Search

This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid.In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™.All groups demonstrated improved performance on the second simulation (p 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences.Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

Chest tube insertion requires interdisciplinary teamwork including an emergency surgeon or physician in conjunction with a nurse. The purpose of the study was to validate an interdisciplinary performance assessment scale for chest tube insertion developed from literature analysis.This prospective study took place in the simulation center of the University of Paris. The participants included untrained emergency/intensivist residents and trained novice emergency/intensivist physicians with less than 2 years of clinical experience and 6 months following training in thoracostomy, and nursing students. Each interdisciplinary pair participated in a high-fidelity simulation session. Two independent observers (O1 and O2) evaluated 61 items. Internal coherence using the Cronbach's α coefficient, intraclass correlation coefficient (ICC), and correlation of scores by regression analysis (R2) were analyzed. Comparison between O1 and O2 mean scores used a t test and F test for SDs. p Value 0.05 was significant.From an initial selection of 11,277 articles, 19 were selected to create the initial scale. The final scale comprises 61 items scored out of 80, including 24 items for nursing items, 24 items for medical competence, and 13 mixed items for the competence of both. 40 simulations including 80 participants were evaluated. Cronbach's α = 0.76, ICC = 0.92, R2 = 0.88. There was no difference between the observers' assessments of means (p = 0.82) and SDs (p = 0.92). Score was 51.6 ± 5.9 in the group of untrained residents and nursing student, and 57.2 ± 2.8 in the trained group of novice physicians and nursing students (p = 0.0003).This first performance assessment scale for interdisciplinary chest tube insertion is valid and reliable.

The aim of this study was to assess intraosseous (IO) access placement performance during a multidisciplinary simulation-based training (SBT) program according to the professional status, experience of caregivers, and the setting of the course.This prospective, multicentric study included emergency physicians, residents, certified registered nurse anesthetists, registered nurses, and students. It was carried out between April 6, 2020 and April 30, 2021 in emergency medical services, an emergency department, and a simulation center. Trainee performance was evaluated by 2 independent observers using a validated scale, before and after SBT. Self-assessment of satisfaction was carried out. Interobserver reproducibility was analyzed by intraclass correlation coefficient. The continuous variables were compared using a Student t test or a nonparametric Mann-Whitney U test. Comparative analysis between the different groups used analysis of variance. Correlation analysis was performed by a nonparametric Spearman test. A P value of 0.05 was considered significant.Ninety-eight participants were included. Intraclass correlation coefficient between the 2 observers was 0.96. Performance significantly increased after training, regardless of the site or device used (for the semiautomatic device, P = 0.004 in tibia and P = 0.001 in humeral; for the manual device, P0.001). Simulation-based training significantly reduced time for IO access (P = 0.02). After SBT, no difference was found according to professional status and the setting of the course. Performance was not correlated with professional experience. All trainees were satisfied with the training.Simulation-based training improved the IO access using a semiautomatic or a manual device, regardless of the experience or status of the trainees. Simulation-based training would work for many disciplines regardless of locations (simulation or clinical facilities).

Introduction:Dispatchers should be trained to interrogate bystanders with strict protocols to elicit information focused on recognizing cardiac arrest and should provide telephone cardiopulmonary resuscitation (CPR) instructions in all cases of suspected cardiac arrest. While an objective assessment of training outcomes is needed, there is no performance assessment scale for simulated dispatcher-assisted CPR.Study Objective:The aim of the study was to create a valid and reliable performance assessment scale for simulated dispatcher-assisted CPR.Methods:In this prospective, randomized, controlled, multi-centric simulation-based trial (registration number TCTR20210130002), the scale was developed according to the European Resuscitation Council (ERC) and American Heart Association (AHA) Guidelines 2015 and revised by experts. The performance of 48 dispatchers’ telephone-CPR and of 48 bystanders carrying out CPR on a manikin was assessed by two independent evaluators using the scale and using a SkillReporter (PC) software to provide CPR objective performance. Continuous variables were described as mean (SD) and categorical variables as numbers and percentage (%). Comparative analysis between two groups used a Student t-test or a non-parametric test of Mann-Whitney. The internal structure of the scale was evaluated, including internal consistency using α Cronbach coefficient, and reproducibility using intraclass correlation coefficient (ICC) and linear correlation coefficient (R2) calculation.Results:The scale included three different parts: two sections for dispatchers’ (32 items) and bystanders’ CPR performance (15 items) assessment, and a third part recording times. There was excellent internal consistency (α Cronbach coefficient = 0.77) and reproducibility (ICC = 0.93; R² = 0.86). For dispatchers’ performance assessment, α Cronbach coefficient = 0.76; ICC = 0.91; R2 = 0.84. For bystanders’ performance assessment, α Cronbach coefficient = 0.75; ICC = 0.93; R2 = 0.87. Reproducibility was excellent for nine items, good for 19 items, and moderate for 19 items. No item had poor reproducibility. There was no significant difference between dispatch doctors’ and medical dispatch assistants’ performances (33.0 [SD = 4.7] versus 32.3 [SD = 3.2] out of 52, respectively; P = .70) or between trained and untrained bystanders to follow the instructions (14.3 [SD = 2.0] versus 13.9 [SD = 1.8], respectively; P = .64). Objective performance (%) was significantly higher for trained bystanders than for untrained bystanders (67.4 [SD = 14.5] versus 50.6 [SD = 19.3], respectively; P = .03).Conclusion:The scale was valid and reliable to assess performance for simulated dispatcher-assisted CPR. To the authors’ knowledge, no other valid performance tool currently exists. It could be used in simulated telephone-CPR training programs to improve performance.

