Vincent Grant

The University of Calgary · Department of Paediatrics

Introduction Emergency medicine (EM) postgraduate medical education in Canada has transitioned from traditional time-based training to competency-based medical education (CBME). In order to promote residents through stages of training, simulated assessments are needed to evaluate residents in high-stakes but low-frequency medical emergencies. There...

Simulation-based education (SBE) literature emphasizes debriefing frameworks, with little discussion on developing SBE competencies. Introduced in 2005 by the Royal College of Physicians and Surgeons of Canada, Entrustable Professional Activities (EPAs) offer a robust curriculum development and assessment process for workplace-based assessments. Th...

Historically simulation-based education (SBE) has primarily focused on program development and delivery as a means for improving the effectiveness of team behaviours; however, these programs rarely embed formal evaluations of the programs themselves. Logic models can provide simulation programs with a systematic framework by which organizations and...

An amendment to this paper has been published and can be accessed via the original article.

Healthcare organizations strive to deliver safe, high-quality, efficient care. These complex systems frequently harbor gaps, which if unmitigated, could result in harm. Systems-focused simulation (SFS) projects, which include systems-focused debriefing (SFD), if well designed and executed, can proactively and comprehensively identify gaps and test...

Background The Alberta Health Services’ Provincial Simulation Program (eSIM) is Canada's largest simulation program. The eSIM mobile simulation program specializes in delivering simulation-based education (SBE) to rural and remote communities (RRC). During the COVID-19 pandemic, a quality improvement project involving rapid cycle in situ virtually-...

Abstract Many simulation programs have recently shifted towards providing remote simulations with virtual debriefings. Virtual debriefings involve educators facilitating conversations through web-based videoconferencing platforms. Facilitating debriefings through a computer interface introduces a unique set of challenges. Educators require practica...

Abstract Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for bo...

Context Although distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback when compared with conventional annual CPR train...

Statement: Despite the critical importance of debriefing in simulation-based education, existing literature offers little guidance on how debriefing skills develop over time. An elaboration of the trajectory through which debriefing expertise evolves would help inform educators looking to enhance their skills. In this article, we present a new con...

Objectives A large proportion of all emergency visits for paediatric patients across Canada are to general emergency departments (EDs). These centres may not be adequately equipped to provide optimal care for high acuity paediatric emergencies. The objective of this study was to determine paediatric readiness for general EDs and urgent care centres...

Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception t...

Statement: Modern healthcare organizations strive for continuous improvement in systems and processes to ensure safe, effective, and cost-conscious patient care. However, systems failures and inefficiencies lurk in every organization, often emerging only after patients have experienced harm or delays. Simulation and debriefing, focused on identify...

Abstract The debriefing is an essential component of simulation-based training for healthcare professionals, but learning this complex skill can be challenging for simulation faculty. There are multiple competing priorities for a debriefer’s attention that can contribute to a high mental workload, which may adversely affect debriefer performance an...

Objective: We aimed to describe the differences in workload between team leaders and CPR providers during a simulated pediatric cardiac arrest, to evaluate the impact of a CPR feedback device on provider workload, and to describe the association between provider workload and the quality of CPR. Methods: We conducted secondary analysis of data fr...

Objectives: Guideline compliant CPR is associated with improved survival for patients with cardiac arrest. Conventional Basic Life Support (BLS) training results in suboptimal CPR competency and skill retention. We aimed to compare the effectiveness of distributed CPR training with real-time feedback to conventional BLS training for CPR skills in...

Introduction: The purpose of this study is to determine if the introduction of a pre-arrival and pre-departure Trauma Checklist as a cognitive aid, coupled with an educational session, will improve clinical performance in a simulated environment. The Trauma Checklist was developed in response to a quality assurance review of high-acuity trauma acti...

Pediatric patients with trauma pose unique challenges, both practical and cognitive, to front-line care providers. The combination of anatomic, physiologic, and metabolic factors leads to unique injury patterns with different approaches and responses to treatment compared with adults. A similar traumatic mechanism can lead to slightly different int...

Statement: Professional development opportunities are not readily accessible for most simulation educators, who may only connect with simulation experts at periodic and costly conferences. Virtual communities of practice consist of individuals with a shared passion who communicate via virtual media to advance their own learning and that of others....

