PosterPDF Available

"Nursing simulation education current and future perspective in middle income countries"

September 2022

September 2022

Conference: 7th Swiss Conference on Standardized Patients and Simulation in Health Care (SPSIM)"Back to the future – From digital revolution to evolution" — 31 August to 2 September 2022
At: CHUV Rue du Bugnon 21 1011 Lausanne

Authors:

Fatjona Kamberi

Universiteti Vlores

Alida Ramaj

University of Cologne

"Nursing simulation education current and future perspective in middle-income countries" Nursing Education internationally has shown increased use of simulation and immersive education as a state-of-the-art learning process that helps students to gain and foster the clinical experience in a safe environment. Different studies have demonstrated that nursing students are satisfied with this learning approach. While nursing faculties in low and middle-income countries with fewer resources are trying to develop their simulation centers to improve nursing education and the quality of care provided globally. A short web-based survey was carried out among Albanian nursing educators to assess current capacities and their training education needs for simulation education. 31% of participants do not feel at all familiar with the simulation education approach. 54% have expressed neutrality in relation to didactic skills in relation while 52% have reported not having enough knowledge of simulation education and clarity in relation to the stages of educational framework simulation. 93% expressed the need for academic training courses for simulation education methodology in teaching. The mentioned needs were in the function of quality and competitive nursing teaching and learning as well as the advantages of the rapid integration of nursing students into the global labor market. Designing a basic training curriculum for staff related to nursing education simulation is recommended.

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7th Swiss Conference on

Standardized Patients and

Simulation in Health Care

(SPSIM)

"Back to the future – From digital

revolution to evolution"

—

31 August to 2 September 2022

Table of contents Welcome

Healthcare professionals' education has relied more and

more on simulation practice in the past years. Challenges,

such as less internship placements in hospitals or the

pandemic, have made us, educational and healthcare

institutions, increase our use of simulation pedagogy.

During SPSIM 2022, we are aiming at sharing our

experiences and learnings from those challenges and

discuss how simulation can help us. Dierent modalities

of this pedagogical method can be used, from skills

training, immersive simulations and/or virtual reality.

Thanks to technology, virtualization of learning can

occur and hopefully, we will share positive outcomes

from practicing virtual learning experiences to develop

competencies and achieve learning objectives.

We really hope that you will take lots of usable

information back to your institution, as well as to be able to

network with colleagues who face similar challenges to yours.

Kind regards.

Juan Muro

President of SPSIM

Welcome

Conference venue

Program

Conference dinner

General & contact information

Sponsors

CAE Healthcare GmbH

www.caehealthcare.com

Erler Zimmer GmbH & Co. KG

www.erler-zimmer.de

Dräger Schweiz AG

www.draeger.com

Gold

Silver

Bronze

Conference language

The ocial conference language is English. Workshops in German and French

are permitted. They will be clearly mentioned in the program.

Wi-Fi connexion

Participants

1. Connect your mobile device with Wi-Fi "PUBLIC-CHUV"

2. Follow the SMS instructions

Members of other universities

The "EDUROAM" (education roaming) Wi-Fi is a secure, worldwide internet

access for the international academic community. With eduroam, students and

employees of the participating educational institutions (universities, colleges

and other educational institutions) have free internet access. You can use the

Wi-Fi infrastructure of participating institutions with the access data of the

home network.

You can access with the email address and password of your home

educational institution.

Attending the event online ?

You will nd all Webex links to connect to the conference on this page :

https://with-simulation.ch/spsim-2022/online-participation/

Help needed ?

CHUV IT Hotline, +41 21 314 61 22 (9 am to 5 pm)

Information for speakers

If you are making a short communication, presenting a poster or leading a

workshop, please bring your presentation les to the room 15 minutes ahead

of time on a USB key; assistants will directly upload it on the computer.

Contact

Should you have any query or problem throughout the conference days, do not

hesitate to contact us : orgspsim2022@hesav.ch

1514

Francine Viret holds a PhD in Humanities. She has extensive experience in

the eld of mediation and conict resolution. For ten years, she has been the

coordinator of the simulated patient program at Lausanne Universit y School

of Medicine (UNIL). She has a particular interest in the empowerment of

simulated patients and their potential contribution to medical education

and the development of improved clinician-patient relations.

Dr. Tolks studied health promotion and health management at the University of

Magdeburg-Stendal and completed his doctorate at the LMU Munich Hospital.

His research focuses on the eld of digital teaching and learning methods,

articial intelligence in medicine, digital health communication and the eld of

serious games and gamication to promote learning and health.

Beside her clinical duties and pre/post grad teaching activities, Karen Lister

works for the CIS (Interprofessional Simulation Center) as a SP trainer for the

faculty of medicine.

Standardized Patients in exceptional circumstances : Pandemic workarounds

that are here to stay and how SP are not tools to use but experts to employ.

The pandemic has forced our simulated patient programmes to adapt

rapidly, in order to full the needs of our health professionals and students.

We have witnessed an incredibly fast development of video consultations,

which had already been showing promise beforehand. Preparing our SP

for virtual meetings and debriengs revealed some specic issues. These

observations were made by people trained to be able to take a posture of

meta-communication, in order to provide feedback. We need to conrm

these obser vations with more research and, if validated, reinject them into

our training programs, thereby further enhancing our progress in remote

consultation between patients and healthcare workers.

More generally, working with SP and integrating their contributions

to the subjects that are of interest to them, like diversity, gender issues,

representation, can only be benecial for our eld. It should be supported by

the resources which lead to integration into our training programs.

Serious Games and Gamication for Health : Why should we be using them

more, why aren't we already and how would we be doing that anyway ? A

serious session to be enjoyed.

The use of games to impart knowledge and change behaviour has accompanied

people since the beginning of human history. Gaming remains an integral part

of culture today and approximately half of the population plays computer

games at least occasionally. The range of topics of playful approaches spans

from Serious Games (the use of games with a pedagogical approach) to

Gamication (the use of game elements in non-game concepts) (Deterding et

al. 2011, Tolks et al. 2018, Sailer & Homner 2020).

The lecture describes the theoretical foundations and possible

application scenarios of game-based elements in medical education. First, the

historical lines of development are considered and the theoretical foundations

and current studies are explained before the individual game elements are

considered in more detail. The advantages and disadvantages as well as an

outlook for the development of serious games and gamication are discussed.

Some application cases in medical education as well as tips for the use of

gamied approaches will be presented (Tolks & Sailer 2021).

Francine Viret

SP program Coordinator

Lausanne University School of Medicine (UNIL)

Dr. Daniel Tolks

Postdoctoral Researcher

WG Digital Medicine, Faculty of Medicine, Bielefeld University

Karen Lister

Chief resident in general internal medicine

University hospitals of Geneva (HUG)

Keynote speakers

1716

As part of a postgraduate programme, Tanja was awarded a Master in Medical

Education (MME) from the Universities of Bern and Illinois at Chicago. She

has long been involved in education and training, including clinical guidelines,

ultrasound training, and simulation-based training. She leads the Virtual

Reality Simulation group in the Department of Digital Emergency Medicine at

the University Emergency Department of Inselspital.

Thomas leads the Department of Digital Emergency Medicine and is working

both scientically and in practical application on the opportunities and risks of

the digitalisation in emergency medicine, especially in the area of virtual reality

in clinical practice as well as in education and training.Tanja Birrenbach and

Thomas Sauter are co-founders of VISL – Virtual Inselspital Simulation Lab

(www.visl.ch).

Virtual Emergency Medicine– Education in Acute Care Medicine

Training in and for emergency medicine is a great challenge. Under high time

pressure, decisions with sometimes great consequences for the patient have

to be made in ad-hoc teams with frequently changing sta. Shift work, scarce

sta and unplanned workloads make training dicult. Virtual reality can be a

possibility of the future to better prepare emergency teams for everyday life.

Ideas, opportunities or obstacles and the current state of the art will be

presented by Dr. Tanja Birrenbach and Dr. Thomas Sauter in their lecture.

Dr. med. Tanja Birrenbach, MME

Senior physician

University Emergency Department of Inselspital

Prof. Dr. med. Thomas Sauter, MME

Senior physician

University Emergency Department of the Inselspital and Endowed Professor of

Emergency Telemedicine University of Bern

Abstracts

1. Short presentations

2. Posters

3. Workshops

1918

Isabelle Ledoux1, Nadia Turgeon2, Lemée Marie-Hélène1, Charland Patrick2,

Lavoie Patrick3, Rassy Jessica1, Charette Sylvie4, Milhomme Daniel5, Carignan Hugo1,

Gosselin Émilie1

1Université de Sherbrooke, Canada; 2Université du Québec à Montréal, Canada;

3Université de Montréal, Canada; 4Université du Québec en Outaouais, Canada;

5Université du Québec à Rimouski, Canada

Background

The use of fully immersive virtual realit y (FIVR) in the context of simulation

in health sciences has evolved rapidly in recent years (Bryant et al., 2020).

These simulations have demonstrated many advantages for nursing students,

as it may contribute to developing skills related to clinical assessment

and favor the development of clinical reasoning (Chiniara, 2019). While

using standardized patients (SPs) makes sometimes dicult to reproduce

the simulation environment, FIVR makes it possible decompartmentalize

simulation environments by recreating environments better suited to learning

needs. Notwithstanding these positive ndings, only a few studies compare

SPs with FIVR in the context of nursing education. The goal of this presentation

is to describe issues and challenges faced during the pretesting of FIVR with

baccalaureate nursing students in comparison with SPs.

Methods

A pilot mixed-methods study comparing FIVR with SPs, in the form of a

crossover randomized controlled trial, followed by interviews, was carried out

among 9 students from the third year of the initial baccalaureate in nursing.

The participants took par t at random in successive 15 minutes simulations

about mental health evaluation (FIVR vs SP). Short semi-directed qualitative

individual interviews lasting 15 minutes allowed to assess the participant's

point of view on both types of simulation. Field notes were kept by the research

team throughout the project. The focus was on feasibilit y indicators as

described by Sidani and Braden (2011) such as the interventionist's availabilities,

training, material resources, context, intervention's reliability and the

intervention's reach. Descriptive analysis of quantitative socidemographic data

was performed with SPSS software and qualitative data were analyzed with

concept analysis based on Brown and Clark (2021).

Results

The results make it possible to identify institutional, pedagogical,

organizational issues and challenges related to the implementation of FIVR

in nursing education. Both simulation types require the presence of facilitators

and human resources. Early planning and implications of all actors appear

" The use of virtual reality versus standardized patients :

issues and challenges "

to be a good strategy to ensure the optimal implementation of simulation

activities. Extra training needed to be organized for FIVR activities, as they

are new in the program. A familiarization session with FIVR lasting 30 minutes

was developed, including 15 minutes of home preparation and 15 minutes

of experimenting the pre-existing tutorial in the FIVR platform. Many pre-

existing scenarios are available in the chosen platform, which facilitates

its use and in return imposes certain limits. Material acquisition during the

Covid-19 pandemic was challenging and many delays occurred, postponing

the implementation of the project. Moreover, constantly changing sanitary

measures made it hard to plan simulation activities in presence, specically

with SPs. A cleaning process had to be set up to disinfect the FIVR material

between each participant. Institutional and political issues regarding the

responsibility for the follow-up and technical support with the FIVR slowed the

implementation. Both simulation activities lasted between 10 to 15 minutes

and the scenario was very similar from one simulation modality to the other.

However, the FIVR's patient's expressions were harder to decode than the SP's

expression, which was key information in a mental health evaluation scenario.

As this study took place in an extracurricular context, issues in recruitment

appeared. Close lashing with student's schedule and avoiding the internship

training period could overcome this diculty. Overall, the feasibility challenges

and issues faced within this study were similar between FIVR and SPs, with the

main dierences due to the novelty aspect of the FIVR.

Discussion

To improve teaching practices using simulation in nursing education,

challenges regarding the use of FIVR and SPs must be considered. This

nding is particularly relevant in the context of the implementation of a new

simulation modality, such as FIVR. Issues such as, learner preparation and

teacher training must be considered when deciding the type of simulation to

use in the nursing program. A larger-scale multicenter study will compare the

acceptability and the preliminar y eects of FIVR and SPs.

Short presentations 1

" Standardized Patients "

Kerstin Löer, Anna Jerusalem, Judith Goldgruer, Lisa Weidinger

Geriatric Health Care Centers, City of Graz, Austria

Background

Currently, the care for elderly people is provided mainly on an informal basis

by relatives. This is often associated with psychological and physical stress.

Caregiving relatives usually take over the role unprepared and they lack both

knowledge and skills to full the tasks. Therefore, arrangements must be

" Respite service for informal caregivers : evaluation of

simulation-training based education program "

2120

Tim Peters1, Daniel Bauer2, Beate Brem2, Peter Eberz3, Ulf Goerges4, Laura Schwarz5,

Gesine Weckmann6, Christian Thrien7

1University of Bielefeld, Germany; 2University of Bern, Switzerland; 3Charité

Berlin, Germany; 4University of Oldenburg, Germany; 5University of Witten/Herdecke,

Germany; 6University of Applied Sciences Rhein/Erft, Germany; 7University of Köln,

Germany

Background

Working with simulated patients (SPs) is an established and indispensable

"Quality assurance of role portrayal of simulated

patients – The current status of a multicenter qualitative

exploratory study"

made to provide respite for family carers. Simulation training is a validated

experiential learning tool traditionally incorporated in health professional

education but has not been commonly used in the hands-on training of informal

caregivers. This study tried to measure whether participation in a special

simulation training aects the trust in one's own ability to care, the quality of

life and the stress perception of caring relatives.

Methods

98 caring relatives participated in the prospective, controlled (non-randomized)

intervention study. The intervention involved an eight-month educational

program in a simulation-training center in Graz (Austria). The program is either

Manikin-based or Standardized Patient simulation trainings and take place in a

show apartment. The impact on the caregiving competence, the quality of life

and the burden-of-care was measured at the beginning (T1), after four months

(T2) and after eight months (T3) using validated questionnaires (Self-Ecacy

Scale, EQ-5D-5L and HPS).

Results

The results show a signicant inuence of the education program on self-

ecacy (p 0.0018) and the increase in knowledge (p 0.04) of the participants.