To evaluate the validity and reliability of an innovative training model for endocrine surgical procedures. A simulator training model for endocrine procedures (SimLife) was developed at an academic center. The model consisted of a realistic operating environment with a coherent simulated patient dynamized by pulsatile vascularization with simulated blood warmed to 37 °C, and ventilation. Training sessions were designed for adrenal and thyroid surgery, as well as neck dissection. The primary outcome of interest was to evaluate learners’ performance and satisfaction. Learners’ performance was evaluated based on a scoring scale that followed the Downing method for the assessment of competency. While learners’ satisfaction was evaluated using a Likert scale of 1 to 10 on four items (ease of learning, anatomic correspondence of landmarks, realism, and overall satisfaction). Participants were engaged in 32 training sessions. These included 24 adrenalectomies (conventional and laparoscopic both transabdominal and posterior), and 4 thyroid lobectomies with concomitant functional lateral compartment neck dissection. competency scores were procedure-specific addressing specific core components of a given procedure. Learners’ performance scored above average in all procedures evaluated. Satisfaction scores for the specified four items ranged between 8.43 (SD 0.87) and 8.89 (SD 0.96). No major events were reported for the adrenalectomies, while only one jugular vein injury occurred during neck dissection. SimLife is a hyper-realistic training model that allows for satisfactory acquisition of skills and the evaluation of performance progression. It has the potential to become a cornerstone in specialized surgical training. Electronic supplementary material The online version of this article (10.1007/s13304-020-00871-x) contains supplementary material, which is available to authorized users.

Background The demand for bariatric surgery is high and so is the need for training future bariatric surgeons. Bariatric surgery, as a technically demanding surgery, imposes a learning curve that may initially induce higher morbidity. In order to limit the clinical impact of this learning curve, a simulation preclinical training can be offered. The aim of the work was to assess the realism of a new cadaveric model for simulated bariatric surgery (sleeve and Roux in Y gastric bypass). Aim A face validation study of SimLife, a new dynamic cadaveric model of simulated body for acquiring operative skills by simulation. The objectives of this study are first of all to measure the realism of this model, the satisfaction of learners, and finally the ability of this model to facilitate a learning process. Methods SimLife technology is based on a fresh body (frozen/thawed) given to science associated to a patented technical module, which can provide pulsatile vascularization with simulated blood heated to 37 °C and ventilation. Results Twenty-four residents and chief residents from 3 French University Digestive Surgery Departments were enrolled in this study. Based on their evaluation, the overall satisfaction of the cadaveric model was rated as 8.52, realism as 8.91, anatomic correspondence as 8.64, and the model’s ability to be learning tool as 8.78. Conclusion The use of the SimLife model allows proposing a very realistic surgical simulation model to realistically train and objectively evaluate the performance of young surgeons.

Resume En formation medicale initiale et continue, la simulation devient une technique obligatoire. Tout comme devenir pilote necessite des competences, l’acquisition de competences techniques est essentielle pour devenir chirurgien. Le modele ancien du compagnonnage « je vois, je fais, et j’enseigne » n’est actuellement pas completement compatible avec les contraintes socioeconomiques du bloc d’operation, la demande de securite du patient et la reduction des heures de travail des residents. Nous proposons un nouveau modele de simulation chirurgicale utilisant des corps donnes a la Science rendus dynamiques avec une vascularisation pulsatile et une ventilation, disponible aussi bien pour la chirurgie ouverte que pour la laparoscopie. La chirurgie sur un corps humain donne a la Science permet de reproduire avec precision les caracteristiques haptiques des procedures chirurgicales. Apprendre dans un contexte de simulation, approprie et realiste, augmente le niveau d’acquisition des competences des residents et reduit le stress et l’anxiete lors de la realisation de procedures reelles.

INTRODUCTION Adverse events (AEs) in health care are a public health issue. Although mandatory, error disclosure is experienced by health providers as a difficult task. METHODS In this prospective study, the primary objective was to assess performance in disclosing AEs to simulated parents using a validated scale before and after training among a pediatric residents' population. Secondary objectives were to assess correlation with year of residency, sex, and previous experience and to analyze gain in knowledge (theoretical pretest/posttest scores) and satisfaction. Two evaluation simulations (simulation [SIM] 1 and SIM 2) were scheduled at 3-week interval. In the intervention group, mastery learning was offered after SIM 1 including a didactic approach and a training session using role-playing games. For the control group, the course was carried out after SIM 2. Assessments were performed by 2 independent observers and simulated parents. RESULTS Forty-nine pediatric residents performed 2 scenarios of AE disclosure in front of simulated parents. In the intervention group, performance scores on SIM 2 (72.36 ± 5.40) were higher than on SIM 1 (65.08 ± 9.89, P = 0.02). In the control group, there was no difference between SIM 1 and SIM 2 (P = 0.62). The subjective scores from simulated parents showed the same increase on SIM 2 (P < 0.01). There was no correlation with the residents' previous experience or their residency year. There was an increase in self-confidence (P = 0.04) for SIM 2. There was also an increase in posttest theoretical scores (P = 0.02), and residents were satisfied with the training. CONCLUSIONS This study showed the benefits of simulation-based training associated with mastery learning in AE disclosure among pediatric residents. It is important to train residents for these situations to avoid traumatic disclosure generating a loss of confidence of the family regarding physicians and possible lawsuits.

