the cine-VR training. We performed paired t tests to examine changes in these constructs before and after the training.

A total of 65 health professional students participated in and completed the full cine-VR training for 100% retention. Participants did not report any technological difficulties or adverse effects from wearing the head-mounted displays or viewing the 360-degree video. Out of the 65 participants, 48 completed the pre- and postassessments. We observed an increase in awareness of discrimination towards people with disability (t47=-3.97; P<.001). In addition, we observed significant improvements in self-efficacy to identify and manage elder abuse and neglect (t47=-3.36; P=.002). Finally, we observed an increase in participants' empathy (t47=-2.33; P=.02).

We demonstrated that our cine-VR training program was feasible and acceptable to health professional students at our Midwestern university. Findings suggest that the cine-VR training increased awareness of discrimination towards people with disabilities, improved self-efficacy to identify and manage elder abuse and neglect, and increased empathy. Future research using a randomized controlled trial design with a larger, more diverse sample and a proper control condition is needed to confirm the effectiveness of our cine-VR training.

With the increasing availability and use of digital tools such as virtual reality in medical education, there is a need to evaluate their impact on clinical performance and decision-making among healthcare professionals. The Trauma SimVR study is investigating the efficacy of virtual reality training in the context of traumatic in-hospital cardiac arrest.

This study protocol (clinicaltrials.gov identifier: NCT06445764) for a single-center, prospective, randomized, controlled trial focuses on first-year residents in anesthesiology/intensive care, traumatology, and emergency medicine. The study will compare the clinical performance in a simulated scenario between participants who received virtual reality training and those who received traditional e-learning courses for preparation. The primary endpoint is the time to a predefined intervention to treat the underlying cause of the simulated traumatic cardiac arrest. Secondary endpoints include protocol deviations, cognitive load during simulated scenarios, and the influence of gender and personality characteristics on learning outcomes. The e-learning and the virtual reality training content will be developed in collaboration with experts from various medical specialties and nursing, focusing on procedural processes, guideline adherence specific to trauma patient care, and traumatic in-hospital cardiac arrest.

The results of this study will provide valuable insights into the efficacy of virtual reality training, contributing to the advancement of medical education, and serve as a foundation for future research in this rapidly evolving field.

Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals.

This study aims to co-design an escape room for training mental health care professionals' eMH skills and test the escape room's usability by exploring their experiences with this concept as a training method.

This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice.

An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game's complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training.

We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals' clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals.

Background Our institution has established priorities for graduate medical education (GME) simulation which include increasing adoption of, garnering additional financial support for, and creating a core simulation curriculum. Better understanding of the Accreditation Council for Graduate Medical Education (ACGME) simulation requirements will inform our efforts and serve as a guide for other institutions. Objective The purpose of this study was to perform a structured review of ACGME simulation standards using a document analysis to guide GME simulation activities at an institutional level. Methods A document analysis was performed from May 2023 to June 2024 to select and search ACGME Institutional and Program Requirements corresponding to the primary specialties for 21 clinical departments that financially support our simulation center. Content relevant to simulation was identified, and iterative coding with investigator team consensus was performed to assign categories, characterize the requirements, and interpret the findings. Results Twenty-four documents included 120 simulation requirements that were assigned to 12 categories; 70 (58%) requirements were mandatory whereas 50 (42%) were not, and 48 (40%) were simulation-specific, whereas 72 (60%) were simulation-optional. All reviewed specialties had simulation requirements (average 5.4, range 2-12), but the ACGME Institutional Requirements did not. Moderate to strong evidence supported (1) simulation usage by all 21 departments; (2) the need for institutional resource support; and (3) institutional-level patient safety simulation curricula. Conclusions This study identified a large number of simulation requirements, including mandatory patient safety curricula requirements, for all specialties analyzed.

There is no conclusive evidence which one is the optimal methodology for enhancing the quality and efficacy of learning for medical students. Therefore, this systematic review and network meta-analysis aims to evaluate and prioritize various teaching strategies in medical education, including simulation-based learning (SBL), flipped classrooms (FC), problem-based learning (PBL), team-based learning (TBL), case-based learning (CBL), and bridge-in, objective, pre-assessment, participatory learning, post-assessment, and summary (BOPPPS).