With regard to the subjective quality of life and the perception of stress no

signicant eects were shown.

Conclusions

The results show that the participation of family carers at the education

program has dierent inuence on the dened parameters. Not only the stable

quality of life of the intervention group but also the shor t-term signicant

reduction in subjective stress perception directly after the training can be

emphasized as positive indicators for the program.

method in medical education (Cleland et al. 2009, Lewis et al. 2017, Nestel

2015). In this context, adequate role portrayal and its quality assurance are

of great importance both in teaching and, in particular, in standardized,

summative assessments. Tensions may occur between role specications and

local contextual conditions on the one hand and a credible and authentic role

portrayal on the other. With the Fair-OSCE (Brem et al. 2015), the Maastricht

assessment of Simulated Patients (Wind et al. 2004) and the Nijmegen

Evaluation of the Simulated Patient (Bouter et al. 2013), tools exist that focus

partly on the role portrayal of SPs in medical education, but a broad, scientic

evaluation of the importance of good role portrayal and relevant aspects of

quality assurance is lacking so far in the international literature.

Methods

To address this research gap, a working group was formed within the German

Society for Medical Education's standing committee on simulated persons and

the following research questions were formulated : (1) What is the inuence of

the quality of simulated patients' role portrayal for the achievement of learning

objectives/examination goals in health professions education ? (2) What is good

role portrayal in the context of simulations in health professions education ?

Subsequently, a research concept was created to address these questions.

Taking a qualitative-explorative approach, semi-structured interviews and

focus groups will be conducted at institutions of medical and health professions

education in the German-speaking countries Austria, Germany, and Switzerland.

The audio data will be transcribed according to the GAT 2-scheme (Selting et al.

2009) and subsequently analyzed inductively according to qualitative content

analysis (Mayring 2000) following concepts of grounded theory.

Results

In the course of the multicenter preparations, the four stakeholder groups,

students, lecturers, SP-trainers, and simulated patients were identied.

For each stakeholder group, relevant aspects of role portrayal and quality

assurance were identied in several workshop rounds over a period of 2

years and inter view guides for the stakeholder groups were developed and

consented. To gather data from both individual statements and group-dynamic

discussions, individual semi-structured interviews and focus group discussions

are planned with each stakeholder group. IRB approval for this study is in

progress and the study start is planned for the summer or early fall 2022; rst

results can be expected in spring 2023.

Discussion

Despite the high signicance of employing SP methodology, the understanding of

terms such as "quality" and "good acting" or "sucient role portrayal" can var y

greatly depending on the perspective. Research is needed to address this lack of

standardization. Because of the high eort of the research needed to address this

2322

issue, it is of central importance for the group of authors to discuss the concept

with experts in the international area before it goes into implementation.

References

Brem B, Christen R, Richter S, Schnabel K. Anwendung einer Liste von

Qualitätsmerkmalen des Rollenspiels von SPs im Rahmen von OSCE-Prüfungen.

Poster presented at : Annual Conference of the German Association for Medical

Education; 30. Sep to 03. Oct 2015; Leipzig, Germany.

Bouter S, van Weel-Baumgarten E, Bolhuis S. Construction and validation

of the Nijmegen Evaluation of the Simulated Patient (NESP) : assessing

simulated patient s' ability to role-play and provide feedback to students. Acad

Med. 2014;88(2) :253-259. DOI : 10.1097/ACM.0b013e31827c0856.

Cleland JA, Abe K, Rethans JJ. The use of simulated patient s in medical

education : AMEE Guide No 42. Med Teach. 2009;31(6) :477-486. DOI :

10.1080/01421590903002821.

Lewis KL, Bohner t CA, Gammon WL, Hölzer H, Lyman L, Smith C,

Thompson TM, Wallace A, McConvey GM. The Association of Standardized

Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul.

2017;2 :10. DOI : 10.1186/s4107 7 - 017- 0 0 43-4 .

Mayring P. Qualitative Inhaltsanalyse. Weinheim : Beltz; 2010.

Nestel D, Bearman M. Simulated Patient Methodology : Theory, Evidence

and Practice. Chichester : John Wiley & Sons; 2015.

Selting M, Auer P, Barth-Weingarten D, Bergmann J, Bergmann P, Birkner

K, Couper-Kuhlen E, Deppermann A, Gilles P, Gunthner S, Hartung M, Kern F,

Mertzlut C, Meyer C, Morek M, Oberzaucher F, Peters J, Quastho U, Schutte

W, Stukenbrock A, Uhmann S. Gesprächsanalytisches Transkriptionssystem

2 (GAT 2). Gesprächsforschung – Online-Zeitschrift zur verbalen Interaktion.

2009;1 0 :353 -402 .

Wind LA, van Dalen J, Muijtjens AMM, Rethans JJ. Assessing simulated

patients in an educational setting : the MaSP (Maastricht Assessment

Simulated Patients). Med Educ. 2004;38(1) :39-4 4. DOI : 10.1111/j.1365-

2923.2004.01686.x.

Sylvie Ferchichi1, Camille Zwissig1, Félicia Bielser2, Corinne Gaudin3, Nicolas Perret1

1Lecturer, Department of Physiotherapy, University of Health Sciences

Lausanne (HESAV); 2R&D, University of Health Sciences Lausanne (HESAV);

3Lecturer, Manager of the SP programm and SP trainer (UES), University of Health

Sciences Lausanne (HESAV)

Background

Some neurological impairments such as spasticity or ataxia cannot be

" Patient instructor : a new way of teaching neurology

to physiotherapy students ? "

simulated. To properly learn how to be and act as a physiotherapist with people

with neurological impairments, lecturers from Haute Ecole de Santé Vaud

(HESAV) opted for a new pedagogical framework : to resort to real patient to

take on the role of patients instructor (PI), sometimes called real simulated

patients (Bokken et al., 2010; Cleland et al., 2009). In this situation, real

patients put their experiential knowledge at the service of the learner (Pageau

et al., 2021). PI should be recruited among expert patients. They have a good

knowledge of their disease and an excellent perception of the quality of the

physical examination and the physiotherapeutic treatment (Demaurex & Vu,

2013). The objective of the inclusion of PI was to create a pedagogical framework

that promotes learning while guaranteeing an authenticity valued by the

students (Bokken et al., 2010). The par ticipation of real patients is known to

improve their sense of responsibility, professional identit y and empathy (Bokken

et al., 2010). To overcome some limitations known in teaching with real patient

(Bokken et al., 2010), the purpose of the framework chosen at HESAV was to

strengthen the PI's knowledge and to train them to give constructive feedbacks.

The recruiting of expert patients in neurology was made amongst the

lecturers' patient networks. After a presentation of the program and obtaining

a minimum score of 27 on the Mini Mental State Evaluation, the patients

conrmed their participation. The simulation specialist nished the process in

carrying out a last inter view to identify the expectations, motivations, and limits

of the patients in order to guarantee their physical and psychological safet y.

The training of the PI was then carried out over four half-days to transmit

the essential elements of evaluation and treatment in neurology and to develop

their capacit y to deliver constructive feedbacks. Finally, they have been four

sessions of teaching with the students. The entire program was then evaluated

and the students' perception are presented here.

Methods

53 students who participated in the PI program were questioned. An online

questionnaire containing 18 questions wa s administered to them.

Results

47 complete answers (89%) were analyzed. Students' adherence to the training

program with PI was high and the evaluation highlighted the importance given

to the dierent pedagogical methods used in this device. 80% of the students

thought they had enough tools and knowledge to take full advantage of the

meetings. The encounter with the patient was the most impor tant dimension

in student learning. Although this was a formative situation, it seemed realistic

to the students. It allowed them to keep their place as learners while exercising

their professional role. Despite the perception of a caring environment, students

reported feeling stressed when they had to practice in front of their peers. This

was due to their uncertainty in their ability to adapt to the dierent clinical

presentation of the patients, particularly to their physical and cognitive skills.

2524

Discussion

Teaching with PI seems to be coherently integrated into the device of training

skills in neurological physiotherapy. The added value is to allow students

to practice the assessment s of impairments, dicult or even impossible to

simulate, learned in a non-played situation. The authenticity was valued by

students, increasing their involvement. The meetings with the PI are also an

opportunit y to realize the importance of adapting the tests and the treatment to

the patients' capacities, a complex skill, developed normally only in internship.

In addition, it is possible to recruit and train neurologically aected

"real patients" to become patient instructors through a procedure based on

specic criteria. PI should have the ability to increase their expertise about their

illness, about physiotherapy assessments and treatments, and in providing

constructive feedback to student s.

References

Bokken, L., Rethans, J.-J., Jöbsis, Q., Duvivier, R., Scherpbier, A., & van der

Vleuten, C. (2010). Instructiveness of real patients and simulated patients

in undergraduate medical education : A randomized experiment. Academic

Medicine : Journal of the Association of American Medical Colleges, 85(1), 148 154.

Cleland, J. A., Abe, K., & Rethans, J.-J. (2009). The use of simulated patients

in medical education : AMEE Guide No 4 2. Medical Teacher, 31(6), 477 486.

Demaurex, F., & Vu, N. (2013). Patients simulés/standardisés. In S. Boet, G.

Savoldelli, & J.-C. Granry (Éds.), La simulation en santé De la théorie à la pratique

(p. 51 62). Springer.

Pageau, S., Burnier, I., & Fotsing, S. (2021). Stratégies de recrutement et de

formation des patients en éducation : Une synthèse de la littérature. Pédagogie

Médicale, 22(2), 91 100.

Marine Laforge

University of Health Sciences Lausanne (HESAV)

Introduction

The Année Propédeutique Santé (APS), allows students to discover and create

their path in the direction of a health-related eld work, within the HES-Santé

organization, such as nursing, physiotherapy, ergotherapy, nutrition and

dietetic, osteopathy and medical radiology technicians.

APS's particularity lies in the regular combination of theoretical lessons

with practical sessions and also 8 weeks in socio-medical apprenticeship.

This multiplicity of approaches helps students dene their future professional

career path.

" Using simulation to prepare APS students for their

rst apprenticeship "

During the last 2 academic periods, in order to address the Covid situation in the health

care environment, the APS educational content framework (Plan d'étude cadre) had to be

adapted by reducing the apprenticeship from 8 weeks to 6 weeks.

It was then decided to compensate those apprenticeship hours with simulation practices,

using High Fidelity (HF) models, in order to mobilize knowledge and abilities during situations

as close to reality of care.

Objective

This new didactic modality oered to students, will allow them to put into action theoretical

and practical knowledge in a context of simulation but as

in the case in health care.

Methods

The simulation sessions were organized before students left to their socio-medical apprenticeship.

In order to prepare for these sessions, a session (brieng) was held to inform them

about aims, objectives and expectations of the simulation session and to introduce the

specic clinical situation.

Supporting material for this lesson was uploaded on Cyberlearn.

During the simulation activity, students participated in groups of two during 10 minutes.

The rest of the group observed them via video transmission from another room. A 5 minutes

feedback was given after each 10 minutes session.

2 debrieng periods on site took place one week after the simulation session to review

all the simulation sessions participated/observed.

Results

Sometimes, students didn't come well prepared to the simulation sessions. All were very

anxious before the sessions. But to ensure a secure environment and the activation of

knowledge, proved to be very helpful for students. Signicant benets in the learning have been

noticed during the discussions with the trainer and the fellow students.

In 2021, a survey was organized with 45 students during a debrieng session in order to

analyze and support of this pedagogical approach. More than half of the students felt that the

simulation situation allowed them to develop knowledge and to develop self-analysis abilities

and therefore, be better prepared when starting the apprenticeship.

Students repeatedly highlighted the impor tance of having the debrieng on site in order

to get accustomed to the Model Hight delity (HF), having a clinical situation as possible to

reality, students required to have more time after the simulation in order to debrief thorough

and have the opportunity to redo a simulation in the same session and the last demand is to do

the simulation with a real patient instead of a model lacking realism.

Conclusion

Simulation allows to approach healthcare reality in a safe environment. This allows to

adapt the knowledge and the abilities for APS students.

APS students are a very heterogeneous population in their learnings, which is why, an

assimilation, accommodation and generalization process is interesting.

2726

" Pediatrics, obstetrics, gynecology, and family health care

lesson with e-book and Virtual Reality "

Markus Stadler, Uwe Weber

Berner Bildungszentrum Pege, Switzerland

Introduction

Pediatrics, obstetrics, gynecology, and family health care are the topics of

one of the main fo-cuses of nursing education at the Bern Centre of Higher

Education in Nursing. The range of these topics is indeed very wide, so it

is necessar y to focus on the core topics. One of the ap-proaches is a newly

released e-book that focuses on the practical skills of future pediatric nurses.

A specic part of the e-book (chapter : "pregnancy") is oered in combination

with patient situations in virtual realit y. This combination allows students to

learn the theory in an e-book with automatic access to an online platform to

learn the practical actions with a Virtual Reality Head-Motion-Set.

Method

Students work with the e-book on specic cases on the topic of

• Pregnancy, birth (based on the skill mix between midwives and nurses).

• Postpartum care (with a separate chapter on postpartum depression).

• Infan ts/chil d hea lth/c are

• Family (e.g., Calgary model)

• Women's health (some diagnostic/nursing topics).

The principles and advantages of a "hybrid e-book" are

• more detailed and updated information can be accessed directly through

appropriate links

• there is a possibility to consider a book as a kind of "stable backbone" -

including further knowledge in its evolving digital networks

• topics to be taught can be displayed directly in 3D - such as an anatomy atlas

(visiblebody.com). A topographical perspective is by the way crucial when

acquiring knowledge about the development of pregnancy.

The patient situations in virtual realit y are deepened by means of two

dierent diagnoses.

• Pre-eclampsia

• Hyperemesis Gravidarum

In virtual reality, the students could query and control sequences of action,

including the moni-toring of the two patients, and of course the corresponding

patient data.

Short presentations 2

" Virtual Reali t y "

Djazia Bessalah

Université de Lille, France

As part of an internship at "Fabrique des formations" of the University of

Lille, we conducted a sur vey on teaching practices and virtual realit y in class.