Simulation-based educational activities are happening in the clinical environment but are not all uniform in terms of their objectives, delivery, or outputs. While these activities all provide an opportunity for individual and team training, nuances in the location, timing, notification, and participants impact the potential outcomes of these sessi...

Context: Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifie...

Objectives: Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validat...

Statement: Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching of...

Healthcare simulation continues to expand in a wide variety of venues, including undergraduate and postgraduate education as well as continuing professional development. Combined with scenarios designed with clear learning objectives in mind, debriefing remains a cornerstone of simulation-based education. A debriefing framework structures the conve...

Objectives: To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Design: Multicenter prospective interventional study. Setting: Four tertiary-care children's...

Statement: Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of s...

The Promoting Excellence and Reflective Learning in Simulation (PEARLS) blended approach to debriefing encourages educators to purposefully merge various debriefing strategies to tailor discussion to learner needs and learning context. While debriefing is a key component to simulation-based education, few resources exist to promote implementation o...

Statement: Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of...

This chapter discusses how pediatric simulation should evolve in the future to best address the needs of pediatric patients and their families. The chapter specifically highlights several key areas that offer opportunity for the future: (1) optimizing simulation resources within and between programs to enhance productivity, (2) integration of simul...

Effectively designed and implemented simulation-based education (SBE) programs have the power to change the behavior of people and the systems they work in. This chapter outlines critical elements of a well-designed SBE program, and some of the theoretical considerations that underpin the recommendations given. Careful consideration is given to the...

Statement: Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing...

The pediatric emergency medicine (PEM) environment is well suited for simulation-based activities, be they educational interventions for PEM learners, evaluations of the interface between health providers and the environment that they work in, or research investigations using simulation as a tool to answer specific clinical questions. As such, PEM...

The role of simulation-based education in training trauma teams is growing, and debriefing is a critical component of this educational modality. With increasing evidence to support the role of debriefing, more trauma programs are integrating structured debriefings into their trauma training programs. This chapter will: (1) discuss the body of liter...

This is a practical guide to the use of simulation in pediatric training and evaluation, including all subspecialty areas. It covers scenario building, debriefing and feedback, and it discusses the use of simulation for different purposes: education, crisis resource management and interdisciplinary team training, competency assessment, patient safe...

Introduction: Human errors occur during resuscitation despite individual knowledge of resuscitation guidelines. Poor teamwork has been implicated as a major source of such error; therefore interprofessional resuscitation teamwork training is essential. Hypothesis: A one-day team training course for pediatric interprofessional resuscitation team mem...

Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardia...

Statement: Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many option...

This Viewpoint elaborates on the use of simulation to educate health care professionals and improve quality and patient safety within pediatric institutions. Simulation, defined as “the imitation of the operation of a real-world process or system over time,”1 is a powerful tool that has been adapted for use in health care. To date, the use of simu...

Statement: As part of simulation-based education, postevent debriefing provides an opportunity for learners to critically reflect on the simulated experience, with the goal of identifying areas in need of reinforcement and correcting areas in need of improvement. The art of debriefing is made more challenging when 2 or more educators must facilita...

Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions , and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardia...

The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF)...

Objectives: To examine the effect of simulation-based seizure management teaching on improving caregiver competence and reported confidence with managing seizures. The authors hypothesized that simulation-based education would lead to a higher level of demonstrated competence and reported confidence in family members and caregivers. Simulation has...

Abstract This study provides information for educators about levels of competence in teams comprised of medical, nursing and respiratory therapy students after receiving a simulation-based team-training (SBT) curriculum with and without an additional formalized 30-min team-training (TT) module. A two-group pre- and post-test research design was use...

Objectives: Debriefing is a common feature of technology-enhanced simulation (TES) education. However, evidence for its effectiveness remains unclear. We sought to characterise how debriefing is reported in the TES literature, identify debriefing features that are associated with improved outcomes, and evaluate the effectiveness of debriefing when...

Introduction/Background: Debriefing is a common feature of technology-enhanced simulation (TES) education. Evidence for its effectiveness, however, remains unclear. The authors sought to characterize how debriefing is reported in the TES literature, evaluate the effectiveness of debriefing in TES and identify features of debriefing that are associa...

