Search

This scoping review aims to examine and map the current state of faculty development for healthcare simulation educators. This review will include an exploration of the range and type of faculty development programs designed to enhance simulation-based education (SBE). Simulation has become a staple method for educating health professionals, but no standard approaches exist for training simulation instructors, both for initial training and ongoing professional development. As this education modality continues to expand, there is a need to better understand what interventions and approaches improve the knowledge, skills, abilities and other attributes (KSAOs) for those who are responsible for the design, delivery and evaluation of simulation-based educational sessions. This scoping review will consider empirical research and other relevant published works that address faculty development for simulation educators in health professions education. This will include faculty development interventions, conceptual and theoretical frameworks, recommendations for implementation and other discussions of issues related to faculty development for SBE. These may include experimental, quasi-experimental, observational, qualitative studies, commentaries and perspectives. The following electronic databases will be searched: Medline (Ovid); EMBASE (Ovid); CINAHL (EBSCO); ERIC (EBSCO); PsycInfo (Ovid); and Web of Science without time limits. Reference lists of eligible studies will be back-searched, and Google Scholar and Scopus will be used for forward citation tracking. The findings will be summarized in tabular form and a narrative synthesis, to inform recommendations and areas for future research and practice.

The last decade has seen a significant increase in ventricular assist device (VAD) utilization in children. Challenges remain in acquiring adequate hands-on training for trainees and clinical staff and maintaining device competency given the number of different devices in use and the relatively small number of patients in a given center. Medical simulation provides a mechanism to establish and maintain VAD experience as the field grows. Herein, we describe the creation of a VAD simulation program and knowledge gained to date.

The SAGES flexible endoscopy course for minimally invasive surgery (MIS) fellows improves confidence and skills in performing gastrointestinal (GI) endoscopy. This study evaluated the long-term retention of these confidence levels and investigated how fellows changed practices within their fellowships due to the course.Participating MIS fellows completed surveys 6 months after the course. Respondents rated their confidence to independently perform 16 endoscopic procedures (1 = not at all; 5 = very), barriers to use of endoscopy, and current uses of endoscopy. Respondents also noted participation in additional skills courses and status of fundamentals of endoscopic surgery (FES) certification. Comparisons of responses from the immediate post-course survey to the 6-month follow-up survey were examined. McNemar and paired t tests were used for analyses.23 of 57 (40%) course participants returned to the 6-month survey. No major barriers to endoscopy use were identified. Fellows reported less competition with GI providers as a barrier to practice compared to their original post-course expectations (50% vs. 86%, p 0.01). In addition, confidence was maintained in performing the majority of the 16 endoscopic procedures, although fellows reported significant decreases in confidence in independently performing snare polypectomy (- 26%; p 0.05), control of variceal bleeding (- 39%; p 0.05), colonic stenting (- 48%; p 0.01), BARRX (- 40%; p 0.05), and TIF (- 31%; p 0.05). Fewer fellows used the GI suite to manage surgical problems than was anticipated post course (26% vs. 74%, p 0.01). Fellows who passed FES noted no significant loss of independence, changes in use, or barriers to use. 18% made additional partnerships with industry after the course. 41% stated flexible endoscopy has influenced their post-fellowship job choice.The SAGES flexible endoscopy course for MIS fellows results in long-term practice changes with participating fellows maintaining confidence to perform the majority of taught endoscopic procedures 6 months later. Additionally, fellows experienced no major barriers to implementing endoscopy into practice.

Barth syndrome (BTHS) is associated with myocardial disease, frequently left ventricular noncompaction cardiomyopathy, which may necessitate cardiac transplantation or lead to death in some patients. We report a child with BTHS who had an "undulating cardiac phenotype" and ultimately developed decompensated heart failure requiring mechanical circulatory support with a ventricular assist device as a bridge to transplantation. His course was complicated by acute lung injury requiring placement of an in-line oxygenator to maintain end-organ function. Not only was his course complicated by cardiac and respiratory failure but his BTHS associated comorbidities complicated the management of his therapy using mechanical assist device support. He was successfully supported and subsequently was transplanted. Here we discuss the management of a child with BTHS using mechanical circulatory support and describe the use of an in-line oxygenator, Quadrox, with the Berlin Excor device.