Background One of the primary goals of simulation-based education is to enable long-term retention of training gains. However, medical literature has poorly contributed to understanding the best timing for repetition of simulation sessions. There is heterogeneity in re-training recommendations. Objectives This study assessed, through simulation-based training in different groups, the long-term retention of rare pediatric technical procedures. Methods This multicenter observational study included 107 emergency physicians and residents. Eighty-eight were divided into four groups that were specifically trained for pediatric emergency procedures at different points in time between 2010 and 2015 ( Results There was a significant difference in performance between groups (p p = 0.57). There was no correlation between clinical level of experience and performance (p = 0.39). Conclusion Performance decreased at 6 months after specific training for pediatric emergency skills, with total loss at 4 years after training, irrespective of experience. Repetition of simulation sessions should be implemented frequently after training to improve long-term retention and the optimal rate of refresher courses requires further research.

La demande de chirurgie bariatrique est importante et celle de formation des chirurgiens bariatrique aussi. La formation théorique universitaire, diplomante est associée à des stages au sein d’équipes référentes. La chirurgie bariatrique impose une courbe d’apprentissage qui peut, initialement, être associée à une morbidité plus élevée. Pour limiter l’impact de cet apprentissage, une formation préclinique par simulation peut être proposée. Le but du travail est d’évaluer le réalisme d’un nouveau modèle cadavérique d’enseignement par simulation de la chirurgie bariatrique.

In initial surgical formation and continuing surgical education, simulation has become a compulsory technique. Just as becoming an airplane pilot requires skills, the acquisition of technical skills is essential to becoming a surgeon. The old apprenticeship model "I see, I do, and I teach" is no longer entirely compatible with the socio-economic constraints of the operating room, demands for guaranteeing patient safety, and the compulsory reduction in resident working hours. We propose a new surgical simulation model, using cadavers donated to science that are rendered dynamic with pulsatile vascularization and ventilation. Such models are available for simulation of both open surgery and laparoscopy. Surgery on a human body donated to science makes it possible to accurately reproduce the hand gestures characteristic of surgical procedures. Learning in an appropriate and realistic simulation context increases the level of skills acquired by residents and reduces stress and anxiety when they come to perform real procedures.

BACKGROUND Stress may impair the success of procedures in emergency medicine. The aims were to assess residents' stress during simulated and clinical lumbar punctures (LPs) and to explore the correlation of stress and performance. METHODS A prospective study (2013-2016) was carried out in a pediatric emergency department. A mastery training and subsequently a just-in-time training were conducted immediately preceding each clinical LP. Stress was self-assessed by the Stress-O-Meter scale (0-10). Performance (checklist 0-6 points) and success rate (cerebrospinal fluid with

Introduction For emergency physicians, pediatric emergencies represent rare and challenging situations. Simulation-based training (SBT) is increasingly used in medical education and recommended for implementation in the curriculum and postgraduate training. Objectives The objective of this study was to explore the self-assessment of emergency physicians' and residents' clinical practice in pediatric emergency care after SBT. Methods We surveyed emergency physicians and residents who successfully took a course of Pediatric Emergency Procedures (University of Poitiers, France) between 2010 and 2015. The course included didactics 50% of the time, and simulation the other 50%. According to Kirkpatrick model, 3 levels were approached: satisfaction, learning (knowledge, skills, and attitudes), and changes in clinical practice. The main results are expressed in numbers (percentages). Results One hundred percent of the 46 included emergency physicians and residents were satisfied with the course. Sixty-nine percent agreed with the realism of low-fidelity simulation, whereas 22% disagreed. Ninety-six percent agreed with high-fidelity simulator realism. One hundred percent of responders perceived a gain in knowledge, 98% in practical skill, and 83% in improved self-confidence. Among the clinical practice changes, 91% involved anticipation, 81% procedural skills, 92% algorithms, and 79% communication and teamwork. One hundred percent expressed the wish to repeat simulation sessions at a rate of 2 ± 1 sessions per year. Conclusions Self-assessment of the Pediatric Emergency Procedures university course was very positive. According to the participants, this type of SBT on very specific pediatric emergency cares should be integrated to the emergency resident's curriculum. As regards pediatric emergency care, particularly dealing with low-volume, high-stake procedures, the participants were favorable to further, more regular simulation training.

RESUME La technologie « SimLife » repose sur un module technique, objet d’un brevet international, raccorde a un corps donne a la science Elle lui donne une vascularisation pulsatile et une ventilation, simulant un patient anesthesie au bloc operatoire. Cette innovation est destinee a l’apprentissage selon les principes de la pedagogie par simulation des chirurgiens en formation initiale ou continue. Le realisme du modele, niveau 1 de l’echelle d’evaluation des formations selon Kirkpatrick, a ete valide par l’Ecole Francophone de Prelevement Multiorganes ; elle rend licite la diffusion universitaire de scenarii et de leurs echelles d’evaluation utilisant la technologie « SimLife ». Ceci est possible pour differentes specialites chirurgicales grâce a un reseau numerique sous l’egide du Ministere de l’Enseignement Superieur de la Recherche et de l’Innovation.