Purpose: Interprofessional simulation-based team training is strongly endorsed as a potential solution for improving teamwork in health care delivery. Unfortunately, there are few teamwork evaluation instruments. The present study developed and tested the psychometric characteristics of the newly developed KidSIM Team Performance Scale checklist....

Pediatrics is a clinical domain extremely well suited for simulation-based training. Pediatric resuscitation opportunities are rare, although pediatric patients are likely to do well if resuscitated appropriately. As such, amplifying the experience in acute care pediatrics with simulation-based training is an evolving necessity in both training pro...

Objectives: The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. Methods: A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in ped...

Introduction: Existing attitude scales on interprofessional education (IPE) focus on students' attitudes toward the concepts of teamwork and opportunities for IPE but fail to examine student perceptions of the learning modality that also plays an important role in the teaching and learning process. The purpose of this present study was to test the...

It is critical that competency in pediatric resuscitation is achieved and assessed during residency or post graduate medical training. The purpose of this study was to create and evaluate a tool to measure all elements of pediatric resuscitation team leadership competence. An initial set of items, derived from a literature review and a brainstormin...

The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algo...

The objective of this study was to assess the incidence, outcomes, and costs of trauma-related nosocomial bloodstream infection (BSI). This was a 3:1 matched cohort study in patients with severe trauma [defined by an injury severity score (ISS)≥12] admitted to adult or paediatric regional trauma centres over a four-year period. Case patients with n...

Previous studies have reached a variety of conclusions regarding the effect of gender on performance in objective structured clinical examinations (OSCEs). Most measured the effect on students' overall OSCE score. The authors of this study evaluated the effect of gender on the scores of specific physical examination OSCE stations, both "gender-sens...

Educational programs dedicated to pediatric trauma are either not available or comprehensive. Pediatric trauma is thus managed by a range of specialists with training in a variety of related fields. Post-certification fellowships in pediatric medicine all mandate education in the assessment and management of the injured child. The purpose of this s...

Although trauma is associated with major acute morbidity and mortality, its long-term outcome is less well defined. We sought to define the rate of readmission to hospital and long-term mortality of victims of major trauma. All Calgary Health Region residents presenting to the regional trauma program with an injury severity score (ISS) > or = 12 be...

An increased incidence of severe injury due to falls from buildings (FFB) is reported in the rural area of northern Israel. This makes FFB, and motor vehicle collision (MVC) the two leading causes of severe paediatric trauma. A single-centre, age-sex matched comparison analysis of the two mechanisms of injury was conducted. Children involved in MVC...

Binge Drinking has been argued to be the number one public health hazard and the primary source of preventable morbidity and mortality for the the more than 6 million college students in the United States. Binge drinking often begins in adolescence and continues into young adulthood. Recent estimates indicate that 1 in 5 adolescents and 1 in 2 coll...

This study uses population-based estimates to assess the sensitivity and representativeness of an injury surveillance system using a 1-year population-based approach. Data from the Ottawa Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) site (Children's Hospital of Eastern Ontario) were compared with those from six expansion site...

Recent changes in the culture of medical education have highlighted deficiencies in the traditional apprenticeship model of education, and emphasized the need for more experiential modalities of learning. Simulations, which are scenarios or environments designed to closely approximate real-world situations, have recently found their way into the me...

OBJECTIVE To determine the reasons for unscheduled return visits in patients with presumed acute viral gastroenteritis and attempt to identify potential prevention strategies. METHODS A retrospective chart review of all patients seen in the Emergency Department of the Children's Hospital of Eastern Ontario from February to June 2002, with a discha...

Following the launch of a publicly funded influenza immunization program for all residents of Ontario over the age of 6 months, we evaluated 203 parents of children who presented to our emergency department between January and March of the following year (2001). Overall, 54 (27%) of the children had been vaccinated. Parents of non-immunized childre...

In this study, the possible role of the retinal enkephalin system in form-deprivation myopia (FDM) in the chick eye was investigated. Daily intravitreal injection of the nonspecific opiate antagonist naloxone blocked development of FDM in a dose-dependent manner, while injection of the opiate agonist morphine had no effect at any dose tested. The E...