Although the teachers who took par t in this study had various backgrounds,

the reection that we propose in this study is of a general nature and could be

applied to several elds of expertise. A state of the art on higher education

and virtual reality was carried out and served as a basis for the drafting of a

semi-directed interview guide which led to several interviews with teachers

with various levels of experience, ranging from no experience to more than ve

years of experience with teaching with virtual reality. We also interviewed a

multimedia instructional designer and a virtual reality researcher and had the

opportunit y to observe a virtual reality course taught at university.

First, our analyses seem to indicate a change in the role of the teacher

which would be induced by this new media that is virtual reality. Virtual reality

would also be a source of development for teachers, particularly in terms

of changes in practices that would move more towards learning by doing

or simulation. We then note technological, logistical and communication

diculties in the classroom that aect the learning moments as well as

attempts to experiment with learning through simulation. The diculty in

designing original content raises problems of scripting and the lack of pre-

developed resources does not allow for the variation of learning situations

hence limiting the opportunities for the learner to progress. Finally, the VR

teacher seems to struggle with a lack of visibility of the learner's activity. This

lack of visibility of the virtual reality activity, which we will call the blind spot,

could constitute an interesting eld of research in the sense that the origins of

these concerns are not yet clearly dened. These concerns relate to the lack of

visibility of the activity, of the results, of error diagnoses, and the impossibility

of measuring the learner's progress.

In conclusion, the use of virtual reality in higher education requires

several types of knowledge; technological but also in learning through

" Analysis of Teaching Practices with Virtual Reality in

Higher Education "

Results

This VR experiment is in its initial stages and is intended to become a routine

simulation-based task.

Discussion

The discussion to be established revolves around the "learning success" in the

virtual reality environment of the two diagnoses mentioned above.

2928

simulation. Classroom management, specic to virtual reality, can also become

cumbersome for learning and intense for the teacher. The lack of skills in these

dierent areas, but also the lack of awareness of the dierent obstacles to

the use of this technology, not yet totally adapted to teaching, can become

critical for student learning. Finally, training in the use of the technology, in

the management of the organization of activities and in learning through

simulation could be oered to teachers in order to help them in this change of

role induced by this new technology. The use of the classroom management

method developed by Doerner and Horst could prove useful. However, there

may be a need to build on the exible classroom by providing other activities

in the instructional scenario, not necessarily using digital technology. Further

study could also be devoted to identifying the origins of the blind spot concerns.

We can already ask ourselves if the blind spot is a symptom of immersion or a

symptom of this new teacher role that puts the emphasis on obser vation or is it

simply a symptom of teaching itself that virtual reality and the development of

articial intelligence would like to nd a cure for ?

Bibliography

Boivin-Delpieu, G., & Joubert, P. (2021). Didactique de la physique et conception

d'un simulateur pour l'enseignement de l'astronomie au cycle 3. 28. h tt p ://

sticef.org/num/vol2021/28.1.2.boivin/28.1.2.boivin.htm

Doerner, R., & Horst, R. (2022). Overcoming challenges when teaching

hands-on courses about Virtual Reality and Augmented Reality : Methods,

techniques and best practice. Graphics and Visual Computing, 6, 200037.

https ://doi.org/10.1016/j.gvc.2021.20 0037

Théorie de la réalité virtuelle—Presses des Mines. (s. d.). https ://www.

pressesdesmines.com/. Consulté 23 janvier 2022, à l'adresse https ://www.

pressesdesmines.com/produit/theorie-de-la-realite-virtuelle/

Weber, M.-L., Rodhain, F., & Fallery, B. (2019). Usage de la réalité virtuelle

et développement individuel des enseignants-chercheurs. Une approche par la

didactique professionnelle. Management Avenir, 6(112), 37 57.

Youngblut, C. (s. d.). Educational Uses of Virtual Reality Technology. 131.

Anke Sabine Baetzner1, Rafael Wespi2, Yannick Hill1, Thomas Sauter2, Cornelia Wrzus1,

Marie Ottilie Frenkel1

1Heidelberg University, Germany; 2Bern University Hospital, University Bern,

Switzerland

Eective performance of medical rst responders (MFRs) is crucial for ensuring

" The role of modern technologies in disaster training :

an overview of scientically evaluated training methods

used to prepare medical rst responders for disasters "

patients' survival and recovery. Therefore, MFRs need to be adequately trained,

especially for high-stress situations like disasters which involve multiple

victims. Although such incidents are t ypically challenging to train in terms of

resources, new technologies like virtual and mixed reality (VR and MR) may be

leveraged to increase critical training time. We conducted a systematic review

to provide an over view of all scientically evaluated training methods used to

prepare MFRs for disasters. This enabled us to explicitly identify how often and

what types of VR and MR are being used in current disaster training research

and how they compare to standard training.

The systematic review was conducted according to the PRISMA

guidelines and focused specically on (quasi)experimental designs or pre-post

comparisons. The literature search was conducted via Web of Science and

PubMed and led to the inclusion of 55 articles.

Besides traditional trainings methods (e.g., e-learning, screen-based

serious gaming), we found that technology-based methods (e.g., e-learning,

screen-based serious gaming) are indeed used for disaster training. However,

few studies systematically evaluated VR and MR training. Furthermore, the

few VR studies most often evaluated screen-based VR instead of the more

immersive modalities with head-mounted displays or CAVE. Only one study

used augmented reality. Regarding the eectiveness indicators, the overall aim

of most studies was to increase the trainees' knowledge of either the triage

process or proper crisis management procedures. Thus, the eectiveness of the

trainings was mainly assessed through pre-post comparisons of knowledge

tests although some studies also examined behavioral performance indicators

(e.g., triage accuracy). Surprisingly, while MFRs typically work in teams, the

training evaluations rarely included the assessment of group performance.

Altogether, few studies evaluated realistic trainings focusing on actual

behavior. Modern training technologies are increasingly close to reality

and thus represent a promising approach to train MFRs with relatively few

resources. Our results call for a systematic evaluation and comparison of

dierent methods.

" Never have I ever… Supporting teachers and

trainers during their rst experiences with immersive

technologies "

Raquel Becerril Ortega1,2, Juan Antonio Muro Sans1

1HESAV Haute École de Santé Vaud, HES-SO Haute école spécialisée de Suisse

occidentale, Switzerland; 2Université de Lille, ULR 4354, CIREL, France

First experiences with immersive technologies : beyond the Uhau eect

Below we introduce a techno-pedagogical development intervention carried

out at the Haute École de Santé de Vaud (HESAV) during the year 2022.

3130

This intervention aims at the introduction of immersive technologies in the

simulation-ba sed training program (Howard et al., 2018) for the development of

future healthcare professionals.

We started this pedagogical reection with the establishment of a consensual

denition of virtual reality (Kardong-Edgren & et., 2019) that we were

considering in terms of vir tual simulation, this literature mainly focuses on the

learning process.

Thus, the literature surrounding immersive technologies emphasizes

the advantages, especially in terms of immersion in a virtual world (Chang &

al., 2010 ; Fleck, 2016 ; Gobin Mignot & Wolf, 2019), or improvement knowledge

acquisition (Kononowicz et al., 2019 ; Kyaw et al., 2019 ; Chen et al., 2020)

through virtual reality experiences. Dierent studies also shed light on the

pilot character of training experiences with virtual reality, augmented reality or

mixed reality ( Wüller et al., 2019 ; Radianti et al., 2020).

However, the technical and pedagogical diculties linked to the

introduction of these ressources have not been widely exposed : i. They rstly

appear linked to diculties in their use, because teachers/ trainers do not

always have the competences in the use of dierent technologies; ii. Then

pedagogical diculties emerge, when, for example the introduction of a

simulation scenario implies a challenge for teachers/trainers who are more

familiar with other forms of immersive simulation, such as, with mannequin or

simulated patient.

This techno-pedagogical development intervention tries to articulate

these two elements by oering an experimentation for teachers/trainers. In

order to allow them to go beyond the uhau eect, it integrates an environment

favoring the acquisition of technical skills, ensuring that it is also a mean to

consider the potentialities and the limits of immersive technologies in an

educational context.

This intervention will actually involve identifying the training needs of

each situation and empower the teachers/trainers in the use of immersive

technologies. Finally, from an ecological point of view, the solution adopted is

intended to be as energy-ecient as possible and is based on the ethical use

of technology.

Design-based research to integrate both stakeholders and target audiences

The design method for the intervention builds on design-based research

methodologies that develop a vision of educational research as applied

research and proposes a synthesis of dierent methodological currents which

have in common their pragmatic and collaborative purposes (Sanchez &

Monod-Ansaldi, 2015).

This methodology involves the dierent actors (teachers/trainers

and students) in the design process of training situations that involve

immersive technologies.

The intervention method includes a triple mechanism : technological,

pedagogical and scientic. The technological mechanism is the environment

of the experiment (virtual reality headsets, good practices recommendations,

etc.). The pedagogical mechanism consists in experimenting one or two

immersive situations which can give an overview of the didactic potential of

immersive technologies and can induce to a discussion, before and after the

experimentation, allowing the teacher/trainer to express the potentialities of

pedagogical use in their courses. Finally, the research mechanism integrates

the data collection and analysis.

Results & discussion

The data, which will be collected during the period of June-July 2022,

concentrates on interviews on-the-y conducted ante and post-

experimentation, as well as data collected from a questionnaire on the

technological and pedagogical skills of the teachers/trainers involved.

The interpretative framework of these data will allow us to identify

training needs and possible leverage points to develop pilot pedagogical

solutions to integrate immersive technologies where needed. The novelty of

this techno-pedagogical development intervention also lies in its capacity to

articulate a local training intervention with a techno-pedagogical innovation

and to back it all up with collaborative research.

Armand Viadé1, Raquel Becerril-Ortega2, Florent Occelli1

1Laboratoire d'expériences immersives (Lexim) - UFR3S - Faculté Ingénierie et

Management de la Santé (ILIS) - Université de Lille, Lille, France; 2EA 4354 - CIREL -

Centre Interuniversitaire de Recherche en Éducation de Lille, F-59000 Lille, Université

de Lille - France

Introduction

Professionals are facing fast and tremendous technical, social, economic,

and organizational changes. Simulation-based virtual reality training coupled

with the didactic approach allow to achieve high standards of operational

performance in dicult working environments, with scalable and cost-

eective deployment.

In addition, according to the World Health Organization, each year,

hundreds of millions of patients around the world are aected by health care-

associated infections (HAIs). Most HAIs are preventable through good hand

hygiene practices – cleaning hands at the right times and in the right way.

" Design process of a virtual reality simulation

environment for training Quality, Health and Safety

managers : an approach to instructional design principles

adaptable to health simulation context "

3332

This study covers the design of a virtual reality simulation environment,

from identication of training needs, activity analysis of various work

situations (from obser vations and interviews), to process of conception and

representation in 360-degree enhanced educational experience.

Methods

The design process, based on an empiric analysis of the operators' activity, is

interested in the way situations are represented by this virtual reality medium.

What are the constraints, particularly technical ones, and how to manage to

create a form of authenticity and preserve the functional representation of

situations ? In short, how to represent, by virtual reality, situations of dierent

nature resulting from the activity analysis ?

Results

During the process leading to the design of simulation scenarios, we mobilized

four categories, depending on the epistemic nature of the didactic situations.

The rst type of scenario, consisting of point and click and sequencing games,

preserves the characteristic features of the target situations, namely to equip

oneself with personal protective equipment and to correctly wash hands. The

second represents a sequence of operations to guarantee safety in the working

environment and explain the functioning of the production line. The third

scenario focuses on problematic situations identied from an analysis of the

activity. The learner embodies an operator and must make choices in response

to critical situations, his decisions impacting his path through branching

scenarios. Finally, the last scenario consists of a hazard spotting 360-degree

scene compiling health and safety risks, similar to a patient safety room of

horrors in the healthcare eld.

Discussions

This methodology, based on the didactic design of simulation scenarios with

virtual reality, could be easily exported to a health simulation context, as some

situations (hygiene, safety, etc.) are similar.

References

Becerril-Ortega, R. Vanderstichel, H., Petit, L., Urbiolagallegos, M-J., Schoch,

J., Dacunha, S., Benamara, A., Ravenet, B., Zagdou, J. & Chaby, L. (2022).

Design Process for a Virtual Simulation Environment for Training Healthcare

Professionals in Geriatrics. In S. Flandin, C. Vidal-Gomel & R. Becerril-Ortega

(Ed.). Simulation Training Through the lens of experience and activity analysis.

pp. 101-127 Switzerland : Springer

Becerril Ortega, R., (2021). Vers une perspective anthropologique en

formation des adultes. Autour de la transposition didactique. Éducation

Permanente, n° 228, pp. 55- 66.

Clot, Y., Faïta, D., Fernandez, G. et Scheller, L. (2000). Entretiens en

autoconfrontation croisée : une méthode en clinique de l'activité. Perspectives

interdisciplinaires sur le travail et la santé, 2(1).

Delannoy, V., Dutrech, R., Galy, E., Leger, C., Duchein, P., Marie, S.,

Vergnes, H., & Zaro- Goni, D. (2016). Guide d'aide à la mise en œuvre d'une

chambre des erreurs dans un établissement. https ://www.cpias-nouvelle-

aquitaine.fr/wp- content/uploads/2015/08/Guide_chambre_erreurs_Denitif.pdf

Haute Autorité de Santé. (2019). Simulation en santé et gestion des

risques – Outils du guide méthodologique. https ://www.has-sante.fr/upload/

docs/application/pdf/2019- 02/outils_du_guide_methodo_simulation_en_sante_

et_gestion_des_risques.pdf

Huard, V. (2006). Restructuration de la représentation fonctionnelle lors

d'un processus de formation. 8ème Biennale de l'éducation et de la formation –

INR P. ht tp ://www.inrp.fr/biennale/8biennale/contrib/longue/99.pdf

Leplat, J. (1996). Petites histoires pour des Histoires. In Y. Clot (Ed.) Les

histoires de la psychologie du travail (pp.87-98). Toulouse : Octarès

Pastré, P. (2005). Apprendre par la simulation : de l'analyse du travail aux

apprentissages professionnels. Toulouse : Octarès.