BackgroundHand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT).MethodsThe study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge.ResultsIn total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B (P=.04). In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish (P=.003) but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29 (scale of 0–5; PConclusionThis study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.

The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores.Prospective observational study performed as part of a larger randomized controlled trial.Medical simulation laboratory.Forty-eight participants distributed among 12 Emergency Medical System teams.Individual and team performance measures and individual stress response were assessed during a high-fidelity simulation. Technical performance was assessed by the intraosseous access performance scale and the Team Average Performance Assessment Scale; nontechnical performance by the Behavioral Assessment Tool for leaders, and the Clinical Teamwork Scale. Stress markers (salivary cortisol, heart rate, pNN50, low- and high-frequency ratio) were measured both before (T1) and after the session (T2). Participants self-reported stress before and during the simulation, self-confidence, and perception of dissatisfaction with team performance, rated on a scale from 0 to 10.Scores (out of 100 total points, mean ± SD) were intraosseous equals to 65.6 ± 14.4, Team Average Performance Assessment Scale equals to 44.6 ± 18.1, Behavioral Assessment Tool equals to 49.5 ± 22.0, Clinical Teamwork Scale equals to 50.3 ± 18.5. There was a strong correlation between Behavioral Assessment Tool and Clinical Teamwork Scale (Rho = 0.97; p = 0.001), and Behavioral Assessment Tool and Team Average Performance Assessment Scale (Rho = 0.73; p = 0.02). From T1 to T2, all stress markers (salivary cortisol, heart rate, pNN50, and low- and high-frequency ratio) displayed an increase in stress level (p0.001 for all). Self-confidence was positively correlated with performance (Clinical Teamwork Scale: Rho = 0.47; p = 0.001, Team Average Performance Assessment Scale: Rho = 0.46; p = 0.001). Dissatisfaction was negatively correlated with performance (Rho = -0.49; p = 0.0008 with Behavioral Assessment Tool, Rho = -0.47; p = 0.001 with Clinical Teamwork Scale, Rho = -0.51; p = 0.0004 with Team Average Performance Assessment Scale). No correlation between stress response and performance was found.There was a positive correlation between leader (Behavioral Assessment Tool) and team (Clinical Teamwork Scale and Team Average Performance Assessment Scale) performances. These performance scores were positively correlated with self-confidence and negatively correlated with dissatisfaction.

According to the recommendations of HAS in 2014, the learning curve of surgeons can no longer be the same as in the past when they were trained on the patient: ‘never the first time on the patient’...

But La demande de chirurgie bariatrique est importante et celle de formation des chirurgiens bariatrique aussi. La formation theorique universitaire, diplomante est associee a des stages au sein d’equipes referentes. La chirurgie bariatrique impose une courbe d’apprentissage qui peut, initialement, etre associee a une morbidite plus elevee. Pour limiter l’impact de cet apprentissage, une formation preclinique par simulation peut etre proposee. Le but du travail est d’evaluer le realisme d’un nouveau modele cadaverique d’enseignement par simulation de la chirurgie bariatrique. Materiel et methode La simulation en chirurgie impose un realisme tres proche du bloc operatoire : le modele mis en place repose sur un corps frais donne a la science, rendu dynamique avec une vascularisation pulsatile avec du sang simule a 37 °C et une ventilation. Mise en place d’une evaluation du realisme anatomique et chirurgical du modele a l’aide d’un auto-questionnaire et d’une echelle d’evaluation de Likert de 0 a 10. Resultats Un total de 24 participants aux formations specifiques chirurgie bariatrique ont evalues la capacite du modele a etre utilise comme modele d’enseignement a 8,67, le realisme anatomique a 8,75, le realisme global du modele a 8,36 et la satisfaction globale a 8,33. Conclusions L’utilisation du modele cadaverique reperfuse permet de proposer un modele de simulation chirurgicale bariatrique tres realiste, pertinent pour la formation des jeunes chirurgiens.

Resume L’acquisition d’un savoir-faire est indispensable pour devenir chirurgien, de la meme facon que l’on doit devenir competent pour etre pilote d’avion. Le modele du compagnonnage selon Halsted « je vois, je fais, j’enseigne » n’est plus actuellement compatible avec la realite des contraintes socio-economiques du bloc operatoire, de la demande de securite du patient, de la diminution du temps de travail des internes. Dans tous les pays, cela conduit a recourir a la pedagogie par simulation pour la formation des internes en chirurgie. De nombreux modeles sont disponibles : simulateur informatique, animal ou cadavre humain… La dissection cadaverique humaine est depuis longtemps utilisee pour enseigner l’anatomie chirurgicale. La chirurgie sur modele cadaverique humain apporte le plus de fidelite pour le caractere haptique des procedures chirurgicales. L’apprentissage dans un contexte approprie et realiste de simulation augmente le niveau d’acquisition des competences de l’interne et diminue son stress et son anxiete. Nous presentons une technique de perfusion et de ventilation d’un cadavre humain frais qui restore la circulation pulsatile et les mouvements respiratoires du modele.