We conducted a comprehensive systematic search of PubMed, Embase, Web of Science, the Cochrane Library, and some key medical education journals up to November 31, 2023. The following keywords were searched in MeSH: ("medical students") AND ("problem-based learning" OR "problem solving") AND ("Randomized Controlled Trials as Topic"). Two authors independently carried out data extraction and quality assessment from the final selection of records following a full-text assessment based on strict eligibility criteria. Pairwise and network meta-analyses were then applied to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (95%CIs) using a random-effects model. Statistical analysis was performed by R software (4.3.1) and Stata 14 software.

A total of 80 randomized controlled trials with 6,180 students were included in the study. Compared to LBL, CBL (SMD = 1.19; 95% CI 0.49-1.90; p < 0.05; SUCRA = 89.4%), PBL (SMD = 3.37; 95% CI 1.23-5.51; p < 0.05; SUCRA = 93.3%), and SBL (SMD = 2.64; 95% CI 1.28-4.00; p < 0.05; SUCRA = 96.2%) were identified as the most effective methods in enhancing theoretical test scores, experimental or practical test scores, and students' satisfaction scores, respectively. Furthermore, subgroup analysis indicated that CBL (SUCRA = 97.7%) and PBL (SUCRA = 60.3%) were the most effective method for enhancing learning effectiveness within clinical curricula.

Among the six novel teaching strategies evaluated, CBL and PBL are more effective in enhancing the quality and efficacy of learning for medical students; SBL was determined to offer a superior learning experience throughout the educational process. However, this analysis revealed only minor differences among those novel teaching strategies.

Clinical simulation is a recent and now most used educational approach in health training programs. Its use for educational purposes in nursing education has gradually become widespread throughout the world. The aim of this study was to assess students' satisfaction and self-confidence with simulation-based learning and to identify the association of simulation design characteristics and educational practices with those outcomes.

This study utilized a correlational cross-sectional research design. Using a convenience sample, 110 nursing students were selected. Data were collected based on a questionnaire involving three instruments: the Simulation Design Scale, Educational Practices in Simulation Scale, and Student Satisfaction and Self-Confidence in Learning Scale. Data were analysed using SPSS software, version 26.0. Pearson's correlation coefficients was determined to describe and test the relationships between the different variables.

Nursing students were mostly satisfied with their simulation-based learning activity and felt self-confident: M=21/25 and M=33.8/40, respectively. For simulation design characteristics, only "Support"was correlated with student satisfaction (r = 0.468, p = 0.000) and it was the factor most correlated with students' self-confidence levels (r = 0.477, p = 0.000). Furthermore, there were significant correlations between all educational practices and student satisfaction/self-confidence in learning, at a level of p < 0.01. "Diverse ways of learning" was the factor most correlated with student satisfaction (r = 0.858, p = 0.000) and student self-confidence levels (r = 0.738, p = 0.000).

The current study's findings show that consideration of simulation design elements and the features of all educational practices is necessary for the development of a successful simulation experience and the improvement of student satisfaction and self-confidence.

As a widely accessible, cost-effective, and safe imaging tool, obstetric and gynecologic (OB/GYN) ultrasound (ULS) plays a vital role in diagnostics and patient care. With its growing relevance, the demand for comprehensive education in this field increases. The objective of this work was to outline the current state of OB/GYN ULS education.

A scoping literature search was performed until May 2023 using the medical database PubMed according to PRISMA guidelines. Using specific keywords, relevant publications were filtered. Subsequently, abstracts were independently reviewed by two authors and the inclusion of each publication was assessed against pre-defined key search terms. Full-text versions of the included publications were scrutinized and pertinent information was extracted.

In this review, 126 articles from the literature search matched the inclusion criteria and were investigated. Our findings revealed a diverse range of course concepts and programs, a lot of them not meeting the expectations of trainees and international guidelines. OB/GYN ULS training primarily targets residents, yet opportunities for early exposure and continuing education are underexplored. International organizations, such as the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the German Society for Ultrasound in Medicine (DEGUM) have proposed guidelines and curricula for standardized training. However, adoption remains varied. There is an emergent need to innovate teaching methods.

There is consensus that standardizing OB/GYN ULS curricula could enhance training quality and streamline the creation of new programs, ultimately improving patient care. Further research is needed to define the most effective strategies for curriculum development and implementation.

Healthcare simulation is critical for medical education, with traditional methods using simulated patients (SPs). Recent advances in artificial intelligence (AI) offer new possibilities with AI-based simulators, introducing limitless opportunities for simulation-based training. This study compares AI-based simulators and SPs in undergraduate medical education, particularly in history-taking skills development.