Pastré, P. (2011). L'ingénierie didactique professionnelle. Dans P. Carré et P.

Caspar (dir.), Traité des sciences et des techniques de la formation (p. 401-421).

Paris : Duno d.

Pastré, P., Mayen, P., & Vergnaud, G. (2006). La didac tique professionnelle.

Revue française de pédagogie, 154, 145-198. https ://doi.org/10.40 00/rfp.157

Piaget, J. (1945). La formation du symbole chez l'enfant : imitation, jeu et

rêve, image et représentation. Neuchâtel, Suisse : Delachaux et Niestlé.

3534

Camille Deforges1, Déborah Fort 1, Emily Holmes2, Antje Horsch1,3

1Institute of Higher Education and Research in Healthcare (IUFRS), University

of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; 2Department

of Psychology, Uppsala University, Uppsala, Sweden; 3Woman-Mother-Child

Department, Lausanne University Hospital, Lausanne, Switzerland

Background

Childbirth-related intrusive traumatic memories (CB-ITM) are involuntary and

distressing sensor y impressions of the birth, and a key symptom of childbirth-

related posttraumatic stress disorder (CB-PTSD). Laboratory studies suggest

that ITM and PTSD symptoms could be reduced via exposure to trauma-related

reminder cues combined with a task hypothesized to interfere with trauma

memory reconsolidation. However, this has never been tested for old and real-

life single-event trauma, nor in the perinatal context. This translational proof-

of-principle study aimed at testing the ecacy of a single-session behavioural

intervention, based on memory reconsolidation processes, to reduce CB-PTSD

symptoms, particularly ITM.

Methods

In this translational pre-post study, we included 18 mothers suering from

CB-ITM, whose traumatic childbirth had occurred bet ween seven months

and 6.9 years earlier. They received a behavioural intervention consisting

of a combination of the traumatic childbirth evocation with a visuospatial

task (the video game Tetris) assumed to interfere with childbirth memory

reconsolidation. Mothers daily reported their CB-ITM during the two weeks

before the intervention (diary 1; primar y outcome), the two weeks after (diary

2), and the 5th and 6th weeks post-intervention (diary 3). CB-PTSD symptoms

were assessed with the PCL-5 just before and one month after the inter vention.

Results

Compared to diary 1, 15 out of 18 participants had ≥ 50% fewer CB-IMs in diary

2. The median (IQR) reduction of the number of CB-IMs was 81.89% (39.58%)

in diary 2, and persisted in diary 3 (n = 17). At one month post-inter vention,

CB-PTSD symptom severity was reduced by ≥ 50% in 10 out of 18 participants.

Total CB-PTSD symptom severity was, on average, reduced by 56.76% (SD

= 28.97) (n = 17). All the eect sizes were large. Of the 8 participants with

a CB-PTSD diagnosis pre-inter vention, none met diagnostic criteria post-

intervention. The intervention was rated as highly acceptable, all participants

would have been willing to participate in a second session.

Short presentations 3

" Serious Games & Virtual Reality "

" Reducing childbirth-related intrusive memories and PTSD

symptoms via a singlesession behavioural intervention

including a visuospatial task : A proof-of principle study "

Discussions

This innovative single-session behavioural intervention seems promising

but the design, although appropriate given the very innovative nature of the

tested intervention, limits the causal interpretation of observed improvement.

Thus, our results justify the launch of a large randomized controlled trial.

Encouragingly, there are strong reasons to believe that such a brief intervention

could benet to anyone having PTSD symptoms and ITM, even beyond the

perinatal context.

Dominique correia de Oliveira1, Songuel yavavli1, Dominique Jaccard2,

Pierre-Benjamin Monaco2, Félicia Bielser1

1University of Health Sciences Lausanne (HESAV); 2HEIG-VD

The objective of this article is to present the "Patients' Rights & Innovative

Teaching Strategy" (PRITS) project, which consists of a serious game whose

goal is as much to support students in learning the legal rules applicable in the

eld of health that broaden the educational options of teaching law courses.

The authors establish the links between pedagogy and play, which by

their characteristics, can precipitate evolutions towards active pedagogies and

the development of soft skills. This tool was developed by collaborators of the

Haute École d'Ingénierie et de Gestion du Canton de Vaud, in collaboration

with the Haute École de Santé Vaud. The project, which was supported

by the digital competence center of the HES-SO as part of its mission of

teaching in the digital age, takes shape through a multidisciplinary design and

development bringing together several elds, including health, law, education

and engineering. The simulation aspects allow students to develop practical

skills related to legal rules, skills that are necessary for them in their future

professional life.

Goals of the project

1. Encourage the acquisition of new knowledge and the development of

practical skills

2. Assess the feasibility of using digital technologies to support active

pedagogies, constructivist and socio-constructivist approaches

3. Evaluate the potential use of the data collected in the simulation for

educational research (acceptance by students, eects on motivation,

eects on learning) or professional (decision making, dierences in behavior

depending on the level of education).

" The place of Serious Games for the Future Of Legal

Education – PRITS "

3736

Methodology and deployment

The development of the serious game follows an iterative and co-creative

approach. From the start of the project, experts from the health and legal unit

of HESAV and AlbaSim collaborated on the design and development. We used

a co-design framework developed by the HEIG-VD team, the co.LAB project,

which allows for the collaborative design of serious games. An authoring

system allows the whole team to develop the serious game simultaneously,

thus facilitating co-creation. Computer scientists and designers develop

the game alongside the lawyers and medical professionals who create and

input the content. Iterations with user tests and validation by professionals

guarantee the development of a solution that meets the needs of students,

trainers, professionals and researchers as closely as possible. Patient rights

issues are implemented in the game in the form of scenarios transposed

into dialogues between a healthcare professional and a patient, their loved

ones and their families. The serious game oers interactive narrations and

knowledge consolidation exercises. Immersion in simulation takes place in

professional situations where the rights of patients must be mobilized, such as

when a health professional must inform a patient of the various consequences

of a decision treatment, thus ensuring the patient's right to information.

Students will have resources at their disposal to help them in discussions with

patients, but will also be invited to seek information from the various online

resources, in par ticular by consulting the ocial websites of the cantons and

the Confederation.

A rst use of the game by students took place in the fall semester of the

2021-2022 academic year. It was used by approximately three hundred and

fty students from various streams, including nursing, physiotherapy, and

APS. The students rst had ex cathedra courses where theoretical notions

were discussed. Then, in a second step, the students played the game, in the

presence of the teachers to accompany them. A pre-brieng phase on the

game and its use is organized to present the instructions. Once the game is

over, a debrieng follows to allow students to ask their questions and provide

additional theoretical input, if necessary.

Conclusion

The rst results are encouraging with active and enthusiastic participation of

students in the rst lessons with the use of serious games. The Assessment has

three main objectives and we used three tools. The rst objective consists in

evaluating the system with the French validated version of AttrakDi standard

questionnaire. The second objective aims at assessing the learning experience

and the subjective learning. This carried out by using an adaptation of the

Serious Game Evaluation Scale developed by Fokides and colleagues. Both have

been implemented on an online survey platform and passation will take place

just after the students have played the game. The third objective consists in

evaluating training eectiveness at the second level of Kirkpatrick's taxonomy

Rafael Wespi1, Tanja Birrenbach1, Juliane Kämmer1, Tanja Manser2, Stefan Schauber3,

Thomas Sauter1

1Department of Emergency Medicine, Inselspital, Bern University Hospital,

University of Bern, Bern, Swit zerland; 2FHNW School of Applied Psychology, University

of Applied Sciences and Ar ts Northwestern Switzerland, Switzerland; 3Center of

Health Science Education - University of Oslo, Norway

Introduction

Medical care is a team endeavour and requires interprofessional and

interdisciplinary teamwork. Especially in emergency medicine, teams work

together in situations that need high-risk and high-stake decisions under time

pressure. It is known that the performance of such teams does not only depend

on their technical skills but also on their teamwork and leadership skills.

Currently, many studies on teamwork rely on expert assessments, which are

time-consuming and potentially subjectively biased, for which objective data

could be a useful alternative.

Objective

The aim of this work is to compile a toolbox of measurement methods that can

be used in real time for an objective assessment of teamwork in a virtual reality

(VR) environment.

Methods

In a rst step, an overview of meaningful objectively measurable factors

that can be collected in VR trainings such as the participants' biosignals,

cone of vision, eye-tracking, motion patterns, absolute and relative distance

between simulation participants was provided. For this, a literature search,

including literature on VR also in disciplines that go beyond medical use

was conducted. In a second step, these measures were evaluated with

respect to their usefulness for evaluating team performance. For this, semi

structured interviews with experts from dierent elds like team research,

VR programming, etc. were conducted.

Results

The outcome of this wo rk is a theoretically conceive d conceptual measurement to olbox.

" A glimpse of future – exploring objective measures for

evaluating medical teamwork in VR settings – a mixed

methods review "

which is "learning". It assessed comparing scores between pre and post-test

questionnaires developed by experts in law. The pre-test take place before the

students play the game and the post-test after they have played the game.

3938

Uwe Weber, Claudia Schlegel

Berner Bildungszentrum Pege, Switzerland

Introduction

In combination with a computer-controlled high-delity manikin, at the

Bern Centre of Higher Education in Nursing we also use virtual reality (VR)

technology, to train nursing students in emergency situations. This sequential

simulation with two high-tech teaching meth-ods makes it possible to increase

the complexity of a patient situation.

Method

With the use of a Vir tual Reality software, which was specially developed for

nursing students, we were able to further develop the patient case using the

VR technolog y, so students could experience a patient pathway in sequences,

rst with the high-delity manikin and then learn in a vir tually/immersive

environment. With this approach the complexity of the case could be increased.

Results

The students showed a high readiness to learn and a very high satisfaction with

the learning opportunity.

Discussion

It is apparent that the combined simulation with virtual reality and computer-

controlled manikins is an ideal supplement for learning nursing skills.

" Combined simulation with VR and computer-controlled

manikins "

Conclusion

Even if the objective measurements presented seem to partly support

teamwork evaluations, further research specically addressing these

evaluations is needed. Saira Al Balushi

Sultanate of Oman

Background

Simulation from its earliest conception into teaching training practice to

modern time applications has been an acceptable method for both teachers

and learners. Unlike the modern simulation resources strike for its high-tech

impact, the value of incorporating standardized patient simulation (SP) in

teaching and evaluation of selected skills remains unique. Examples of these

skills are many, and not limited to interpersonal skills, and communication. SP

simulation as a distinguished type of simulation is acknowledged for its realism,

interactive approach, and high delity.

Integration of modern simulation into teaching learning methods in

Oman has been reported by number of institutions of various specialties :

Eective integration of SPs into teaching learning experiences mandates

advance preparatory considerations since the role portrayed by the SPs is

not limited to simulation case narration. Accordingly, preparation of SPs in

a culturally oriented system such as Oman has facilitated generation of new

learnings. Par ticularly, preparation of SPs has been commonly reported for their

contributions in teaching and evaluation of selected lab skills, compared to

related preparatory procedures for their role in research studies.

Despite simulation related challenges are widely reported : SP based

simulation challenges within a context of a culturally oriented system has not

gained an ecient empirical investigation.

Presentation purpose

To share experiences (processes, challenges, outcomes, and recommendation)

a researcher gained during preparation of SPs based simulation training

program required in fulllment of a doctorate study.

Study design

This study considered a pilot intervention study including a single group,

pretest and posttest.

Study aim

The study aimed to assess the fea sibility of an education program that included

a SP simulation, and to explore the perceptions of Omani primary care nurse

participants about barriers and facilitators to use of SP simulation. For this

purpose, the target competency focused on the use of SP simulation to enhance

primary care nurses' competence in patient assessment (History taking and

physical examination – Cardiovascular risk assessment).

Short presentations 4

" Cost "

" Standardized Patient simulation research in a culturally

oriented system : experiences and outcomes "

4140

Study sample

A convenient sample of (N = 20) practicing primar y care nurses from regional

health care facilities (primar y health care centers) were recruited for 4 days.

Study setting : The study was conducted in an outpatient clinic for a local

governmental health care facility (Poly Clinic) in Oman, and facilitated through

collaboration with respective regional continuous education department (CPD)

for the Ministry of Health.

Léonore Cabin, Félicia Bielser, Céline Schnegg, Séverine Rey

University of Health Sciences Lausanne (HESAV)

Background

Immersive simulation requires a signicant nancial and human investment.

It involves a complex technical environment (cameras, high-delity manikin,

healthcare equipment, simulation and control rooms) and educational process

(clinical scenario, brieng, simulation activity, debrieng). Facilitators ensure

the quality of these training sessions, but their role often remains in the shadow

of the technological device. Furthermore, the scientic literature deals with the

practice of debrieng (Jarelot & Pelaccia, 2016; Johnston et al., 2017; Policard,

2018) and with the design of the scenario (Dieckmann et al., 2007). From a social

science perspective, we propose an original analysis of the managing of the

simulation-ba sed experience, a phase where facilitators are, strictly speaking,

major actors.

Method

Our pragmatic analysis of the facilitator's actions is rstly based on an

ethnography of immersive simulation sessions (proposed for several health

professions) in a School of Health Sciences in French-speaking Switzerland.

Secondly, we observed the meetings of a working group, whose mission is

to support the implementation of a simulation teaching program. We nally

conducted inter views with various educators involved in simulation.

Results

Managing a simulation-based experience is a complex and active role :

facilitators interact with and on the technical environment and the educational

process. They direct participants' actions when these deviate from the

established scenario or when the simulation does not progress quickly enough

for the time allowed. They also give a personality to the manikin to make it

"more human". Moreover, they regularly work to circumvent the technical and

relational limitations of the machines that could defeat the simulation : for

" Managing an immersive simulation session : an analysis

of the facilitators' role "

example, they provide oral cues to compensate for the missing visual cues that

participants face during the simulation.