The concept that the natural history of certain heart defects could be positively modified through in utero intervention has stimulated extensive research in fetal cardiac intervention and surgery since the early 1980s. Since the management of certain defects would require the use of cardiopulmonary support, extensive studies have been directed toward the application of a variety of perfusion circuits. The unique features of the fetal patient have directed the focus of many of these designs toward miniaturization of components and minimization of prime volume. Large extracorporeal surface contact areas and prime volumes have been identified as potential contributors to a frequently observed placental dysfunction following fetal cardiopulmonary bypass (CPB). We set out to develop means of CPB using a centrifugal micro-system that would not require supplemental prime volume. We describe the unique application of an adult right heart assist device, primarily used for ‘off-pump’ coronary revascularization for fetal cardiopulmonary support. Finally, while previous fetal experiments have used late-gestation mature fetuses, we studied more immature fetuses of mid-gestation, relevant to current clinical attempts in fetal therapy.

Background We examined potential maternal-fetal interactions during fetal cardiopulmonary bypass. these interactions, not previously described, may significantly influence attempts at fetal cardiac surgery. Methods Eight fetal sheep underwent cardiopulmonary bypass (5 singletons, 3 twins; 100–109 days) for 60 minutes using a centrifugal microcircuit (20 mL prime), and the placenta as oxygenator. We measured maternal hemodynamics, arterial blood gases, and changes in blood flow to the gravid uterus using bilateral uterine artery flow probes. Maternal measurements were correlated to fetal hemodynamics, blood gases, and umbilical blood flows. After bypass, fetuses were followed for 60 minutes. Results Decreases in uterine blood flow occurred without changes in maternal hemodynamics or arterial blood gases, but were associated with worsening fetal arterial blood gases (pH decreased from 7.2 ± 0.2 to 7.0 ± 0.1, partial pressure of carbon dioxide increased 45.6% and partial pressure of oxygen decreased 15.4%). Changes in maternal hemodynamics (decreased systolic blood pressure [17.5%, SD=11] and decreased diastolic blood pressure [20.3%, SD=15]) were only noted when uterine blood flows decreased by greater than 38.2% (SD = 26). Correction of maternal hypocalcemia (0.89g/dL, SD=0.1) led to improved uterine artery flows (28.3% increase, SD=30). Finally, fetal sternotomy, cannulation, and cardiopulmonary bypass each decreased uterine artery flows by 27.5% (SD = 18), 31.0% (SD = 26), and 39.7% (SD = 25), respectively. Similar changes were not observed in the nonbypass twin. Conclusions Significant changes in uterine blood flow can occur during fetal cardiopulmonary bypass support without apparent changes in maternal hemodynamics or arterial blood gases. These changes imply a unique transplacental maternal-fetal interaction. Limited data from the twin fetus suggest a localized mechanism involving only the segment of placenta exposed to extracorporeal circulation.

We investigated a miniature magnetically levitated centrifugal blood pump intended to deliver 0.3-1.5 l/min of support to neonates and infants. The back clearance gap between the housing and large volume of the rotor, where the suspension and motor bearings are located, forms a continuous leakage flow path. Within the gap, flow demonstrates a very complex three-dimensional structure: the fluid adjacent to the rotating disk tends to accelerate by centrifugal force to flow radially outwards toward the outlet of the impeller against an unfavorable pressure gradient, which in turn forces blood to return along the stationary housing surfaces. Consequently, one or multiple vortices may be generated in the gap to block blood flow and cause the formation of a retrograde and antegrade leakage flow phenomenon at the gap outlet using an optimization process including extensive computational fluid dynamics (CFD) analysis of impeller refinements, we found that secondary blades located along the back or extended to the side surfaces of the rotor have the capacity to reduce and eliminate the retrograde flow in the back clearance gap. Flow visualization confirmed the CFD-predicted flow patterns. This work demonstrates the utility of CFD-based design optimization to optimize the fluid path of a miniature centrifugal pump.

Currently, neonatal arch reconstruction requires the use of circulatory arrest or, predominantly, regional cerebral perfusion techniques.' With regional perfusion, the question remains as to the adequacy of brain perfusion. 2,3 Recent clinical and experimental evidence suggests that, with all techniques, systemic perfusion is sacrificed and unwanted effects of deep hypothermia remain. With the use of the INVOS cerebral oximeter (Somanetics, Troy, Mich), changes in the regional cerebral oxygen saturation are now noninvasively and continuously monitored, allowing for the comparison of different techniques. We present a case of successful aortic arch reconstruction in an infant using a novel technique that allows total cerebral as well as systemic perfusion during arch reconstruction.