A randomized controlled trial will be conducted to identify the effectiveness of delivering a simulation session around history-taking skills to 67 fifth-year medical students in their clinical years of study. Students will be assigned randomly to either an AI-simulator group (intervention) or a simulated patient group (control), both will undergo a history-taking simulation scenario. An Objective Structured Clinical Examination (OSCE) will measure the primary outcomes. In contrast, secondary outcomes including student satisfaction and engagement, will be evaluated following the validated Simulation Effectiveness Tool-Modified (SET-M). The statistical approach engaged in this study will include independent t-tests for group performance comparison and multiple imputations to handle missing data.

This study's findings will provide valuable insights into the comparative advantages of artificial intelligence-based simulators and simulated patients. Results will guide decisions regarding integrating AI-based simulators into healthcare education and training programs. Hybrid models might be considered by institutions in the light of this study, providing diverse and effective simulation experiences to optimize learning outcomes. Furthermore, this work can prepare the ground for future research that addresses the readiness of AI-based simulators to become a core part of healthcare education.

Introduction Transitioning from a medical student to a foundation doctor presents numerous challenges, particularly in managing on-call duties that require quick decision-making, clinical skills, and prioritisation under pressure. The Simulation On-Call (SOC) program was developed as a one-day, immersive simulation event to equip final-year medical students with the skills and confidence needed for these responsibilities. Methods The SOC program is an annual event held for final-year medical students at the Royal Blackburn Hospital, Blackburn, UK. It is conducted over five days, with 80 final-year medical students rotating through nine stations that replicated common on-call scenarios. Each station required students to address critical medical situations, such as managing an acutely unwell patient, electrolyte abnormalities, and referring and communicating with colleagues, while managing realistic interruptions through a "bleep" system. Pre- and post-event questionnaires, featuring 25 Likert-scale items, were disseminated to assess student feedback and self-reported confidence across competencies, including communication, clinical decision-making, and task prioritisation. A retrospective review and analysis of the feedback was performed to assess the impact of the SOC program by assessing the pre- and post-session questionnaires. Results Of the 80 participants, 70 completed the pre-event questionnaire, and 72 completed the post-event questionnaire. Statistical analysis revealed a significant increase in students' self-reported confidence across all 25 Likert-scale items, with marked improvements in task prioritisation (rₛ = 0.74, p < 0.001), managing acutely unwell patients (rₛ = 0.60, p < 0.001), and escalation skills (rₛ = 0.49, p < 0.001). Effect sizes ranged from moderate to large, underscoring the practical impact of the Simulation On-Call program in enhancing preparedness and confidence for on-call responsibilities. Conclusion The SOC program provided a valuable, realistic, and supportive environment for final-year medical students to practice on-call responsibilities. The significant improvement in student confidence highlights the effectiveness of this program as a preparatory tool for foundation doctors. Future iterations will incorporate feedback to continually refine the simulation experience, ensuring its alignment with clinical demands.

Objective Hemodynamically unstable upper gastrointestinal bleeding (UGIB) represents a life-threatening emergency that often lacks adequate high-fidelity training in the insertion of balloon tamponade devices. To address this gap, we developed an affordable task trainer that provides real-time feedback to enhance the training experience for emergency medicine residents. This study aims to evaluate the realism of the task trainer and its impact on residents' confidence in managing massive UGIB. Methods Constructed from low-cost, readily available materials, the task trainer was utilized in a training session attended by 28 emergency medicine residents. Following the review of an instructional video, participants were timed during the insertion of the balloon tamponade device. Subsequently, they completed a paper survey to assess their experiences and confidence levels. Results All 28 residents completed both the pre- and post-session surveys. The average time for inserting the balloon tamponade device was 3 minutes and 49 seconds. Sixteen participants strongly agreed, 11 agreed, and one felt neutral regarding the task trainer's realism in teaching the procedure. Additionally, all residents rated the simulation average or above average compared to previous educational experiences. Fourteen residents reported feeling significantly more confident in managing massive UGIB, while 13 felt slightly more confident, and one noted no change in confidence. Participants provided several positive remarks regarding the training session. Conclusions The balloon tamponade device task trainer proved beneficial in enhancing emergency medicine residents' confidence in managing patients with massive UGIB. Furthermore, the task trainer was perceived as realistic and superior to other educational modalities.