Discussion

Facilitators' actions, which could not be replaced by technology, help to ll

the limits of the manikin and to recompose the care practice in a simulated

environment (Johnson, 2007; Hindmarsch et al., 2014). They raise questions

about the theoretical framework of simulation, formulated in terms of 'realism'

and 'delity' (Horcik & Durand, 2015), and about the standardisation of

simulation practices : is a scenario facilitated by dierent educators always

the same scenario ? Does the discrepancy between the almost iner t and

stereotyped body of the manikin and the experienced and singular voice of

the facilitator disturb the simulation experience ? The notion of socio-material

assemblage (Denis & Pontille, 2018) allows us to consider the distribution of

roles and agency during the simulation experience, including the vulnerability

of this assemblage and of the objects that make it up (Hennion, 2019) :

facilitators intervene to remedy sometimes a programming defect in the

manikins, which are very complicated to use, and sometimes one of the

breakdowns that punctuate simulation sessions, to the point that they are

mentioned in the brieng. Our results show that beyond the sophistication of

the manikin, the smooth running of the simulation is above all ensured by the

educators, who take care to produce an experience that is certainly unstable

but educationally eective.

References

Denis, J., Pontille, D. (2018). L'eacement des gratis à Paris : un agencement

de maintenance urbaine. In N. Dodier & A. Stavrianakis (dir.), Les objets

composés. Agencements, dispositifs, assemblages. Paris : EHESS, 41-74.

Dieckmann, P., Gaba, D., Rall, M. (2007). Deepening the Theoretical

Foundations of Patient Simulation as Social Practice. Simulation in Healthcare,

2(3), 183-193.

Hennion, A. (2019). Maintenir/soutenir : la fragilité comme mode

d'existence. Pragmata, 1(2), 484-500.

Hindmarsch, J., Hyland, L., Banerjee, A. (2014). Work to make simulation

work : "Realism", instructional correction and the body in training. Discourse

Studies, 16(2), 247-269.

Horcik, Z., Durand, M. (2015). L'expérience mimétique dans

l'apprentissage adulte : le cas des formations par simulation. Revue suisse des

sciences de l'éducation, 37(1), 167-186.

Jarelot, M., Pelaccia, T. (2016). La simulation en santé : principes, outils,

impacts et implications pour la formation des enseignants. Recherche et

formation, 82, 17-30.

Johnson, E. (2007). Surgical Simulators and Simulated Surgeons :

Reconstituting Medical Practice and Practitioners in Simulations. Social Studies

4342

of Sciences, 37(4), 585-608.

Johnston, S., Coyer, F., Nash, R. (2017). Simulation debrieng based on

principles of transfer of learning : A pilot study. Nurse Education in Practice, 26,

102-108.

Policard, F. (2018). Formateurs en soins inrmiers et simulation clinique :

prols et manifestations de l'engagement dans l'activité. Thèse de doctorat,

Université de Nanterre Paris X.

Dörte Wat zek, Ninetta Scura, Gisela Bähler, Angela Düvel, Sibylle Matt Robert,

Esther Weishaupt

Berner Fachhochschule, Switzerland

Background

Communication with patients or other professionals are so-called sof t-factors

but they are crucial for therapists. Patients' perceptions of communication,

perceptions of partner¬ship and a positive doctor approach explained 78% of

variance related to "patient satisfaction" (Little et al., 2001). The main goal

of communication training is enabling therapist to build eective therapeutic

relationships. Competent conversation includes a comprehensive use of

knowledge and skills, these skills must be trained in specic training and need

reection, in communicative tasks we are dependent on personal feedback,

which patients often do not (or cannot) give. For years, in our institution

communication training is established according to Standards of Best

Practice (Lewis et al., 2017). Professional actors are supplemental trained in

moderating the feedback session and in ca se-relevant medical knowledge. This

study evaluates the added value in the apperception of former students. We

examined the costs of communication training and discussed these regarding

self-reported benets of the learning method.

Methods

After their Bachelor degree students reported their perception on the value

of the communication training in a digital survey. The evaluation included 26

items, two of them were open-ended questions. For the quantitative data,

a factor analysis was calculated and nally analysed descriptively. These

Factors are (a) negotiation, (b) alternatives to action, (c) transfer to practice,

(d) reecting capacity, (e) sense of self, (f) feedback. With the qualitative data,

a content analysis according to Mayring (2015) was carried out. Evaluation

of pricing per student of that training is based on the amount of lessons and

hourly rate for feedback-moderating professional actor.

" Retrospective view from professional sight on value of

communication training "

Results

243 students responded (90.6% women), the response rate was 30%. Of

the participants, 62% were already practicing, i.e. had at least one year of

work experience as trainees. Almost one third were former nursing students,

midwifery was involved with 15.6%. The study programs Nutrition and

Dietetics as well as Physiotherapy made up about a quar ter of the participants.

The quantitative results show a rating between 2.8 and 3.3 out of 4 points.

The qualitative results reected not exclusively but predominantly positive

experiences. In BSc Physiotherapy students get six trainings, where they act in

two cases as professional respectively as observer. SP and administration are

calculated with about SFR 180,- per training, makes SFR 1080,- per student.

Discussion & conclusions

The eectiveness of this form of teaching cannot be veried with this study

design. Former students conrm an added value of communication training

with a view from ever yday practice. Paying about 1000 Swiss Francs for

every student to a program, that students associate with good intensive

learning moments should not be questioned. In further studies one could

compare experiences from former students with and without the experience

of communication training. To test the eectiveness of the program further

studies should consider a randomised procedure but have to control diverse

co-variates.

Literature

Lewis, K. L., Bohner t, C. A., Gammon, W. L., Hölzer, H., Lyman, L., Smith, C.,

Thompson, T. M., Wallace, A., & Gliva-McConvey, G. (2017). The association

of standardized patient educators (ASPE) standards of best practice (SOBP).

Advances in Simulation, 2(1), 1–8.

Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould,

C., Ferrier, K., & Payne, S. (2001). Observational study of eect of patient

centredness and positive approach on outcomes of general practice

consultations. Bmj, 323(7318), 908–911.

Mayring, P. (2015). Qualitative Inhaltsanalyse. Beltz Verlagsgruppe.

" Frugal innovation in a healthcare education context. Case

study of an eco-sustainable approach in simulation "

Pierre André Favez1, Raquel Becerril Ortega1,2

1University of Health Sciences Lausanne (HESAV); 2Université de Lille, ULR

4354, CIREL, France

This paper is a contribution to an eco-sustainable approach in training systems,

particularly those that use simulation.

4544

Frugal initiatives

First, we will discuss the denition of frugal innovation (jugaad innovation).

Born in 2015 by N. Radjou and J. Prabhu, this Hindu word synthesizes the

pursuit of ingenious solutions or the ability to do better with less. In light

of these perspectives, anthropologists challenged technical innovation

dierently. They used criterias that are based less on the sophistication of

manufacturing processes and more on their capacity to be recomposed in

contexts characterized by heterogenous needs and issues (Grimaud, Tastevin

& Vidal, 2017). Other perspectives, such a s Responsible Research Innovation

(RRI), advocate citizen's participation throughout all phases supportof the

development of technological innovations. They also support an openness to

scientic and ethical principles as well as to gender equality (Reber, 2018).

In simulation, low-tech innovations are seen in initiatives that mobilize low-

delity, low-cost simulators. In the eld of technical skills, simple resources are

used to learn gestures such as punctures or sutures with, for example, dierent

fruits (tomatoes, oranges, bananas, etc.). Others, mobilize animal parts, but

sometimes their use face logistical problems, related to contamination or

ideological or religious convictions from the learners or teachers/ trainers

(Bazin & Péan, 2013).

Dierent criteria of frugality in innovation

In order to determine the frugal character of an innovation, the qualitative

analysis is based on four criterias : i. The rst criteria is didactical : the adopted

solution, must respond to a functional representation of a situation that is

suciently faithful and aims at the reproducibility of a technical gesture during

the simulation. ii. The second criteria is technological : because the proposed

innovation uses (or recycles) pre-existing materials in new congurations.

At the end, it is a matter of meeting this double requirement of novelty and

low-tech. Iii. The third criteria is economic : to guarantee an eco-responsable

positioning, short circuits, sustainable and aordable solutions are sought.

iv. The fourth criteria is social : considers the participation of stakeholders

(consumers) in the innovation process.

The data, in the form of observations and interviews, reveal the stages in

the innovation process.

The situation of reference is the removal of stitches and/or staples. A priori

analysis of the removal of stitches. identies three successive operations :

mobilizing the thread with forceps (to detach it from the skin); cutting the

thread (under the knot ush with the skin); and removing the thread. The main

performance indicator is the presence of three strands of thread under the

forceps after the operation is completed. For staple removal, the technique

is similar, a staple forceps is used to generate the opening of the staple. The

performance indicator here is the presence of the complete staple.

A low-tech and low-cost wound simulator for an eco-responsible approach

in health education context

The simulation device represents a rectangle cut from a nylon material of

dimensions 11 cm by 17 cm. A brownish line represents the healing wound.

Five staples followed by ve stitches are placed on this line, at a distance of

about 1 cm from each other. This simulation device, thus, concentrates two

distinct removal operations.

This case study can be seen as a trend as well as an exception to

an eco-responsible approach to simulation. Within the simulation eld in

healthcare, we aim at mirroring the same situations that occur in regards to

waste and energy consumption. Before describing the case, we identify the

criteria of frugality in innovation. Finally, we insist on the social criterion : the

innovator knew how to put in place the constraints and needs of the users who,

in one way or another, largely contributed to improve this wound simulator.

Jean-Christophe Servotte

Haute Ecole Namur-Liège Luxembourg

Introduction

The number of clinical apprenticeship for nursing students has increa sed

substantially in Europe. Indeed, they are required to complete 2,300 hours

of clinical practice near patient s (1). However, it appears there are a lack of

nursing student suppor t and supervision by nurses or by teachers. Thus,

clinical learning competency are developed by trial and error, depending on

opportunities and learning situations (2, 3). However, feedback by professional

or nursing teacher has been shown to improve learners' competency, skills and

learning (4). Moreover, student supervision by a teacher decreased or, even,

stopped during COVID-19 crisis.

To address this situation, the DISCERN-STUDENT© (Debrieng In Situ

Clinical End-of-shift Reection Now for Student Thinking, Understanding,

and Discourse to Extend New Thinking) program was developed. It was

implemented, during the second wave of COVID-19 with undergraduate nursing

students as well as postgraduate students specializing in critical care and

emergency medical assistance.

Methods

This observational study aimed to identify subjects described and discussed

during remote clinical debriengs.

The method used was a content analysis of the debriengs such as

" Improving nursing student skills through the

implementation of a remote clinical debrieng program "

4746

Jean-Christophe Servotte1, B Pilote2

1Haute Ecole Namur-Liège-Luxembourg, Département Paramédical, Belgium;

2Université Laval, Faculté des Sciences Inrmières, Québec, Canada

Introduction

Medication administration error is a worldwide concern [1], which has been

linked with a lack of knowledge and skills in safe medication administration

among new graduates and student nurses [2-3]. Preventing medication errors

" Eect of repeated simulation-based learning in

intravenous medication safety : a randomized

controlled study "

technical and non-technical skills, etc. as well as social transactions recorded in

reports. Nursing student socio-demographic data as well as characteristics of

the debriengs were collected.

Results

Participants (n=40) were mainly postgraduate students (n=24; 60.0%) or fourth

year nursing students (n=15; 37.5%). They were in intensive care unit (n =18;

45.0%), emergency (n =10; 25%), medicine (n =10; 25%), or surgery (n =2; 5.0%).

During the debriengs, only six (5.2%) did not address non-technical

skills, whereas technical skills were always discussed. Of these, procedures

and medications (n=52; 45.2%) were the most frequently mentioned. In terms

of non-technical skills, communication problems (n=73; 63.5%), stress (n=42;

36.5%), decision making (n=32; 27.8%), collaboration with the team (n=26;

22.6%) and situational awareness (n=25; 21.7%) were the recurrent themes.

During the debriengs, 64 adverse events (55.6%) and 42 near misses (36.5%)

were discovered. Reective questions (n=111; 96.5%), feedback by teacher

(n=66; 57.4%) and discussion of the emotions felt by the students (n=50; 34.8%)

constituted the majority of the social transactions.

Students found that debriengs were useful (n=50; 43.5%) or very useful

(n=53; 46.0%). They were also satised with the teaching practices (19.4/20).

However, they declared that they had voluntarily omitted to discuss certain

events (n=85; 85.6%).

Conclusion

DISCERN-STUDENT during the second wave of COVID-19 allowed nursing

students remote debrieng. Clinical debriengs revealed adverse events or

near-misses. We must oer a pedagogical structure to minimize risks of errors

or omissions. Through DISCERN-STUDENTS, both technical and non-technical

skills, can be this type of strategy. Further studies are needed to validate this

nursing student clinical debrieng program and analyze the items discovered.

could therefore involve training through simulation-based-learning (SBL). The role of traditional

education strategy to improve students' medication administration skills has been questioned

[4]. Indeed, it has been focused on medication administration checks and drug calculation while

it is critical to gain clinical experience and skills to avoid any incidents [5]. Recently, a study

demonstrated that SBL induced higher skill acquisition compared to traditional education

approach for procedural oral medication administration [6]. In a before/after study, the

intervention group received simulation education strategy, which enhanced knowledge and

skills on medication administration [7]. If SBL has demonstrated with added value, questions

remain regarding the dose-response relationship between simulation and impact on care [8].

Methods

This randomized controlled study compared the dierence between two SBL designs on

medication dosage calculation skills and medication administration skills. Participants (n=99)

were randomly assigned either to the control group (CG, n=50) or the experimental group

(EG, n=49). CG completed two 4-hours-SBL with a time inter val of four weeks. EG completed

each of their scenarios with one 2-hour-SBL each week. SBL used standardized patients in

the context of an intensive care unit (ICU). The two groups were assessed three times : at T0,

T1 (six weeks later) and T2 (eleven months after). Students' medication dosage calculation

skills were mea sured using a 10-ow calculations questionnaire, specically developed for

the study (Content Validit y Index = 0.91). The Medication Administration Safety Assessment

Tool (MASAT), an eight-item assessment tool, measured the adherence to six intravenous

medication administration rights in simulation lab and in ICU : right patient, right drug, right

dose, right route, right time and right documentation. [9].