Summary Introduction Alike becoming a pilot requires competences, acquisition of technical skills is essential to become a surgeon. Halsted's theory on surgical education “See one, do one, and teach one” is not currently compatible with the reality of socio-economic constraints of the operating room, the patient's safety demand and the reduction of residents’ work hours. Materiel and methods In all countries, this brings mandatory to simulation education for surgery resident's training. Many models are available: video trainers or pelvi-trainers, computed simulator, animal models or human cadaver… Human cadaveric dissection has long been used to teach surgical anatomy. Results Surgery on human cadaveric model brings greatest accuracy to the haptic characteristics of surgical procedures. Learning in an appropriate and realistic simulation context increases the level of acquisition of the residents’ skills and reduces stress and anxiety when performing real procedures. Conclusion We present a technique of perfusion and ventilation of a fresh human cadaver that restores pulsatile circulation and respiratory movements of the model.

To demonstrate an effect of 1 year of training using immersive simulations repeated every 6 weeks versus every 6 months to improve the performance of multidisciplinary teams (MDTs) working with children in lifethreatening situations.Randomized controlled trial in 12 MDTs of emergency responders in France. Each MDT consisted of 4 persons: a physician, a resident, a nurse, and the ambulance driver. Six MDTs participated in 9 different high-fidelity simulations of pediatric shock over the course of a year. Six control MDTs were presented with 3 of the experimental group's simulations at 3 time points (starting point, 6 months, and 1 year). Technical performance was assessed with the Team Average Performance Assessment Scale (TAPAS) and an intraosseous (IO) access performance scale. Nontechnical performance assessment instruments were the Clinical Teamwork Scale (CTS) and, for leadership, the Behavioral Assessment Tool (BAT). Progress over time was analyzed by comparing the 2 groups during the 3 simulations they experienced in common.Performance scores rose significantly over the study period in the experimental group (P=.01 for the TAPAS score, P=.008 for IO access, P=.03 for the CTS score, and P=.02 for the BAT score) but did not change in the control group (P=.46 for TAPAS, P=.55 for IO access, P=.62 for CTS, and P=.58 for BAT). All mean (SD) scores were higher in the experimental group than in the control group in the last session: TAPAS, 55.8 ± 6.3 vs 31.2 ± 10.3, P=.01; IO access, 91.7 ± 8.0 vs 62.9 ± 16.2, P=.01; CTS, 63.2 ± 9.3 vs 47.2 ± 13.1, P=.03; and BAT, 72.8 ± 5.1 vs 51.2 ± 14.3, P=.01). The 6-month assessment showed significant between-group differences on 2 technical performance measures (P=.02 for TAPAS and P=.03 for IO access); the experimental group's scores were higher. We also observed close correlations between the performance of the leader and the group on both nontechnical (rho0.9) and technical (rho0.7) assessments.Simulation-based training should be repeated more than 3 times per year. Our findings suggest the advisability of repeating simulations of infrequent, high-risk scenarios every 6 weeks to improve all performance scores and guarantee acceptable technical and nontechnical performance throughout the year.Demostrar el efecto de simulaciones inmersivas repetidas cada 6 semanas, en comparación con su repetición cada 6 meses, sobre la evolución del rendimiento de un equipo multidisciplinar en situaciones pediátricas de riesgo vital durante un año.Ensayo controlado aleatorizado unicéntrico que incluyó 12 equipos multidisciplinares (EMD) del servicio de emergencias médicas (SEM) de Francia compuesto por 4 miembros (médico/residente/enfermera/conductor de ambulancia). En el grupo experimental, 6 EMD se enfrentaron a 9 escenarios diferentes de shock pediátrico en simulaciones de alta fidelidad durante un año. En el grupo de control, 6 EMD tuvieron 3 escenarios comunes a los del grupo experimental (inicial, intermedio –después de seis meses– y final –después de un año–). Se evaluó el rendimiento técnico, mediante la Team Average Performance Assessment Scale (TAPAS) y la escala de rendimiento de acceso intraóseo (IO), y el no técnico, mediante la Clinical Teamwork Scale (CTS) y la Behavioral Assessment Tool (BAT) para los líderes. Se analizó la evolución en el tiempo y se compararon los dos grupos durante los simulacros comunes.Las puntuaciones del rendimiento se incrementaron significativamente a lo largo del tiempo en el grupo experimental (p = 0,01 para TAPAS, p = 0,008 para IO, p = 0,03 para CTS y p = 0,02 para BAT) en comparación con el grupo control (p = 0,46 para TAPAS, p = 0,55 para IO, p = 0,62 para CTS y p = 0,58 para BAT). Todas las puntuaciones fueron más altas en el grupo experimental que en el grupo control durante la última sesión (55,8 ± 6,3 vs 31,2 ± 10,3, p = 0,01 para TAPAS; 91,7 ± 8,0 vs 62,9 ± 16,2, p = 0,01 para IO, 63,2 ± 9,3 vs 47,2 ± 13,1, p = 0,03 para CTS; y 72,8 ± 5,1 vs 51,2 ± 14,3, p = 0,01 para BAT). Se observó una diferencia significativa en las dos escalas de puntuación de rendimiento técnico (p = 0,02 para TAPAS y p = 0,03 para IO) a favor del grupo experimental durante la sesión intermedia. También hubo una estrecha relación entre los rendimientos del líder y del equipo, tanto para el rendimiento no técnico (rho0,9) como el técnico (rho0,7).La formación basada en la simulación debería repetirse más de tres veces al año. Nuestros resultados favorecen la repetición de una situación poco común de alto riesgo cada seis semanas para mejorar todas las escalas de puntuación de rendimiento y garantizar puntuaciones aceptables de rendimiento técnico y no técnico durante un año.