The objective of this study was to develop and validate 6 checklists for evaluating abdominal pain in clinical simulation scenarios; to assess student competencies in managing 6 clinical cases using OSCE, based on faculty evaluations; and to analyze discrepancies between faculty and student evaluations.

A practical workshop was designed to address 6 clinical scenarios of abdominal surgical conditions. Four scenarios employed medium fidelity simulators, while 2 scenarios employed standardized patient methodology. Prior to the workshop, students received theoretical audiovisual material. At the conclusion of the workshop, students were evaluated using checklists that assessed communication, privacy, anamnesis, and technical skills. Ten workshops were conducted over 3 years, using the OSCE (Objective Structured Clinical Examination) format for evaluation.

In the statistical analysis, t-Student tests or ANOVA were employed to ascertain whether there were any significant differences between the groups. In the process of validating checklists for clinical scenarios, 6 experts were asked to evaluate each item on a scale of 1 to 9. To assess the degree of agreement among experts, the intraclass correlation coefficient (ICC) was employed.

The study involved a total of 670 third-year medical students from the University of Murcia (UMU), Spain, who participated in the subject "Medical-Surgical Skills."

High levels of appropriateness were observed for the checklist items, with mean scores above 7.5 points, as well as high levels of inter-expert agreement. Students obtained a mean score of 8 points in the evaluation of each clinical scenario. No significant differences were found between faculty and student scores (p < 0.05).

The learning method focused on clinical scenarios of abdominal surgical diseases effectively enhanced the clinical skills of third-year medical students. It used pre-existing audiovisual materials, hands-on workshops with medium-fidelity simulators, and standardized patients. Consistent evaluations from students and faculty confirmed the efficacy of these strategies.

Clinical Simulation improves results in the students' learning tests and allows for preserving acquired knowledge for longer periods of time, promoting more significant learning. This study was conducted to analyze Nursing students' satisfaction with Clinical Simulation in three centres attached to a university from southern Spain.

A quantitative, non-experimental and cross-sectional descriptive study was carried out. The students included were attending their third year of the Nursing undergraduate course and had already taken part in training sessions by means of Clinical Simulation. The Satisfaction Scale with High-Fidelity Clinical Simulation in Students (SSHF) was used for data collection. This scale has been validated and has 33 items grouped into eight factors. The SPSS software (version 28), was used for data analysis, establishing p-values < 0.05 for the statistically significant differences.

The participants were 180 students, with a mean age of 22.17 years old. Of them, 90.56% belonged to the female gender. A mean score of 3.82 out of 5 was obtained in the SSHF items. The items that obtained the highest scores were the following: benefits of Clinical Simulation as it relates theory with practise; possibility of learning based on the mistakes made; and comfort and respect while the sessions were developed. The item that obtained the lowest score was "timing for each simulation case". We found significant differences in the results obtained according to each attached centre.

The students showed high satisfaction levels regarding High-Fidelity Clinical Simulation in each of the three attached centres included in the study. Nevertheless, they stated the need to invest more time in Clinical Simulation sessions.

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Debriefings are central to effective learning in simulation-based medical education. However, educators often face challenges when conducting debriefings, which are further compounded by the lack of empirically derived knowledge on optimal debriefing processes. The goal of this study was to explore the technical feasibility of audio-based speaker diarization for automatically, objectively, and reliably measuring debriefing interaction patterns among debriefers and participants. Additionally, it aimed to investigate the ability to automatically create statistical analyses and visualizations, such as sociograms, solely from the audio recordings of debriefings among debriefers and participants.

We used a microphone to record the audio of debriefings conducted during simulation-based team training with third-year medical students. The debriefings were led by two healthcare simulation instructors. We processed the recorded audio file using speaker diarization machine learning algorithms and validated the results manually to showcase its accuracy. We selected two debriefings to compare the speaker diarization results between different sessions, aiming to demonstrate similarities and differences in interaction patterns.

Ten debriefings were analyzed, each lasting about 30 min. After data processing, the recorded data enabled speaker diarization, which in turn facilitated the automatic creation of visualized interaction patterns, such as sociograms. The findings and data visualizations demonstrated the technical feasibility of implementing audio-based visualizations of interaction patterns, with an average accuracy of 97.78%.We further analyzed two different debriefing cases to uncover similarities and differences between the sessions. By quantifying the response rate from participants, we were able to determine and quantify the level of interaction patterns triggered by instructors in each debriefing session. In one session, the debriefers triggered 28% of the feedback from students, while in the other session, this percentage increased to 36%.