A generalized linear mixed model compared group-by-time changes at T0 and after SBL

(T1 and T2) for medication dosage calculation and MA SAT. Afterwards, relative gains were

calculated between T0, T1 and T2 with the following formula : (post-test – pre-test / pre-test).

A McNemar Test compared the proportion of students who reached the MASAT maximum

score between T0 and T1, and between T1 and T2 within the groups. Results were considered

statistically signicant at the 5% critical level (p < 0.05).

Results

There were no statistically dierences between groups at T0. A signicant group-by-time eect

(p<0.001) of the SBL on medication dosage calculation was found. Four weeks after the training,

there was a 100% improvement (43-200%) in the EG and a 50% improvement (25-125%) in the

CG. The dierence between groups was signicant (p=0.04). Eleven months after the training,

no statistical dierence was found (p=0.85) between groups. Regarding the measurement of

medication administration skills with MASAT, a signicant group-by-time eect was found

throughout the study (p<0.001). The EG had consistently better MASAT scores than the CG.

There was a 100% (67-167%) improvement between T0 and T1 in the EG compared to a 25%

(0-50%) improvement for the CG. The dierence between these gains was signicant (p<0.001).

Between T0 and T2 (eleven month after), the dierence was also signicant (p=0.008) with a

100% (75-167%) improvement for the EG, and a 67% (40-133%) improvement in the CG.

4948

Conclusion

The results of this study revealed that SBL may improve medication

administration kills of nursing students overtime, eleven month after. It

showed statistically signicant dierences in scores bet ween groups, especially

for medication administration skills. Result conrm that repeated simulation

may contribute to clinical improvements of the nursing students. While both

groups had the same number of hours of simulation, it seems that it's the

repetition of the sessions that is most eective. These results are intriguing and

many questions remain. There is a need for further explorations of how learning

in the medication administration eld may be most eective.

Posters

5150

Poster 1

" What role do knowledge and the diagnostic process play in clinical

reasoning in the context of virtual patients ? "

Matthias Siebeck1,4, Maximilian C. Fink1,2, Nicole Heitzmann3,4, Victoria Reitmeier1,4, Frank Fischer3,4,

Martin R. Fischer1,4

1LMU Hospital, Munich, Germany, Germany; 2Department for Education, Universität der

Bundeswehr München; 3Department of Psycholog y, LMU Munich; 4Munich Center of the Learning

Sciences (MCLS), LMU Munich

Objectives

Renowned clinical reasoning theories

such as the illness-script theory 1 and the

hypothethico-deductive method 2 have

claimed for decades that both knowledge

and the diagnostic process play a major role

in diagnosing. Nevertheless, even current

clinical reasoning research 3,4 cannot pinpoint

precisely what proportion of knowledge

and the diagnostic process account for

variance in diagnostic success. Consequently,

we examined in a study the relationships

between knowledge, the diagnostic process,

and diagnostic success closer. Virtual patients

were used in this study as assessment method

because of their high standardization and the

great opportunities to generate insights into

the diagnostic process.

Methods

We carried out a study with N = 106 medical

undergraduate students from year 4 to year

5 in a 6-year program. At the beginning of the

study, the participants lled out conceptual

knowledge (20 items, α = .66) and strategic

knowledge tests (16 items, α = .65). Then, the

participants diagnosed four vir tual patients

focussing on histor y-taking for dyspnea.

Success in diagnosing was measured twofold.

A narrow diagnostic accuracy score tracked

the correctness of the selected diagnoses for

each case. A broad diagnostic quality score

aggregated diagnostic accuracy with other

clinical reasoning outcome variables (e.g., the

treatment selected). The diagnostic process

was assessed with the three diagnostic

activities hypothesis generation, evidence

generation, and evidence evaluation.5 These

diagnostic activities were selected because

they are assumed to play a crucial role in

diagnosing in history-taking contexts. 6

All gathered data was compared by R-scripts

to expert solutions and then scored

automatically. The study was approved

by the responsible IRB and funded by the

DFG. Participants took part voluntarily and

provided informed consent.

Results

Multiple regression analyses showed that

knowledge was a signicant predictor of

the broad diagnostic quality score but failed

to predict the narrow diagnostic accuracy

score. Other multiple regression analyses

demonstrated that the three diagnostic

activities were signicant predictors of

diagnostic quality as well as diagnostic

accuracy. Diagnostic activities explained

unique variance in the broad diagnostic

quality score when they were included in a

hierarchical regression model subsequently

to knowledge.

Conclusions

In general, our results corroborate clinical

reasoning theories which assert that both

knowledge and the diagnostic process play

a major role in diagnosing. In the context

of history taking, our results specify the

proportions to which knowledge and the

diagnostic process account for variance in

diagnostic success. Finally, our study oers

new ideas on measuring clinical reasoning

through process measures and broad

outcome measures, adding to available

assessment methods.3

References

1 Schmidt H, Norman G, Boshuizen H. A

cognitive perspective on medical expertise :

Theory and implications. Acad Med 1990;65

(10) : 61 1–2 1 .

2Elstein AS, Shulman LS, Sprafka SA.

Medical problem solving : An analysis of

clinical reasoning. Cambridge, MA : Harvard

University Press 1978.

3Daniel M, Rencic J, Durning SJ et al.

Clinical reasoning assessment methods : a

scoping review and practical guidance. Acad

Med 2019;94 (6) :902–12.

4 Elstein AS. Thinking about diagnostic

thinking : A 30 -year perspective. Adv Health

Sci Educ 2009;14 (Suppl. 1) :7–18.

5Heitzmann N, Seidel T, Opitz A et

al. Facilitating diagnostic competences in

simulations in higher education : A framework

and a research agenda. Frontline Learn Res

2019;7 (4) :1–24 .

Poster 2

" Measurement of social skills with standardized patients "

Jan Siebenbrock, Johanna Kollet, Julia Browne, Thomas Geldmacher, Janina Sensmeier, Helmut Ahrens,

Bernhard Marschall, Hendrik Ohlenburg

IfAS (Institut für Ausbildung und Studienangelegenheiten) Münster, Germany

Background

Social skills are crucial for the future

working life of physicians. In the behavior-

based ta xonomy of medical social skills,

three core aspects of medical social skills

were identied : Agency, Communion and

Interpersonal Resilience.1 At the Institut für

Ausbildung und Studienangelegenheiten

(IfAS) in Münster, a procedure has been

developed to test these three core aspects by

using standardized patients [SPs].

Methods

In order to be able to measure social skills,

a separate setting was created for each of

these core aspects. Using a scale (from 1

to 6), observers were able to assess how

much competence was demonstrated by

the students in each scene. To measure

Agency, students were confronted with

SPs in which they had to assert themselves

(e.g., a counseling session in which the SP

constantly digresses from the topic). To

measure Communion, students encountered

SPs in need of help (e.g., after an accident

or after receiving bad news). To measure

Interpersonal Resilience students had to

encounter SPs who put them under pressure

(e.g., a strict professor). 1

5352

Results

In order to successfully measure social skills

using SPs, the setting must be very clearly

tailored to the relevant core aspects of the

competence. It is easy for a setting to trigger

both interpersonal resilience and agency, for

example.

In addition, in order to establish

comparabilit y between students, the setting

must be very standardized and simulated.

The use of SPs in this context must be valid,

practicable and reliable.2

Nevertheless, the liveliness of the

scene must not be lost, since especially

social competences show themselves in

interpersonal relationships, which are always

shaped on both sides and thus can never be

predicted.

A three-step approach is recommended

for this balancing act in the training of SPs :

1. clear role description with emotional

standardization and clear starting point;

2. training video with exemplary SP;

3. joint rehearsal with all SPs of the same role

(model learning 3).

Discussion

Social competencies can be measured with

the help of SPs. For this, ver y clear settings

have to be developed and the SPs have to be

trained in a standardized way without losing

the liveliness of the scene.

Literature

1 Breil, S. M., Amelung, D., Oberst, S.,

Rollinger, T., Ahrens, H., Garbe, A., Kadmon,

M., Marschall, B., Back, M. D., & Peters, H.

(2021). Physicians' social skills –

conceptualization, taxonomy, and behavioral

assessment. [Manuscript submitted for

publication].

2 Brem, B., Steinweg, B. : Prüfungen

mit SPs. In : Peters, T./Thrien, C., editors.

Simulationspatienten. Handbuch für die

Aus- und Weiterbildung in medizinischen und

Gesundheitsberufen. Bern : Hogrefe Verlag.

2018. S.

3Lauber, H. : Ausbildung von SPs für die

medizinische Lehre. In : Peters, T./Thrien, C.,

editors. Simulationspatienten. Handbuch für

die Aus- und Weiterbildung in medizinischen

und Gesundheitsberufen. Bern : Hogrefe

Verlag. 2018. S. 47- 62

Poster 3

" The eects of an acute care training module on student

nurses' self – condence in clinical assessment and judgement :

a quasi-experimental study "

Emil Scolari, Josée Des Granges Zimmermann

University of Health Sciences Lausanne (HESAV)

Background

In an increasingly complex health care

system, qualit y clinical judgment can improve

patient safety. This is true in all settings in

which nurses practice.1 The development of

quality clinical assessment and judgment

can be stressful for nursing students in

acute care situations as well. In education

institutions, clinical judgment is developed

throughout training.

Simulation is used, in several countries,

to support students in the development of

these skills. It allows students to exercise

their clinical judgment in a safe setting and in

care situations close to real practice. Several

studies show that the use of simulation in

learning clinical judgment increases students'

sense of condence.

In our institution, for several years, an

acute care option module has been oered to

students in the third year of their Bachelor's

degree. Its objectives are to develop clinical

judgment and decision-making skills in the

nal-year students.

The aim of this study is to evaluate the

impact of this module on the students' feeling

of condence in their clinical judgment in

acute somatic care situations.

Methods

This quasi-experimental single-group before-

and-after study was conducted between

November 15 and December 16 2021 at the

school of Health Sciences (HESAV).

Intervention

A pedagogical engineering model was

developed and is articulated over 5 weeks.

It includes targeted theoretical courses, group

work in preparation for simulated clinical

situations, immersive simulations, debriengs

directly after the simulations, as well a s

remote debriengs for conceptualization-

generalization purposes.

Instruments

A questionnaire measuring students' self-

condence was distributed on the rst and

last day of the module. In the absence of a

validated survey in French, a free translation

of the Self-condence scale was made and

used for this study. This 12-item survey

focuses on three patient typologies (cardiac,

respiratory and neurological symptoms).

For each type of patient, the students

evaluate their self-condence in recognizing

symptoms, assessing the patient, the nursing

interventions to be implemented and the

evaluation of these interventions. For each

item, students are given a 5-point rating

(1 = not at all condent, 5 = very condent).

Statistical analysis

A pre- and post-intervention distributional

analysis was conducted. In order to determine

whether the improvement in students' self-

condence after the elective module was

statistically signicant, a Wilcoxon paired-

samples rank test was per formed. Each

question was analyzed individually.

Results

34 students completed the pre- and post-

training questionnaire. For situations with

cardiac pathology, a signicant improvement

in students' self-condence was observed.

This in symptom recognition (median

dierence between before and after +1.1, z=

-4.47, p<0.001), in assessment (+1.2, z=-5.01,

p<0.001), in nursing interventions (+1.0, z=-

4.68, p<0.001) and in intervention a ssessment

(+1.4, z=-4.76, p<0.001). In the situation with

a respiratory pathology an improvement was

also noted. In the recognition of symptoms (+

0.9, z=-4.61, p<0.001), in the assessment (+ 1.2,

z= 5.01, p<0.001), in the nursing interventions

(+1.3, z= -4.87, p<0.001) and in the assessment

of interventions (+1.5, z= -5.09, p<0.001). For

a situation with a neurological patholog y the

improvement of self-condence in students is

statistically signicant. In recognition (+0.8,

z= -3.86, p<0.001), in evaluation (+1.2, z=-4.08,

p>0.001), in interventions (+1.0, z=-4.08,

p<0.001) and in evaluation of interventions (+

1.2, z= -4.75, p<0.001).

Discussion

The acute care module oered at HESAV

seems to allow an improvement in the

students' self-condence when practicing

clinical assessment and judgment in all the

5554

Poster 4

" What does the tattoo studio have to do with simulations ? "

Urs-Beat Schaer, Edith Jäggi, Claudia Schlegel

Berner Bildungszentrum Pege, Switzerland

More than ten years ago, no model for a

port-à-cath puncture simulation was available

that met our requirements. All conventional

models were constructed in such a way, that

the port-à-cath model was built into a whole

Mannikins Torso. So we created these models

ourselves at the Berner Bildungszentrum

Pege 1.

We constructed the models in such a

way, that a hybrid simulation 2 could be carried

out, by putting a por t-a-cath model on a

simulated patient, where the puncture of the

port-a-cath could be performed. This gives the

nursing students the opportunity to perform

punctures on the model and at the same

time communicate with the patient. At that

time, we did not think about the durability

and repair of the model. Over the years, we

noticed a wear and tear, that we could no

longer repair with our own resources.

Tattoo studio

The training of a tattoo artist requires

constant practice, just as in nursing. Training

makes perfect, as the saying goes. But in

this sense, it does not always work on the

customer. This is where tattoo artists have

been looking for solutions for a long time.

For a rst time, they used pig skin for tattoo

trainings. But this wa s connected with

circumstances that called for new solutions.

A new path was taken and an articial skin,

ReelSkin was developed. These training skins

are the realest training skins one can get 3.

It looks like real skin, is 2-3 mm thick and feels

almost like real skin.

Methods

We started looking for new materials to

replace the defective skins of our models.

We found what we were looking for in a tattoo

shop. The ReelSkin seemed to us to be well

suited for the replacement of the skin of the

port-a-cath. So we ordered a small quantit y

and we gave it a try, and repaired 2 models to

start with. We quickly realised that the repair

worked and ordered more ReelSkins to repair

the remaining models.

Results

We cannot yet say how the ReelSkin will last

in the long run and how it will restist certain

amount of stitches. However, we hope that we

will be able to achieve a puncture number of

proposed situations. Our data conrm the

results of other studies.