BackgroundSimulations in healthcare reproduce clinical situations in stressful conditions. Repeated stress exposure might influence the learning process in simulation as well as real-life.Objectives1) To record heart rate and heart rate variability evolution during one-day simulation over one year; 2) To analyze the effect of repetitive high-fidelity simulations on the risk of post-traumatic stress disorder.Study designSingle-center, investigator-initiated RCT. 48 participants were randomized in 12 multidisciplinary teams of French Emergency Medical Services to manage infant shock in high-fidelity simulations. In the experimental group, 6 multidisciplinary teams were exposed to 9 different simulation sessions over 1 year. In the control group, 6 multidisciplinary teams participated in only 3 simulation sessions, in common with those of the experimental group (initial, intermediate after 6 months, and finally after 1 year). Heart rate (HR) and heart rate variability (HRV) were analyzed on a 24-hour Holter from the day prior to simulation until the end of simulation. Questionnaires of Impact of Event Scale-Revised at 7 days and Post-traumatic Check-List Scale at 1 month were used to detect possible post-traumatic stress disorder in participants. pResultsStress increased during each simulation in the two groups. After analysis on the 24-hour period, there was no significant difference between the two groups during the initial simulation session in terms of heart rate and heart rate variability. In the 24-hour period of the intermediate and final simulation sessions, the level of stress was higher in the control group during the diurnal (p = 0.04) and nocturnal periods (p = 0.01). No participant developed post-traumatic stress disorder after the 72 simulation sessions.ConclusionsDespite the stress generated by simulation, the more the sessions were repeated, the less were their repercussions on the daily lives of participants, reflected by a lower sympathetic activity. Moreover, repetition of simulations did not lead to post-traumatic stress disorder.Trial registrationClinicalTrials.gov NCT02424890.

Les modalites de l’enseignement anatomique est discutee mais constitue un element important de la formation des futures professionnels en medecine. Des outils numeriques procurent actuellement des modeles anatomiques, cependant leur utilisation en education medicale reste limitee. La dissection cadaverique humaine continue d’etre un outil essentiel dans l’apprentissage de l’anatomie dans la formation medicale. L’enseignement et la recherche en anatomie est basee sur le Don du Corps a la science. Plus encore, le cadavre humain reste une reference pour la simulation chirurgicale en raison de son realisme anatomique et tissulaire.

International audience; Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men

An anatomically based assessment scale of handwashing quality with alcohol-based hand rub was designed. Contents of the scale divided each hand into 40 zones. Psychometric measurements were studied in 30 participants (120 hand sides). The scale was both valid (Cronbach α: 0·83 dorsal side and 0·73 palmar side) and reproducible (linear regression R2, 0·91; intraclass correlation coefficient, 0·99).

This case report presents a 14-month follow-up of a case of Hashimoto's encephalopathy (HE) treated with im- munoglobulins for the first time in an 11-year-old adolescent. The diagnostic criteria were: (a) a drop in school performance and psychological withdrawal for several weeks, (b) an euthyroid state with a past medical history of autoimmune thyroiditis treated with thyroxin, (c) a first episode of tonic-clonic seizure with clinical and electroencephalographic (EEG) findings of encephalopathy, (d) a high serum concentration of antithyroglobulin and antithyroid peroxidase antibodies, (e) negative results of cerebrospinal fluid and blood studies for viral and bacterial infections. Her acute epileptic symptoms resolved with clonazepam. Immunoglobulin therapy (400 mg/kg/day for 5 days every 6 weeks) was given for 14 months. Her cognitive function was greatly improved but a light-to-mild cognitive deficit remained. An EEG performed at her 14-month follow-up showed a correlation with her cognitive improvement. We suggest that immunoglobulin can be used as a first-line therapy in HE to avoid side effects or relapses as has been described with long-term steroid therapy.

Background. Debriefing is a fundamental step in simulation, particularly in the medical field. Simulation sometimes even serves as a pretext for debriefing. Most often, debriefing takes place easily, producing a qualitative feedback and an optimal learning transfer. But sometimes, the facilitator faces difficulties. An unproductive debriefing can be described as follows: the debriefing of a clinical simulation session is unproductive when facilitators or learners perceive the occurrence of an obstacle that has hindered the learning process. Objectives & method. Considering the difficulties encountered in this type of debriefing, we believe it is necessary to investigate the topic in depth in order to bring out some theoretical principles. Based on a Nominal Group Technique involving the authors of this article, this project aimed at drawing up and proposing informed recommendations for ensuring productive debriefing in simulation-based education in healthcare. Results. The authors make the following recommendations: Reflect on your own performances as an instructor (asking for feedback from the learners and peers, and being appropriately trained as an instructor who can facilitate learning) Establish simulation ground rules (preparing and briefing the learners before the simulation experience, controlling the timing of the simulation session and the quality of the scenarios) Manage unexpected events and intended learning objectives by using a confederate during scenarios. Respect the steps of the debriefing process and good practice recommendations regarding learning psychology. Maintain the balance between emotion and teaching by decontextualizing the experience from the participants during the debriefing. Manage the input from the peers during the debriefing so they do not antagonise the learning process. Conclusion. Six key recommendations are proposed. They have been deemed as core skills required of every simulation facilitator to prepare for productive debriefing and so the set learning objectives of a simulation session can be achieved successfully.

Background Emergency Medicine (EM) is a new specialty in France. Since 2004, the training is validated after obtaining an additional specialized diploma in EM. No studies have evaluated the training so far in France.