Our results indicate that speaker diarization technology can be applied accurately and automatically to provide visualizations of debriefing interactions. This application can be beneficial for the development of simulation educator faculty. These visualizations can support instructors in facilitating and assessing debriefing sessions, ultimately enhancing learning outcomes in simulation-based healthcare education.

Immersive simulation is used increasingly in medical education, and there is increasing awareness of the impact of simulation scenarios on emotional state and cognitive load and how these impact learning. 1 There is growing awareness of the requirement to equip veterinarians with skills for managing high-pressure environments and provide training on human factors.

Veterinary students participated in a high-fidelity immersive simulation of a road traffic collision involving multiple casualties. The students took part in the same simulation twice, the second time after a debrief. Each participant's emotional state and cognitive load were assessed after participating in each simulation. Each participant was asked to score the effect of pressure on their performance.

One hundred twenty-five students participated and demonstrated a higher cognitive load with more positive emotional states during the second scenario after the completion of a structured debrief and discussion focusing on pressure relief techniques (cognitive load - ¯ μ Scenario run 1 = 4.44 ± 1.85 [SD], ¯ μ Scenario2 = 5.69 ± 1.74 [SD]). Most (63%) participants described being in a low-performance state of frazzle during the first scenario compared with most (61%) who described being in a high-performance state of flow during the second.

Immersive simulation scenarios, with structured debriefing, may allow the measurement of emotional state and cognitive load in participants. Furthermore, this study suggests that curriculum training in human factors and pressure relief techniques, coupled with immersive simulation and debrief, may improve future performance in high-stakes and high-pressure scenarios.

Simulation-based education (SBE) is common in healthcare education and is increasingly being incorporated in preclinical curriculum. Preclinical students typically have had little exposure to the clinical setting (i.e. hospital patient rooms, equipment) and often feel uncomfortable when first placed in the simulated clinical environment. Prebriefing, a standard of best practice in simulation, prepares learners for simulation exercises. To successfully integrate SBE in preclinical education, we recommend expanding the prebriefing to include: multiple activities that orient learners to the learning space and the structure of a simulation activity, the goals of simulation as a learning process, faculty modeling of a simulated patient encounter, and expected learner outcomes. This approach increases student familiarity with the simulation learning environment and performance expectations, which can reduce cognitive load and improve learning outcomes. We describe 12 tips for increasing the scope of the prebriefing to promote effective learner participation and development during preclinical SBE.

Background: With the rise of new 3D printers, assessing accuracy is crucial for obtaining the best results in patient care. Previous studies have shown that the highest accuracy is achieved with SLS printing technology; however, SLA printing technology has made significant improvements in recent years. Methods: In this study, a realistic anatomical model of a mandible and skull, a cutting guide for mandibular osteotomy, and a splint for orthognathic surgery were replicated five times each using two different 3D printing technologies: SLA and SLS. Results: The SLA group had a median trueness RMS value of 0.148 mm and a precision RMS value of 0.117 mm. The SLS group had a median trueness RMS value of 0.144 mm and a precision RMS value of 0.096 mm. There was no statistically significant difference in RMS values between SLS and SLA technologies regarding trueness. Regarding precision, however, the RMS values for SLS technology were significantly lower in the splint and cutting guide applications than those printed with SLA technology. Conclusions: Both 3D printing technologies produce modern models and applications with equally high dimensional accuracy. Considering current cost pressures experienced by hospitals, the lower-cost SLA 3D printer is a reliable choice for point-of-care 3D printing.

Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system.

A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue.

Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%).

The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.

Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS.

A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage.

Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280).

Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters.

This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model.

III.

Phenomenon: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student's perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. Approach: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. Insights: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students' self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.

Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation.

To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities.

Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool.

Among the 39 included articles, the majority were published in the last 5 years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16).

Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.

Critical CHD is associated with morbidity and mortality, worsened by delayed diagnosis. Paediatric residents are front-line clinicians, yet identification of congenital CHD remains challenging. Current exposure to cardiology is limited in paediatric resident education. We evaluated the impact of rapid cycle deliberate practice simulation on paediatric residents' skills, knowledge, and perceived competence to recognise and manage infants with congenital CHD.