Conclusion

The use of simulation in a module focused

on the management of acute somatic care

patients should be proposed in the training

program for Bachelor's degree nursing

students. The use of real-life situations

in a safe setting helps to improve their

self-condence in clinical assessment and

judgment. This educational practice could be

applied to graduate nurses and improve the

quality and safety of care.

+/- 100 due to the always identical puncture

point of the port-à-cath model. Then we will

be at a level of material wear, that we note in

the simulations for other models.

Discussion

In the simulations that we oer at the Berner

Bildungaszentrum, it is always important to

think outside the box and break new ground.

This also applies to repairs of models. If we

stick to the oers that the nursing or medical

landscape provides, we are conned and

always deal with the same things. Discovering

and exploring new things is important and

exciting at the same time.

References

1 Schlegel C., Shaha M., (2014), Turning old into

new, in The clinical Teacher 2014; 11 : 561-562

2 Kneebone, R.L. Simulation reframed. Adv

Simul 1, 27 (2016) https ://doi.org/10.1186/

s41077-016-0028-8

3 www.tattooneeds.ch

Poster 5

" Keeping the eye on the ball : How we built articial eyes to extend

a fundoscopy simulator's scope "

Daniel Bauer, Johanna Stierlin, Miria Germano, Kai Schnabel

Institute for Medical Education, University of Bern, Switzerland

The range of commercially available

simulators in undergraduate medical skills

training is limited. This is especially true for

simulators that allow for the integration

of own ndings, i.e., that do not limit the

scope of what can be simulated to what

the manufacturers distributed with their

simulator. Unfortunately, in assessment

settings using one's own pathologic ndings

can be of high impor tance for the case,

why one often reverts to the skills being

demonstrated on the simulator, but delivers

the pathological ndings using photography

or other media, breaking the simulation's ow

and risking the candidates' engagement with

the scenario. To address this, we set out to

expand the scope of our fundoscopy simulator

to also depict pathologies of the cornea,

sclera, iris, and vitreous body.

We identied and addressed three major

challenges. First was the question whether we

could build an eye of dierent modules that

could be combined depending on a specic

case or build eyes that were case-specic from

the start but could be built using less eort

and parts. Second, it was decided that corneal

lesions should be made in a way that would

allow for a positive uorescein staining. Third

and last, the issue arose how to xate the eye

in the simulator so it could be easily installed

and removed without risking the simulator's

integrity.

Result

For the initial trials it was found that building

case-specic eyes was the preferable

approach. While this meant the individual

components of the eye could not be

assembled at will, it also meant there would

be fewer parts and thus less eor t for a proof-

of-concept pilot. Second, uorescein staining

would be simulated using encapsulated

uranine. Lastly, the eye would be xated in

the simulator both from behind, and from the

5756

front, e.g., using an orbital prosthetic, further

widening the scope of pathologies that can be

simulated.

Discussion

There will for some time be the need to

further rene the approach taken. Having

an ophthalmologist on the team is crucial so

that the authenticity of the simulation can

be guaranteed, especially relevant in the

assessment setting, of course. Future trials

could use 3D printing technology to increase

standardization.

Poster 6

" Nursing simulation education current and future perspective

in middle income countries "

Fatjona Kamberi 1, Alida Ramaj 2

1 Research Centre of Public Health, Faculty of Health, University of Vlora "Ismail Qemali"

Albania; 2 Berner Bildungszentrum Pege, Bern, Swizerland

Nursing Education internationally has shown

increased use of simulation and immersive

education as a state-of-the-art learning

process that helps students to gain and foster

the clinical experience in a safe environment.

Dierent studies have demonstrated

that nursing students are satised with this

learning approach. While nursing faculties

in low and middle-income countries with

fewer resources are trying to develop their

simulation centers to improve nursing

education and the quality of care provided

globally.

A short web-based survey was carried

out among Albanian nursing educators to

assess current capacities and their training

education needs for simulation education.

31% of participants do not feel at all familiar

with the simulation education approach.

54% have expressed neutrality in relation

to didactic skills in relation while 52% have

reported not having enough knowledge of

simulation education and clarity in relation

to the stages of educational framework

simulation. 93% expressed the need for

educational training courses for simulation

education methodology in teaching.

The mentioned needs were in the

function of quality and competitive nursing

teaching and learning as well as advantages

of the rapid integration of nursing students

into the global labor market. Designing a basic

training curriculum for sta related to nursing

education simulation is recommended.

Workshops

5958

Background

Digitization has been part of medicine and

medical studies for several years1. The

Covid-19 pandemic at the latest showed how

important it is to be digitally positioned in

simulation as well. In Münster we have been

developing and staging digital simulation

scenarios in the eld of telemedicine for

several years. In the past two years, we have

perfected simulation with virtually connected

standardized patients [SPs]. The way of

playing and training SPs for a digital context

can be dierent from a present setting with

directly physical contact between students

and SPs. In this workshop we would like

to present the possibilities and challenges

of virtual interaction with SPs and give a

practical experience of what needs to be taken

into account when staging and training SPs for

digital contexts.

Already at the beginning of the

pandemic, a very large part of the events with

SPs could be continued digitally at the Institut

für Ausbildung und Studienangelegenheiten

(IfAS), Münster - based on the telemedical

preliminary experiences. SPs were connected

to the students with video and sound for

medical histor y discussions and educational

interviews as far as psychosomatic therapy

discussions and telemedical examinations.

This created unfamiliar challenges for the

SPs : How do you create an atmosphere/

relationship across the digital distance ?

How do you act in front of the camera ?

How do you deal with technical disruptions ?

SP trainers have to support the SPs

in these questions. In addition, there are

organizational challenges : How can SPs

be trained and supported at a distance -

especially in this sensitive medical eld ? What

(technical, spatial) conditions must be created

in order to implement a successful event ?

Of course there are seminars and

manuals on how to use the camera correctly2.

The good handling of video conferences is also

addressed in handouts and workshops3. The

special challenges of simulations in digital

settings have hardly been investigated so far.

Objectives

After the workshop, the participants will be able to :

• create appropriate conditions for digital formats with SPs,

• guide SPs so that they can convey atmosphere, relationship, status and emotion over the

virtual distance,

• train SPs to create the desired eect through the camera.

Target audience

This workshop is an oer for SP-Trainers.

Pre-conference workshop 1

" Digital play – Training of standardized patients for digital formats "

Jan Siebenbrock, Johanna Kollet, Julia Browne, Bernhard Marschall

IfAS (Institut für Ausbildung und Studienangelegenheiten) Münster, Germany

Description

After an introduction, in which the range of possibilities for the use of digital simulation is

presented, the participants will act out a simulation themselves. They will be guided by the

workshop leaders in their preparation, execution and follow-up with the help of practical

exercises. Finally, the dierences between the vir tual and the physically present simulation

will be discussed.

Literature

1Kuhn, S., Frankenhauser, S., Tolks, D. : Digitale Lehr- und Lernangebote in der medizinischen

Ausbildung. Schon am Ziel oder noch am Anfang ? In : Bundesgesundheitsblatt -

Gesundheitsforschung - Gesundheitsschutz 61(2). 2018. S. 201-209

2Arijon, D. : Grammar of the Film Language. Los Angeles 1991

3Matschnig, M. : Und plötzlich war die Kamera an... – Souverän wirken in

Videokonferenzen, Webinaren und Co. Oenbach 2021

Background

Stereotypes reduce and generalize

information into (assumed) group

characteristics. This simplication leads

to behaviours, appearances and traits

being attributed to group members, even

when not true for the individual person.

Medical education, including formats with

simulated patients, too often relies on

assumed prototypical ("classic") but really

stereotypical case scenarios in formation

and assessment of medical competencies.

Though based on the noble didactic idea that

circumstantial information would distract

learners from a targeted learning objective,

or likewise, distract examinees from the focus

of the assessment task, it still means that

dierent groups of society are inadequately

represented in the curriculum. It seems that

so far diversity issues receive little attention

at an institutional and curricular level

throughout medical schools and academic

hospitals (Zanting et al. 2020). At the same

time, SP-programs are reaching their limits

in accommodating diversity in their current

constitution.

Nonetheless, the possibilities of better

addressing diversity issues at a curricular level

are manifold (Dogra et al. 2009), especially

when thinking about the design of role scripts

as well as the casting and stang of SPs.

Their function in this matter should not be

underestimated (Vora et al. 2021, Picketts et

al. 2021, Paroz et al. 2016, Miller et al. 2021).

Carefully chosen simulations with diversely

designed roles and selection of SPs can reect

social diversity and provide access to the topic

of diversity among students.

Pre-conference workshop 2

" Simulated patients and stereotypes – How to deal with diversity

in human simulation "

Tim Peters1, Daniel Bauer2, Susanne Borgmann3, Linn Hempel4

1University of Bielefeld, Germany; 2University of Bern, Switzerland; 3University of Göttingen,

Germany; 4University of Halle-Wittenberg, Germany

6160

Objectives

After the workshop, participants will be able to :

• explain the relevance of diversity for working with SPs in health professions education.

• reect on their own SP program in ter ms of diversity with regard to sta, SP-pool and role scripts.

• optimize their work within the SP-program so that they better consider diversity when

designing cases and assigning SPs to roles.

• create and revise case scripts that consider aspects of diversity in a non-stereotypical way.

Target audience

The workshop is intended for all SP-trainers, managers and sta of SP-programs, simulated

patients and lecturers working with SPs in teaching or assessment in health professions

education. Previous experience with diversity as a topic is not required but SP methodology

should be well-known.

Description

In this 3-hour work shop we would like to address the topic of diversity in everyday work with

SPs. In particul ar, SPs representing stereot ypical patient roles in teaching and assessment s is

considered. After a short input, we will together reect on how to deal with diversity in creating

cases and assigning SPs, using concrete SP-scripts as material. At the end, the reection on

developed processes and criteria will be merged into concrete and practical instructions for the

creation of ca se scenarios or revision of already existing simulations. The goal for the participants is

to question and reect on their current working methods with regard to diversity and, at the same

time, to take home concrete suggestions in order to represent diversity adequately in the future.

Participants will receive literature and preparatory information in advance that will be

revisited later in the workshop. It is also requested to bring two SP scripts from the own institution;

one that assumedly takes diversity a spects well into account and one for improvement. Please

consider your institution's regulations for disclosing cases to third parties, especially when bringing

assessment material.

References

Dogra N, Reitmanova S, Carter-Pokras O. Twelve tips for teaching diversity and embedding it in

the medical curriculum. Med Teach. 2009; 31 :990-993.

Miller JL, Bryant K, Park C. Moving From "Safe" to "Brave" Conversations. Committing to

Antiracism in Simulation. Simul Heathc. 2021; 16(4) :231-232.

Paroz S, Daele A, Viret F, Vadot S, Bonvin R, Bodenmann P. Cultural competence and

simulated patients. Clin Teach. 2016; 13 :369-373.

Picketts L, Warren MD, Bohnert C. Diversity and inclusion in simulation : addressing

ethical and psychological safety concerns when working with simulated par ticipants. BMJ Simul

Technol Enhanc Learn. 2021; 0 :1-10. doi :10.1136/bmjstel-2020-00085

Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations

and Guidelines for the Use of Simulation to Adress Structural Racism and Implicit Bias. Simul

Healthc. 2021; 16(4) :275-284.

Zanting A, Meershoek, A, Frambach JM, Krumeich A. The "exotic other' in medical

curricula : Rethinking cultural diversit y in course manuals. Med Teach. 2020; 42(7) : 791-798.

Background

Virtual reality (VR) is based on computer

systems which generate realistic pseudo-

environments to give the user visual,

tactile and auditory impressions and allow

interaction with the virtual environment

(Pensieri & Pennacchini, 2014). VR simulation

is a novel, innovative teaching method that

combines the benets of active knowledge

transfer simulation with time-, place- and

even tutor-independent learning. VR is a

technology that allows users to experience

and manipulate computer-generated three-

dimensional environments in realtime to

learn practical knowledge that can be used in

clinical practice. The benet of VR in medical

training has already been demonstrated in

various settings, such as surgery (various

review articles like Clarke, 2021; Gerup et al.,

2020; Kyaw et al., 2019) or emergency medicine

(Educational Tool for Safe Performance of

COVID-19 Diagnostics, Birrenbach et al.,

2021; cardiopulmonary resuscitation (CPR)

training, Semeraro et al., 2017). With the

help of special headsets (head mounted

displays - HMDs), educational content can

be "experienced" in a multisensory, three-

dimensional, fully immersive and safe way.

VR thus oers a number of advantages, such

as the possibility of exible learning and

self-learning, standardisation, reproducibility

and the control of stimuli, as well as the

possibility of extensive automated data

generation in combination with automated

individualised feedback (Ustun et al., 2020).

Possible limitations due to social distancing

and resource requirements can thus be

circumvented or at least reduced. Another

advantage of VR is scalabilit y. The initial cost

and eort of creating the programme can be

compensated for by widespread dissemination

and repetition of a training.

Recent studies suggest that VR training

situations even lead to greater knowledge and

skill gains than traditional forms of training

and other types of digital training (Birrenbach

et al., 2021; Kyaw et al., 2019; Rourke, 2020).

Accordingly, VR training (of technical skills)

has also recently been successfully introduced

into regular medical training (Birrenbach et

al., 2021).

Objectives

Due to the novelty of VR technology, very few medical practitioners had the opportunity to try

it out and get a rst impression of it until now. To change this, we want to oer a workshop in

which participants can experience VR rst-hand. In addition, we will work out where the use of

Workshop 3

" Entering a new reality – chances and limitations of VR in

medical education "

Rafael Wespi1,3, Anke Sabine Baetzner2,3

1University of Bern, Switzerland; 2Department of Sport Psychology, Institute for Sports and Sport

Sciences, Heidelberg University, Germany; 3MED1stMR, Horizon 2020 Research Project, https ://www.

med1stmr.eu/

Suppor ted by :

Thomas Sauter1,3 , Tanja Birrenbach1,3, Marie Ottilie Frenkel2,3, MED1stMR3

6362

VR makes sense, how it should be used and where the advantages and disadvantages are.