This chapter has intentionally been included in this pocket book with blank pages for you to record key personal learning events as a debriefer, whether they are linked to model or exemplary debriefings in which you or your co-debriefer amazingly disentangled interesting learning gaps, closed a performance gap, or allowed for a difficult situation to develop through minimalistic environment orientation, misleading scenario briefing, or inadequate management of the learners’ input in the debriefing. These are learning experiences that you may eventually forget over time and are really worth writing down, so you may remind yourself in the future and share these valuable experiences with others you may eventually mentor to become the next generation of debriefers. We advise you not to write any names or clear identifiers in this diary as the learning diary should be more about the actual events rather than the individuals involved. The first section of this chapter is for this pocket book’s owner to describe who they are as a professional and as a debriefer, hence providing a context for their debriefing practice and maybe identify gaps. The second and third sections are the platform for a personal reflective plus/delta analysis of their debriefing practice encompassing all key phases for which they need to develop mastery to become a proficient and effective debriefer. In the fourth section, the book’s owner is encouraged to seek and document feedback from peer debriefers, mentors, and learners and reflect upon that valuable information to refine their debriefing practice, while Sect. 4.5 is the place to describe and reflect on key debriefer learning episodes. Finally the last two sections are, respectively, to write down newly identified and valuable debriefing references and resources but also provide cognitive aids that can help guide the briefing and debriefing phases of a simulation session.

This section starts with a list of general debriefing tips and advice about preventing and handling difficult debriefing situations that are applicable to most circumstances and will benefit simulation educators. It then addresses a series of commonly faced issues or queries that are often discussed in the simulation community. Whether or not to play back the video recording in the debriefing process is often debated, and research is still inconclusive as there are so many possible confounding factors. Similarly, insight into the use of within-scenario debriefing is provided with support from relevant references. An additional approach that can be perceived as being a supportive measure for learners new to simulation-based education followed by debriefing is the provision of a complete demonstration cycle, live or by playing back a recording of the whole process. On the other hand, a real dilemma sometimes faced by simulation educators relates to the mutual promise of confidentiality in relation to simulation session with learners and the potentially very concerning performance or behaviour of a participant. An introduction to rapid cycle deliberate practice in relation to how it affects debriefing is presented. Finally we briefly review the current debriefing assessment tools.

Debriefing is a crucial aspect of simulation-based educational interventions in healthcare. This section of this pocket book aims to clarify what debriefing is really about and why it is such an important aspect of the learning process for everyone involved: participants, simulation observers, and facilitators alike. It also places emphasis on the aspect of briefing as a phase that sets foundation for a successful debriefing so learners understand the approach adopted and what will be expected from them during that phase and its purpose. The many other critical aspects around the practicalities of debriefing, which are “the what, who, when, where, and how to debrief”, are individually explored to provide clear advice with support of relevant references. Of notable importance in this section is the clear description of the most common education performance review approaches (directive feedback, plus/delta, after action review, structured debriefing, etc.) so the most appropriate one can be selected depending on various parameters such as the learning objectives being addressed, the level of expertise of the participants, and the time available.

This section of the pocket book covers the actual facilitation aspect of the debriefing based on a model including introduction, reactions, analysis, summary, and closing/conclusion. It presents the investigational techniques that can be used during the debriefing analysis phase such as the non-judgemental debriefing, the good-judgement debriefing, and the advocacy-inquiry approach. These various approaches aim to demonstrate respect for the participants’ actions and decisions at the same time as more or less probing into the rationale or mental frame behind those in order to close the identified performance gaps, which can be cognitive, behavioural, or technical. The advocated approach that can be used involves individually “repackaging” the identified deficiencies, generalising or decontextualising those, and asking learners for solutions, which forces them to actually fill those performance gaps and promotes deeper learning. The summary phase helps reviewing the important learning points or “take-home messages”. It is a way for the debriefer to ensure that learners actually recall the solutions of all the performance gaps, which have been closed through the debriefing, and hence that it has been effective (at least in terms of immediate recall). The closing or conclusion phase is more general and provides a further opportunity for learners to express concerns or reveal actual needs regarding additional practical skills training or access to recommended reading material to further their knowledge. It is also a key phase during which to thank the participants for their engagement and reminding them about the confidentiality aspect. Finally some useful debriefing sentences and questions relating to each of the debriefing phases are provided as a guide for debriefers.

Introduction/Objectifs Le prelevement multi-organe (PMO) est un maillon indispensable dans la chaine de la transplantation realise chez plus de 34 000 donneurs par annee dans le monde [1] . La technique est standardisee mais la courbe d’apprentissage, liee au debut d’experience d’une majorite des chirurgiens preleveurs, se traduit par un allongement de la duree d’extraction qui a des consequences sur les resultats de la greffe [2] , [3] . Nous proposons l’evaluation du niveau 1 du modele de Kirkpatrick [4] de la formation EFPMO dont l’apprentissage theorique est couple a un enseignement par simulation sur SimLife depuis 2 ans. Methode Une simulation en equipe des apprenants sur corps reperfuses et reventiles grâce a la technologie Simlife [5] etait proposee au milieu de la formation. En fin de session, un questionnaire portant sur l’experience de l’apprenant, la fidelite anatomique du modele et les competences acquises, gradues selon une echelle de Likert de 1 a 10 etait propose. Les resultats sont rapportes en moyenne (ecart-type). Resultats Entre 2017 et 2018, 93 apprenants organises en 24 equipes ont participe a l’etude. Le score de satisfaction globale etait 8,91(1,22), la correspondance anatomique du modele SimLife 8,37(1,19) et le degre de realisme 7,86(1,29). Il n’y avait pas de differences significatives suivant l’annee de formation de l’apprenant. On observait un score de competences acquises plus important chez les apprenants sans experience prealable en tant qu’operateur principal. Conclusion Le modele anatomique et dynamique Simlife est un outil permettant d’obtenir une bonne adherence des apprenants a une seance de simulation en prelevement multi-organe. Il permet d’ameliorer la connaissance anatomique et la confiance dans la technique du PMO, avec un effet plus marque chez les apprenants sans experience prealable comme operateur.