We conducted a 6-month pilot study. Interns rotating in paediatric cardiology completed a case scenario assessment during weeks 1 and 4 and participated in paired simulations (traditional debrief and rapid cycle deliberate practice) in weeks 2-4. We assessed interns' skills during the simulation using a checklist of "cannot miss" tasks. In week 4, they completed a retrospective pre-post knowledge-based survey. We analysed the data using summary statistics and mixed effect linear regression.

A total of 26 interns participated. There was a significant increase in case scenario assessment scores between weeks 1 and 4 (4, interquartile range 3-6 versus 8, interquartile range 6-10; p-value < 0.0001). The percentage of "cannot miss" tasks on the simulation checklist increased from weeks 2 to 3 (73% versus 83%, p-value 0.0263) and from weeks 2-4 (73% versus 92%, p-value 0.0025). The retrospective pre-post survey scores also increased (1.67, interquartile range 1.33-2.17 versus 3.83, interquartile range 3.17-4; p-value < 0.0001).

Rapid cycle deliberate practice simulations resulted in improved recognition and initiation of treatment of simulated infants with congenital CHD among paediatric interns. Future studies will include full implementation of the curriculum and knowledge retention work.

The transition from medical student to emergency medicine resident is a critical point in training. Medical students start residency with different levels of understanding and some are not meeting the emergency medicine (EM) Level 1 milestones. Residency preparation courses (RPCs) were created to fill this gap and prepare medical students for residency.

The objective was to review content from current RPC curricula to determine the content that should be included in an EM-specific transition to residency preparation course.

We collected curricula from RPC course directors at different institutions and reviewed and coded the topics into categories: (1) didactics, (2) procedures, and (3) unique topics (defined as nontraditional topics that did not fit squarely into didactics or procedures).

We obtained content from 13 different RPC curricula. Length of the courses ranged from one to 8 weeks with the mean being three weeks. Most courses were taught within a larger medical school course and were not specific to EM (62%). The most frequently taught didactic topics were airway interventions (85%), critical care (69%), and chest pain/shortness of breath (62%). Most programs included a simulation component (92%) and the most common procedures included airway interventions (69%); lines-central, arterial, and Cordis (69%); lumbar puncture (62%); and ultrasound (62%). Many of the courses had unique or special features taught within the curriculum. The most frequently taught unique content were sessions on self-awareness and self-regulation (85%) and advanced communication (69%).

After multiple RPC curricula content was reviewed, a set of basic curriculum has been determined and supported by the content analysis. By including a standardized curriculum within RPC's, this will help better prepare medical students and create a standard for medical students entering EM residency and may allow intern orientations to focus on higher level skills.

Effective interprofessional teamwork is essential for the efficiency, safety and quality of healthcare system services and requires interprofessional education for medical students. Physical education is a simple and easy way to teach teamwork, which translates into team performance in the work environment. This study was conducted to examine the effectiveness of the physical education competition model, instead of the exams model, for improving teamwork skills among medical students.

A quasiexperimental intervention design was used to measure the effect of a 16-week cheerleading programme on subjects' teamwork skills by completing a teamwork scale comprising four subdimensions, namely, personal characteristics, teamwork, leadership, and conflict management, before the start and at the end of the programme, and by comparing nonwinning to winning students to measure the effect of teamwork skills on team performance.

A total of 179 students completed the valid baseline and posttest (effective rate = 95.21%). The teamwork scale scores (B M = 4.81, R M = 5.05, p < 0.001) and 4 subdimension scores (personal characteristics p = 0.002, teamwork p = 0.028, leadership p < 0.001, conflict management p < 0.001) were statistically significant. Twenty-two of the 44 items in the scale improved significantly. The differences between students who won the competition and those who did not (N M=4.86, W M=5.14, p<0.01) were statistically significant, with no significant differences in personal characteristics p = 0.183; significant differences in the 3 subdimensions of teamwork p < 0.01, leadership p = 0.024, and conflict management p = 0.037; and a significant increase in 13 out of 44 self-efficacy items on the scale.

The "race for exams" physical education programme improved teamwork among medical students, and increased teamwork improved team performance. The "competition instead of examination" physical education programme provides a quantifiable method for improving interprofessional teamwork among medical students.