Target audience

Any person interested in an innovative teaching and learning opportunity. No prior knowledge /

experience required.

Language

English

Timetable (total 3 hours)

• Opening and introduction about VR technology and dierent kinds of educational software

(10 min)

• Discussion : Where does the use of VR in teaching make sense ? (20 min)

• Experience of dierent VR programs and hardware in up to 4 groups for individual (guided)

testing (120 min)

• Clsoing discussion and wrap up of experiences and learning of the last 2 hours (30 min)

Sources

Birrenbach, T., Zbinden, J., Papagiannakis, G., Exadaktylos, A. K., Müller, M., Hautz, W. E., &

Sauter, T. C. (2021). Eectiveness and Utility of Virtual Reality Simulation as an Educational

Tool for Safe Performance of COVID-19 Diagnostics : Prospective, Randomized Pilot Trial. JMIR

Serious Games, 9(4), e29586.

Clarke, E. (2021). Virtual reality simulation—the future of or thopaedic training ? A

systematic review and narrative analysis. Advances in Simulation, 6(1), 2.

Gerup, J., Soerensen, C. B., & Dieckmann, P. (2020). Augmented reality and mixed reality

for healthcare education beyond surger y : An integrative review. International Journal of Medical

Education, 11, 1–18.

Kyaw, B. M., Saxena, N., Posadzki, P., Vseteckova, J., Nikolaou, C. K., George, P. P., Divakar,

U., Masiello, I., Kononowicz, A. A., Zary, N., & Car, L. T. (2019). Virtual Reality for Health

Professions Education : Systematic Review and Meta-Analysis by the Digital Health Education

Collaboration. Journal of Medical Internet Research, 21(1), e12959.

Pensieri, C., & Pennacchini, M. (2014). Overview : Virtual Reality in Medicine. Journal of

Virtual Worlds Research, 7. https ://doi.org/10.1007/978-3-319 -2 20 41-3 _1 4

Rourke, S. (2020). How does virtual reality simulation compare to simulated practice in

the acquisition of clinical psychomotor skills for pre-registration student nurses ? A systematic

review. International Journal of Nursing Studies, 102, 103466.

Semeraro, F., Scapigliati, A., Ristagno, G., Luciani, A., Gandol, S., Lockey, A., Müller, M.

P., Wingen, cation (S. 56–73).S., & Böttiger, B. W. (2017). Virtual Reality for CPR training : How

cool is that ? Dedicated to the "next generation". Resuscitation, 121

Ustun, A., Yılmaz, R., & Karaoğlan Yılmaz, F. G. (2020). Virtual Reality in Medical Edu

Background

The eects of being a simulated participant

(SP) on an individual are still a subject of

research, but it is clear that the eects include

benets and risks (1). To minimize any risk

for the physical and mental health of SPs,

the Standards of Best Practice (SOBP) of

the Association for SP educators (ASPE) (2)

formulate guidelines for safe work practices.

When the Covid-19 pandemic started,

from one day to the other face-to-face

teaching was stopped and most institutions

shifted their teaching to web-based formats.

These online solutions also included online

work with SPs (communication trainings,

OSCEs, etc.).

Now, more than two years later, some of

these formats that started as "work-around"

seem to be here to stay. But what about the

SPs' safety ? Do we have sucient guidelines

to guarantee a safe work environment for SPs

online ? Where are the benets and where are

the risks of online work with SPs ?

Objectives

This workshop intends to kindle a discussion about guidelines and standards for working with

SPs online.

Target audience

Anyone interested in working with SPs online

Description

The workshop's goal is to enable an exchange of SP educators' experiences from various

backgrounds. During the workshop, participants will have the opportunity to exchange good

practices and possible unintended harm for the work with SPs online. It will not be possible to

develop denite guidelines, but ideas and recommendations can be collected as one step in

generating future guidelines.

• Welcome & Introduction (plenary,10 minutes)

• Looking back – experiences made during Covid or at other occasions (small group discussion,

10 minutes)

• Presentation & collection of experiences incl. expiriences of the presenters, analysis of

advantages & drawbacks (plenary, 30 minutes)

• Standards of Best Practice in working with SPs (ppt-presentation, 10 minutes)

• Break (15 minutes)

• Relate SOBPs to online work (small group discussion, 10 minutes)

• Presentation & discussion (plenary, 30 minutes)

Workshop 4

" Working with Simulated Participants online without putting them "on

the line ""

Beate Gabriele Brem, Tanja Hitzblech

Institute for Medical Education, University of Bern, Switzerland

6564

Background

HESAV is a university of health that

oers training through simulation

within its 4 Bachelor programs and its

Health Propaedeutic Year. The simulated

patient program was created in 2009. In

collaboration with the teachers, it quickly

set up a few simulated patient stations.

Today, the program oers about 50 formative

and summative stations. Some simulated

patients (SP) have been loyal to the program

since its inception. Over the years, SP training

has thus been rened and perfected so

that all actors involved in the simulation

can achieve the target objectives for good

professional practice.

Objectives

This workshop will aim to present a part of the training methodology of the SP program

at HESAV, through the eyes of the SP trainer and the simulated patient.

Target audience

SP trainers, simulation collaborators, teachers, pedagogues.

Description

Simulated patients play an important role in enhancing the professional skills of student nurses,

physiotherapists, midwives and radiology technicians.

The SP program has been oering a training based on a pedagogical methodolog y that is

both transversal and specic to each program.

Indeed, each program sets learning objectives related to the level of training of its

students. The training of SPs is then adapted to these objectives, which in most cases overlap

between the programs.

SPs are trained to embody a patient role as well as to give constructive feedback.

After several years of experience and training, the SPs have tools that enable them to

Workshop 5

" HESAV : transversality and specicity of simulated patient training "

Isabelle Chebil Dobbi, Corinne Gaudin

University of Health Sciences Lausanne (HESAV)

• Compiling ideas & recommendations for working with SPs online (plenary, 30 minutes)

• Summary/Take home message/good-bye (ppt-presentation, 5 minutes)

Sources

1Plaksin JN, J.; Kundrod, S.; Zabar, S.; Kalet, A.; Altshuler, L. . The Benets and Risks of Being a

Standardized Patient : A Narrative Review of the Literature. Patient. 2016;9 :15 - 25.

2Lewis KL, Bohnert CA, Gammon WL, Holzer H, Lyman L, Smith C, et al. The Association

of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul (Lond).

2017;2 :10.

handle any type of simulation situation within each HESAV program.

These tools, mainly focused on the communication between a patient and a health

professional, are essential to reach the pedagogical objectives of the teachers.

The training is adapted to each simulated patient. Indeed, SP have very dierent life paths

that inuence their games and feedbacks. The main objective of the SP trainers is to preserve

the specicit y of each SP, while ensuring the key values of a successful simulation experience :

safety, reliability, adaptability and relevance.

Note : this workshop will be held in French

6766

Organization SPSIM 2022

Steering committee

Carole Wyser (Head), Haute École de Santé Vaud, Lausanne

Urs Brügger, Bern University of Applied Sciences Health Professions

Sissel Guttormsen, Institute for Medical Education, University of Bern

Claudia Schlegel, College of Higher Education in Nursing Bern

Kai Schnabel, Institute for Medical Education, University of Bern

Juan Antonio Muro Sans, Haute École de Santé Vaud, Lausanne

Jonas Csakodi, Haute École de Santé Vaud, Lausanne

Stefanie Wunderle, Bern University of Applied Sciences Health Professions

Scientic committee

Kai Schnabel (Head), Institute for Medical Education, Universit y of Bern

Daniel Bauer, Institute for Medical Education, University of Bern

Josée des Granges Zimmermann, Haute École de Santé Vaud, Lausanne

Stefan Gisin, Society in Europe for Simulation Applied to Medicine

Carine Layat Burn, Medical Centre, La Providence Hospital, Neuchâtel

Benjamin Rapphold, Bern University of Applied Sciences Health Professions

Thomas Sauter, Department of Emergency Medicine, University Hospital Bern

Dörte Watzek, Bern University of Applied Sciences Health Professions

Uwe Weber, College of Higher Education in Nursing Bern

Organizing committee

Claudia Schlegel, College of Higher Education in Nursing Bern

Kai Schnabel, Institute for Medical Education, University of Bern

Juan Antonio Muro Sans (Head), Haute École de Santé Vaud, Lausanne

Jonas Csakodi, Haute École de Santé Vaud, Lausanne

Stefanie Wunderle, Bern University of Applied Sciences Health Professions

Your notes

ResearchGate has not been able to resolve any citations for this publication.

L’expérience mimétique dans l’apprentissage adulte: le cas des formations par simulation

Article

Full-text available

Sep 2018

L’objectif cet article est de discuter la pertinence de la notion de mimétisme dans l’apprentissage adulte en prenant appui sur une recherche effectuée au cours d’une formation sur simulateur de pleine-échelle pour des infirmiers en anesthésie. Les résultats montrent que les participants engagés dans des dispositifs de formation par simulation font une expérience particulière, qualifiée de mimétique, qui ne peut être réduite entièrement au travail de référence. Nos résultats soulèvent la question du rapport de «similarité-différence» entre l’activité de travail et l’activité de formation. Nous faisons l’hypothèse que l’expérience mimétique est également présente dans d’autres environnements d’apprentissage qui sont considérés comme «sérieux»: c’est-à-dire ne nécessitant pas d’engagement explicitement ludique ou mimétique de la part des participants.

The ‘exotic other’ in medical curricula: Rethinking cultural diversity in course manuals

Article

Full-text available

Mar 2020

Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of ‘cultural diversity’. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula. Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments. Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic. Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of ‘problematic stranger’ can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.

L’ingénierie didactique professionnelle

Chapter

Jun 2011

Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias

Article

Aug 2021
Simulat Healthc J Soc Med Simulat

Summary statement: Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition to transformation, with the goal of changing discriminatory behaviors and policies. As simulation educators tasked with training health care professionals, we have an opportunity to meet this need for transformation. Simulation can shift behaviors, but missteps in design and implementation when used to address implicit bias can also lead to negative outcomes. The focus of this article is to provide recommendations to consider when designing simulation-based education to specifically address racism and implicit bias.

Moving From “Safe” to “Brave” Conversations: Committing to Antiracism in Simulation

Article

Aug 2021

La simulation en santé : principes, outils, impacts et implications pour la formation des enseignants

Article

Sep 2016

For ethical, didactic or pedagogical reasons, simulation is widely used as a teaching method in healthcare science education. Recent technological developments and the involvement of senior authorities responsible for assessing the quality of care and patient safety have encouraged its development in initial and continuing education for healthcare professionals. After discussing the issues and principles of simulation in healthcare, we will present the tools and methods used and analyse their impact and the implications for the training of healthcare science teachers.

Cultural competence and simulated patients

Article

Jan 2016
Clin Teach

Background: Cultural competence education is central in addressing the socio-cultural factors that affect health care; however, there is little agreement over the best teaching approach. Although simulated patients are widely used in medical education, little is known about their application to cultural competence education. Context: At the Department of Ambulatory Care and Community Medicine, University of Lausanne, the content of a cultural competence education module for resident doctors was recently restructured, with a final session emphasising previous principles through a simulated patient-doctor encounter. Innovation: We tested the feasibility of cultural competence training with simulated patients. We created two complementary case scenarios based on real clinical practice and focused on specific clinical skills. An interdisciplinary team trained two simulated patients, and a 90-minute pilot session took place. General satisfaction was high and the increased opportunity for interaction was greatly appreciated. According to the learners, the simulated case setting was relevant for improving self-reflection and cultural sensitivity: applying skills in the session enhanced perceived impact for 'real-world' practice. We tested the feasibility of cultural competence training with simulated patients IMPLICATIONS: The use of patient-centred simulated clinical practice as a teaching approach seems to be advantageous in increasing providers' self-reflection about cultural competence and intensifying the impact of cultural competence education in clinical practice, and hopefully will improve the quality of care for every patient. Case scenarios based on a diversity of socio-cultural factors and oriented towards a broad skills set would seem preferable to avoid cultural drift and to enhance the learning of cultural approaches that are adaptable to every patient.

Deepening the Theoretical Foundations of Patient Simulation as Social Practice

Article

Feb 2007

Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffman's concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.

Restructuration de la représentation fonctionnelle lors d'un processus de formation. 8ème Biennale de l'éducation et de la formation

Jan 1996
87-98

V Delannoy
R Dutrech
E Galy
C Leger
P Duchein
S Marie
H Vergnes
D Zaro-Goni

Delannoy, V., Dutrech, R., Galy, E., Leger, C., Duchein, P., Marie, S., Vergnes, H., & Zaro-Goni, D. (2016). Guide d'aide à la mise en oeuvre d'une chambre des erreurs dans un établissement. https ://www.cpias-nouvelleaquitaine.fr/wp-content/uploads/2015/08/Guide_chambre_erreurs_Definitif.pdf Haute Autorité de Santé. (2019). Simulation en santé et gestion des risques -Outils du guide méthodologique. https ://www.has-sante.fr/upload/ docs/application/pdf/2019-02/outils_du_guide_methodo_simulation_en_sante_ et_gestion_des_risques.pdf Huard, V. (2006). Restructuration de la représentation fonctionnelle lors d'un processus de formation. 8ème Biennale de l'éducation et de la formation -INRP. http ://www.inrp.fr/biennale/8biennale/contrib/longue/99.pdf Leplat, J. (1996). Petites histoires pour des Histoires. In Y. Clot (Ed.) Les histoires de la psychologie du travail (pp.87-98). Toulouse : Octarès Pastré, P. (2005). Apprendre par la simulation : de l'analyse du travail aux apprentissages professionnels. Toulouse : Octarès.

Maintenir/soutenir : la fragilité comme mode d'existence

Jan 2014
247-269

A Hennion
J Hindmarsch
L Hyland
A Banerjee

Hennion, A. (2019). Maintenir/soutenir : la fragilité comme mode d'existence. Pragmata, 1(2), 484-500. Hindmarsch, J., Hyland, L., Banerjee, A. (2014). Work to make simulation work : "Realism", instructional correction and the body in training. Discourse Studies, 16(2), 247-269.

"Nursing simulation education current and future perspective in middle income countries"

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