Resume L’objectif de cette etude etait de presenter les concepts de la simulation et les modalites de son utilisation en pediatrie. La simulation dans le domaine medical est une methode d’apprentissage peu developpee en Europe et encore peu repandue dans le domaine pediatrique en France. Les motivations pour la simulation sont tout d’abord ethiques : « Jamais la premiere fois sur le patient ! ». La simulation permet aussi des benefices dans l’apprentissage de la communication et l’acquisition de connaissances theoriques. Elle est un moyen essentiel pour maintenir la securite du patient en limitant le risque d’erreurs. Elle concerne l’apprentissage de gestes techniques requerant des modeles les plus realistes possibles, mais aussi celui de la communication et de la gestion d’une crise en equipe utilisant souvent des mannequins haute-fidelite (HF). Il est egalement possible de l’utiliser pour l’apprentissage de l’annonce d’une mauvaise nouvelle, en faisant appel a des acteurs de theâtre. L’acquisition de competences en simulation ne peut se realiser que lors d’un debriefing pendant lequel le superviseur joue le role d’un facilitateur. L’evaluation de la simulation est indispensable. Elle repose sur celle du realisme des modeles et du degre de performance d’un geste technique ou d’une prise en charge en equipe. Ce dernier ne peut etre evalue objectivement qu’au moyen d’outils valides. La simulation va devenir une methode d’apprentissage incontournable en medecine.

Summary Background Xeroderma pigmentosum type C (XP-C) is a rare, autosomal, recessive condition characterized by the association of various clinical manifestations mostly involving the skin and eyes. Objectives To evaluate the clinical manifestations in a homogeneous, genetically characterized cohort of patients with XP-C. Methods All patients with XP-C, which was confirmed genetically or by unscheduled DNA synthesis, from the registry of our department and from the French association of patients ‘Les Enfants de la Lune’ were contacted. During a planned consultation, clinical information was collected using a standardized case-record form. Results In total, 31 patients were seen. The mean age at diagnosis was 2·95 years; skin symptoms started at a mean age of 1·49 years. Among the patients, 52% had relatively short stature, with a height-for-weight z-score below −1 SD; 62% showed pyramidal syndrome and 45% had photophobia and/or conjunctivitis. Four patients had several pyogenic granulomas. Twenty-four patients (77%) had skin cancer. The mean age of onset of the first skin cancer was 4·76 years (range 2–14·5 years). Basal-cell carcinoma was the most frequent cancer. Melanomas were rare and mostly desmoplastic. Multinodular thyroid was the most frequent internal tumour. Conclusions Our data highlight several new aspects of XP-C. Patients with XP-C are at risk of developing pyogenic granulomas, desmoplastic melanomas and multinodular thyroid. Involvement of the central nervous system is frequent, but its mechanism remains unclear. The relatively short stature of the patients needs further investigation in order to be explained. XP-C is not only a cancer-prone disorder but is also a polysystemic disorder.

International audience; Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children

Background Chest tube insertion is required for most cases of traumatic pneumothorax. However, this procedure entails risks of potentially life-threatening complications. A “surgical” approach is widely recommended to minimize these risks. Simulation-based education has previously been used in surgical chest tube insertion, but not been subjected to rigorous evaluation. Methods The primary objective was to evaluate the success rate of surgical chest tube insertion in a task trainer (previously published). Secondary objectives were to assess performance with a performance assessment scale (previously designed), to measure the time of insertion, and to seek out a correlation between the learner’s status, experience, and performance and success rate. Participants were surveyed for realism of the model and satisfaction; 65 participants (18 residents, 47 senior physicians) were randomized into SIM+ or SIM− groups. Both groups received didactic lessons. The SIM+ group was assigned deliberate practice on the model under supervision. Both groups were assessed on the model 1 month later. Results There was no difference between the SIM+ (n = 34) and SIM− (n = 31) groups regarding status (p = 0.44) or previous surgical insertion (p = 0.12). Success rate was 97 % (SIM+) and 58 % (SIM−), p = 0.0002. Performance score was 16.29 ± 1.82 (SIM+) and 11.39 ± 3.67 (SIM−), p = 3.13 × 10−8. SIM+ presented shorter dissection time than SIM− (p = 0.047), but procedure time was similar (p = 0.71). Status or experience was not correlated with success rate, performance score, procedure time, or dissection time. SIM+ gained more self-confidence, judged the model more realistic, and were more satisfied than SIM−. Conclusions Simulation-based education significantly improved the success rate and performance of surgical chest tube insertion on a traumatic pneumothorax model.