The key step in evaluating the quality of clinical nursing practice education lies in establishing a scientific, objective, and feasible index system. Current assessments of clinical teaching typically measure hospital learning environments, classroom teaching, teaching competency, or the internship quality of nursing students. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development, or identify specific areas for clinical teachers to implement change and improvement. Therefore, the purpose of our study was to to construct a scientific, systematic, and clinically applicable evaluation index system of clinical nursing practice teaching quality and determine each indicator's weight to provide references for the scientific and objective evaluation of clinical nursing practice teaching quality.

Based on the "Structure-Process-Outcome" theoretical model, a literature review and Delphi surveys were conducted to establish the evaluation index system of clinical nursing practice teaching quality. Analytic Hierarchy Process (AHP) was employed to determine the weight of each indicator.

The effective response rate for the two rounds of expert surveys was 100%. The expert authority coefficients were 0.961 and 0.975, respectively. The coefficient of variation for the indicators at each level ranged from 0 to 0.25 and 0 to 0.21, and the Kendall harmony coefficients were 0.209 and 0.135, respectively, with statistically significant differences (P < 0.001). The final established index system included 3 first-level, 10 second-level, and 29 third-level indicators. According to the weights computed by the AHP, first-level indicators were ranked as "Process quality" (39.81%), "Structure quality" (36.67%), and "Outcome quality" (23.52%). Among the secondary indicators, experts paid the most attention to "Teaching staff" (23.68%), "Implementation of teaching rules and regulations (14.14%), and "Teaching plans" (13.20%). The top three third-level indicators were "Level of teaching staff" (12.62%), "Structure of teaching staff" (11.06%), and "Implementation of the management system for teaching objects" (7.54%).

The constructed evaluation index system of clinical nursing practice teaching quality is scientific and reliable, with reasonable weight. The managers' focus has shifted from outcome-oriented to process-oriented approaches, and more focus on teaching team construction, teaching regulations implementation, and teaching design is needed to improve clinical teaching quality.

Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics.

To provide a more complete understanding of the relative merits and limitations of modalities, military combat medics (N = 33) were surveyed on the capabilities of simulation modalities during a 5-day technical experimentation event where they observed medical simulations from industry developers. The survey asked them to rate each of eleven modalities on each of seven attributes. To elicit additional context for the strengths, limitations, and unique considerations of using each modality, we also collected open-ended comments to provide further insight on when and how to use specific simulation modalities.

Results showed differences among the simulation modalities by attribute. Cadavers, role play, moulage, and live tissue all received high ratings on two or more attributes. However, there was no modality that was rated uniformly superior to the others. Instead, modalities appear to have unique strengths and limitations depending on the training context and objectives. For example, cadavers were seen as highly realistic, but not very reusable.

The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.

The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training.

A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed.

Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant.

Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.

This study describes a unique two-week simulation-based medical education (SBME) rotation for transitional year (TY) residents. During the rotation, residents are fully integrated into the simulation team, actively participating in clinically based interprofessional scenarios, procedural techniques, and mixed reality experiences. Residents also created and ran their own simulations while receiving content expert feedback. We evaluated the rotation's effectiveness in preparing TY graduates for their specific advanced residency track.

A retrospective survey evaluated the experiences of 11 TY residents who participated in a unique two-week simulation rotation. The survey assessed residents' perceptions of the program's value and skill development, course design, scenario relevance to future practice, and preparedness to develop future scenarios.

Residents (11 out of 12 residents, 92% response rate) overwhelmingly endorsed the simulation rotation (100% positive, 45.45% extremely valuable). The program demonstrably improved core clinical skills (100% reported improvement) and fostered self-efficacy for future practice. Scenario relevance was high (81.82% highly relevant). Collaboration and communication skills showed promise (72.73% positive) while highlighting a potential area for future refinement. Residents unanimously agreed on effective time allocation and the program's value for debriefing skills. Notably, 91% strongly supported residency-specific simulation training.

The two-week simulation was perceived by prior TY residents as valuable, with a majority finding the experience highly valuable across multiple survey questions. Residents overwhelmingly expressed a preference for residency-specific training, suggesting future development of specialty-tailored modules and enhanced debriefing sessions. The findings highlight the program's effectiveness and successful implementation into a TY residency curriculum.

We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME).

We conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥70% rated the item as extremely important and exclusion as ≥70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of three rounds.

A total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least one content item that experts considered important to teach through simulation as compared to other modalities.

Using consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content.